Mental Health Status and Quality of Life Among People living with Leprosy in Southwest and North Central Nigeria.

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Olubukola Omobowale, Temitope Odetoye, Olufisayo Elugbadebo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5979566/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Leprosy significantly impacts mental health and quality of life, yet research on this issue in Nigeria is scarce. This study assessed the mental health status and quality of life among individuals living with leprosy in two settlements in Nigeria. Methods A cross-sectional study was conducted among 53 people living with leprosy in two leprosy settlements in Ondo and Kwara States. A semi-structured instrument consisting of sociodemographic characteristics as well as the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and World Health Organization Quality of Life Brief (WHOQOL-BREF) was used to assess depression, anxiety, and quality of life respectively. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression. The level of statistical significance was set at p < 0.05. Results The prevalence of depression and anxiety was 84.9% and 43.4% respectively. Quality of life was very poor for 94.3% of respondents. Significant associations were found between depression and quality of life (p = 0.037), duration of stay in settlements and depression (p = 0.04), age and anxiety (p = 0.026), and source of income and quality of life (p = 0.03). Respondents aged 70 years and older were more likely to experience anxiety (p = 0.02). Conclusion The high prevalence of depression and anxiety, coupled with very poor quality of life, highlights the need for comprehensive mental health interventions and support systems for individuals affected by leprosy in Southwestern and North Central Nigeria. Targeted strategies addressing age-specific needs and economic empowerment may improve overall well-being and quality of life of this vulnerable population. Preventive Medicine Leprosy mental health depression anxiety quality of life Nigeria Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 INTRODUCTION Leprosy, with an estimated burden of disease of around 21,100 disability-adjusted life years (DALYs),[ 1 ] is one of the oldest and most neglected illnesses that is known to generate prejudice and stigma, particularly in low- and middle-income nations, compared to other stigmatizing diseases.[ 2 ] It is a deforming disease caused by Mycobacterium leprae that primarily affects the peripheral nerves, respiratory tract mucosa, and skin [ 3 ]. Annually, over 200,000 new cases of leprosy are recorded and the World Health Organization (WHO) states that leprosy is not seen as a priority in over 120 nations especially in the African region where there are over 20,000 new cases each year, despite the reported overall decrease in prevalence [ 4 ]. It is crucial to recognize that neglected tropical diseases (NTDs), including skin conditions such as leprosy, are frequently linked to considerable stigma and disability, which can result in adverse mental health outcomes. Leprosy is a public health issue in Nigeria with 4,000 new cases reported each year, with 12% of these cases resulting in disability. The national prevalence rate stands at about 0.4 per 10,000 persons, showing a decline compared to previous years [ 5 ]. There are regional variations in Nigeria regarding the prevalence of leprosy such as Zaria Local Government Area (LGA) in Kaduna State which reported a high prevalence rate of 1.4 per 10,000 population, likely due to the presence of the National Tuberculosis & Leprosy Training Centre, a referral center for many northern states [ 6 ] and a low prevalence rate of 0.1 per 10,000 in some southern states in the country. A study conducted in the country revealed that some LGAs in eight states (Zamfara, Sokoto, Yobe, Adamawa, Kaduna, Cross River, Benue and Jigawa states) are high clusters for the burden of leprosy while states such as Ekiti, Lagos, Federal Capital Territory and Imo are low clusters for the burden of leprosy [ 6 ] Several factors significantly influence the perception and treatment of leprosy in Nigeria such as the cultural beliefs in some regions, particularly among the Yorùbá people, attributing the disease to supernatural causes despite its recognized biomedical aspects [ 7 ]. These erroneous beliefs often lead to the ostracization of people living with leprosy and their isolation from the society. [ 8 ]Also, communities with limited or no education often lack awareness about leprosy and its treatment options. Additionally, the way leprosy is being portrayed in the media promotes false perceptions and attitudes towards the disease [ 9 ] Beyond physical disability, reports show that leprosy affects the mental health of affected individuals. [ 10 ]The visible impairments, stigma and discrimination associated with leprosy predisposes persons living with the illness to poor mental health outcomes. [ 11 ] For example, systematic literature review showed a higher prevalence of mental health disorders among people affected by leprosy than in the general population [ 12 ]. Leekassa et al further revealed that there was a higher prevalence of mental distress among people affected by leprosy (52·4% prevalence) than any other dermatological condition assessed (7·9% prevalence) [ 13 ]. In developing countries such as Nigeria where mental health issues are less prioritized,[ 14 ] persons with leprosy are faced with a dual problem of dealing with both leprosy and mental disorders such as depression and anxiety [ 15 ]. Moreover, leprosy does not only influence the lives of the victims; but also, the lives of their direct contacts, such as family members, friends and people in their community; the impairments and social barriers associated with the disease can lead to emotional reactions and negative behaviors among these individuals.[ 16 ] Depression and anxiety have been identified as the most common mental disorders that affects persons living with leprosy [ 16 ]. Studies show that 33.1% of people living with leprosy have depression and 19% have anxiety disorders, respectively [ 17 ]. In Northern Nigeria, a study revealed that 79.4% of individuals with leprosy experienced anxiety disorders and 89.9% had depressive symptoms [ 10 ]. Another study by Litt et al. (2012) which examined the relationship between NTDs, including leprosy, and mental health conditions found that the consequences of NTDs include stigma, social exclusion, reduced access to healthcare services, lack of educational and employment opportunities, restriction of rights, increased disability and early mortality. Each of these consequences may result in poor mental wellbeing by increasing feelings and behaviors such as sadness, hopelessness and social withdrawal. [ 18 ] The Quality of Life of persons living with leprosy can be significantly affected[ 19 ] as studies have noted poor QoL among this population [ 10 ]. The physical disabilities and mental health challenges caused by leprosy predispose these individuals to psychological, economic, and social problems, adversely affecting their QoL [ 20 ] Given the increasing burden of leprosy in this part of the world, more attention needs to be given to its care. Leveraging on research, interventions centered on addressing the mental needs of this population and improving their QOL are highly needed. Although numerous studies have examined the relationship between mental disorders and quality of life among leprosy patients globally and in Northern Nigeria; research in the southwestern states of Nigeria remains scarce. To address the research gap, this study aimed to investigate the connection between the mental health effects of leprosy and the quality of life of individuals living with the disease in leprosy settlements in Nigeria. METHODS Study design A community based cross-sectional study conducted in June and July, 2024 to assess the mental health status and quality of life among people living with leprosy in two settlements in Akure, Ondo State and Omu-Aran, Kwara State, Nigeria Sampling A simple random sampling technique was used to select 2 leprosy settlements and total sampling was used to select a total of 53 eligible participants aged 18 years and above in the two settlements between June and July, 2024. Study location The study was carried out in two settlements in Nigeria namely Oke Igbala Leprosarium, Kwara state and Ago Ireti Leprosy Control Center in Akure, Ondo state. The Oke Igbala Leprosarium, also known as the Omu-Aran Leprosy Settlement, is situated in a dense forest area between Omu-Aran and Oke Onigbin villages in Kwara State, Nigeria. It was established by the Evangelical Church Winning All (ECWA). Ago-Ireti, meaning "Settlement of Hope," is a leprosy colony located in Akure, the capital of Ondo State, Nigeria. It was founded in 1943 and it has served as a safe haven for individuals affected by leprosy for over 80 years. Study Population The study was conducted among 53 eligible participants aged 18 years and above in the two settlements. Data Collection We used a semi-structured questionnaire consisting of four sections namely: participants socio-demographic characteristics, Patient Health Questionnaire-9 (PHQ-9); Generalized Anxiety Disorders-7 (GAD-7) and the World Health Organization Quality of Life Brief (WHOQOL-BREF) to assess depression, anxiety and quality of life respectively. Trained research assistants were also used to collect data from respondents. Outcome measures Patient Health Questionnaire-9 The PHQ-9 is a validated questionnaire that is used for screening, diagnosing, monitoring and measuring the severity of depressive symptoms. It contains nine statements with the responses in a Likert scale format consisting of scores ranging from zero to three (0-never, 1-rarely, 2-sometimes, 3-always) making the minimum score that could be obtained for each respondent 0 while the maximum score to be 27. The tool is then graded as score of zero to 4 as Minimal depression, score of 5 to 9 as Mild depression, score of 10 to 14 as Moderate depression, score of 15 to 19 as Moderately severe depression and a score of 20 to 27 as Severe depression. [ 21 ]. The PHQ 9 score was further categorized as a score of 0 to 3 as No depression and a score of 4 to 27 as depression. [ 22 ] Generalized Anxiety Disorder-7 The GAD 7 is a validated questionnaire that is used as an initial screening tool for generalized anxiety disorder. It contains seven statements with the responses in a Likert scale format consisting of scores ranging from zero to three (0-never, 1-rarely, 2-sometimes, 3-always) making the minimum score that could be obtained for each respondent 0 while the maximum score to be 21. The tool is then graded as score of zero to 4 as Minimal anxiety, score of 5 to 9 as Mild anxiety, score of 10 to 14 as Moderate anxiety and a score of 15 to 21 as Severe anxiety.