Stigma, depression and quality of life among people affected by neglected tropical diseases in Nepal.

BACKGROUND: Stigma and poor mental health are important factors influencing the quality of life (QOL) of people with neglected tropical diseases (NTDs). This study examines the relationship between stigma, depression and QOL among people affected by leprosy and lymphatic filariasis (LF) in Nepal. METHODS: A cross-sectional community-based survey was conducted among 102 NTD-affected persons (70 leprosy and 32 LF) using interview-administered questionnaires measuring the level of stigma (5-QSI-AP), symptoms of depression (PHQ-9) and QOL (WHOQOL-8). Three different regression models were developed, each using the ordinary least squares and Poisson regression to evaluate the association between stigma and QOL, depression and QOL, and stigma and depression. RESULTS: The mean scores were 21.8±4.4 for QOL, 6.6±5.6 for depression and 3.0±2.8 for stigma. Almost 17% reported the prevalence of depression symptoms. Both stigma (ß=-0.65, p<0.001) and depression (ß=-0.32, p<0.001) were associated with lower scores for QOL, while there was a significant positive relationship between stigma and depression (ß=0.92, p<0.001). Similar results were obtained from the Poisson regression models. CONCLUSIONS: The study showed a considerable burden of depression, stigma and poor QOL among study participants with leprosy and LF in Nepal. A holistic package of care that addresses the physical, mental and psychological well-being of people with NTD is required. CONTEXTE: La stigmatisation et la mauvaise santé mentale sont des facteurs importants qui influencent la qualité de vie des personnes atteintes de maladies tropicales négligées (MTN). Cette étude examine la relation entre la stigmatisation, la dépression et la qualité de vie chez les personnes atteintes de lèpre et de filariose lymphatique au Népal. MÉTHODES UTILISÉES: Une enquête communautaire transversale a été menée auprès de 102 personnes atteintes de MTN (70 de la lèpre et 32 de la filariose lymphatique) à l'aide de questionnaires administrés par entretien mesurant le niveau de stigmatisation (5-QSI-AP), les symptômes de dépression (PHQ-9) et la qualité de vie (WHOQOL-8). Trois modèles de régression différents ont été développés, chacun utilisant les moindres carrés ordinaires et la régression de Poisson pour évaluer l'association entre : (i) la stigmatisation et la QV; (ii) la dépression et la QV; et (iii) la stigmatisation et la dépression. RÉSULTATS: Les scores moyens étaient de 21,8±4,4 pour la QV, 6,6±5,6 pour la dépression, et 3,0±2,8 pour la stigmatisation. Près de 17% des personnes interrogées ont signalé la prévalence de symptômes dépressifs. La stigmatisation (ß = -0,65, p<0 001) et la dépression (ß = -0,32, p<0 001) ont été associées à des scores plus faibles pour la qualité de vie, tandis qu'il existait une relation positive significative entre la stigmatisation et la dépression (ß = 0,92, p<0 001). Des résultats similaires ont été obtenus à partir des modèles de régression de Poisson. CONCLUSIONS: L'étude a montré une incidence importante de dépression, de stigmatisation et d'une mauvaise qualité de vie parmi les participants atteints de lèpre et de FL au Népal. Il convient donc de mettre en place un ensemble de soins holistiques pour ces patients qui prendrait en compte le bien-être physique, mental et psychologique des personnes atteintes de MTN. ANTECEDENTES: La estigmatización y la mala salud mental son factores importantes que influyen en la calidad de vida de las personas con enfermedades tropicales desatendidas. las personas con enfermedades tropicales desatendidas (ETD). Este estudio examina la relación entre el estigma, la depresión y la CdV entre las personas afectadas por lepra y lepra y la filariasis linfática en Nepal. MÉTODOS: Se realizó una encuesta comunitaria transversal entre 102 personas afectadas por ETD (70 de lepra y 32 de filariasis linfática) utilizando cuestionarios entrevistas para medir el nivel de estigma (5-QSI-AP), los síntomas de depresión (PHQ- 9) y la CdV (OMS- 9). 9) y la calidad de vida (WHOQOL-8). Se desarrollaron tres modelos de regresión diferentes regresión de Poisson para evaluar la asociación entre: (i) el estigma y (ii) la depresión. entre: (i) estigma y CdV; (ii) depresión y CdV; y (iii) estigma y depresión. RESULTADOS: Las puntuaciones medias fueron 21,8±4,4 para la CdV, 6,6±5,6 para la depresión y 3,0±2,8 para el estigma. Casi el 17% informó de la prevalencia de síntomas de depresión. Tanto el estigma (ß = -0,65, p<0 001), como la depresión (ß = -0,32, p<0 001) se asociaron con puntuaciones más bajas para la CdV, mientras que hubo una relación positiva significativa entre el estigma y la depresión (ß = 0,92, p<0 001). Se obtuvieron resultados similares en los modelos de regresión de Poisson. CONCLUSIONES: El estudio mostró una carga considerable de depresión, estigma y mala CdV entre los participantes del estudio con lepra y FL en Nepal. Se requiere un paquete holístico de atención que aborde el bienestar físico, mental y psicológico de las personas con ETD.

Development of Anxiolytic and Depression-like Behavior in Mice Infected with Mycobacterium lepraemurium.

