The Impact of Leishmaniasis on Mental Health and Psychosocial Well-being: A Systematic Review

Abstract

19Background: Leishmaniasis is a neglected tropical parasitic disease endemic in South 20 Asia, East Africa, South America and the Middle East. It is associated with low 21 socioeconomic status (SES) and responsible for considerable mortality and morbidity. 22Reports suggest that patients with leishmaniasis may have a higher risk of mental illness 23 (MI), psychosocial morbidity (PM) and reduced quality of life (QoL), but this is not 24 well characterised. The aim of this study was to conduct a systematic review to assess 25 the reported impact of leishmaniasis on mental health and psychosocial wellbeing. 26Methods: A systematic review of the literature was carried out. Pre-specified criteria 27 were applied to identify publications including observational quantitative studies or 28 systematic reviews. Two reviewers screened all of the titles, abstracts and full-studies 29 and a third reviewer was consulted for disagreements. Data was extracted from papers 30 meeting the criteria and quality appraisal of the methods was performed using the 31 Newcastle-Ottowa Scale or the Risk of Bias in Systematic Review tool. 32Results: A total of 14 studies were identified from 12,517 records. Nine cross-sectional, 33 three case-control, one cohort study and one systematic review were included. Eleven 34 assessed MI outcomes and were measured with tools specifically designed for this; nine 35 measured PM and 12 measured QoL using validated measurement tools. Quality 36 appraisal of the studies showed that six were of good quality. Cutaneous leishmaniasis 37 and post kala-azar dermal leishmaniasis showed evidence of associated MI and PM 38 including depression, anxiety and stigma, while all forms of disease showed decreased 39 QoL. The findings were used to inform a proposed model and conceptual framework to 40 show the possible links between leishmaniasis and mental health outcomes. 3 41 Conclusion: There is evidence that leishmaniasis has an impact on MI, PM or QoL of 42 patients and their families and this occurs in all the main subtypes of the disease. There 43 are however large gaps in the evidence. Further research is required to understand the 44 full extent of this problem and its mechanistic basis. 45 46 AUTHOR SUMMARY 47 Leishmaniasis is a parasitic disease prevalent in many low-and middle-income countries 48 worldwide. In this study the authors looked for evidence as to whether leishmaniasis 49 affected the mental health and quality of life of patients. To conduct the review, a wide 50 search of the literature was conducted, where a total of 14 full articles were included 51 and analysed. It was found that different forms of leishmaniasis (visceral leishmaniasis, 52 cutaneous leishmaniasis and post kala-azar dermal leishmaniasis) do cause a significant 53 impact on patients' mental health and quality of life through societal factors such as 54 stigma, lack of knowledge, culture and low self-esteem among others. However, no 55 evidence of biological mechanisms was found linking leishmaniasis to mental i...

Prevalence and Risk Factors of Human Leishmaniasis in Ethiopia: A Systematic Review and Meta-Analysis

“…Leishmaniasis impacts public health, socioeconomics, and the nation's economy and growth [18]. Leishmaniasis causes high mortality, morbidity, affects the quality of life, causes mental illness, stigma, and psychosocial morbidity among those affected [17,19]. Assefa did a systematic review and meta-analysis on leishmaniasis [6].…”

Early reduction in PD-L1 expression predicts faster treatment response in human cutaneous leishmaniasis

“…One billion people are thought to be at risk of leishmaniasis, a group of diseases caused by infection with protozoan parasites of the genus Leishmania and transmitted by phlebotomine sand flies 3–5 . Approximately 600,000 – 1 million new cases of CL occur, with a broad global distribution, often leading to stigma and reduced life chances and placing a burden on health services 6,7 . Treatment options for CL have changed little in over 70 years, since pentavalent antimonial drugs were first introduced, and there are scant new treatments on the horizon 8,9 .…”

The impact of leishmaniasis on mental health and psychosocial well-being: A systematic review

“…It combines the results of the quantitative studies through narrative synthesis looking at anxiety and depression, low QoL, stigma and fear of scars. The three last cited quantitative studies were picked up by us during the title screen but did not fulfil the abstract or full-article screen criteria for this review, and were thus excluded (refer to protocol for inclusion and exclusion criteria) [43].…”

“…The review methodology including the search strategy for this review was published in PROSPERO [43] following CRD [44] and PRISMA [45] guidelines. The recommendations in the Cochrane Handbook [46] were adhered to for reporting the review.…”

“…The inclusion and exclusion criteria used to select studies is shown in the protocol [43], which used an adapted PICOS framework for observational studies. As this study was examining observational studies and not randomised control studies, there was no “intervention” being studied, and instead, the term “exposure” was used.…”