[ 23 ]. World Health Organization Quality of Life Brief The WHOQOL-BREF is a validated 26-item questionnaire used to assess the quality of life across four domains namely physical health, psychological health, social relationship and environment. It is made of a 5 Likert scale indicating zero as no and four as very good or very satisfactory. The domain scores were calculated by averaging the item scores within each domain. The total score is the average of the four domain scores. The tool is graded as a score of 0 to 2.99 as very poor, score of 3 to 3.99 as poor, score of 4 to 4.99 as fair and a score of 5 as excellent quality of life. [ 24 ] The total WHOQOL-BREF score was further categorized as ≤ 13 and ≥ 14 indicating poor quality of life and good quality of life respectively. [ 25 ] Statistical analysis Data entry and analysis were done using IBM Statistical Product for Service Solution (SPSS) statistical software version 26. For the univariate analysis, continuous variables were coded, categorized and presented using frequencies and proportions. Quantitative variables like sociodemographic characteristics were grouped. Depression, anxiety and quality of life were also coded and grouped based on their grades. Bivariate analysis using chi-square test was used to determine the association between socio-demographic characteristics and the prevalence of mental health disorders (depression and anxiety) and also with the quality of life. It was also used to determine the association between mental health (depression and anxiety) and quality of life. Multivariate analysis using logistic regression was used to determine the predictors. The level of statistical significance was set at a p value of < 0.05. RESULTS The mean age of the respondents was 67.25 ± 13.6 years with more respondents, 52.8% being in the age group 51–70 years. A higher proportion of the respondents were male (62.3%), married (64.2%), Yoruba (100%) and Christians (86.8%). Nearly half ,43.4% had no formal education with 50.9% working as farmers. Regarding duration of infection, 83% of the respondents have had leprosy for more than 20 years, and 69.8% have been in the settlements for this same period. About half of the respondents, 52.8% had received some support from the state government, and 58.5% of the respondents were currently receiving treatment for leprosy (Table 1 ). Table 1 Socio-demographic characteristics of respondents (N = 53) Variables Frequency Percentage (%) Age 31–50 years 51–70 years Greater than 70 years 7 28 18 13.2 52.8 34.0 Gender Female Male 20 33 37.7 62.3 Marital Status Divorced Married Single Widowed 3 34 2 14 5.7 64.2 3.8 26.4 Religion Christianity Islam 46 7 86.8 13.2 Level of Education No formal education Formal education 23 30 43.4 56.6 Occupation Artisans Farmers Others 14 27 12 26.4 50.9 22.6 Length of diagnosis of leprosy 0–20 years Above 20 years 9 44 17.0 83.0 Duration of Stay in Leprosy Settlement (years) 0–20 years Above 20 years 16 37 30.2 69.8 Source of Income Begging Family Support Farming/Agriculture Government Support/Social Welfare 5 7 13 28 9.4 13.2 24.5 52.8 Currently receiving treatment for leprosy No Yes 22 31 41.5 58.5 Regarding the mental health status of the respondents, the prevalence of depression and anxiety among the respondents was 84.9% (PHQ-9 score of 4–27), and 43.4% (GAD-7 score of 4–21) respectively (Figs. 1 and 2 ). Some of the respondents (26.4%) were minimally depressed, followed by 50.9%, who were mildly depressed, 18.9% who were moderately depressed and 3.8% had moderately severe depression as shown in Fig. 3 below. Regarding anxiety, a larger percentage of the respondents were minimally anxious (66%), followed by 26.4% who were mildly anxious, 5.7% who were moderately anxious and 1.9% who had severe anxiety as seen in Fig. 4 . According to Fig. 5 , 94.3% of the respondents has very poor quality of life with 5.7% having poor quality of life. On bivariate analysis of the socio-demographic characteristics of the respondents and mental health outcomes, it can be seen that the time spent at the settlement was statistically significant with depression (p = 0.040) while other characteristics were not. The only socio-demographic characteristics that was statistically significant with anxiety is age (p = 0.026). (Table 2 ) Table 2 Relationship between socio-demographic characteristics and Mental health outcomes (Depression and Anxiety) Prevalence of depression X 2 P-value Prevalence of anxiety X 2 P-value Not depressed N (%) Depressed N (%) Not anxious N (%) Anxious N (%) AGE 30 years and lesser 31–50 51–70 greater than 70 0(0.0) 1(14.3) 6(22.2) 1(5.6) 0(0.0) 6(85.7) 21(77.8) 17(94.4) 2.580 0.275 0(0.0) 1(14.3) 15(55.6) 13(72.2) 0(0.0) 6(85.7) 12(44.4) 5(27.8) 7.286 0.026* GENDER Female Male 4(20.0) 4(12.1) 16(80.0) 29(87.9) 0.588 0.443 14(70.0) 16(48.5) 6(30.0) 17(51.5) 2.347 0.126 Marital Status single married divorced widowed 1(50.0) 4(11.8) 0(0.0) 3(21.4) 1(50.0) 30(88.2) 3(100.0) 11(78.6) 3.029 0.387 1(50.0) 19(55.9) 2(66.7) 8(57.1) 1(50.0) 15(44.1) 1(33.3) 6(42.9) 0.171 0.982 Religion Christianity Islam 5(10.9) 3(42.9) 41(89.1) 4(57.1) 3.792 0.052 27(58.7) 3(42.9) 19(41.3) 4(57.1) 0.615 0.433 Level of Education no formal primary secondary tertiary 4(17.4) 3(15.0) 1(14.3) 0(0.0) 19(82.6) 17(85.0) 6(85.7) 3(100.0) 1.077 0.783 13(56.5) 14(70.0) 3(42.9) 0(0.0) 10(43.5) 6(30.0) 4(57.1) 3(100.0) 7.059 0.070 Occupation farmer artisan others 3(11.1) 4(28.6) 1(8.3) 24(88.9) 10(71.4) 11(91.7) 2.508 0.285 15(55.6) 8(57.1) 7(58.3) 12(44.4) 6(42.9) 5(41.7) 0.028 0.986 Length of diagnosis of leprosy 0–20 Above 20 2(20) 6(14) 8(80) 37(86) 1.208 0.877 6(60)24(55.8) 4(40) 19(44.2) 4.599 0.331 Duration of Stay in Leprosy Settlement (years) 0–20 Above 20 5(29.4) 2(5.7) 12(70.6) 33(94.3) 4.211 0.040* 9(52.9) 20(57.1) 8(47.1) 15(42.9) 1.325 0.723 Source of Income begging farming government support family support 1(20.0) 1(7.7) 4(14.8) 2(28.6) 4(80.0) 12(92.3) 23(85.2) 5(71.4) 1.567 0.667 4(80.0) 6(46.2) 13(48.1) 6(85.7) 1(20.0) 7(53.8) 14(51.9) 1(14.3) 5.310 0.150 (*P ≤ 0.05) As shown in Table 3 , the source of income of the respondents was statistically significant with quality of life (p = 0.036) while the other factors were not significant. Table 3 Relationship between socio-demographic characteristics and Quality of life QOL X 2 P-value POOR N (%) GOOD N (%) AGE 30 years and lesser 31–50 51–70 greater than 70 0(0.0) 6(85.7) 18(66.7) 13(72.2) 0(0.0) 1(14.3) 9(33.3) 5(27.8) 0.956 0.620 GENDER Female Male 14(70.0) 23(69.7) 6(30.0) 10(30.3) 1.091 0.296 Marital Status single married divorced widowed 1(50.0) 23(67.6) 3(100.0) 10(71.4) 1(50.0) 11(32.4) 0(0.0) 4(28.6) 4.056 0.255 Religion Christianity Islam 34(73.9) 3(42.9) 12(26.1) 4(57.1) 0.862 0.353 Level of Education no formal primary secondary tertiary 15(65.2) 14(70.0) 5(71.4) 3(100.0) 8(34.8) 6(30.0) 2(28.6) 0(0.0) 0.086 0.769 Occupation farmer artisan others 17(63.0) 10(71.4) 10(83.3) 10(37.0) 4(28.6) 2(16.7) 0.012 0.913 Duration of diagnosis of leprosy 0–20 years Above 20 years 7(70) 30(69.8) 3(30) 13(30.2) 1.771 0.778 Duration of stay in Leprosy settlement 0–20 years Above 20 years 11(64.7) 26(74.3) 6(35.3) 9(25.7) 0.720 0.869 Source of Income begging farming government support family support 3(60.0) 8(61.5) 21(77.8) 4(57.1) 2(40.0) 5(38.5) 6(22.2) 3(42.9) 6.009 0.036* (*P ≤ 0.05) There is a statistically significant association between depression and the quality of life of respondents (p = 0.037) and there is no association between anxiety and quality of life of respondents (p < 0.076) as presented in Table 4 . Table 4 Relationship between Quality of life and mental health outcomes (Depression and Anxiety) Quality of life X 2 P-value VERY POOR N (%) POOR N (%) FAIR N (%) EXCELLENT N (%) Depression minimal depression mild depression moderate depression moderately severe depression Anxiety minimal anxiety mild anxiety moderate anxiety severe anxiety 11(22.0) 27(54.0) 10(20.0) 2(4.0) 32(64.0) 14(28.0) 3(6.0) 1(2.0) 3(100.0) 0(0.0) 0(0.0) 0(0.0) 3(100.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 8.509 2.581 0.037* 0.461 (*P ≤ 0.05) Age of the respondents was statistically significant with anxiety on bivariate analysis. On multivariate analysis using logistic regression, it was seen that respondents aged 70 years and above were more likely to experience anxiety (p = 0.022, OR = 0.064, CI = 0.006–0.675) compared to the other age groups as seen in Table 5 . Table 5 Multivariate analysis of age as a predictor of anxiety using logistic regression Prevalence of anxiety X 2 P-value OR CI P-value No N (%) Yes N (%) AGE 30 years and lesser 31–50 51–70 greater than 70 0(0.0) 1(14.3) 15(55.6) 13(72.2) 0(0.0) 6(85.7) 12(44.4) 5(27.8) 7.286 0.026* 6.000 0.133 0.064 0.014–1.264 0.006–0.675 0.079 0.022* (*P ≤ 0.05) DISCUSSION In this study, we assessed the relationship between mental health disorders and the quality of life of respondents living with leprosy. Our study revealed that a larger percentage of the respondents were between the age of 51–70 years and predominantly male (62.3%) which is consistent with findings in Enugu, Nigeria[ 26 ] and Ethiopia.[ 27 ] The study revealed that most of the respondents were married with only 3.8% who had never experienced marriage. 50.9% and 28.3% of the respondents have been diagnosed with leprosy for over 21–40 years and 41–60 years respectively. There is a likelihood of the respondents getting married before they got diagnosed since only 13.2% of the respondents are aged below 50 years which is consistent with existing literature.[ 28 ] The larger percentage of married men living with this illness is inconsistent with findings from South Africa[ 29 ] who reported many cases of partners leaving the respondents after they had been diagnosed. Also, 43.4% and 37.7% of the respondents have no formal education and primary education respectively. We also found from our study a high prevalence of depression, with 84.9% of respondents experiencing depressive symptoms such as feeling sad, low mood and low energy. This is consistent with findings from a previous study conducted by Thapa where he reported a high prevalence of depression among people living with leprosy in Nepal compared to their general population.[ 30 ] The high prevalence of depression in this study could be attributed to factors such as low income due to disability, stigma and discrimination, economic burden, feelings of inferiority or low self-esteem and visible impairments due to leprosy. Additionally, the study found that 43.4% of respondents experienced anxiety, similar to the high prevalence reported by Van Brakel in Thailand.[ 31 ] The high prevalence of anxiety among respondents can be attributed to similar factors that are causing high prevalence of depression. We also found that more of the respondents were mildly depressed which is consistent with findings from the study conducted by Govindasamy in India where he reported that 33% of the respondents experienced mild depression.[ 32 ] However, some other findings conducted in India were not consistent with the findings from our study with respondents having severe depression rates of 71%.[ 33 ] The findings around anxiety level of respondents in our study was consistent with that seen in the study conducted by Bow Bertrand where he reported similar levels of minimal anxiety among respondents.