Murine leprosy is a systemic infectious disease of mice caused by Mycobacterium lepraemurium (MLM) in which the central nervous system (CNS) is not infected; nevertheless, diseased animals show measurable cognitive alterations. For this reason, in this study, we explored the neurobehavioral changes in mice chronically infected with MLM. BALB/c mice were infected with MLM, and 120 days later, the alterations in mice were evaluated based on immunologic, histologic, endocrine, neurochemical, and behavioral traits. We found increases in the levels of IL-4 and IL-10 associated with high bacillary loads. We also found increase in the serum levels of corticosterone, epinephrine, and norepinephrine in the adrenal gland, suggesting neuroendocrine deregulation. Mice exhibited depression-like behavior in the tail suspension and forced swimming tests and anxiolytic behavior in the open field and elevated plus maze tests. The neurobehavioral alterations of mice were correlated with the histologic damage in the prefrontal cortex, ventral hippocampus, and amygdala, as well as with a blood-brain barrier disruption in the hippocampus. These results reveal an interrelated response of the neuroimmune--endocrinological axis in unresolved chronic infections that result in neurocognitive deterioration.

Burden of depression and anxiety among leprosy affected and associated factors-A cross sectional study from India.

BACKGROUND: Leprosy is a Neglected Tropical Diseases (NTDs) known to cause stigma and discrimination in low-and middle-income countries. It often results in visible impairments, thus pre-disposing to poor mental health. Aim of the study was to estimate the prevalence of depression and anxiety among people affected by Leprosy and to determine the associated factors. METHODOLOGY/PRINCIPAL FINDINGS: A multi-centric, cross-sectional study was carried out in four leprosy endemic states of India-Chhattisgarh, Maharashtra, West Bengal and Tamil Nadu in randomly selected blocks (a sub-unit of district), from one district in each state. From selected blocks those registered for leprosy treatment at public health or referral centres, people above the age of 18 years were interviewed with PHQ-9 and GAD-7 questionnaires for Depression and Anxiety, respectively. Disease profile like leprosy classification, deformity grade, number and site of the patches and socio-economic status were collected along with individual data. Of the total 220 respondents, prevalence of depression and anxiety symptoms was, 33% (73) and 19% (42), respectively. Presence of disability (47%) and Female gender (46%) were significantly associated with depression. Presence of disability (32%), Lower income group (27%) and low education (22%) were significantly associated with symptoms of anxiety. As the severity of disability increased, risk of developing depression and anxiety increased. CONCLUSION: The study indicates that more than 30% of people affected by leprosy have mental health problems, which emphasizes the importance of mental health care services in leprosy. Women, those who had lower level of education, those belonging to lower socio-economic status and those with any level of disability due to leprosy are at risk of developing depression and/or anxiety. The study concludes more attention to be paid to the categories identified to be at risk.

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

BACKGROUND: Podoconiosis, lymphatic filariasis (LF) and leprosy are neglected tropical diseases (NTDs) that cause lymphoedema. When left untreated, they lead to substantial disability. This study determined the quality of life (QOL) and depression associated with lymphoedema in patients with podoconiosis, LF and leprosy. The study was conducted in northwestern Ethiopia. METHODS: This baseline cross-sectional study, nested within an interventional, non-comparative, longitudinal study, included patients with lymphoedema. Depression and QOL were assessed using versions of the 9-item Patient Health Questionnaire and Dermatologic Life Quality Index (DLQI), respectively, that had been translated into Amharic and validated. Factors associated with depression and QOL were assessed using multivariate linear regression analysis. RESULTS: Of the 251 patients with lymphoedema included in the study, 119 (47.4%) had moderate to severe depression and overall QOL was poor (mean±standard deviation [SD] DLQI score: 11.4±4.2). Disability was significantly associated with depression (ß=0.26 [95% confidence interval {CI} 0.19 to 0.33]). Currently receiving treatment (ß=-3.05 [95% CI -5.25 to -0.85), disability (ß=-0.08 [95% CI -0.15 to -0.01]) and social support (moderate support: ß=-2.27 [95% CI -3.66 to -0.89] and strong support: ß=-2.87 [95% CI -5.35 to -0.38]) were significantly associated with better QOL. CONCLUSION: High levels of depression and low QOL were found among patients with lymphoedema due the three NTDs in Ethiopia.

Depression and mental wellbeing in people affected by leprosy in southern Nepal.

BACKGROUND: Leprosy, a leading cause of disability, remains endemic in southern Nepal. Alongside physical impairment and stigmatization, many people affected by leprosy suffer from mental health problems. OBJECTIVES: This study had two objectives: (a) Establishing a baseline level of mental wellbeing and depression among people affected by leprosy in southern Nepal, and (b) Examining factors that influence mental wellbeing and depression in this target group. METHODS: A cross-sectional survey was conducted using three interview-administered questionnaires measuring level of depression (PHQ-9), mental wellbeing status (WEMWBS) and level of stigma (5-QSI-AP). Random clustering sampling was used to include leprosy-affected people from Self Help Groups (SHGs) and the reference group was matched based on socio-demographic characteristics. All participants were adults with no additional major morbidities. A sample of 142 persons affected by leprosy and 54 community controls were included. RESULTS: People affected by leprosy participating in SHGs had a significantly lower level of mental wellbeing and higher level of depression than the general population. Both mental wellbeing and depression were influenced by gender and the level of stigma. In addition, the level of depression was associated with the disability grade of leprosy-affected people. CONCLUSION: Leprosy-affected people need mental health-care interventions at different organizational levels, with attention to identifying individuals at increased risk for mental health problems or with additional needs. These findings highlight the demand for further research on specific interventions to improve the mental health of leprosy-affected people.

Type D personality is associated with poor quality of life, social performance, and psychological impairment in patients with moderate to severe psoriasis: A cross-sectional study of 130 patients.

