Higher depressive symptoms among arsenicosis patients: Evidence from a case-control study conducted in an arsenic-affected rural village of Bangladesh

Abstract

Background
Access to safe drinking water is fundamental for health and one of the millennium development goals in resource-poor countries. Unfortunately underground water in Bangladesh is heavily contaminated by arsenic, putting about 35 million rural people at risk of drinking such water. As long-term exposure to arsenic (>0.05 mg/l) through drinking water is highly toxic and affects all organs of human body, already several thousands arsenicosis cases are diagnosed in Bangladesh with a prospect of rapid increase in the future. Globally studies regarding mental health of arsenicosis patients are seriously lacking particularly in Bangladesh.

Objectives and study design:

This study assessed a higher level of depressive symptoms (HDS) by employing a frequency-matched case-control study (cases=138, controls=142; 10-95 years old) in an arsenic-affected rural village of Bangladesh in 2006. Subjects with and without melanosis/keratosis were considered as cases and controls, respectively. Five questions using 5-points Likert scale (ranging from never=1 to always=5) were used to assess depressive symptoms. The cut-off point >3^rd quartile of the composite score indicated HDS. In the presentation we will also demonstrate e.g. possible sources of groundwater contamination by arsenic, social problems of arsenicosis, and mitigation and prevention activities including their feasibilities.

Results and conclusions:

One-forth of the subjects reported HDS in our case-control study. HDS was significantly associated with various health problems such as arsenicosis, breathing problems, constipation, weakness, weight loss, drowsiness, insufficient sleep, poor self-rated heath, scarcity of resources, and dissatisfaction about daily activities. Older age and female sex were also significantly positively associated with HDS. The odds ratio for HDS adjusted for age, sex and self-rated health was 2.7 (95% confidence interval: 1.2-5.9) among arsenicosis cases compared to controls. Higher prevalence of depressive symptoms among people with arsenicosis indicates the importance of public health interventions in the arsenic affected areas of rural Bangladesh.