[ 34 ] Our findings were not consistent with findings from Ossai who reported higher percentage (79.4%) of severe anxiety among respondents.[ 10 ] Furthermore, findings from our study indicated that 94.3% of respondents had a very poor quality of life. This is consistent with studies Rahman in Egypt and Dako-Gyeke in Ghana, which reported very poor quality of life among people living with leprosy.[ 35 ] [ 36 ]Factors such as stigmatization, low education, negative public perception, lack of employment opportunities and socio-economic conditions significantly influence the quality of life of individuals with leprosy, shaping their perceptions and satisfaction with life. We found a statistically significant association between depression and the quality of life of respondents. Depression can adversely affect quality of life, and poor quality of life can contribute to depression. This finding is consistent with studies by Thapa and Govindasamy in India, where they reported similar association.[ 30 ] [ 32 ] Higher levels of depression correlate with lower quality of life scores, and vice versa. However, a study by Barakat did not support this association, suggesting variability in how depression and quality of life interact across different populations.[ 37 ] Poor quality of life can lead to stress, potentially resulting in mental disorders like depression, while depression can diminish life satisfaction and interest. Additionally, our study showed that the duration of stay in the settlements was statistically significant with depression, consistent with findings. Extended stays in leprosy settlements can lead to negative perceptions of life, low self-esteem and increased seclusion, impacting their mental health over time. The study found a statistically significant association between age and anxiety, aligning with findings from Mangeard-Lourme who reported that different age groups experience varying levels of anxiety.[ 38 ] Multivariate analysis indicated that respondents aged 70 years and above were more likely to experience anxiety which is consistent with existing literature such as Somar in India who reported higher anxiety prevalence in this age group.[ 33 ] Notably, some participants had low level of education. This can play a major role in their mental health disorder as their low level of education can be a result of their illness. Their mental health coupled with their illness can predispose them to why they have no standard jobs and have low-income levels. This is evident based on a study carried out in India. [ 39 ] It can be seen from this study that most of the respondents are farmers and may only be producing enough food for their families alone and this finding is in line with a study in Bangladesh which reported that most of the respondents were involved in subsistence farming. [ 40 ] Finally, we found that the source of income was the only socio-demographic factor who highlighted the importance of income sources in determining quality of life.[ 41 ] While many respondents received support from the government and family, these factors did not sufficiently improve their quality of life, suggesting that financial independence plays a critical role in having a good quality of life. Limitation Many of the respondents were not willing to participate in the study due to the fear of them being stigmatized or reported. Some were not added to the study due to their severe mental health disorder and some did not show interest at all. Also, the study design only provides a snapshot of mental health outcomes and quality of life at a single point in time, which limits the ability to establish causation between leprosy and the observed outcomes. The stigma associated with leprosy and mental health may cause participants to underreport psychological distress or overstate their quality of life to align with perceived societal expectations. CONCLUSION Our study sought to assess and document the mental health status of people living with leprosy and the relationship with their quality of life. There was a high prevalence of depression and anxiety among our study participants as well as poor quality of life. Associated factors such as stigma, seclusion, poor education, low socio-economic status and visible impairments were identified. Other significant socio-demographic factors included older age, duration of stay in leprosy settlements, and source of income. These findings show that there is a need for more involvement of families and communities in ensuring that people living with leprosy are not secluded thereby improving their quality of life. This vulnerable group would benefit from integrating mental health support into social and economic empowerment interventions or programs specifically for those persons living with this disease. Abbreviations PHQ 9-Patient Health Questionnaire-9 GAD 7-Generalized Anxiety Disorder-7 WHOQOL BREF-World Health Organization Quality of Life Brief DALYs Disability-Adjusted Life Years WHO World Health Organization NTDs Neglected Tropical Diseases QoL Quality of Life SPSS Statistical Product for Service Solution LGA Local Government Area Declarations Competing Interest: Authors declare no competing interests. Ethics Approval: Approval was received from the Oyo State Ministry of Health Ethical Review Committee with code number NHREC/OYOSHRIEC/10/11/22. Informed Consent: Informed consent was taken from participants, confidentiality of data was ascertained, and permission was sought and gotten from settlements heads. Verbal permission was also given by the respondents at the settlements before the study commenced. Funding: This project was funded by the Royal Society of Tropical Medicine and Hygiene through the Early Career Grants Programme. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript. Author Contributions: Conceptualization and design [Olubukola Omobowale] Material preparation, data collection and analysis were performed by [Olubukola Omobowale] and [Temitope Odetoye]. The first draft of the manuscript was written by [Olubukola Omobowale].; writing, review and editing of the first draft was done by [Olubukola Omobowale], [Temitope Odetoye] [Olufisayo Elugbadebo] and [Adeola Fowotade]. All authors have read and agreed to the published version of the manuscript. Acknowledgments We are grateful to all our respondents for participating in our study. We thank the settlement heads, community leaders and health workers/carers for the support given to the project team. References Hay SI et al (2017) Sep., Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016, The Lancet , vol. 390, no. 10100, pp. 1260–1344. 10.1016/S0140-6736(17)32130-X Erubami J, Bebenimibo P, Ezeah G, Muobike O (Nov. 2023) Newspaper depiction of mental illness in Nigeria. 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BMC Psychiatry 20(1):474. 10.1186/s12888-020-02885-6 Dhira TA, Rahman MA, Sarker AR, Mehareen J (2021) Validity and reliability of the Generalized Anxiety Disorder-7 (GAD-7) among university students of Bangladesh, PLoS One , vol. 16, no. 12, p. e0261590, Dec. 10.1371/journal.pone.0261590 Kalfoss MH, Reidunsdatter RJ, Klöckner CA, Nilsen M (Jan. 2021) Validation of the WHOQOL-Bref: psychometric properties and normative data for the Norwegian general population. Health Qual Life Outcomes 19(1):13. 10.1186/s12955-020-01656-x Gholami A, Jahromi LM, Zarei E, Dehghan A (2013) Application of WHOQOL-BREF in Measuring Quality of Life in Health-Care Staff., Int J Prev Med , vol. 4, no. 7, pp. 809–17, Jul Peters ES, Eshiet AL (2002) Male-female (sex) differences in leprosy patients in south eastern Nigeria: females present late for diagnosis and treatment and have higher rates of deformity., Lepr Rev , vol. 73, no. 3, pp. 262–7, Sep Ramos JM, Martínez-Martín M, Reyes F, Lemma D, Belinchón I, Gutiérrez F (2012) Gender differential on characteristics and outcome of leprosy patients admitted to a long-term care rural hospital in South-Eastern Ethiopia. Int J Equity Health 11(1):56. 10.1186/1475-9276-11-56 Peters ES, Eshiet AL (2002) Male-female (sex) differences in leprosy patients in South Eastern Nigeria: females present late for diagnosis and treatment and have higher rates of deformity, Lepr Rev , vol. 73, no. 3, pp. 262–267, Sep. 10.47276/lr.73.3.262 SCOTT J (2000) The psychosocial needs of leprosy patients. Lepr Rev 71(4). 10.5935/0305-7518.20000050 Thapa DK et al (2023) Stigma, depression and quality of life among people affected by neglected tropical diseases in Nepal, Int Health , vol. 15, no. Supplement_3, pp. iii79–iii86, Dec. 10.1093/inthealth/ihad099 Sermrittirong S, Van Brakel WH (Mar. 2014) Stigma in leprosy: concepts, causes and determinants. Lepr Rev 85(1):36–47. 10.47276/lr.85.1.36 Govindasamy K, Jacob I, Solomon RM, Darlong J (Jan. 2021) Burden of depression and anxiety among leprosy affected and associated factors-A cross sectional study from India. PLoS Negl Trop Dis 15(1):e0009030. 10.1371/journal.pntd.0009030 Somar P, Waltz M, van Brakel W (2020) The impact of leprosy on the mental wellbeing of leprosy-affected persons and their family members – a systematic review, Global Mental Health , vol. 7, p. e15, Jun. 10.1017/gmh.2020.3 Bow-Bertrand A, Pahan D, Mangeard-Lourme J (2019) An exploration into the psychological impact of leprosy in Sirajganj, Bangladesh, Lepr Rev , vol. 90, no. 4, pp. 399–417, Dec. 10.47276/lr.90.4.399 Abdul Rahman N, Rajaratnam V, Burchell GL, Peters RMH, Zweekhorst MBM (Oct. 2022) Experiences of living with leprosy: A systematic review and qualitative evidence synthesis. PLoS Negl Trop Dis 16(10):e0010761. 10.1371/journal.pntd.0010761 Dako-Gyeke M, Asampong E, Oduro R (2017) Stigmatisation and discrimination: Experiences of people affected by leprosy in Southern Ghana., Lepr Rev , vol. 88, no. 1, pp. 58–74, Mar Barakat MM, Zaki HN (2019) Relationship between Psychological Problems and Quality of Life among Leprosy Patients, Evidence-Based Nursing Research , vol. 1, no. 2, p. 15, Jun. 10.47104/ebnrojs3.v1i2.42 Mangeard-Lourme J, Robert de Arquer G, Parasa J, Singh RK, Satle N, Mamhidi R (2020) Depression and anxiety in people affected by leprosy and lymphatic filariasis: a cross-sectional study in four States in India, Lepr Rev , vol. 91, no. 4, pp. 367–382, Dec. 10.47276/lr.91.4.367 Singh G (2012) Psychosocial aspects of Hansen′s disease (leprosy). Indian Dermatol Online J 3(3):166. 10.4103/2229-5178.101811 Feenstra SG, Nahar Q, Pahan D, Oskam L, Richardus JH (May 2011) Recent Food Shortage Is Associated with Leprosy Disease in Bangladesh: A Case-Control Study. PLoS Negl Trop Dis 5(5):e1029. 10.1371/journal.pntd.0001029 Das N et al (2020) A quality of life study of patients with leprosy attending the dermatology OPD of a tertiary care center of Eastern India. Indian J Dermatol 65(1):42. 