Screening for symptoms of depression, anxiety and associated factors among leprosy patients at referral hospitals in the Amhara region, Ethiopia

Abstract

BACKGROUND: Leprosy, a neglected tropical disease (NTD), is closely associated with stigma and discrimination, particularly in low- and middle-income countries, which significantly worsen mental health challenges. In Ethiopia's Amhara region, leprosy accounts for 26.1% of cases, often leading to stigma, isolation, and increased depression and anxiety risk. This study aimed to assess depression and anxiety symptoms among leprosy patients in hospitals across the Amhara region, providing a basis for targeted mental health interventions and policies. METHODS AND MATERIALS: An institution-based cross-sectional study was conducted in three referral hospitals in the Amhara region from December 14 to 20, 2023. The Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) assessment tools were used to evaluate symptoms of depression and anxiety, respectively. Binary logistic regression was employed to identify factors associated with symptoms of depression and anxiety, using a significance level of p ≤ 0.05. RESULTS: Among 383 participants, 36% reported depressive symptoms, and 32.6% experienced anxiety symptoms. Several factors were found to significantly contribute to mental health symptoms in individuals with leprosy. Symptoms of depression were significantly associated with being female (AOR = 1.20; 95% CI: 1.09-3.42), being aged above 50 years (AOR = 2.42; 95% CI: 1.23-3.22), having a chronic disease (AOR = 1.64; 95% CI: 1.07-3.66), having multibacillary leprosy (AOR = 1.40; 95% CI: 1.08-3.22), and being on multidrug therapy (AOR = 1.20; 95% CI: 1.12-3.22). Similarly, symptoms of anxiety were more likely among individuals who were female (AOR = 1.34; 95% CI: 1.14-2.67), had chronic diseases (AOR = 1.40; 95% CI: 1.05-2.70), smoked (AOR = 1.25; 95% CI: 1.02-2.40), had multibacillary leprosy (AOR = 1.40; 95% CI: 1.10-3.30), or had borderline lepromatous leprosy (AOR = 1.30; 95% CI: 1.05-2.10). CONCLUSION AND RECOMMENDATIONS: This study identified factors influencing anxiety and depression in leprosy patients, including gender, age, disease classification, multidrug therapy, chronic diseases, and smoking habits. It is important to note that the study assesses symptoms, not diagnoses. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) questionnaires are crucial for early detection, especially in high-risk groups such as females, older adults, and those with chronic or multibacillary leprosy. Routine screening and integrating mental health assessments into care, along with specialized services and awareness campaigns, will improve patient outcomes and reduce the psychosocial impact of leprosy.