Jennifer Thorpe, from medical think tank Polygeia writes about the link between leprosy and mental health. 

It's believed that 1 in 2 people living with the effects of leprosy will experience anxiety and depression.

By 2030, it's believed that mental health conditions could become the largest contributor to the global health burden and tackling diseases which link to mental health issues will play a key part in reducing the incidence.

Leprosy and mental health

Mental health issues within leprosy patients has significantly increased over the last decade and stigma is a key factor to this.  

A study in Delhi showed that within the population, ignorance of the cause of the condition was common, and 6% of the individuals interviewed even believed that it arose as a consequence of an individual’s past wrong-doings – hence, those affected are often isolated from society.

Because the infection progressively affects peripheral nerves, lack of treatment from potential shame or poor access to health care can eventually lead to a loss of sensation in the hands and feet, muscle paralysis and even blindness.

This, associated with the somatic and neuropathic pain symptoms may aggravate the shame or ‘self-stigma’ endured by the affected individual.

But why is this a key concern for treatment?

Mental disorders aggravating leprosy

Psychiatric illness can greatly aggravate the management of leprosy. Patients may become less compliant to self-administered and long-lasting treatment. Multi-drug therapy is the cure for the disease, however, therapy requires regular medication for 6 months to 1 year, during which patient compliance is key.

Furthermore, psychiatric illness can aggravate many conditions directly. Depression and chronic stress have been associated with immune depression and a shift in the type of cellular immune responses to pathogens. This may impede proper response to M. Leprae, the bacterium responsible for leprosy.

Are women more at risk?

The potential worsening of the condition and its consequences on quality of life for women is two-fold. Firstly, the lack of support, advice and the increased stigma associated with the condition in female patients can precipitate mental health conditions. Furthermore, women have been shown to be more vulnerable to mental health issues.

The level of disability caused by the disease seems to correlate better with the incidence of mental health conditions than the duration of the disease. This may be because of the increased stigma severe patients suffer from, as this is further increased in people that admit to having been ‘physically attacked’ or refused services in their community.

Because of the greater proportion of delayed diagnoses in women, increased incidence of deformities may aggravate their social status and hence their mental health.

What can be done?

It is believed that the association of leprosy and psychiatric illness is mostly explained through the social stigma associated with the condition and the consequences of lack of diagnosis and treatment compliance.

This highlights the key potential for interaction by providing support to affected individuals and attempting to reduce the discrimination they suffer from in their surroundings.

Attempts to provide earlier diagnosis and treatment, especially to women who may struggle to receive such support, may aid to reduce the progression of the disease and as such could be coupled to increase mental health support in order to ensure a better outcome.

A controlled randomised trial with over 3,000 participants in the state of Goa, India, demonstrated that addition of a range of psychosocial treatments delivered by trained people under the supervision of visiting psychiatrists can significantly reduce the incidence of depression.

Hence targeted training of caregivers in the matter of mental health management may provide considerable improvement to the management and quality of life of patients affected by the condition.

What Lepra has achieved

Indirectly, attempts at reducing stigma within the population can aid to reduce the sense of exclusion experienced by people living with mental health conditions. In addition, the training of outreach staff members and incorporation of counsellors into certain teams in India has been coupled to the installation of self-help groups providing peer-support.

The latter initiatives aim to directly target those at greatest risk of suffering from psychiatric disorders. Further outreach into households and targeting of women for early diagnosis and increase counselling may aid in focusing the action of certain teams.

In the longer term the integration of a mental health component to all projects could be achieved. Further investigation into the consequences of mental disorder on the outcome of leprosy treatment may help support the new initiatives taken by Lepra and aid in monitoring their impact.

Find out more about how we're working to beat stigma