10.4103/ijd.IJD_729_18 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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depression\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5979566/v1/8dee7586c4628eef5245e71e.png"},{"id":76688313,"identity":"9feda111-34ae-4cfc-ae0c-b612c294ffb9","added_by":"auto","created_at":"2025-02-19 16:33:20","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":60420,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eLevels of anxiety\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5979566/v1/0e0dc64dbed1e0e1f29050e8.png"},{"id":76690217,"identity":"26b4641e-6dd5-424b-8c1c-3d61ec88c9f3","added_by":"auto","created_at":"2025-02-19 16:57:20","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":47501,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eQuality of life of respondents\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5979566/v1/533807c42957255c27b8337b.png"},{"id":76690456,"identity":"460f161f-31f7-4db5-a92a-ba860a2555b6","added_by":"auto","created_at":"2025-02-19 17:05:25","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1969116,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5979566/v1/df1e9e2e-a577-4153-abc1-862b9475b26c.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eMental Health Status and Quality of Life Among People living with Leprosy in Southwest and North Central Nigeria.\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eLeprosy, with an estimated burden of disease of around 21,100 disability-adjusted life years (DALYs),[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] is one of the oldest and most neglected illnesses that is known to generate prejudice and stigma, particularly in low- and middle-income nations, compared to other stigmatizing diseases.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] It is a deforming disease caused by Mycobacterium leprae that primarily affects the peripheral nerves, respiratory tract mucosa, and skin [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Annually, over 200,000 new cases of leprosy are recorded and the World Health Organization (WHO) states that leprosy is not seen as a priority in over 120 nations especially in the African region where there are over 20,000 new cases each year, despite the reported overall decrease in prevalence [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It is crucial to recognize that neglected tropical diseases (NTDs), including skin conditions such as leprosy, are frequently linked to considerable stigma and disability, which can result in adverse mental health outcomes.\u003c/p\u003e \u003cp\u003eLeprosy is a public health issue in Nigeria with 4,000 new cases reported each year, with 12% of these cases resulting in disability. The national prevalence rate stands at about 0.4 per 10,000 persons, showing a decline compared to previous years [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. There are regional variations in Nigeria regarding the prevalence of leprosy such as Zaria Local Government Area (LGA) in Kaduna State which reported a high prevalence rate of 1.4 per 10,000 population, likely due to the presence of the National Tuberculosis \u0026amp; Leprosy Training Centre, a referral center for many northern states [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and a low prevalence rate of 0.1 per 10,000 in some southern states in the country. A study conducted in the country revealed that some LGAs in eight states (Zamfara, Sokoto, Yobe, Adamawa, Kaduna, Cross River, Benue and Jigawa states) are high clusters for the burden of leprosy while states such as Ekiti, Lagos, Federal Capital Territory and Imo are low clusters for the burden of leprosy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eSeveral factors significantly influence the perception and treatment of leprosy in Nigeria such as the cultural beliefs in some regions, particularly among the Yor\u0026ugrave;b\u0026aacute; people, attributing the disease to supernatural causes despite its recognized biomedical aspects [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. These erroneous beliefs often lead to the ostracization of people living with leprosy and their isolation from the society. [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]Also, communities with limited or no education often lack awareness about leprosy and its treatment options. Additionally, the way leprosy is being portrayed in the media promotes false perceptions and attitudes towards the disease [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eBeyond physical disability, reports show that leprosy affects the mental health of affected individuals. [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]The visible impairments, stigma and discrimination associated with leprosy predisposes persons living with the illness to poor mental health outcomes. [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] For example, systematic literature review showed a higher prevalence of mental health disorders among people affected by leprosy than in the general population [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Leekassa et al further revealed that there was a higher prevalence of mental distress among people affected by leprosy (52\u0026middot;4% prevalence) than any other dermatological condition assessed (7\u0026middot;9% prevalence) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In developing countries such as Nigeria where mental health issues are less prioritized,[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] persons with leprosy are faced with a dual problem of dealing with both leprosy and mental disorders such as depression and anxiety [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Moreover, leprosy does not only influence the lives of the victims; but also, the lives of their direct contacts, such as family members, friends and people in their community; the impairments and social barriers associated with the disease can lead to emotional reactions and negative behaviors among these individuals.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] Depression and anxiety have been identified as the most common mental disorders that affects persons living with leprosy [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Studies show that 33.1% of people living with leprosy have depression and 19% have anxiety disorders, respectively [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In Northern Nigeria, a study revealed that 79.4% of individuals with leprosy experienced anxiety disorders and 89.9% had depressive symptoms [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Another study by Litt et al. (2012) which examined the relationship between NTDs, including leprosy, and mental health conditions found that the consequences of NTDs include stigma, social exclusion, reduced access to healthcare services, lack of educational and employment opportunities, restriction of rights, increased disability and early mortality. Each of these consequences may result in poor mental wellbeing by increasing feelings and behaviors such as sadness, hopelessness and social withdrawal. [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe Quality of Life of persons living with leprosy can be significantly affected[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] as studies have noted poor QoL among this population [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The physical disabilities and mental health challenges caused by leprosy predispose these individuals to psychological, economic, and social problems, adversely affecting their QoL [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eGiven the increasing burden of leprosy in this part of the world, more attention needs to be given to its care. Leveraging on research, interventions centered on addressing the mental needs of this population and improving their QOL are highly needed. Although numerous studies have examined the relationship between mental disorders and quality of life among leprosy patients globally and in Northern Nigeria; research in the southwestern states of Nigeria remains scarce. To address the research gap, this study aimed to investigate the connection between the mental health effects of leprosy and the quality of life of individuals living with the disease in leprosy settlements in Nigeria.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA community based cross-sectional study conducted in June and July, 2024 to assess the mental health status and quality of life among people living with leprosy in two settlements in Akure, Ondo State and Omu-Aran, Kwara State, Nigeria\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling\u003c/h3\u003e\n\u003cp\u003eA simple random sampling technique was used to select 2 leprosy settlements and total sampling was used to select a total of 53 eligible participants aged 18 years and above in the two settlements between June and July, 2024.\u003c/p\u003e\n\u003ch3\u003eStudy location\u003c/h3\u003e\n\u003cp\u003eThe study was carried out in two settlements in Nigeria namely Oke Igbala Leprosarium, Kwara state and Ago Ireti Leprosy Control Center in Akure, Ondo state. The Oke Igbala Leprosarium, also known as the Omu-Aran Leprosy Settlement, is situated in a dense forest area between Omu-Aran and Oke Onigbin villages in Kwara State, Nigeria. It was established by the Evangelical Church Winning All (ECWA). Ago-Ireti, meaning \"Settlement of Hope,\" is a leprosy colony located in Akure, the capital of Ondo State, Nigeria. It was founded in 1943 and it has served as a safe haven for individuals affected by leprosy for over 80 years.\u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003e The study was conducted among 53 eligible participants aged 18 years and above in the two settlements.\u003c/p\u003e\n\u003ch3\u003eData Collection\u003c/h3\u003e\n\u003cp\u003eWe used a semi-structured questionnaire consisting of four sections namely: participants socio-demographic characteristics, Patient Health Questionnaire-9 (PHQ-9); Generalized Anxiety Disorders-7 (GAD-7) and the World Health Organization Quality of Life Brief (WHOQOL-BREF) to assess depression, anxiety and quality of life respectively. Trained research assistants were also used to collect data from respondents.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eOutcome measures\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003ePatient Health Questionnaire-9\u003c/h2\u003e \u003cp\u003eThe PHQ-9 is a validated questionnaire that is used for screening, diagnosing, monitoring and measuring the severity of depressive symptoms. It contains nine statements with the responses in a Likert scale format consisting of scores ranging from zero to three (0-never, 1-rarely, 2-sometimes, 3-always) making the minimum score that could be obtained for each respondent 0 while the maximum score to be 27. The tool is then graded as score of zero to 4 as Minimal depression, score of 5 to 9 as Mild depression, score of 10 to 14 as Moderate depression, score of 15 to 19 as Moderately severe depression and a score of 20 to 27 as Severe depression. [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. The PHQ 9 score was further categorized as a score of 0 to 3 as No depression and a score of 4 to 27 as depression. [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eGeneralized Anxiety Disorder-7\u003c/h3\u003e\n\u003cp\u003eThe GAD 7 is a validated questionnaire that is used as an initial screening tool for generalized anxiety disorder. It contains seven statements with the responses in a Likert scale format consisting of scores ranging from zero to three (0-never, 1-rarely, 2-sometimes, 3-always) making the minimum score that could be obtained for each respondent 0 while the maximum score to be 21. The tool is then graded as score of zero to 4 as Minimal anxiety, score of 5 to 9 as Mild anxiety, score of 10 to 14 as Moderate anxiety and a score of 15 to 21 as Severe anxiety.