Journal Article

Cutaneous leishmaniasis and co-morbid major depressive disorder: A systematic review with burden estimates

Vélez, Iván D., Alvar, Jorge, Alorfi, Ahmed, Eaton, Julian, Al-Salem, Waleed, Hotez, Peter, Olabi, Amina, Bailey, Freddie, Ruiz-Postigo, José Antonio, Molyneux, David H., Acosta-Serrano, Álvaro, Mondragon-Shem, Karina, Haines, Lee Rafuse, Adams, Emily R.

2019

Overview

Major depressive disorder (MDD) associated with chronic neglected tropical diseases (NTDs) has been identified as a significant and overlooked contributor to overall disease burden. Cutaneous leishmaniasis (CL) is one of the most prevalent and stigmatising NTDs, with an incidence of around 1 million new cases of active CL infection annually. However, the characteristic residual scarring (inactive CL) following almost all cases of active CL has only recently been recognised as part of the CL disease spectrum due to its lasting psychosocial impact. We performed a multi-language systematic review of the psychosocial impact of active and inactive CL. We estimated inactive CL (iCL) prevalence for the first time using reported WHO active CL (aCL) incidence data that were adjusted for life expectancy and underreporting. We then quantified the disability (YLD) burden of co-morbid MDD in CL using MDD disability weights at three severity levels. Overall, we identified 29 studies of CL psychological impact from 5 WHO regions, representing 11 of the 50 highest burden countries for CL. We conservatively calculated the disability burden of co-morbid MDD in CL to be 1.9 million YLDs, which equalled the overall (DALY) disease burden (assuming no excess mortality in depressed CL patients). Thus, upon inclusion of co-morbid MDD alone in both active and inactive CL, the DALY burden was seven times higher than the latest 2016 Global Burden of Disease study estimates, which notably omitted both psychological impact and inactive CL. Failure to include co-morbid MDD and the lasting sequelae of chronic NTDs, as exemplified by CL, leads to large underestimates of overall disease burden.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Biology / Biology and Life Sciences / Comorbidity / Complications / Complications and side effects / Cost of Illness / Cutaneous leishmaniasis / Depression (Mood disorder) / Depressive Disorder, Major - complications / Depressive Disorder, Major - parasitology / Diseases / Global Burden of Disease / Global Health / Health aspects / Humans / Identification / Incidence / Infection / Injuries / Laboratories / Leishmaniasis / Leishmaniasis, Cutaneous - complications / Life Expectancy / Life span / Major depressive disorder / Medical research / Medicine / Medicine and Health Sciences / Mental depression / Mental disorders / Mental health / Mortality / Neglected Diseases - complications / Neglected Diseases - parasitology / Parasitic diseases / Prevalence / Psychological aspects / Psychological research / Psychology / Public health / Quality-Adjusted Life Years / Risk factors / Scars / Systematic review / Tropical climate / Tropical diseases / Vector-borne diseases / Zoonoses