Anxiety and depressive symptoms are common complications of leprosy, yet their predictors remain poorly understood21. To address this gap, we investigated the prevalence of these symptoms and identified key determinants among patients who had completed MDT. Newly diagnosed cases were excluded due to the low prevalence of leprosy in China, the need to assess long-term psychological outcomes without confounding from active infection, and the persistence of mental health issues even after successful treatment. Studying this population provides valuable insights for improving follow-up care and psychosocial support.
Among the cases included in this study, 24.08% experienced anxiety, 22.51% experienced depression, 45.81% faced challenges in ADLs, and 65.18% had at least one of these conditions. The levels of depression and anxiety were higher than those in the general population globally (4.4%/3.6%) and in China (3.58%/5.0%)22,23,24. The findings suggest that there is an association between mental disease and a history of leprosy. International comparisons showed variability: an Indian study reported rates of 33% for depression and 19% for anxiety, whereas in Nepal the prevalence was lower (10%/13%)5. Such discrepancies likely reflect variations in study design, patient populations, assessment tools, and cultural contexts. For example, the Indian study included both newly diagnosed and long-term cases, while our study focused exclusively on patients who had completed MDT, capturing long-term psychological outcomes without the confounding effects of active disease. The Nepalese survey used different screening instruments, which may have contributed lower estimates compared with the SAS and SDS applied here. Cultural perceptions of psychological distress, as well as differences in healthcare access and social support, may further shape cross-country differences. In China, the relatively high prevalence of mental health symptoms may be releated to persistent stigma, physical impairments, limited social support, and socioeconomic or healthcare barriers, which may reinforce isolation, dependence, and chronic psychological stress. These findings highlighting the importance of culturally informed psychosocial support and comprehensive mental health strategies that may help address the needs of leprosy patients.
Multiple linear regression analyses were conducted to identify factors associated with anxiety (SAS) and depression (SDS) among patients. A significant positive correlation was observed between anxiety and depression, indicating that patients with higher anxiety scores often also had higher depression scores. This suggests that these psychological conditions tend to co-occur and interact. Such co-occurrence may arise from shared psychological stressors, the burden of chronic disease, functional impairments, and social stigma. Previous studies have similarly reported frequent co-occurrence of depression and anxiety25,26. In our study, lower income was associated with SAS scores, which may be related to financial stress and limited access to healthcare resources. Financial constraints may impede engagement in activities promoting physical and mental benefits, affecting emotional regulation and stress relief27. Ethnicity was also associated with SAS, with patients from minority groups exhibiting higher anxiety scores. This association may reflect differences in cultural beliefs, lifestyles, education, and socioeconomic status, and increased exposure to prejudice or discrimination, which could contribute to elevated psychological burden28,29,30. Finally, cohabitation with other leprosy patients was inversely associated with anxiety. It is possible that anxiety is more prominent during the early stages of the disease, and living with peers who have undergone similar experiences may provide emotional reassurance and opportunities for discussion of health-related challenges, thereby reducing feelings of social isolation and loneliness. This form of social interaction may preferentially attenuate acute anxiety arising from uncertainty, treatment burden, and social stigma. In contrast, depression often reflects more chronic psychological burden, including feelings of helplessness and cumulative disability-related stress, which may be less responsive to peer presence alone. Therefore, while peer-based social support may help buffer acute stress and anxiety, its association with long-standing depressive symptoms appears more limited, highlighting the importance of considering comprehensive psychosocial support strategies for depression among leprosy patients.