BACKGROUND: Psoriasis is a systemic autoinflammatory disease that is related to an increased risk of organic and psychological comorbidities. Type D personality has been related to poor quality of life and worse physical and psychological outcomes in different diseases. AIMS: The aim of this study is to explore whether type D personality is associated with an increased risk of presenting physical and/or psychological comorbidities, their relationship with the capacity of social adaptation, and health-related quality of life (HRQOL) in patients with psoriasis. METHODS: This was a cross-sectional study. In all, 130 patients with moderate to severe psoriasis were included in this study. Participants completed the DS14 test and different validated questionnaires regarding quality of life and psychological morbidities. RESULTS: Type D personality was present in 38.4% (50/130) of the participants of the study. Patients with psoriasis and type D personality presented a higher risk of depression and anxiety. We observed that type D personality was associated with a lower educational level. These patients also presented a worse HRQOL in different dimensions of the Short Form Health Survey-36 questionnaire, more sleep problems, poor social adaptation, and a higher frequency of sexual disturbances. LIMITATIONS: Due to the cross-sectional design of the study, we could not confirm causality. Selection of sample was not random. Diagnoses of physical comorbidity were collected through clinical interview of patients under active treatment, which may imply a classification bias. CONCLUSION: Type D personality could represent a frequent personality profile in patients with psoriasis that could identify subjects with poor coping abilities to the disease with poorer levels of quality of life, increased psychological comorbidities, and inadequate social adaptation mechanisms.

Infertility-related stress and the risk of antidepressants prescription in women: a 10-year register study.

STUDY QUESTION: Is the first-time redeemed prescription of antidepressants predicted by the level of infertility-related stress in women seeking ART treatment? SUMMARY ANSWER: Infertility-related stress in the personal and marital domains and general physical stress reactions were significant predictors of a first redeemed prescription of antidepressants after ART treatment in this 10-year follow-up cohort study. WHAT IS KNOWN ALREADY: The literature has found inconsistent findings regarding the association between infertility-related stress and later psychological adjustment in fertility patients. The association between infertility-related stress and later prescription of antidepressants had never been explored in long-term cohort studies. STUDY DESIGN, SIZE, DURATION: All women (n = 1169) who participated in the Copenhagen Cohort Multi-centre Psychosocial Infertility (COMPI) cohort study in the year 2000 (questionnaire data) were linked with the register-based Danish National ART-Couple (DANAC) I cohort, which includes women and their partners having received ART treatment from 1 January 1994 to 30 September 2009. The study population were among other national health and sociodemographic registers further linked with the Danish National Prescription Registry. PARTICIPANTS/MATERIALS, SETTING, METHODS: Women initiating ART treatment were followed until they had redeemed the first prescription of antidepressants or until 31 December 2009. Logistic regression analyses were conducted to test the association between general physical stress reactions and infertility-related stress in the personal, marital and social domains, respectively, and a future redeemed prescription of antidepressants. Age, education level, marital status, number of fertility treatments prior to study inclusion and female infertility diagnosis were included as covariates in the adjusted analyses. Further, the analysis was stratified according to childbirth or no childbirth during follow-up. MAIN RESULTS AND THE ROLE OF CHANCE: The final sample consisted of 1009 women with a mean age of 31.8 years. At study inclusion, women had tried to conceive for an average of 3.45 years. At 10-year follow-up, a total of 13.7% of women had a first redeemed prescription of antidepressant medication. The adjusted odds ratio (OR) showed that high general physical stress predicted the later prescription of antidepressants (adjusted (adj) OR = 2.85, 95% confidence interval (CI) 1.96-4.16). Regarding infertility-related stress domains, high personal stress (adj OR = 2.14, 95% CI 1.46-3.13) and high marital stress (adj OR = 1.80, 95% CI 1.23-2.64) were significantly associated with the later prescription of antidepressants. Social stress was not significantly associated with the future redeemed prescription of antidepressants (adj OR = 1.10, 95% CI 0.76-1.61). Among women not having achieved childbirth during follow-up, the risk of a first-time prescription of antidepressants associated with infertility-specific stress was higher compared to the risk among women having childbirth during follow-up. LIMITATIONS, REASONS FOR CAUTION: This study did not account for potential mediating factors, such as negative life events, which could be associated with the prescription of antidepressants. Second, we are not able to know if these women had sought psychological support during follow-up. Additionally, antidepressants might be prescribed for other health conditions than depressive disorders. WIDER IMPLICATIONS OF THE FINDINGS: Our results suggest that women presenting high infertility-related stress in the personal and marital domains were at higher risk of redeemed first-time prescription of antidepressants after ART, independently of having delivered a child or not after initiation of ART treatment. Women would benefit from an initial screening specifically for high infertility-related stress. The COMPI Fertility Problem Stress Scales can be used by clinical staff in order to identify women in need of psychological support before starting ART treatments. STUDY FUNDING/COMPETING INTEREST(S): This study was supported by the Portuguese Foundation for Science and Technology (FCT) under an individual doctoral grant attributed to the first author (SFRH/BD/103234/2014). The establishment of the DANAC I cohort was funded by Rosa Ebba Hansen's Fund. The COMPI Infertility Cohort project was supported by The Danish Health Insurance Fund (J.nr. 11/097-97), the Else and Mogens Wedell-Wedellsborgs Fund, the manager E. Danielsens and Wife's Fund, the merchant L.F. Foghts Fund, the Jacob Madsen and Wife Olga Madsens Fund. The authors have no conflicts of interest. TRIAL REGISTRATION NUMBER: NA.

Involvement of the nitric oxide pathway in the anti-depressant-like effects of thalidomide in mice.

