Abstract
BackgroundAlthough the physical consequences of dengue are well documented, delayed psychological co-morbidities are not well studied to date. Therefore, the objective of the present study was to determine the prevalence of depressive, anxiety and stress symptoms among past dengue patients.MethodsA community-based, case–control study in a multi-ethnic urban setting was conducted in Sri Lanka involving adults who were diagnosed to have dengue fever by a positive dengue IgM antibody response between 6 and 24 months ago. Self-administered Depression, Anxiety and Stress Scale (DASS-21), Centre for Epidemiological Studies Depression Scale (CESD-20) and a structured clinical interview by a psychiatrist were done in the patients and in an age and gender-matched control group.ResultsFifty-three participants each in the patient (mean age 42.9 years, SD 15.5) and control (mean age 41.6 years, SD 15.3) groups were surveyed. The ages ranged from 18 to 70 years and 64.2% were females. The majority (90.6%; n = 48) of the individuals had been diagnosed with dengue fever followed by dengue haemorrhagic fever (9.4% n = 5). Dengue patients had higher DASS-21 mean depressive scores (means 11.7/9.4, SD 6.4/4.0, t = 2.2, p = .028), anxiety scores (means 10.7/7.2, SD 6.8/1.8, t = 3.6, p = .0005), stress scores (means 12.0/8.8, SD 5.3/3.5, t = 3.6, p = .0004) and CESD-20 scores (means 16.1/11.7, SD 9.4/7.3, t = 2.6, p = .008) than controls. The DSM-5 depressive disorder was clinically detected by the psychiatrist among 15.1 and 7.5% in patient and control groups (OR 2.1; CI .5–7.7; p = .22). Limitations: a limitation is the small sample size.ConclusionPatients with past dengue had significantly higher depressive, anxiety and stress symptoms than the control group according to the DASS-21 and CESD-20 tools. To our knowledge, this is the first report on delayed psychological morbidity related to dengue. This may warrant healthcare professionals to incorporate mental counselling for dengue patients.
Highlights
The physical consequences of dengue are well documented, delayed psychological co-morbidities are not well studied to date
All patients residing in Ragama Medical Officer of Health (MOH) division who have been diagnosed with dengue fever by the fulfilment of clinical criteria for probable dengue fever according to the guidelines of the World Health Organization (WHO), confirmed by a positive IgM antibody test and notified to the Ragama MOH office by a medical practitioner were considered for the study
The findings revealed that participants who had dengue fever previously had significantly higher depressive, anxiety, stress symptoms as measured by Depression Anxiety Stress Scale 21 item version (DASS-21) and depressive symptoms as measured by CESD-20, compared to that of the controls
Summary
The physical consequences of dengue are well documented, delayed psychological co-morbidities are not well studied to date. Dengue is a mosquito-borne viral disease endemic in tropical and subtropical countries of the world. This has arisen as a serious international public health hazard with almost half of the world’s population at risk of infection [1]. Symptomatic dengue illness is typically classified into dengue fever (DF), which is a self-limiting febrile illness, or a more severe form, dengue haemorrhagic fever (DHF)/dengue shock syndrome (DSS) [2]. This disease has been recognised as a regular epidemic since 1989, indicating an exponential increase in the incidence within Sri Lanka [3]. During 2016, 54,364 suspected dengue cases have been reported to the Epidemiology Unit of the Ministry of Health, Sri Lanka from all over the island indicating the highest ever number of cases per year [4]
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