03158nas a2200457   4500000000100000008004100001260001200042653003900054653001400093653001200107653001800119653001500137653001200152653001500164100001500179700001400194700001300208700001600221700002000237700001400257700001600271700001300287700001300300700001300313700001300326700001400339700001200353700001400365700001300379700001300392700001600405700001300421700001500434700001100449245013000460856006600590300000900656490000600665520201500671022001402686       2024                            d  bMDPI AG10aNeglected tropical diseases (NTDs)10asyndemics10aLiberia10aMental Health10aDepression10aAnxiety10aDisability1 aMcCollum R1 aBarrett C1 aZawolo G1 aJohnstone R1 aGodwin-Akpan TG1 aBerrian H1 aChowdhury S1 aKollie J1 aKollie K1 aRogers E1 aParker C1 aPhillip M1 aSempe L1 aSeekles M1 aSmith JS1 aSeekey W1 aWickenden A1 aZaizay Z1 aTheobald S1 aDean L00a‘The Lost Peace’: Evidencing the Syndemic Relationship between Neglected Tropical Diseases and Mental Distress in Liberia  uhttps://www.mdpi.com/2414-6366/9/8/183/pdf?version=1724144565  a1-240 v93 a<jats:p>Neglected Tropical Diseases (NTDs) are a group of chronic infectious diseases of poverty affecting over one billion people globally. Intersections of NTDs, disability, and mental ill-health are increasingly evidenced but are rarely studied from a mixed-methods perspective. Here, we advance syndemic understandings by further assessing and contextualising the syndemic relationship between NTDs (particularly their associated disability) and mental distress in Liberia. Participatory qualitative methods, including body mapping (56 participants), social mapping (28 participants), and in-depth interviews (12) provided space for persons affected by NTDs to narrate their experiences. Simultaneously, 201 surveys explored experiences of common mental health conditions among persons affected by skin NTDs. An intersectionality approach was applied within the analysis for both qualitative and quantitative methods informed by Meyer’s minority stress model, adapted for NTDs. Qualitative data was analysed thematically and gender-disaggregated, univariable and multivariable analyses were applied to survey data for the outcome measures depression (PHQ-9) and anxiety (GAD-7). Disability was associated with higher levels of depression and anxiety (p &lt; 0.001). An interaction between disability and being a women increased incidence risk ratio of depression (p &lt; 0.001). In alignment with qualitative findings, persons affected experienced additional generalised (financial concerns), external (experience of stigma) and internal (experience of pain and physical symptoms) minority stressors, to varying degrees, which contributed towards their mental distress, and mental health conditions. These findings were used to co-develop a syndemic-informed person-centred health system response to address the suffering associated with NTDs and mental distress, including a focus on strengthening relationships between formal and informal community health actors and the broader health system.</jats:p>  a2414-6366