The SDS results revealed a positive correlation between the duration of disease and live with family. Longer disease duration may lead to treatment fatigue and increase risk of depression31,32,33. This prolonged treatment and care process can lead to feelings of frustration, helplessness, and despair, which could be related to depressive symptoms. Regarding living arrangements, both “living with patients” and “living with family” were negatively correlated with SDS scores compared to living alone. This observation may reflect enhanced social support and emotional connection provided by cohabitants, which could help buffer stress and improve overall mental well-being. Individuals living alone may lack immediate emotional support, making them more vulnerable to depressive symptoms during the chronic course of leprosy34,35. Additionally, the No. of other chronic diseases and ADLs may also associated with both SAS and SDS. It is well known that leprosy is a chronic disease that requires long-term treatment and nursing care, and the treatment regime may become even more damaging when the patients have comorbid conditions such as hypertension or diabets. This complexity likely contributes to the observation of higher anxiety and depression scores in patients with three or more chronic diseases. ADL impairments were also related to elevated SAS/SDS scores, Although the exact mechanisms are unclear, it is plausible that functional limitations themselves, even in the absence of social stigmatization, may contribute to anxiety or depression due to reduced independence and self-efficacy. Experts suggested that patients with ADL impairments may be more prone to psychological distress, although the relationship could sometimes be bidirectional, with anxiety or depression further limiting daily functioning. However, due to the limited sample size, no statistically significant association was found between disability and mental health outcomes.
As previously described, we conducted SEM analyses to elucidate the mediating effects of SAS and SDS among the relevant factors (No. of other chronic diseases and residence forms). Our findings suggest that the direct impact of anxiety on the count of diverse chronic disorders among leprosy patients may be limited. Put differently, this means that the association between anxiety and the escalation of other chronic ailments may be influenced by depression. This aligns with accumulating evidence suggesting shared biological mechanisms linking anxiety, depression, and the emergence of chronic disorders later in life. We found a significant mediating effect of anxiety between depression and reduced ADLs. The relationship highlights the intricate interplay between psychological factors in leprosy patients and their impact on functional autonomy. This concurs with the findings of Peng et al.‘s study, where they indicated that depression is a pivotal predictive factor for impairments in activities of daily living36. It was worth noting that they did not identify a mediating relationship between depression and ADL in the research. In contrast, a study conducted by Atsuro et al. in Bangladesh reported no significant differences in ADLs between leprosy patients and healthy individuals, and the relationship between anxiety and depression in patients was not examined37. These discrepancies indicate the need for further, large-scale surveys to verify and refine our understanding of the psychological determinants of functional outcomes in patients.
This study represents the first systematic assessment in China of anxiety and depression among leprosy patients who have completed MDT, providing insights into long-term psychological outcomes. It integrates functional ability and mental health by linking ADL impairments with psychiatric symptoms, highlighting their potential combined impact on daily life. Using SEM, we explored complex relationships and mediating effects, including the previously unreported potential role of anxiety between depression and ADL limitations. The analysis is based on multi-province dataset covering four provinces in China, which may enhance representativeness and generalizability. By comparing findings with studies from India and Nepal, the study situates the psychological burden of leprosy within an international context. Additionally, it identifies specific sociodemographic and clinical influencing factors, such as chronic diseases, residence, income, and ethnicity, to inform targeted interventions. We found that anxiety and depression often co-exist among leprosy patients, placing a heavy burden on them, which may underscores the urgency of comprehensive care strategies and strengthened overall patient management. Self-help health groups have been established in some leprosy-endemic countries, where patients meet regularly and are taught how to care for ulcers and other disabilities to promote physical and psychological recovery. In our view, general hospitals could consider improving diagnosis and treatment, promoting early detection, and shorten disease duration, thereby reducing anxiety and depression. Furthermore, local measures could be implemented to reduce stigma, such as producing video and audio programs and training medical staff.
Limitations
Several limitations of this study should be acknowledged. The small sample size and predominance of elderly participants, reflecting the low prevalence of leprosy, may limit generalizability. Recall and other survey-related biases could have influenced the findings. The cross-sectional design precludes causal inference, restricting conclusions regarding the directionality of associations between ADLs and mental health. Permanent sequelae and participants’ psychiatric histories were not assessed, which may contribute to psychological distress even after treatment. Moreover, leprosy may continue to affect mental health through persistent stigma, subtle functional impairments, reduced self-esteem, or socioeconomic and healthcare-related challenges. Future research could consider employ longitudinal designs to clarify causal relationships, incorporate assessments of sequelae and pre-existing psychiatric conditions, explore interactions among sociodemographic and clinical factors, and evaluate interventions aimed at alleviating anxiety and depression. Such studies would provide a more comprehensive understanding of mental health outcomes in leprosy patients and guide evidence-based psychosocial care.