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

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Abstract

Background

Leishmaniasis is a neglected tropical parasitic disease endemic in South Asia, East Africa, Latin America and the Middle East. It is associated with low socioeconomic status (SES) and responsible for considerable mortality and morbidity. Reports suggest that patients with leishmaniasis may have a higher risk of mental illness (MI), psychosocial morbidity (PM) and reduced quality of life (QoL), but this is not well characterised. The aim of this study was to conduct a systematic review to assess the reported impact of leishmaniasis on mental health and psychosocial wellbeing.

Methods

A systematic review of the literature was carried out. Pre-specified criteria were applied to identify publications including observational quantitative studies or systematic reviews. Two reviewers screened all of the titles, abstracts and full-studies and a third reviewer was consulted for disagreements. Data was extracted from papers meeting the criteria and quality appraisal of the methods was performed using the Newcastle-Ottawa Scale or the Risk of Bias in Systematic Review tool.

Results

A total of 14 studies were identified from 12,517 records. Nine cross-sectional, three case-control, one cohort study and one systematic review were included. Eleven assessed MI outcomes and were measured with tools specifically designed for this; nine measured PM and 12 measured QoL using validated measurement tools. Quality appraisal of the studies showed that six were of good quality. Cutaneous leishmaniasis and post kala-azar dermal leishmaniasis showed evidence of associated MI and PM including depression, anxiety and stigma, while all forms of disease showed decreased QoL. The findings were used to inform a proposed model and conceptual framework to show the possible links between leishmaniasis and mental health outcomes.

Conclusion

There is evidence that leishmaniasis has an impact on MI, PM or QoL of patients and their families and this occurs in all the main subtypes of the disease. There are however large gaps in the evidence. Further research is required to understand the full extent of this problem and its mechanistic basis.

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Most cited references 67

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Cochrane Handbook for Systematic Reviews of Interventions

Julian P. T. Higgins, Sally Green (2008)

Healthcare providers, consumers, researchers and policy makers are inundated with unmanageable amounts of information, including evidence from healthcare research. It has become impossible for all to have the time and resources to find, appraise and interpret this evidence and incorporate it into healthcare decisions. Cochrane Reviews respond to this challenge by identifying, appraising and synthesizing research-based evidence and presenting it in a standardized format, published in The Cochrane Library (www.thecochranelibrary.com).<p><i>The Cochrane Handbook for Systematic Reviews of Interventions</i> contains methodological guidance for the preparation and maintenance of Cochrane intervention reviews. Written in a clear and accessible format, it is the essential manual for all those preparing, maintaining and reading Cochrane reviews. Many of the principles and methods described here are appropriate for systematic reviews applied to other types of research and to systematic reviews of interventions undertaken by others. It is hoped therefore that this book will be invaluable to all those who want to understand the role of systematic reviews, critically appraise published reviews or perform reviews themselves.

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Post-kala-azar dermal leishmaniasis.

E Zijlstra, A. M. Musa, E A G Khalil … (2003)

Post-kala-azar dermal leishmaniasis (PKDL) is a complication of visceral leishmaniasis (VL); it is characterised by a macular, maculopapular, and nodular rash in a patient who has recovered from VL and who is otherwise well. The rash usually starts around the mouth from where it spreads to other parts of the body depending on severity. It is mainly seen in Sudan and India where it follows treated VL in 50% and 5-10% of cases, respectively. Thus, it is largely restricted to areas where Leishmania donovani is the causative parasite. The interval at which PKDL follows VL is 0-6 months in Sudan and 2-3 years in India. PKDL probably has an important role in interepidemic periods of VL, acting as a reservoir for parasites. There is increasing evidence that the pathogenesis is largely immunologically mediated; high concentrations of interleukin 10 in the peripheral blood of VL patients predict the development of PKDL. During VL, interferon gamma is not produced by peripheral blood mononuclear cells (PBMC). After treatment of VL, PBMC start producing interferon gamma, which coincides with the appearance of PKDL lesions due to interferon-gamma-producing cells causing skin inflammation as a reaction to persisting parasites in the skin. Diagnosis is mainly clinical, but parasites can be seen by microscopy in smears with limited sensitivity. PCR and monoclonal antibodies may detect parasites in more than 80% of cases. Serological tests and the leishmanin skin test are of limited value. Treatment is always needed in Indian PKDL; in Sudan most cases will self cure but severe and chronic cases are treated. Sodium stibogluconate is given at 20 mg/kg for 2 months in Sudan and for 4 months in India. Liposomal amphotericine B seems effective; newer compounds such as miltefosine that can be administered orally or topically are of major potential interest. Although research has brought many new insights in pathogenesis and management of PKDL, several issues in particular in relation to control remain unsolved and deserve urgent attention.

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Cautionary Statement for Forensic Use of DSM-5

(2013)

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Author and article information

Contributors

Malini Pires:

ORCID: http://orcid.org/0000-0002-9609-7550

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SoftwareRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing

Barry Wright: Role: ConceptualizationRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: Writing – original draftRole: Writing – review & editing

Paul M. Kaye:

ORCID: http://orcid.org/0000-0002-8796-4755

Role: ConceptualizationRole: Funding acquisitionRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing

Virgínia da Conceição: Role: Methodology

Rachel C. Churchill: Role: ConceptualizationRole: MethodologyRole: SupervisionRole: VisualizationRole: Writing – review & editing

Albert Picado: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 17 October 2019

Publication date Collection: 2019

Volume: 14

Issue: 10

Electronic Location Identifier: e0223313

Affiliations

[1 ] Mental Health Research Group, Hull York Medical School and Dept. of Health Sciences, University of York, England, United Kingdom

[2 ] Centre for Reviews and Dissemination, University of York, England, United Kingdom

[3 ] Centre for Immunology and Infection, Hull York Medical School and Dept. of Biology, University of York, England, United Kingdom

[4 ] Institute of Public Health, University of Porto, Portugal

FIND, SWITZERLAND

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: malini.pires@ 123456york.ac.uk

Author information

Malini Pires http://orcid.org/0000-0002-9609-7550

Paul M. Kaye http://orcid.org/0000-0002-8796-4755

Article

Publisher ID: PONE-D-19-24670

DOI: 10.1371/journal.pone.0223313

PMC ID: 6797112

PubMed ID: 31622369

SO-VID: 16854753-da27-48a0-8ce5-a4a8dfbd84c6

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 4 May 2019

Date accepted : 18 September 2019

Page count

Figures: 1, Tables: 2, Pages: 21

Funding

Funded by: Wellcome Trust

Award ID: WT1063203

Award Recipient :

ORCID: http://orcid.org/0000-0002-8796-4755

Paul M. Kaye

PK is supported by a Wellcome Trust Senior Investigator Award (WT1063203; https://wellcome.ac.uk) and MRC Global Challenges Research Fund Foundation Award (MR/P024661/1; https://www.ukri.org/research/global-challenges-research-fund/). The sponsors did not play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. MP, BW and RC received no specific funding for this work.

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

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Most cited references 67

Cochrane Handbook for Systematic Reviews of Interventions

Post-kala-azar dermal leishmaniasis.

Cautionary Statement for Forensic Use of DSM-5

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