BACKGROUND: Thalidomide is a sedative/hypnotic agent that is currently used to treat patients suffering from multiple myeloma, myelodysplastic syndromes and erythema nodosum leprosum. Although previous studies have demonstrated that thalidomide possesses anti-depressant-like properties, the exact mechanism that thalidomide exerts this effect is not understood. In this study, we used two mouse models of depression and investigated the possible role of nitric oxide (NO), NO synthase (NOS) and inducible NOS (iNOS) in the ant-depressant-like effects of thalidomide. METHODS: Male mice were injected with different doses of thalidomide intraperitoneally. In order to assess the anti-depressant-like properties of thalidomide, the immobility time of mice was assessed in the forced swimming test (FST) and tail suspension test (TST). Locomotor activity was assessed using the open-field test. To assess the role of nitric oxide, N(G)-nitro-L-arginine methyl ester (L-NAME, non-specific NOS inhibitor), aminoguanidine (selective iNOS inhibitor) or L-arginine (NO precursor) were administered intraperitoneally along with specific doses of thalidomide. RESULTS: Thalidomide (10 mg/kg) significantly reduced immobility time in FST and TST. Aminoguanidine (50 mg/kg) and L-NAME (10 mg/kg) significantly augmented the anti-immobility effects of thalidomide (5 mg/kg). L-arginine (750 mg/kg) significantly inhibited the anti-immobility effects of thalidomide (10 mg/kg). None of the treatment groups demonstrated alteration of locomotor activity. CONCLUSION: Thalidomide exerts its anti-depressant-like effects through a mechanism dependent upon NO inhibition.

Sintomas depressivos secundário ou reativo em adultos doentes com hanseníase / Secondary or reactive depressive symptoms in adult patients with leprosy / Síntomas depresivos secundarios o reactivos en pacientes adultos con lepra

Objetivo: investigar a presença dos sintomas depressivos em adultos doentes com hanseníase. Método: estudo descritivo, com abordagem quantitativa, realizado em dois programas de controle de hanseníase, em São Luís (MA), Brasil, com 47 pessoas com hanseníase, notificadas e em registro ativo. A coleta de dados foi realizada com um questionário (Escala CES-D) para avaliação de sintomas depressivos. Em seguida, os dados foram armazenados no software Epi-info versão 7.0, analisados, apresentados em tabelas e discutidos com a literatura. Resultados: a maioria dos participantes estava na fase de transição entre mania e depressão, com predominância da fase depressiva e presença discreta da ideação suicida. Conclusão: os sintomas depressivos secundários foram frequentes na população de estudo, havendo necessidade de novas pesquisas, principalmente no que se refere ao surgimento e desenvolvimento de abordagem multiprofissional, otimização de promoção e educação a saúde.

Objective: to investigate the presence of depressive symptoms in adult patients with leprosy. Method: descriptive study with a quantitative approach, performed in two leprosy control programs, in São Luís (MA), Brazil, with 47 people with leprosy, reported and in the active record. Data collection was performed using a questionnaire (CES-D Scale) for evaluation of depressive symptoms. The data were then stored in the Epi-Info version 7.0 software, analyzed, presented in tables and discussed with the literature. Results: the majority of the participants were in the transition phase between mania and depression, with predominance in the depressive phase and a discreet presence of suicidal ideation. Conclusion: secondary depressive symptoms were common in the study population, demonstrating the need for further studies, especially with regard to the emergence and development of a multidisciplinary approach, optimizing health promotion and education.(AU)

Objetivo: investigar la presencia de síntomas depresivos en pacientes adultos con lepra. Método: estudio descriptivo con un enfoque cuantitativo, realizado en dos programas de control de la lepra en São Luís (MA), Brasil, con 47 personas con lepra, y se informó en el registro activo. La recolección de datos se realizó con un cuestionario (escala CES-D) para la evaluación de los síntomas depresivos. Em seguida, datos eran armazenados no software Epi-info version 7.0, bem analisado e discutido apresentados em tabelas com literatura. Resultados: la mayoría de los participantes estaban en transición entre la manía y la depresión, con un predominio de la fase depresiva y discreta presencia de ideación suicida. Conclusión: los síntomas depresivos secundarios fueron comunes en la población de estudio, existe la necesidad de una mayor investigación, especialmente en relación con la aparición y el desarrollo de un enfoque multidisciplinario, la optimización de la promoción y educación para la salud.(AU)

[Health-related quality of life, depression, and self-esteem in adolescents with leprosy-affected parents: results of a cross-sectional study in Nepal].

Leprosy is a chronic infectious disease that has an impact on the Health-Related Quality of Life (HRQOL) of sufferers as well as their children. To date, no study has investigated the effects of parental leprosy on the well-being of adolescent children. A cross-sectional study was conducted in the Lalitpur and Kathmandu districts of Nepal. Adolescents with leprosy-affected parents (n=102; aged 11-17 years) and those with parents unaffected by leprosy (n=115; 11-17 years) were investigated. Self-reported data from adolescents were collected using the Kinder Lebensqualität Fragebogen (KINDLR) questionnaire to assess HRQOL, the Center for Epidemiological Studies-Depression Scale (CES-D), and the Rosenberg Self-esteem Scale (RSES). Analysis of covariance (ANCOVA) was used to compare scores between the two groups. Multiple regression analysis was conducted to explore the determinants of HRQOL for adolescents with leprosy-affected parents. ANCOVA revealed that the KINDLR and RSES scores were significantly lower among adolescents with leprosy-affected parents compared with unaffected parents. The CES-D score was significantly higher among adolescents with leprosy-affected parents than for adolescents with unaffected parents. The KINDLR scores for adolescents with both parents affected were significantly lower than the scores for those with one parent affected. Multiple regression analysis revealed that adolescents with leprosy-affected parents who had higher levels of depressive symptoms were more likely to have lower KINDLR scores. A similar result was seen for adolescents where both parents had leprosy. Adolescents with leprosy-affected parents had higher levels of depressive symptoms, lower levels of self-esteem, and lower HRQOL compared with adolescents whose parents were unaffected by leprosy.

