A quantitative study into the mental wellbeing of persons affected by leprosy in province no. 7, Nepal

Introduction: Despite effective treatment for leprosy, the disease is still endemic in Nepal. Studies show that leprosy-affected persons experience stronger stigma than individuals who are affected by other (dermatological) diseases. This experience of stigma can have social and psychological consequences, which increase the risk of mental disorders.

Research objective: To measure the mental wellbeing status and severity of depression among persons with leprosy in Province no.7, and to which extent they experience stigma, compared with community members who do not have leprosy .

Methods: This study used a cross-sectional stratified survey design to gather data about case and control groups. For each person, three questionnaires were used: The Warwick Edinburgh Mental Wellbeing Scale (WEMWBS), the Patients Health Questionnaire (PHQ-9) and the Explanatory Model Interview Catalogue Stigma Scale for affected persons (EMIC-AP) or controls (EMIC-CS).

Results: The median WEMWBS total score of the leprosy-affected group was 53.0 (IRQ 45.0 -46.0).0 The median PHQ-9 total score was .5 (IRQ 0.00 – 6.8).Within this group, mild to severe depression was indicated in 37%. The median total EMIC-AP score, which measures perceived stigma, was 6 (IRQ 0.0 -11.3). The median WEMWBS total score of the control group was 59.5 (IRQ 55.0-65.3). The median PHQ-9 total score was 0 (IRQ 0.0 – 1.0). Within the control group, 7.6% had scores that indicated mild to severe depression. The percentage of community members who perceived negative attitudes and behavior towards people affected by leprosy was 45.5%. The median EMIC-CS score for leprosy was 6.0 (IRQ 2.0 – 16.0).

Conclusion: Leprosy-affected people had a better mental wellbeing and a less severe depression than expected. However it is likely that these results are underestimated due to selection bias within the leprosy-affected group. Also 26% of the leprosy-affected persons recently thought of suicide and/or self-harm. Besides, the prevalence of depression among leprosy-affected persons was almost 5 times higher than among community members. This difference does might be caused by leprosy, but could also be caused by other variables. This study showed that public stigma towards leprosy-affected persons in Province no.7 is still high.