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eWorld Health Organization Quality of Life Brief\u003c/h2\u003e \u003cp\u003eThe WHOQOL-BREF is a validated 26-item questionnaire used to assess the quality of life across four domains namely physical health, psychological health, social relationship and environment. It is made of a 5 Likert scale indicating zero as no and four as very good or very satisfactory. The domain scores were calculated by averaging the item scores within each domain. The total score is the average of the four domain scores. The tool is graded as a score of 0 to 2.99 as very poor, score of 3 to 3.99 as poor, score of 4 to 4.99 as fair and a score of 5 as excellent quality of life. [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] The total WHOQOL-BREF score was further categorized as \u0026le;\u0026thinsp;13 and \u0026ge;\u0026thinsp;14 indicating poor quality of life and good quality of life respectively. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eData entry and analysis were done using IBM Statistical Product for Service Solution (SPSS) statistical software version 26. For the univariate analysis, continuous variables were coded, categorized and presented using frequencies and proportions. Quantitative variables like sociodemographic characteristics were grouped. Depression, anxiety and quality of life were also coded and grouped based on their grades. Bivariate analysis using chi-square test was used to determine the association between socio-demographic characteristics and the prevalence of mental health disorders (depression and anxiety) and also with the quality of life. It was also used to determine the association between mental health (depression and anxiety) and quality of life. Multivariate analysis using logistic regression was used to determine the predictors. The level of statistical significance was set at a p value of \u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThe mean age of the respondents was 67.25\u0026thinsp;\u0026plusmn;\u0026thinsp;13.6 years with more respondents, 52.8% being in the age group 51\u0026ndash;70 years. A higher proportion of the respondents were male (62.3%), married (64.2%), Yoruba (100%) and Christians (86.8%). Nearly half ,43.4% had no formal education with 50.9% working as farmers. Regarding duration of infection, 83% of the respondents have had leprosy for more than 20 years, and 69.8% have been in the settlements for this same period. About half of the respondents, 52.8% had received some support from the state government, and 58.5% of the respondents were currently receiving treatment for leprosy (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSocio-demographic characteristics of respondents (N\u0026thinsp;=\u0026thinsp;53)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercentage (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003cp\u003e31\u0026ndash;50 years\u003c/p\u003e\n \u003cp\u003e51\u0026ndash;70 years\u003c/p\u003e\n \u003cp\u003eGreater than 70 years\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003cp\u003e34.0\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGender\u003c/p\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e37.7\u003c/p\u003e\n \u003cp\u003e62.3\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eDivorced\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMarried\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eSingle\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eWidowed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.7\u003c/p\u003e\n \u003cp\u003e64.2\u003c/p\u003e\n \u003cp\u003e3.8\u003c/p\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eChristianity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIslam\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e46\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e86.8\u003c/p\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo formal education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFormal education\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e43.4\u003c/p\u003e\n \u003cp\u003e56.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eArtisans\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFarmers\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOthers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e26.4\u003c/p\u003e\n \u003cp\u003e50.9\u003c/p\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of diagnosis of leprosy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0\u0026ndash;20 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbove 20 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17.0\u003c/p\u003e\n \u003cp\u003e83.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of Stay in Leprosy Settlement (years)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0\u0026ndash;20 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbove 20 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e30.2\u003c/p\u003e\n \u003cp\u003e69.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource of Income\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eBegging\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFamily Support\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFarming/Agriculture\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eGovernment Support/Social Welfare\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9.4\u003c/p\u003e\n \u003cp\u003e13.2\u003c/p\u003e\n \u003cp\u003e24.5\u003c/p\u003e\n \u003cp\u003e52.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently receiving treatment for leprosy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41.5\u003c/p\u003e\n \u003cp\u003e58.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eRegarding the mental health status of the respondents, the prevalence of depression and anxiety among the respondents was 84.9% (PHQ-9 score of 4\u0026ndash;27), and 43.4% (GAD-7 score of 4\u0026ndash;21) respectively (Figs. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Some of the respondents (26.4%) were minimally depressed, followed by 50.9%, who were mildly depressed, 18.9% who were moderately depressed and 3.8% had moderately severe depression as shown in Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e below. Regarding anxiety, a larger percentage of the respondents were minimally anxious (66%), followed by 26.4% who were mildly anxious, 5.7% who were moderately anxious and 1.9% who had severe anxiety as seen in Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e. According to Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e, 94.3% of the respondents has very poor quality of life with 5.7% having poor quality of life.\u003c/p\u003e\n\u003cp\u003eOn bivariate analysis of the socio-demographic characteristics of the respondents and mental health outcomes, it can be seen that the time spent at the settlement was statistically significant with depression (p\u0026thinsp;=\u0026thinsp;0.040) while other characteristics were not. The only socio-demographic characteristics that was statistically significant with anxiety is age (p\u0026thinsp;=\u0026thinsp;0.026). (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e)\u0026nbsp;\u003c/p\u003e\n\u003ctable id=\"Tab2\" style=\"width: 790px;\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRelationship between socio-demographic characteristics and Mental health outcomes (Depression and Anxiety)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth style=\"width: 290.819px;\" rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth style=\"width: 151.181px;\" colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePrevalence of depression\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 35px;\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 46px;\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 134px;\" colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePrevalence of anxiety\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 35px;\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 46px;\" rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth style=\"width: 87.1806px;\" align=\"left\"\u003e\n \u003cp\u003eNot depressed\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003eDepressed\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 79px;\" align=\"left\"\u003e\n \u003cp\u003eNot anxious\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 55px;\" align=\"left\"\u003e\n \u003cp\u003eAnxious\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth style=\"width: 290.819px;\" align=\"left\"\u003e\n \u003cp\u003eAGE\u003c/p\u003e\n \u003cp\u003e30 years and lesser\u003c/p\u003e\n \u003cp\u003e31\u0026ndash;50\u003c/p\u003e\n \u003cp\u003e51\u0026ndash;70\u003c/p\u003e\n \u003cp\u003egreater than 70\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 87.1806px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e1(14.3)\u003c/p\u003e\n \u003cp\u003e6(22.2)\u003c/p\u003e\n \u003cp\u003e1(5.6)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e6(85.7)\u003c/p\u003e\n \u003cp\u003e21(77.8)\u003c/p\u003e\n \u003cp\u003e17(94.4)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.580\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.275\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 79px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e1(14.3)\u003c/p\u003e\n \u003cp\u003e15(55.6)\u003c/p\u003e\n \u003cp\u003e13(72.2)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 55px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e6(85.7)\u003c/p\u003e\n \u003cp\u003e12(44.4)\u003c/p\u003e\n \u003cp\u003e5(27.8)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.286\u003c/p\u003e\n \u003c/th\u003e\n \u003cth style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.026*\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 290.819px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGENDER\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.1806px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4(20.0)\u003c/p\u003e\n \u003cp\u003e4(12.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e16(80.0)\u003c/p\u003e\n \u003cp\u003e29(87.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.588\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.443\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14(70.0)\u003c/p\u003e\n \u003cp\u003e16(48.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6(30.0)\u003c/p\u003e\n \u003cp\u003e17(51.