Therapeutic workshops and psychosocial rehabilitation for institutionalised leprosy patients.

Leprosy is still a major public health problem and psychosocial rehabilitation services for patients suffering from the disease remain insufficient. This study aimed to assess the impact of therapeutic workshops on quality of life and symptoms of depression among institutionalised leprosy patients. The Beck Depression Inventory (BDI) and generic World Health Organization Quality of Life questionnaire (WHOQOL-BREF) were used before and after the implementation of a series of therapeutic workshops over a period of six months. Sixty-two patients participated in the study. Almost all of the sample were elderly and had a low level of education. There was a significant reduction in the symptoms of depression scores after the intervention (p < 0,001) and a positive impact was shown for the psychological (p = 0,001), physical (p = 0,03) and environment (p < 0,001) domains, but not for the social relationships (p = 0,124) domain. Therapeutic workshops appear to a useful tool for psychosocial rehabilitation work with leprosy patients.

Oficinas terapêuticas para a reabilitação psíquica de pacientes institucionalizados em decorrência da hanseníase / Therapeutic workshops and psychosocial rehabilitation for institutionalised leprosy patients

A hanseníase ainda constitui um importante problema de saúde pública e as ações de promoção da reabilitação psíquica dos pacientes ainda são insuficientes. Este estudo se propôs a avaliar o impacto de oficinas terapêuticas sobre a qualidade de vida e sintomas depressivos em pacientes institucionalizados em decorrência da hanseníase. Aplicou-se o Inventário de Depressão de Beck e o instrumento genérico de avaliação da qualidade de vida WHOQOL-bref, antes e após o desenvolvimento de oficinas terapêuticas ao longo de seis meses. Participaram do estudo 62 pacientes, quase todos idosos, com baixa escolaridade. Observou-se uma redução significativa dos escores de sintomas depressivos após a intervenção proposta (p < 0,001) e impacto positivo para os domínios psicológico (p = 0,001), físico (p = 0,03) e de meio-ambiente (p < 0,001), mas não para as relações sociais (p = 0,124). Oficinas terapêuticas parecem ter o potencial de auxiliar na reabilitação psíquica de pacientes institucionalizados em decorrência da hanseníase.

Leprosy is still a major public health problem and psychosocial rehabilitation services for patients suffering from the disease remain insufficient. This study aimed to assess the impact of therapeutic workshops on quality of life and symptoms of depression among institutionalised leprosy patients. The Beck Depression Inventory (BDI) and generic World Health Organization Quality of Life questionnaire (WHOQOL-BREF) were used before and after the implementation of a series of therapeutic workshops over a period of six months. Sixty-two patients participated in the study. Almost all of the sample were elderly and had a low level of education. There was a significant reduction in the symptoms of depression scores after the intervention (p < 0,001) and a positive impact was shown for the psychological (p = 0,001), physical (p = 0,03) and environment (p < 0,001) domains, but not for the social relationships (p = 0,124) domain. Therapeutic workshops appear to a useful tool for psychosocial rehabilitation work with leprosy patients.

Qualidade de vida, sintomas depressivos e incapacidade física de pacientes com hanseníase / Quality of life, depression and physical disability of patients with leprosy

A hanseníase é uma doença infectocontagiosa com evolução lenta e de natureza crônica, causando impacto no cotidiano dos sujeitos, como sofrimento, abandono, deformidades físicas e problemas psicossociais. Objetivos: Descrever o perfil clínico e socioeconômico, avaliar a qualidade de vida (QV), ocorrência de transtornos depressivos e o grau de incapacidade física de pessoas com hanseníase e suas correlações. Métodos: Estudo transversal, quantitativo, descritivo e analítico, desenvolvido no município de Uberaba (MG), em um centro de saúde especializado. Após o consentimento dos participantes foram realizadas entrevistas com aplicação dos questionários: Clínico e Socioeconômico; Inventário de depressão de Beck- BDI para avaliação dos graus de depressão; Questionário WHOQOL-bref para avaliação da QV. Posteriormente, o Formulário de Classificação de Incapacidades Físicas (IFH) foi preenchido por meio da revisão de prontuários. O estudo foi aprovado pelo comitê de ética local nº 2173/2014. Análises estatísticas descritivas foram realizadas...

Leprosy is a chronic and slowly progressing infectious disease that affects the daily lives of carriers, causing suffering, abandonment, physical deformities and psychosocial problems. Objectives: To describe the clinical and socioeconomic profile, evaluate the quality of life (QOL), occurrence of depressive disorders, and the degree of disability and investigate correlations between these variables in people with leprosy.Methods: This is a cross-sectional, quantitative, descriptive and analytical study, developed in a specialized health center of the city of Uberaba (MG). After receiving consent from the participants, interviews were conducted using questionnaires on clinical and socioeconomic aspects. Moreover, the Beck Depression Inventory (BDI) was used to assess the degree of depression and the WHOQOL-BREF questionnaire was used to assess QoL. Subsequently, the Physical Disability Rating (PDR) form was completed by reviewing patient records. The study was approved by the local Ethics Committee (no. 2173/2014). Descriptive and analytical statistical analysis were performed...

