Cited by 564Chronic Disease Management StrategiesGlobal Health and EpidemiologyDiabetes, Cardiovascular Risks, and Lipoproteins

Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations

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Mendenhall, Emily, Kohrt, Brandon A, Norris, Shane A, Ndetei, David, Prabhakaran, Dorairaj·2017·The Lancet

Abstract

The co-occurrence of health burdens in transitioning populations, particularly in specific socioeconomic and cultural contexts, calls for conceptual frameworks to improve understanding of risk factors, so as to better design and implement prevention and intervention programmes to address comorbidities. The concept of a syndemic, developed by medical anthropologists, provides such a framework for preventing and treating comorbidities. The term syndemic refers to synergistic health problems that affect the health of a population within the context of persistent social and economic inequalities. Until now, syndemic theory has been applied to comorbid health problems in poor immigrant communities in high-income countries with limited translation, and in low-income or middle-income countries. In this Series paper, we examine the application of syndemic theory to comorbidities and multimorbidities in low-income and middle-income countries. We employ diabetes as an exemplar and discuss its comorbidity with HIV in Kenya, tuberculosis in India, and depression in South Africa. Using a model of syndemics that addresses transactional pathophysiology, socioeconomic conditions, health system structures, and cultural context, we illustrate the different syndemics across these countries and the potential benefit of syndemic care to patients. We conclude with recommendations for research and systems of care to address syndemics in low-income and middle-income country settings.

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Crossref · 10.1016/s0140-6736(17)30402-6

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156 of 156 references verified0 citation errors · 0 not checkable

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  • Financial insecurity in low-income populations contributes to stress and depression, which biologically interact with diabetes pathogenesis, and has been associated with poor adherence to treatment in diabetes patients.

    “financial insecurity in low-income populations contributes to stress and depression, which biologically interact with diabetes pathogenesis, and has been associated with poor adherence to treatment in diabetes patients [ 7 ].”

    From Syndemic contexts: findings from a review of research on non-communicable diseases and interviews with experts (2021) · cites this paper as [7]

    In “Syndemic poverty, diabetes, and depression in LMICs” (page unavailable), the paper says financial insecurity causes stress and depression in low-income mothers. “Principles of syndemic theory” describes biological links between depression and diabetes and associates depression in people with diabetes with treatment non-adherence. It does not specifically associate financial insecurity itself with poor adherence. (LLM, conf=0.83)

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  • The article focuses on context because it is a slippery concept, which is understood and addressed in diverse ways across disciplines engaged in syndemics research.

    “The article focuses on context because it is a slippery concept, which is understood and addressed in diverse ways across disciplines engaged in syndemics research [ 4 , 7 ].”

    From Syndemic contexts: findings from a review of research on non-communicable diseases and interviews with experts (2021) · cites this paper as [7]

    The Introduction and Application of syndemic models to improve global health (page numbers unavailable) treat social and cultural context as important to syndemics, while Principles of syndemic theory says the framework brings multiple fields together. The paper does not say that context is a slippery concept or that disciplines understand and address it in diverse ways. (LLM, conf=0.78)

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  • The Lancet Series on syndemics raised the profile of the concept to a broader audience of global health and clinical medicine.

    “The Lancet Series on syndemics raised the profile of the concept to a broader audience of global health and clinical medicine (Mendenhall, 2017; Mendenhall et al., 2017; Singer et al., 2017; Tsai et al., 2017; Willen et al., 2017).”

    From Syndemic theory, methods, and data (2022) · cites this paper as Mendenhall et al., 2017

    The Introduction identifies this as a Series paper applying syndemic theory to global health problems, and 'Application of syndemic models to improve global health' discusses its use in clinical medicine (page unavailable). This supports the claim that the Series presented the concept to those fields, but the paper does not establish that the Series raised its profile or reached a broader audience. (LLM, conf=0.78)

    Experimental — accuracy not yet measured
  • Risk factors for both conditions often cluster in contexts of social and economic marginalization, thereby facilitating disease interactions.

    “risk factors for both conditions often cluster in contexts of social and economic marginalization thereby facilitating diseases interactions [ 7 ].”
  • Adverse contextual factors, such as poverty, violence, limited access to care or stigma, play a central role in facilitating the clustering of some health conditions and worsening their pathogenesis and treatment efficacies.

    “adverse contextual factors, such as poverty, violence, limited access to care or stigma, play a central role in facilitating the clustering of some health conditions and worsening their pathogenesis and treatment efficacies [ 5–7 ].”

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Cites

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8 of the 164 references couldn’t be matched to a known paper.

Research works printed but not linked: 5

  1. [7]Mendenhall E Syndemic suffering: social distress, depression, and diabetes among Mexican immigrant women Walnut Creek, CA Left Coast Press 2012
  2. [65]Chapter 12: HIV Prevalence National Family Health Survey (NFHS-3) 2005–2006 Delhi http://dhsprogram.com/pubs/pdf/FRIND3/FRIND3-Vol1andVol2.pdf
  3. [89]Claassens M Nikuze A Chivese T Zunza M Beyers N Evidence to Inform South African Tuberculosis policies (EVISAT) project: a systematic review of the epidemiology of and programmatic response to TB in people living in urban informal settlements in South Africa Stellenbosch World Health Organization 2014
  4. [99]Kidder A Kwan G Cancedda C Bukhman G Chronic care integration for endemic non-communicable diseases: Rwanda Edition Boston Partners in Health 2011
  5. [146]Pillay Y Mamatja D Mbengashe T Joint review of HIV, TB and PMTCT programmes in South Africa Department of Health (South Africa) http://www.hst.org.za/publications/joint-review-hiv-tb-and-pmtct-programmes-south-africa-april-2014

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Authors
Mendenhall, E., Kohrt, B. A., Norris, S. A., Ndetei, D., & Prabhakaran, D.
Affiliations
  • Georgetown University (US)
  • Duke University (US)
  • University of the Witwatersrand (ZA)
  • University of Nairobi (KE)
  • London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Mendenhall, Emily
Venue
The Lancet
Publisher
Elsevier BV
Published
2017-03
Volume
389
Issue
10072
Pages
951-963
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W2593297402
Cited by
556
References
164
Citations by year
2026: 43 · 2025: 55 · 2024: 66 · 2023: 72 · 2022: 89 · 2021: 80 · 2020: 59 · 2019: 44 · 2018: 35 · 2017: 13
FWCI
5.47
Type
journal article
Language
en
Open access
Locations
  • The Lancet (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • ePrints Soton (University of Southampton) (submittedVersion)
  • University of Nairobi Research Archive (University of Nairobi) (submittedVersion, cc-by-nc-nd)
Funders
  • National Institute of Mental Health (K01MH104310)
  • Fogarty International Center (R24TW007988)
Topics
  • Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
  • Health Sciences › Health Professions › Health Information Management › Global Health and Epidemiology
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
syndemic, non-communicable diseases, diabetes mellitus, depression, poverty, multimorbidity, comorbidities, HIV, tuberculosis, low- and middle-income countries, socioeconomic disparities, health care system, cultural context
MeSH terms
Noncommunicable Diseases, Depressive Disorder, Diabetes Mellitus, Type 2, Humans, Poverty, Risk Factors, Socioeconomic Factors, Syndrome, HIV Infections, Economic Development, Coinfection

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