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.126\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 290.819px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003esingle\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emarried\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003edivorced\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ewidowed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.1806px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003cp\u003e4(11.8)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e3(21.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003cp\u003e30(88.2)\u003c/p\u003e\n \u003cp\u003e3(100.0)\u003c/p\u003e\n \u003cp\u003e11(78.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003cp\u003e19(55.9)\u003c/p\u003e\n \u003cp\u003e2(66.7)\u003c/p\u003e\n \u003cp\u003e8(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003cp\u003e15(44.1)\u003c/p\u003e\n \u003cp\u003e1(33.3)\u003c/p\u003e\n \u003cp\u003e6(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.982\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 290.819px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eChristianity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIslam\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.1806px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5(10.9)\u003c/p\u003e\n \u003cp\u003e3(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e41(89.1)\u003c/p\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3.792\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.052\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e27(58.7)\u003c/p\u003e\n \u003cp\u003e3(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19(41.3)\u003c/p\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.433\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 290.819px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eno formal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eprimary\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003esecondary\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003etertiary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.1806px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4(17.4)\u003c/p\u003e\n \u003cp\u003e3(15.0)\u003c/p\u003e\n \u003cp\u003e1(14.3)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e19(82.6)\u003c/p\u003e\n \u003cp\u003e17(85.0)\u003c/p\u003e\n \u003cp\u003e6(85.7)\u003c/p\u003e\n \u003cp\u003e3(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e13(56.5)\u003c/p\u003e\n \u003cp\u003e14(70.0)\u003c/p\u003e\n \u003cp\u003e3(42.9)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10(43.5)\u003c/p\u003e\n \u003cp\u003e6(30.0)\u003c/p\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003cp\u003e3(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.059\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 290.819px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003efarmer\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eartisan\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eothers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.1806px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3(11.1)\u003c/p\u003e\n \u003cp\u003e4(28.6)\u003c/p\u003e\n \u003cp\u003e1(8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e24(88.9)\u003c/p\u003e\n \u003cp\u003e10(71.4)\u003c/p\u003e\n \u003cp\u003e11(91.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2.508\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.285\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15(55.6)\u003c/p\u003e\n \u003cp\u003e8(57.1)\u003c/p\u003e\n \u003cp\u003e7(58.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12(44.4)\u003c/p\u003e\n \u003cp\u003e6(42.9)\u003c/p\u003e\n \u003cp\u003e5(41.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.986\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 290.819px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of diagnosis of leprosy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0\u0026ndash;20\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbove 20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.1806px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2(20)\u003c/p\u003e\n \u003cp\u003e6(14)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8(80)\u003c/p\u003e\n \u003cp\u003e37(86)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.208\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.877\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6(60)24(55.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4(40)\u003c/p\u003e\n \u003cp\u003e19(44.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.599\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.331\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 290.819px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of Stay in Leprosy Settlement (years)\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0\u0026ndash;20\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbove 20\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.1806px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5(29.4)\u003c/p\u003e\n \u003cp\u003e2(5.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12(70.6)\u003c/p\u003e\n \u003cp\u003e33(94.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.040*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e9(52.9)\u003c/p\u003e\n \u003cp\u003e20(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8(47.1)\u003c/p\u003e\n \u003cp\u003e15(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.723\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 290.819px;\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource of Income\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ebegging\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003efarming\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003egovernment support\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003efamily support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 87.1806px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(20.0)\u003c/p\u003e\n \u003cp\u003e1(7.7)\u003c/p\u003e\n \u003cp\u003e4(14.8)\u003c/p\u003e\n \u003cp\u003e2(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 64px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4(80.0)\u003c/p\u003e\n \u003cp\u003e12(92.3)\u003c/p\u003e\n \u003cp\u003e23(85.2)\u003c/p\u003e\n \u003cp\u003e5(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.567\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.667\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 79px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4(80.0)\u003c/p\u003e\n \u003cp\u003e6(46.2)\u003c/p\u003e\n \u003cp\u003e13(48.1)\u003c/p\u003e\n \u003cp\u003e6(85.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 55px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(20.0)\u003c/p\u003e\n \u003cp\u003e7(53.8)\u003c/p\u003e\n \u003cp\u003e14(51.9)\u003c/p\u003e\n \u003cp\u003e1(14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 35px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e5.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 46px;\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 738px;\" colspan=\"9\"\u003e(*P\u0026thinsp;\u0026le;\u0026thinsp;0.05)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;As shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e, the source of income of the respondents was statistically significant with quality of life (p\u0026thinsp;=\u0026thinsp;0.036) while the other factors were not significant.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRelationship between socio-demographic characteristics and Quality of life\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eQOL\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePOOR\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eGOOD\u003c/p\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAGE\u003c/p\u003e\n \u003cp\u003e30 years and lesser\u003c/p\u003e\n \u003cp\u003e31\u0026ndash;50\u003c/p\u003e\n \u003cp\u003e51\u0026ndash;70\u003c/p\u003e\n \u003cp\u003egreater than 70\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e6(85.7)\u003c/p\u003e\n \u003cp\u003e18(66.7)\u003c/p\u003e\n \u003cp\u003e13(72.2)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e1(14.3)\u003c/p\u003e\n \u003cp\u003e9(33.3)\u003c/p\u003e\n \u003cp\u003e5(27.8)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.620\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGENDER\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFemale\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e14(70.0)\u003c/p\u003e\n \u003cp\u003e23(69.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6(30.0)\u003c/p\u003e\n \u003cp\u003e10(30.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.091\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003esingle\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emarried\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003edivorced\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ewidowed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003cp\u003e23(67.6)\u003c/p\u003e\n \u003cp\u003e3(100.0)\u003c/p\u003e\n \u003cp\u003e10(71.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1(50.0)\u003c/p\u003e\n \u003cp\u003e11(32.4)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e4(28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e4.056\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.255\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eChristianity\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eIslam\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e34(73.9)\u003c/p\u003e\n \u003cp\u003e3(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e12(26.1)\u003c/p\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.353\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eLevel of Education\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eno formal\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eprimary\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003esecondary\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003etertiary\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e15(65.2)\u003c/p\u003e\n \u003cp\u003e14(70.0)\u003c/p\u003e\n \u003cp\u003e5(71.4)\u003c/p\u003e\n \u003cp\u003e3(100.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8(34.8)\u003c/p\u003e\n \u003cp\u003e6(30.0)\u003c/p\u003e\n \u003cp\u003e2(28.6)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.086\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.769\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003efarmer\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eartisan\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eothers\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e17(63.0)\u003c/p\u003e\n \u003cp\u003e10(71.4)\u003c/p\u003e\n \u003cp\u003e10(83.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e10(37.0)\u003c/p\u003e\n \u003cp\u003e4(28.6)\u003c/p\u003e\n \u003cp\u003e2(16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.913\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of diagnosis of leprosy\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0\u0026ndash;20 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbove 20 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7(70)\u003c/p\u003e\n \u003cp\u003e30(69.