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Depression prevalent in patients with outward signs of lymphatic filariasis
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Around 20% of patients with obvious physical symptoms of lymphatic filariasis met the criteria for depression in a small study in central Nigeria — a rate several times higher than the overall adult population, researchers said.
The rate, although similar to the prevalence of depression in patients with any chronic medical condition, underscores the need to focus more attention on the emotional impact of lymphatic filariasis, according to Jibril O. Abdulmalik, MBBS, MSc, MHPM, lecturer in the College of Medicine at the University of Ibadan in Nigeria, and colleagues.
Lymphatic filariasis is the most common cause of permanent disability in the world, affecting more than 120 million people, according to the CDC. The mosquito-borne disease is caused by microscopic filarial worms like Wuchereria bancrofti that live in the human lymphatic system, sometimes causing it to function improperly.
Although most patients show no symptoms, others develop disabling and disfiguring symptoms of lymphedema and elephantiasis, often years after they were infected, according to the CDC. WHO estimates that 40 million people worldwide in 2000 were disfigured to some degree by the disease. Recently, an outbreak of elephantiasis in Uganda was linked to a noninfectious cause: chronically walking barefoot in volcanic soil.
Abdulmalik and colleagues said patients with outward physical signs of lymphatic filariasis “experience rejection, and stigma and discrimination, which can result in significant emotional consequences.”
“Overall functioning and the quality of life of such individuals can be further affected by this exclusion and psychosocial impacts,” they wrote in a study published today in PLoS Neglected Tropical Diseases.
According to Abdulmalik and colleagues, the emotional impact among patients with physical symptoms of lymphatic filariasis is neglected. Aiming to determine the prevalence and severity of depression in this population, they recruited patients with obvious physical manifestations of the disease at five designated treatment centers in Plateau State, Nigeria, and evaluated them using a socio-demographic questionnaire, the Rosenberg self-esteem scale and a nine-item Patient Health Questionnaire (PHQ-9).
Patients with a PHQ-9 score of five or above were further evaluated by two psychiatrists using the Composite International Diagnostic Interview (CIDI) and formally diagnosed and rated for the severity of their depression. Abdulmalik and colleagues said patients with depression were given advice and information, and those with moderate and severe depression were referred for further treatment.
A majority — 61.7% — of the 94 patients who had full documentation and were analyzed were female and 41.5% were older than 60 years of age. Many patients — 22.3% — rated their level of functioning as poor. The median duration of their illness was 17 years, with 24.5% reporting having it for more than 30 years.
Of the 19 respondents who met the CIDI criteria for depression — including 14 women — 42.1% had mild depression, 31.6% had moderate depression and 26.3% had severe depression, Abdulmalik and colleagues reported. They said conditions predictive of depression included history of mental illness, duration of illness between 11 and 20 years, being unemployed and low self-esteem, which was reported by 69 respondents overall.
According to Abdulmalik and colleagues, the reported prevalence of depression among adults in Nigeria is between 3.1% and 5.2%. They recommended that health care staff caring for patients with lymphatic filariasis be made aware of the disease’s link to depression and be trained to recognize its signs and symptoms.
“These are simple steps that can easily be incorporated into specific [neglected tropical disease] services, and general health care for endemic populations, providing the possibility of improving the quality of life of affected persons, and reducing the negative impact of depression on an already marginalized population,” they wrote. – by Gerard Gallagher
Disclosure: The researchers report no relevant financial disclosures.
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