Associação entre sintomas depressivos, trabalho e grau de incapacidade na hanseníase / Relationship between depression, work, and grade of impairment in leprosy

A depressão é o transtorno psiquiátrico mais comum na hanseníase e com alto índice de sintomas depressivos. Objetivo: Verificar a frequência dos sintomas depressivos e sua relação com o grau de incapacidade (GI) da OMS e variáveis sociodemográficas. Método: Aplicou-se um questionário, contendo aspectos sociodemográficos, clínicos e o GI. Foi aplicada a escala original do BDI para identificar a frequência dos sintomas depressivos (21 itens) e a subescala cognitiva chamada BDI-Short Form - BDI-SF (1-13 itens), recomendada para avaliar sintomas depressivos em indivíduos com diagnóstico de alguma patologia. Foi utilizada análise estatística descritiva, com distribuição de frequência para a caracterização da casuística e para o cruzamento das variáveis, foi utilizado oTeste Chi-square-corrected (Yates), considerando resultados significantes valor - p < 0,05. Resultados: Foram avaliados 130 pacientes que tem ou tiveram hanseníase. A idade média dos pacientes foi de 49,64 (SD 14,04).Houve predomínio do sexo masculino (64,6%), dos que vivem com familiares (87,7%), com ensino fundamental incompleto (66,2%), união civil estável (61,6%), não trabalham (75,4%) e recebem aposentadoria ou auxíliosaúde (63,9%). Em relação aos aspectos clínicos, 94,5% são multibacilares, 74,6% concluíram a poliquimioterapia e a maioria apresenta perda da sensibilidade protetora e/ou deformidades (31,5% grau 1 e 37% grau 2). Dentre os casos avaliados 43,1% apresentou sintomas depressivos de intensidade moderada a grave. Não houve correlação significativa entre BDI-SF e GI (valor - p = 0,950), mas, ?não trabalhar? associou-se com sintomas depressivos (BDI-SF) (valor - p = < 0,05). Preocupação somática foi o sintoma mais frequente (80,7%), seguido de dificuldade no trabalho (78,5%), irritabilidade (68,5%), fadiga (67,7%), auto-acusação (62,3%) e choro fácil (60%). Conclusão: Conclui-se que sintomas depressivos moderados e graves acometeram 43,1% dos casos avaliados,independentemente de ter ou não deficiências físicas (GI 1 e 2). As pessoas que não trabalhavam foram mais acometidas por sintomas depressivos em comparação aos que exerciam alguma atividade profissional.

Depression is the most common psychiatric disorder in leprosy and with high depressive symptoms. Objective: The aim of this study was to determine the prevalence and frequency of depressive symptoms andtheir relationship to WHO impairment grading (IG), and sociodemographic variables. Method: We applied a survey containing sociodemographic, clinical aspects and IG. The original scale of the BDI was applied to identifythe frequency of depressive symptoms (21 items), as well as the cognitive subscale BDI-Short Form-BDI-SF (items 1-13), recommended to assess depressive symptoms in individuals with defined pathologies. Descriptivestatistical analysis was used, with the frequency distribution to characterize the sample, and to the intersection of the variables, the Chi-square Test-corrected (Yates) was applied, considering significant results p - value < 0.05. Results: 130 patients who have or have had leprosy were evaluated. The mean age of patients was 49.64 (SD = 14.04). There was a predominance of males (64.6%), those living with family (87.7%), with incomplete primary education (66.2%), stable civil union (61.6%), which did not work (75.4%) and receive retirement or health aid (63.9%). Regarding clinical aspects, 94.5% were multibacillary, 74.6% had multidrug therapy and most have loss of protective sensation and/or deformities (31.5% IG1; 37% IG2). Among the cases evaluated, 43.1% had depressive symptoms of moderate to severe intensity. There was no significant correlation between BDI-SF and IG (p - value = 0.950). However, the individuals without an occupation or job (?which did not work?) were associated with depressive symptoms (BDI-FS; p - value < 0.05). Somatic apprehension was the most frequent symptom (80.7%), followed by difficulty with work (78.5%), irritability (68.5%), fatigue (67.7%), self-blame (62.3%)and tearfulness (60%). Conclusion: It is concluded that moderate and severe depressive symptoms assaulted 43.1% of the cases evaluated, regardless of whether or not physical disabilities (IG1 and 2). Individuals who did not work were the most affected by depressive symptoms compared to those who had some sort of occupation.

Declínio cognitivo, independência funcional e sintomas depressivos em idosos com hanseníase / Cognitive impairment, functional independence and depressive symptoms in elderly people with prior history of leprosy

Os problemas decorrentes da hanseníase podem causar transtornos psiquiátricos e comprometer o desempenho do indivíduo na execução das atividades cotidianas, especialmente no idoso. O objetivo deste estudo foi verificar as associações entre funcionabilidade, sintomas depressivos e aspectos cognitivos em idosos com história pregressa de hanseníase. Trata-se de estudo descritivo transversal. Foram aplicados os seguintes instrumentos de avaliação: Anamnese, Grau de Incapacidades da Organização Mundial da Saúde (GI-OMS), Questionário de Atividades Funcionais de Pfeffer, Escala de Depressão Geriátrica-15, Mini-Exame do Estado Mental e o Índice de Barthel. Quanto aos resultados, foram avaliados 90 idosos que tiveram a doença e a maioria pertencia ao gênero masculino (75,6%) e com baixa escolaridade (42,2%); eram casados/união consensual (58,9%) e apresentaram GI-OMS 1 ou 2 (83,3%). A idade variou entre 60 e 92 anos e a média foi 68,9 (DP7,3). Quanto aos problemas de saúde, houve um predomínio das doenças cardíacas (42,2%). A maioria deles apresentou independência funcional na execução das atividades de vida diária-AVDs (80%) e nas atividades instrumentais de vida diárias-AIVDs (83,3%); 30% apresentou sintomas depressivos e 52,2%, declínio cognitivo. Houve associação significativa entre sintomas depressivos e AVDs (p=0,048), sintomas depressivos e AIVDs (p=0,0111). Conclui-se que a maior parte dos idosos apresentou deficiências físicas, declínio cognitivo, e essas condições não interferiram significativamente na manifestação de sintomas depressivos e na independência funcional. A maioria dos idosos que apresentou independência funcional tinha menor chance de desenvolver sintomas depressivos, embora uma parcela significativa desta casuística demonstrou sintomas depressivos.

