Lower limb lymphoedema-related mental depression: A systematic review and meta-analysis of non-cancer-related studies

Abstract

Background

Lower limb lymphoedema, characterized by persistent swelling in the legs due to lymphatic dysfunction, not only imposes a physical burden but is also associated with significant mental depression. While emerging research suggests a strong link between lower limb lymphoedema and depression, the extent of the problem remains underexplored. This study aims to investigate the relationship between lower limb lymphoedema and mental depression through a meta-analysis of existing studies.

Methods

A comprehensive search was conducted across databases including PubMed, MEDLINE, EMBASE, International Scientific Indexing, Web of Science, and Google Scholar. Study quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. A weighted inverse variance random-effects model was used for pooled estimates, along with subgroup analysis, heterogeneity assessment, publication bias testing, and sensitivity analysis. The prediction interval was computed to estimate where future observations may fall. The review protocol was registered in PROSPERO (CRD42024541596).

Results

Thirteen studies involving 3503 patients with lower limb lymphoedema due to lymphatic filariasis, podoconiosis, or leprosy were included. The pooled estimate of depression related to lower limb lymphoedema was 38.4 % (95 % CI: 26.3 %, 50.5 %). High heterogeneity (I² = 81.48 %) highlighted significant variability among the studies. Depression was more prevalent among leprosy patients (38.1 %) and podoconiosis patients (36.4 %), showing little difference between the two. However, the prevalence was notably lower among those with lymphatic filariasis (22.4 %). A higher prevalence of depression was found in Africa (39.4 %) compared to other regions (36.1 %).

Conclusion

Patients with lower limb lymphoedema experience disproportionately high rates of mental depression compared to the general population. Integrating mental health assessment and treatment into care packages for lymphoedema management is essential, with special attention needed for leprosy patients.