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3(30)\u003c/p\u003e\n \u003cp\u003e13(30.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e1.771\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDuration of stay in Leprosy settlement\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e0\u0026ndash;20 years\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAbove 20 years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11(64.7)\u003c/p\u003e\n \u003cp\u003e26(74.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6(35.3)\u003c/p\u003e\n \u003cp\u003e9(25.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.720\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.869\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eSource of Income\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003ebegging\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003efarming\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003egovernment support\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003efamily support\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3(60.0)\u003c/p\u003e\n \u003cp\u003e8(61.5)\u003c/p\u003e\n \u003cp\u003e21(77.8)\u003c/p\u003e\n \u003cp\u003e4(57.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e2(40.0)\u003c/p\u003e\n \u003cp\u003e5(38.5)\u003c/p\u003e\n \u003cp\u003e6(22.2)\u003c/p\u003e\n \u003cp\u003e3(42.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.036*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"5\"\u003e(*P\u0026thinsp;\u0026le;\u0026thinsp;0.05)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eThere is a statistically significant association between depression and the quality of life of respondents (p\u0026thinsp;=\u0026thinsp;0.037) and there is no association between anxiety and quality of life of respondents (p\u0026thinsp;\u0026lt;\u0026thinsp;0.076) as presented in Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eRelationship between Quality of life and mental health outcomes (Depression and Anxiety)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eQuality of life\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eVERY POOR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003ePOOR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eFAIR\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eEXCELLENT\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eminimal depression\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emild depression\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emoderate depression\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emoderately severe depression\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eminimal anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emild anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003emoderate anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003esevere anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e11(22.0)\u003c/p\u003e\n \u003cp\u003e27(54.0)\u003c/p\u003e\n \u003cp\u003e10(20.0)\u003c/p\u003e\n \u003cp\u003e2(4.0)\u003c/p\u003e\n \u003cp\u003e32(64.0)\u003c/p\u003e\n \u003cp\u003e14(28.0)\u003c/p\u003e\n \u003cp\u003e3(6.0)\u003c/p\u003e\n \u003cp\u003e1(2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e3(100.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e3(100.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e8.509\u003c/p\u003e\n \u003cp\u003e2.581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.037*\u003c/p\u003e\n \u003cp\u003e0.461\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003e(*P\u0026thinsp;\u0026le;\u0026thinsp;0.05)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eAge of the respondents was statistically significant with anxiety on bivariate analysis. On multivariate analysis using logistic regression, it was seen that respondents aged 70 years and above were more likely to experience anxiety (p\u0026thinsp;=\u0026thinsp;0.022, OR\u0026thinsp;=\u0026thinsp;0.064, CI\u0026thinsp;=\u0026thinsp;0.006\u0026ndash;0.675) compared to the other age groups as seen in Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eMultivariate analysis of age as a predictor of anxiety using logistic regression\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth colspan=\"2\" align=\"left\"\u003e\n \u003cp\u003ePrevalence of anxiety\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/th\u003e\n \u003cth rowspan=\"2\" align=\"left\"\u003e\n \u003cp\u003eP-value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eNo\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eYes\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eN (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eAGE\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e30 years and lesser\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e31\u0026ndash;50\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e51\u0026ndash;70\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003egreater than 70\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e1(14.3)\u003c/p\u003e\n \u003cp\u003e15(55.6)\u003c/p\u003e\n \u003cp\u003e13(72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0(0.0)\u003c/p\u003e\n \u003cp\u003e6(85.7)\u003c/p\u003e\n \u003cp\u003e12(44.4)\u003c/p\u003e\n \u003cp\u003e5(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.286\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.026*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e6.000\u003c/p\u003e\n \u003cp\u003e0.133\u003c/p\u003e\n \u003cp\u003e0.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.014\u0026ndash;1.264\u003c/p\u003e\n \u003cp\u003e0.006\u0026ndash;0.675\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003cp\u003e0.022*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"8\"\u003e(*P\u0026thinsp;\u0026le;\u0026thinsp;0.05)\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n\u003c/table\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eIn this study, we assessed the relationship between mental health disorders and the quality of life of respondents living with leprosy. Our study revealed that a larger percentage of the respondents were between the age of 51\u0026ndash;70 years and predominantly male (62.3%) which is consistent with findings in Enugu, Nigeria[\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and Ethiopia.[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] The study revealed that most of the respondents were married with only 3.8% who had never experienced marriage. 50.9% and 28.3% of the respondents have been diagnosed with leprosy for over 21\u0026ndash;40 years and 41\u0026ndash;60 years respectively. There is a likelihood of the respondents getting married before they got diagnosed since only 13.2% of the respondents are aged below 50 years which is consistent with existing literature.[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] The larger percentage of married men living with this illness is inconsistent with findings from South Africa[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] who reported many cases of partners leaving the respondents after they had been diagnosed. Also, 43.4% and 37.7% of the respondents have no formal education and primary education respectively.\u003c/p\u003e \u003cp\u003eWe also found from our study a high prevalence of depression, with 84.9% of respondents experiencing depressive symptoms such as feeling sad, low mood and low energy. This is consistent with findings from a previous study conducted by Thapa where he reported a high prevalence of depression among people living with leprosy in Nepal compared to their general population.[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] The high prevalence of depression in this study could be attributed to factors such as low income due to disability, stigma and discrimination, economic burden, feelings of inferiority or low self-esteem and visible impairments due to leprosy. Additionally, the study found that 43.4% of respondents experienced anxiety, similar to the high prevalence reported by Van Brakel in Thailand.[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] The high prevalence of anxiety among respondents can be attributed to similar factors that are causing high prevalence of depression. We also found that more of the respondents were mildly depressed which is consistent with findings from the study conducted by Govindasamy in India where he reported that 33% of the respondents experienced mild depression.[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] However, some other findings conducted in India were not consistent with the findings from our study with respondents having severe depression rates of 71%.[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] The findings around anxiety level of respondents in our study was consistent with that seen in the study conducted by Bow Bertrand where he reported similar levels of minimal anxiety among respondents.[\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e] Our findings were not consistent with findings from Ossai who reported higher percentage (79.4%) of severe anxiety among respondents.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFurthermore, findings from our study indicated that 94.3% of respondents had a very poor quality of life. This is consistent with studies Rahman in Egypt and Dako-Gyeke in Ghana, which reported very poor quality of life among people living with leprosy.[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e] [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]Factors such as stigmatization, low education, negative public perception, lack of employment opportunities and socio-economic conditions significantly influence the quality of life of individuals with leprosy, shaping their perceptions and satisfaction with life.\u003c/p\u003e \u003cp\u003eWe found a statistically significant association between depression and the quality of life of respondents. Depression can adversely affect quality of life, and poor quality of life can contribute to depression. This finding is consistent with studies by Thapa and Govindasamy in India, where they reported similar association.[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e] [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e] Higher levels of depression correlate with lower quality of life scores, and vice versa. However, a study by Barakat did not support this association, suggesting variability in how depression and quality of life interact across different populations.[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] Poor quality of life can lead to stress, potentially resulting in mental disorders like depression, while depression can diminish life satisfaction and interest.\u003c/p\u003e \u003cp\u003eAdditionally, our study showed that the duration of stay in the settlements was statistically significant with depression, consistent with findings. Extended stays in leprosy settlements can lead to negative perceptions of life, low self-esteem and increased seclusion, impacting their mental health over time. The study found a statistically significant association between age and anxiety, aligning with findings from Mangeard-Lourme who reported that different age groups experience varying levels of anxiety.