The prevalence of anxiety, depression and the mediating role in leprosy patients: a nationally representative cross-sectional study

Leprosy is a chronic disease that severely affects the skin and nerves, sometimes leading to disability. The deformities deepen stigma and discrimination, even among patients who have been cured. Consequently, leprosy patients are more likely to suffer from mental illnesses than other diseases. A cross-sectional study was conducted in four Chinese provinces (Fujian, Yunnan, Shandong, and Guizhou), including patients who had completed the full course of multidrug therapy (MDT). We assessed anxiety and depression using the SAS and SDS scales, and functional ability using the ADLs. Influencing factors were analyzed with multiple linear regression, and structural equation modeling (SEM) was used to examine the relationships between anxiety, depression. A total of 382 valid questionnaires were received, with a participation rate of 95.5%. Among the participants, 24.08% reported anxiety, 22.51% reported depression, 45.81% experienced impairments in ADLs, and 65.18% had at least one of these conditions. Notably, 3.66% of patients experienced anxiety, depression, and ADL impairments concurrently. Multiple linear regression results showed that the No. of other chronic diseases (P = 0.004), income (P = 0.016), live with patients (P = 0.005), and other ethnic (P<0.001) have a significant correlation with anxiety (R² = 0.546). Duration of disease (P = 0.014), No. of other chronic diseases (P = 0.000), live with patients (P = 0.015), and live with family (P = 0.040) were associated with depression (R² = 0.155). SEM results indicated that the paths SDS-SAS, SDS-No.of other chronic diseases, and ADLs-SAS had the highest direct effects of 0.75(95CI%:0.656 ~ 0.834), 0.56(95%CI:0.103 ~ 1.016) and - 0.33(95%CI:-0.490~-0-165). The association between SAS and the (No.of other chronic diseases) was also indirectly influenced by SDS (0.420), exceeding the direct effect (0.040). Similarly, the indirect effect (-0.240) of SAS between SDS and ADLs was higher than the direct effect (-0.100). This study demonstrates that Chinese leprosy patients exhibit high levels of anxiety and depression, which are associated with impaired daily functioning. Mental health is influenced by multiple factors, including comorbid chronic diseases, living arrangements, disease duration, ADLs, income, and ethnicity. SEM revealed that anxiety mediates the impact of depression on functional limitations, highlighting the complex interplay between psychological factors and physical functioning. These findings underscore the need for comprehensive care strategies and psychosocial interventions to improve mental health and overall well-being in leprosy patients.