The problems caused by leprosy can cause psychiatric disorders and compromise the individual’s performance in execution of daily activities, especially in the aged. The aim of this study was to investigate possible associations between functionality, depressive symptoms and cognitive in aged with history of leprosy. This is a cross-sectional descriptive study. They were applied the following assessment instruments: Anamnesis, “World Health Organization leprosy disability grading system” (WHO-DG), Pfeffer’s Functional Activities Questionnaire, 15-item Geriatric Depression Scale, Mini-Mental State Examination and the Barthel Index. They were evaluated 90 aged who had the disease and the most of the patients were male (75.6%) and had low education (42.2%); married or live with partner (58.9%) and classified as WHO-DG 1 or 2 (83.3%). The ages ranged from 60 to 92 years, with a mean age of 68.9 (SD: 7.3). About the health problems, there was a predominance of heart disease (42.2%). The most of them had functional independence in the performance of activities of daily living (ADL) (80%) and in instrumental activities of daily living I (ADL) (83.3%); 30% had depressive symptoms and 52,2% cognitive decline. There was a significant association between depressive symptoms and ADL (p=0.48), depressive symptoms and IADL (p=0.111). It follows that the most aged patients had physical disabilities, cognitive decline, and these conditions did not influence significantly in the manifestation of depressive symptoms and functional independence. The most of seniors patients showed funcional independence had lower chance of developing depressive symptoms, although a significant portion of this subjects, showed depressive symptoms.

Health-related quality of life, depression, and self-esteem in adolescents with leprosy-affected parents: results of a cross-sectional study in Nepal.

BACKGROUND: Leprosy is a chronic infectious disease that has an impact on the Health-Related Quality of Life (HRQOL) of sufferers as well as their children. To date, no study has investigated the effects of parental leprosy on the well-being of adolescent children. METHODS: A cross-sectional study was conducted in the Lalitpur and Kathmandu districts of Nepal. Adolescents with leprosy-affected parents (n = 102; aged 11-17 years) and those with parents unaffected by leprosy (n = 115; 11-17 years) were investigated. Self-reported data from adolescents were collected using the Kinder Lebensqualität Fragebogen (KINDLR) questionnaire to assess HRQOL, the Center for Epidemiological Studies-Depression Scale (CES-D), and the Rosenberg Self-esteem Scale (RSES). Analysis of covariance (ANCOVA) was used to compare scores between the two groups. Multiple regression analysis was conducted to explore the determinants of HRQOL for adolescents with leprosy-affected parents. RESULTS: ANCOVA revealed that the KINDLR and RSES scores were significantly lower among adolescents with leprosy-affected parents compared with unaffected parents. However, the scores of "Friends" and "School" subscales of KINDLR were similar between the two groups. The CES-D score was significantly higher among adolescents with leprosy-affected parents than for adolescents with unaffected parents. The KINDLR scores for adolescents with both parents affected (n = 41) were significantly lower than the scores for those with one parent affected (n = 61). Multiple regression analysis revealed that adolescents with leprosy-affected parents who had higher levels of depressive symptoms were more likely to have lower KINDLR scores. A similar result was seen for adolescents where both parents had leprosy. CONCLUSIONS: Adolescents with leprosy-affected parents had higher levels of depressive symptoms, lower levels of self-esteem, and lower HRQOL compared with adolescents whose parents were unaffected by leprosy. Thus, mental health support programs might be necessary for adolescents with leprosy-affected parents, particularly for adolescents where both parents are leprosy-affected. Further studies with larger sample sizes are necessary to draw decisive conclusions.

Avaliação de sintomas depressivos na hanseníase / Avaliation of depressive Symptoms in leprosy

Na hanseníase, os problemas decorrentes das alterações motoras, sensitivas e autonômicas levam os pacientes a necessitarem de cuidados específicos para prevenir o surgimento de incapacidades e deformidades. Essas deformidades podem ser minimizadas ou evitadas quando o paciente é conscientizado e treinado a realizar os autocuidados a partir do diagnóstico, nas quais as informações são apresentadas gradativamente por meio do suporte da equipe, favorecendo a autonomia do paciente. Vários fatores podem comprometer a decisão do paciente em se responsabilizar pelo seu próprio cuidado: o estigma, baixa auto estima, o isolamento social, relações familiares em conflito, baixa perspectiva profissional, limitações física, dor, entre outros. Os autores entendem que esses fatores podem ser considerados um risco para o desenvolvimento de sintomas depressivos na hanseníase...

In leprosy, the problems arising from motor, sensory and autonomic changes lead patients to require specific care to prevent the emergence of disabilities and deformities. These deformities can be minimized or avoided when the patient is made ​​aware and trained to perform self-care from diagnosis, in which the information is presented gradually through team support, promoting patient autonomy. Many factors may affect the patient's decision to take responsibility for their own care: stigma, low self esteem, social isolation, family relationships in conflict, low professional perspective, physical limitations, pain, among others. The authors believe that these factors can be considered a risk for the development of depressive...

