The results of the study indicate that the overall QOL, general health, and WHOQOL-BREF domains of the arsenic-affected patients in Bangladesh were significantly poorer compared to those of the non-patients in both the sexes. A study reported that the level of QOL was lower among arsenic-affected patients than among control participants in Bangladesh (16
). However, the number of patients was comparatively small (n=104), and the patients and controls were recruited from different districts (16
). In our study, we selected the patients and non-patients from the same villages by matching age (±5 years) and sex. Moreover, the previous study assessed only the QOL of arsenic-affected patients but we assessed both QOL and mental health status of our participants.
One study reported that arsenic toxicity and arsenicosis have extensive social implications for the victims (31
). In Bangladesh, arsenic-affected patients often face problems while seeking healthcare; they have to wait for a long time to get treatment, face discrimination in service delivery, and have inadequate access to separate facilities (32
). Besides, patients with symptoms of arsenicosis suffer physical incapacity and weakness (33
). Moreover, the arsenic-affected people in Bangladesh have been barred from social activities, and they often face rejection even by their immediate family members (15
). For example, children of arsenic-affected people are not allowed to attend social and religious functions, and they are denied access to taking water from a neighbour's tubewell (34
). Female patients are less likely to receive treatment for arsenicosis (32
). These conditions might contribute to patients’ overall QOL, general health, and QOL domains. Social support is known to improve the QOL of patients with cancer (35
), stigmatized diseases, such as HIV infection and AIDS, schizophrenia, and chronic diseases, such as rheumatoid arthritis (36
). Similar interventions might be effective to improve the QOL of arsenic-affected patients.
We also quantified the mental health status of arsenic-affected patients. In our study, the SRQ score of the arsenic-affected patients was significantly lower than that of the non-patients in both the sexes. This result is consistent with a study that showed a considerably higher burden of mental health problems among people from arsenic-affected villages compared to those in arsenic-free villages in Inner Mongolia, China (17
). Besides, in an arsenic-affected community in western Japan, 36% of arsenic victims (n=63) were suffering from a full or partial post-traumatic stress disorder after the arsenic poisoning in 1998 (38
). In Bangladesh, the unaffected people tend to avoid and isolate arsenic-affected patients as they are generally fearful of arsenicosis (39
). In consequence, some unaffected people may behave in a hostile manner, and sentiments harbour that arsenic-affected patients should either remain sequestered in their homes or leave the village (15
). These conditions might have adversely affected the mental health of patients. Mental healthcare or counselling therefor is known to improve the patients’ well-being (40
), and psychological interventions improve the well-being of cancer patients (41
). Arsenic-affected patients might also benefit from similar interventions.
In our study, the severity of symptoms did not significantly affect the QOL and SRQ scores of the arsenic-affected patients. Moreover, the arsenic-affected patients in Bangladesh showed improvement of arsenic-induced skin lesion in the course of vitamin E and selenium intervention (42
). Since all arsenic-affected patients in this study are included in the ongoing double-blind placebo-controlled trial (Bangladesh Vitamin E and Selenium trial where vitamin E and selenium or placebo are supplemented as an intervention or control group), they might have expected that their skin lesions would be reduced by the medication. However, further studies should assess the QOL and SRQ scores of arsenic-affected patients who are not taking vitamin E and selenium supplements.
In this study, being male, being arsenic-affected patients, lower age, and lower annual income were the predictors of lower QOL. In rural Bangladesh, males are typically the main earners in the family. Due to arsenicosis, some men are losing their jobs, facing difficulties in finding new jobs, and encountering social rejections (31
). These conditions might have affected their QOL. Besides, chronic arsenic exposure has serious implications for arsenic-affected patients. The majority of arsenic-affected patients were considered a burden to their family and society, and they face social discrimination and marriage-related problems (31
In our study, the younger participants showed lower QOL, which is also consistent with a study on patients receiving palliative care in Hong Kong, which showed better QOL scores among older patients (43
). The younger participants in our study were more concerned about their health due to arsenicosis. Moreover, they were more likely to have lower income.
We also identified that the lower annual income was associated with lower QOL. In Bangladesh, most arsenic-affected poor patients remain untreated due to financial constraints (31
). Besides, travelling a long distance and purchasing medicines are particularly difficult for poor patients in Bangladesh (32
). Arsenic-affected patients in lower-income groups are more likely to face economic and social problems in Bangladesh (32
). For example, 20-70% of arsenic-affected patients in Bangladesh did not receive any treatment due to financial problems (39
). These circumstances might have affected their QOL.
The present study has three limitations. First, the study was limited by its cross-sectional design, which prohibits definitive conclusion about causality. Second, we did not measure arsenic exposure of the study participants. The arsenic exposure related measurements were done by HEALS in 2000. For this study, we only selected patients and non-patients from the database of HEALS. The patients were diagnosed by experienced physicians based on arsenic-related symptoms. Third, the patients and non-patients in this study might have had other diseases. However, the presence of other diseases might have not affected the QOL and assessment of the mental health status. Moreover, differences of the QOL and SRQ scores between the patients and non-patients are evident in our results. Despite such limitations, the results of the study provide important findings for arsenic-affected patients in Bangladesh.
The results of our study revealed that both QOL and mental health status were lower among arsenic-affected patients in Bangladesh. The lower QOL scores among our study participants were associated with being arsenic-affected patients, having lower age, and having lower annual income. Our findings suggest that a mental health programme focusing on gender, physical conditions, age, and income is urgently needed for arsenic-affected patients in Bangladesh. Such a programme should aim to improve the QOL and mental health status of arsenic-affected patients. Further studies should investigate specific and practical measures.