Depressive Symptoms Amongst People with Podoconiosis and Lower Limb Lymphoedema of Other Cause in Cameroon: A Cross-Sectional Study

Abstract

Evidence is emerging that shows elevated mental distress and disorder amongst people with several neglected tropical diseases (NTDs). This study aimed to establish the prevalence of depressive symptoms amongst people with podoconiosis and lower limb lymphoedema of other cause in Cameroon. The study was part of a larger research piece that mapped the geographical distribution of podoconiosis in Cameroon. The Patient Health Questionnaire (PHQ-9; mean) was employed to determine the prevalence of depressive symptoms amongst people with lower limb lymphoedema. Linear regression was used to assess the association between socio-demographic characteristics of participants and depressive symptoms. Internal consistency of the PHQ-9 was estimated through Cronbach’s alpha (α = 0.651). The mean PHQ-9 score among people with lower limb lymphoedema was 3.48 (SD ± 3.25). Using a PHQ-9 score of 5 or above as the cut-off score, 32 participants (38.6%) displayed at least mild depressive symptoms. Unemployment was the only factor that was significantly associated with more depressive symptoms overall. This study shows that depressive symptoms are common amongst people with lower limb lymphoedema in Cameroon. The findings provide support for the integration of psychosocial interventions into packages of care for the management of lower limb lymphoedema.

A cross-sectional study to evaluate depression and quality of life among patients with lymphoedema due to podoconiosis, lymphatic filariasis and leprosy

“… 37 A study in Cameroon used the PHQ-9 scale to demonstrate a high prevalence of depressive symptoms (38.5%) among individuals with lower limb lymphoedema (predominantly due to podoconiosis), although the majority had mild depression. 38 Studies on individuals affected by leprosy have also reported a high burden of depression. 39 , 40 For example, the prevalence of psychiatric morbidity among leprosy patients in Nigeria was found to be 58% and most cases had depression.…”

High levels of depressive symptoms among people with lower limb lymphoedema in Rwanda: a cross-sectional study

“…For instance, our previous study in Cameroon, which employed a very similar design to the research reported in this paper, found that 38.6% of people with lower limb lymphoedema displayed at least mild depressive symptoms. 18 Studies in northern Ethiopia with podoconiosis patients 9 and in Nigeria with LF patients 19 reported rates of 12.6% and 20% for depression, respectively. One partial explanation for the higher figures in our Rwandan study may be that rates of depressive symptoms within the general population, even in those without chronic disease, might be higher in Rwanda than elsewhere because a large part of the population who survived the 1994 genocide are still experiencing mental disorders such as depression, panic disorder and post-traumatic stress disorder 27 ; indeed, a recent nationwide mental health survey in Rwanda estimated prevalence rates for depression to be 11.9% in the general population and 35% among genocide survivors, 27 while the aforementioned studies from Ethiopia 9 and Nigeria 19 reported depression rates of 0.7% and 3.1–5.2% among healthy neighbours and the general population, respectively.…”

“…In the second stage, during November and December 2017, the 1143 suspected cases were verified as either podoconiosis (n=914; 80.0%) or lower limb lymphoedema of another cause (n=229; 20.0%) by locally recruited expert clinical diagnostic teams, each of which included four health workers, a medical doctor, a nurse, a laboratory technician and a team leader, using procedures that had previously been employed during a mapping study in Cameroon. 18 , 23 All individuals with suspected podoconiosis were physically examined, and a diagnosis of podoconiosis or lymphoedema of another cause was established through this physical examination, as well as via history and disease-specific tests. A podoconiosis case was defined as a person residing in the surveyed district for at least 10 y who had bilateral, asymmetrical lymphoedema of the lower limb lasting for >1 y, negative Filariasis Test Strip (Alere; Scarborough, ME, USA) and Wb123 tests, and a history of any of the signs and symptoms associated with podoconiosis (for more details on this, including information on the aetiologies of those with lymphoedema of another cause, see the larger mapping study conducted by Deribe et al 3 ).…”

“… 15–17 For example, a recent study in Cameroon by our group found that 38.6% of people with podoconiosis or lymphoedema of another cause displayed at least mild depressive symptoms. 18 Other previous research reported that 12.6% of podoconiosis patients in northern Ethiopia had depressive symptoms and that 5.2% were at risk of suicide, compared with only 0.7% and 0.4% of their healthy neighbours, respectively. 9 In Nigeria, 20% of people with LF have been reported to have depression compared with 3.1–5.2% in the general adult population.…”

The design and development of a multicentric protocol to investigate the impact of adjunctive doxycycline on the management of peripheral lymphoedema caused by lymphatic filariasis and podoconiosis

“…This may be accompanied by apparent shortening of the toes also performed using a simplified version of the 12-item Self-Reporting World Health Organization Disability Assessment Schedule (WHODAS) 2.0 [14,15]. Additionally, in Cameroon depression is being assessed in patients with podoconiosis [16]. Treatments were randomized prior to the study start and subjects were entered sequentially to receive placebo or doxycycline 200 mg (or if appropriate the lower 100 mg dose) daily for six weeks.…”