Associação entre sintomas depressivos, ocupação atual e grau de incapacidade na hanseníase / Association between depressive symptoms, work and disability grade in leprosy

Introdução: A depressão é o transtorno psiquiátrico mais comum na hanseníase e com alto índice de sintomas depressivos. O objetivo desse estudo é verificar a prevalência e frequência dos sintomas depressivos e sua relação com o grau de incapacidade (GI) da OMS e variáveis sociodermográficas. Métodos: Aplicou-se um questionário, contendo questões fechadas (aspectos sociodermográficos e clínicos). Foi avaliado o GI que indica a diminuição ou perda da sensibilidade protetora e deformidades visíveis e o Beck Depression Inventory (BDI) com 21 itens. Os 13 primeiros itens foram analisados por meio do Beck Depression Inventory - Short Form (BDI-SF), considerando deprimidos os que tiveram pontuação igual ou acima de dez. Os 21 itens foram avaliados para identificar a frequência dos sintomas depressivos; o escore zero indicou ausência de sintoma; os escores um, dois e três, a presença de sintoma. Foi utilizada análise estatística descritiva, com distribuição de frequência para a caracterização de casuística. Em relação à combinação de variáveis das respostas dos protocolos BDI-SF, GI e outras variáveis, foi utilizado o Teste Chi-square-corrected (Yates), considerando resultados significantes valor-p,0,05. Resultados: Foram avaliados 130 pacientes em tratamento para hanseníase no Instituto Lauro de Souza Lima, Bauru, SP, Brasil. A idade dos pacientes various entre 18 e 78 anos, sendo a média de 49,64 +- (SD14,04). A maioria pertence ao sexo masculino (64,6%), vive com familiares (87,7%), possui ensino fundamental incompleto (66,2%), união civil estavel (61,6%), não trabalham (75,4%) e recebem aposentadoria ou auxílio saúde (63,9%)...

Introduction: Depression is the most common psychiatric disorder in leprosy and with high depressive symptoms. The aim of this study was to assess the frequency of depressive symptoms and their relationship to the WHO grade of disability (GI) and sociodemographic variables. Methods: A structured questionnaire containing sociodemographic and clinical questions was used. The GI indicates which indicates decrease or loss of protective sensation and visible deformities was evaluated. The Beck Depression Inventory (BDI) containing 21 items was applied. The first 13 items were analyzed using the Beck Depression Inventory – Short Form (BD - SF) considering an individuals with depressions that who scored 10 or above. The 21 items were evaluated to identify the frequency of depressive symptoms; a score of zero indicates absence of symptom; scores one, two and three, the present of symptoms. Data was analyzed using descriptive statistics, with frequency distribution symptoms. Data was analyzed using descriptive statistics, with frequency distribution to characterize the sample. /the corrected Chi-square test – (Yates), considering significant results p-value<0,05 was used for the combination of variables of protocol BDI-SF, GI and other response variables. Results: We evaluated 130 patients undergoing treatment for leprosy in the Lauro de Souza Lima Institute, Bauru, SP, Brazil. The age of patients ranged from 18 and 78 years, with mean 49.64+ - (SD 14,04). The majority were males (64,6%), living with their family (87,7%), and who had completed elementary school (66,2%), stable civil union (61,6%), unemployed (75,4%) and retired or receiving health aid (63,9%)…

Depression in adult dermatology outpatients.

OBJECTIVE: To determine the frequency of depression in adult male dermatology outpatients. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Combined Military Hospital, Bahawalpur, from January to March 2007. METHODOLOGY: A consecutive sample was screened for depression by using Urdu version of General Health Questionnaire-12 (GHQ-12). The final diagnosis of depression was based on criteria of International Classification of Diseases-10. RESULTS: Out of the 114 adult males with dermatological disorders, 39 (34.11%) had depression. The frequency and percentage of depression in dermatological conditions was 6 (100%) in psychocutaneous disorders, 2 (66.6%) in urticaria, 3 (66.6%) in pruritis, 7 (57.5%) in acne vulgaris, 4 (50%) in psoriasis, 4 (44.4%) in vitiligo, 3 (37.5%) in melasma, 1 (33.3%) each in hyperhidrosis and alopecia areata, and 9 (20.4%) in eczema. It was not recorded in leprosy and chronic fungal infections. CONCLUSION: Depression was frequently in adult males with dermatological disorders especially psychocutaneous disorders, urticaria, pruritis, acne vulgaris and psoriasis. Depressive symptoms should be specifically explored even at busy dermatology outdoors for early recognition and timely appropriate psychiatric referral.

Avaliação cognitiva, funcional e sintomas depressivos em pacientes idosos institucionalizados (PAP)

O objetivo principal deste estudo foi analisar o nível de independência funcional, ocorrência de sintomas depressivos e o nível cognitivo de pacientes idosos institucionalizados. Para isso, avaliou-se a população idosa que reside no Instituto Lauro de Souza Lima (ILSL), Bauru-SP. Como instrumentos de pesquisa foram utilizados: o Questionário de Atividades Funcionais de Pfeffer, a Escala de Depressão Geriátrica-15, o Mini-Exame do Estado Mental e o Índice de Barthel. A partir dos dados obtidos observou-se que quanto ao estado mental, uma pequena parcela dos idosos apresentou declínio cognitivo (22,7%), 45,4% apresentaram independência nas AVDs e 50% independência nas AIVDs e 27,3% apresentaram sintomas indicativos de depressão. Devido à escassez desse assunto, em particular na hanseníase, essa pesquisa fornece subsídios para a implantação de programas específicos para a terceira idade, a fim de gerar ações preventivas e propiciar o bem estar do idoso institucionalizado.