[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e] Multivariate analysis indicated that respondents aged 70 years and above were more likely to experience anxiety which is consistent with existing literature such as Somar in India who reported higher anxiety prevalence in this age group.[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] Notably, some participants had low level of education. This can play a major role in their mental health disorder as their low level of education can be a result of their illness. Their mental health coupled with their illness can predispose them to why they have no standard jobs and have low-income levels. This is evident based on a study carried out in India. [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e] It can be seen from this study that most of the respondents are farmers and may only be producing enough food for their families alone and this finding is in line with a study in Bangladesh which reported that most of the respondents were involved in subsistence farming. [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eFinally, we found that the source of income was the only socio-demographic factor who highlighted the importance of income sources in determining quality of life.[\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e] While many respondents received support from the government and family, these factors did not sufficiently improve their quality of life, suggesting that financial independence plays a critical role in having a good quality of life.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitation\u003c/h2\u003e \u003cp\u003eMany of the respondents were not willing to participate in the study due to the fear of them being stigmatized or reported. Some were not added to the study due to their severe mental health disorder and some did not show interest at all. Also, the study design only provides a snapshot of mental health outcomes and quality of life at a single point in time, which limits the ability to establish causation between leprosy and the observed outcomes. The stigma associated with leprosy and mental health may cause participants to underreport psychological distress or overstate their quality of life to align with perceived societal expectations.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eOur study sought to assess and document the mental health status of people living with leprosy and the relationship with their quality of life. There was a high prevalence of depression and anxiety among our study participants as well as poor quality of life. Associated factors such as stigma, seclusion, poor education, low socio-economic status and visible impairments were identified. Other significant socio-demographic factors included older age, duration of stay in leprosy settlements, and source of income.\u003c/p\u003e \u003cp\u003eThese findings show that there is a need for more involvement of families and communities in ensuring that people living with leprosy are not secluded thereby improving their quality of life. This vulnerable group would benefit from integrating mental health support into social and economic empowerment interventions or programs specifically for those persons living with this disease.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePHQ\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e9-Patient Health Questionnaire-9\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003e7-Generalized Anxiety Disorder-7\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHOQOL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eBREF-World Health Organization Quality of Life Brief\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eDALYs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDisability-Adjusted Life Years\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eWorld Health Organization\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eNTDs\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNeglected Tropical Diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eQoL\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eQuality of Life\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eStatistical Product for Service Solution\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eLGA\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLocal Government Area\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003ch2\u003eCompeting Interest:\u003c/h2\u003e \u003cp\u003eAuthors declare no competing interests.\u003c/p\u003e \u003c/p\u003e\u003cp\u003e \u003ch2\u003eEthics Approval:\u003c/h2\u003e \u003cp\u003e Approval was received from the Oyo State Ministry of Health Ethical Review Committee with code number NHREC/OYOSHRIEC/10/11/22.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInformed Consent:\u003c/strong\u003e \u003cp\u003eInformed consent was taken from participants, confidentiality of data was ascertained, and permission was sought and gotten from settlements heads. Verbal permission was also given by the respondents at the settlements before the study commenced.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e \u003cp\u003e This project was funded by the Royal Society of Tropical Medicine and Hygiene through the Early Career Grants Programme. The funders had no role in the study design, data collection and analysis, decision to publish or preparation of the manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contributions:\u003c/h2\u003e \u003cp\u003eConceptualization and design [Olubukola Omobowale] Material preparation, data collection and analysis were performed by [Olubukola Omobowale] and [Temitope Odetoye]. The first draft of the manuscript was written by [Olubukola Omobowale].; writing, review and editing of the first draft was done by [Olubukola Omobowale], [Temitope Odetoye] [Olufisayo Elugbadebo] and [Adeola Fowotade]. All authors have read and agreed to the published version of the manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e \u003cp\u003eWe are grateful to all our respondents for participating in our study. We thank the settlement heads, community leaders and health workers/carers for the support given to the project team.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eHay SI et al (2017) Sep., Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990\u0026ndash;2016: a systematic analysis for the Global Burden of Disease Study 2016, \u003cem\u003eThe Lancet\u003c/em\u003e, vol. 390, no. 10100, pp. 1260\u0026ndash;1344. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(17)32130-X\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(17)32130-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eErubami J, Bebenimibo P, Ezeah G, Muobike O (Nov. 2023) Newspaper depiction of mental illness in Nigeria. 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Indian Dermatol Online J 3(3):166. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/2229-5178.101811\u003c/span\u003e\u003cspan address=\"10.4103/2229-5178.101811\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeenstra SG, Nahar Q, Pahan D, Oskam L, Richardus JH (May 2011) Recent Food Shortage Is Associated with Leprosy Disease in Bangladesh: A Case-Control Study. PLoS Negl Trop Dis 5(5):e1029. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pntd.0001029\u003c/span\u003e\u003cspan address=\"10.1371/journal.pntd.0001029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDas N et al (2020) A quality of life study of patients with leprosy attending the dermatology OPD of a tertiary care center of Eastern India. Indian J Dermatol 65(1):42. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/ijd.IJD_729_18\u003c/span\u003e\u003cspan address=\"10.4103/ijd.IJD_729_18\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[{"identity":"8842a6de-b80b-4e99-8d16-886125326a54","identifier":"10.13039/501100000683","name":"Royal Society of Tropical Medicine and Hygiene","awardNumber":"(36525380)","order_by":0}],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"College of Medicine, University of Ibadan","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Leprosy, mental health, depression, anxiety, quality of life, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-5979566/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5979566/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003ePurpose\u003c/b\u003e\u003c/p\u003e \u003cp\u003eLeprosy significantly impacts mental health and quality of life, yet research on this issue in Nigeria is scarce. This study assessed the mental health status and quality of life among individuals living with leprosy in two settlements in Nigeria.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods\u003c/b\u003e\u003c/p\u003e \u003cp\u003eA cross-sectional study was conducted among 53 people living with leprosy in two leprosy settlements in Ondo and Kwara States. A semi-structured instrument consisting of sociodemographic characteristics as well as the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7 (GAD-7), and World Health Organization Quality of Life Brief (WHOQOL-BREF) was used to assess depression, anxiety, and quality of life respectively. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression. The level of statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe prevalence of depression and anxiety was 84.9% and 43.4% respectively. Quality of life was very poor for 94.3% of respondents. Significant associations were found between depression and quality of life (p\u0026thinsp;=\u0026thinsp;0.037), duration of stay in settlements and depression (p\u0026thinsp;=\u0026thinsp;0.04), age and anxiety (p\u0026thinsp;=\u0026thinsp;0.026), and source of income and quality of life (p\u0026thinsp;=\u0026thinsp;0.03). Respondents aged 70 years and older were more likely to experience anxiety (p\u0026thinsp;=\u0026thinsp;0.02).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe high prevalence of depression and anxiety, coupled with very poor quality of life, highlights the need for comprehensive mental health interventions and support systems for individuals affected by leprosy in Southwestern and North Central Nigeria. Targeted strategies addressing age-specific needs and economic empowerment may improve overall well-being and quality of life of this vulnerable population.\u003c/p\u003e","manuscriptTitle":"Mental Health Status and Quality of Life Among People living with Leprosy in Southwest and North Central Nigeria.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-19 16:33:15","doi":"10.21203/rs.3.rs-5979566/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"97711525-3b78-4210-ae54-85346c12b966","owner":[],"postedDate":"February 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":44448445,"name":"Preventive Medicine"}],"tags":[],"updatedAt":"2025-02-19T16:33:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-19 16:33:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5979566","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5979566","identity":"rs-5979566","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}