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Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations
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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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“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]
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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 [ 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]
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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 (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
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“risk factors for both conditions often cluster in contexts of social and economic marginalization thereby facilitating diseases interactions [ 7 ].”
From Syndemic contexts: findings from a review of research on non-communicable diseases and interviews with experts (2021) · cites this paper as [7]
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“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 ].”
From Syndemic contexts: findings from a review of research on non-communicable diseases and interviews with experts (2021) · cites this paper as [7]
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“comprehensively examining syndemics as inextricably entangled complexes of phenomena benefits from integrating methodologies and knowledge from diverse fields [ 4 , 7 , 10 ].”
From Syndemic contexts: findings from a review of research on non-communicable diseases and interviews with experts (2021) · cites this paper as [7]
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“Here, epidemiological transitions mean that non-communicable diseases (NCDs) are co-emerging and interacting with other health conditions, such as infectious diseases, in settings shaped by instability [ 7 , 15 ].”
From Syndemic contexts: findings from a review of research on non-communicable diseases and interviews with experts (2021) · cites this paper as [7]
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“Researchers, such as Mendenhall et al. [ 7 , 16 ], are bringing attention to NCDs and mental health conditions in countries where policies and research often prioritize infectious diseases or disease-specific interventions [ 17 ].”
From Syndemic contexts: findings from a review of research on non-communicable diseases and interviews with experts (2021) · cites this paper as [7]
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“Lithium is also associated with thyroid disease 176 , including development of goitre (occurring in up to 50% of patients 177 ), hypothyroidism 178 ), as well as hyperthyroidism.179”
From The Lancet Psychiatry Commission: a blueprint for protecting physical health in people with mental illness (2019) · cites this paper as [178]
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Metadata
- 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
- PMC
- PMC5491333
- OpenAlex
- W2593297402
- Semantic Scholar
- 926e10eb83374dfbc0912080f6b689ab435e1cb7
- 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
- green
- www.ncbi.nlm.nih.gov
- 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 › Medicine › Public Health, Environmental and Occupational Health › 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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