Leprosy-related disability and the association with secondary mental health problems in the Eastern Region of Nepal.
INTRODUCTION: Disability has a large influence on the lives of the affected persons. A result of disability could be secondary mental health problems. Previously, the relation between stigma and mental health was already studied. Especially persons with leprosy-related disability suffer from a high level of stigma, which results in a higher level of mental distress. Although leprosy has been eliminated as a public health problem in Nepal, the disease is still endemic in most of the Terai areas. In Nepal the association between stigma and mental health for persons with leprosy-related disability has already been studied. However the association between activity limitations, participation restrictions and stigma with secondary mental health problems was not studied before.
OBJECTIVE: To investigate the association between (leprosy-related) disabilities and mental health and to evaluate the relationship with other factors (such as stigma, participation and activity) that influence perceived disability and mental health problems, in the Eastern Region of Nepal.
METHODS: Data was gathered by means of quantitative and qualitative methods. The quantitative part of the study involved different questionnaires: SRQ for mental distress, GPAS for activity limitations, P-scale for participation restrictions and the ISMI for internalized stigma. Quantitative data was validated and supplemented by in-depth interviews. In addition, experts were interviewed about their knowledge and attitudes towards disability and mental health problems.
RESULTS: 20 PLD, 21 PWD and 20 controls were included in the sample. PLD (7.5) and PWD (8.9) show similar results on mental distress scores (range …). Both groups showed a significant higher score than the controls (p<.0001). The multivariate model predicts mental distress by participation restrictions, internalized stigma, ‘years since disability’ and health condition. The model explained 80% of the variability of the SRQ-score. The in-depth interviews add the important influence of activity restriction and the hopelessness of the situation. From the expert interviews it appeared that health care workers were able to recognize mental health problems, but that they were not able to treat them.
DISCUSSION: From the analyses some prominent results were evident. The SRQ-score indicated that PLD did not experience more mental distress than …, which could be associated with fewer deformities in leprosy, due to fast diagnosis and treatment. Related to this was internalized stigma, which was the same for PLD and PWD. This also provides an explanation for the similar results on the SRQ, as stigma was associated with mental distress in previous studies. Both may be related to the high number of PWD with visible signs of disability compared to the low number of PLD with visible signs of disability. Moreover, hopelessness was found in most of the interviews. This seems to be highly influential in mental distress, as it creates despair, worries and tension and eventually may create a wish to die.
CONCLUSION: When designing a program for PLD and PWD to decrease secondary mental health problems, there should be a focus on addressing activity limitations, participation restrictions, stigma and hopelessness. Furthermore, the available mental health care and facilities should be decentralized to improve their availability.