Original research BMJ Glob Health: first published as 10.1136/bmjgh-2020-004131 on 30 November 2020. Downloaded from Mental health conditions after snakebite: a scoping review 1,2 2,3 1 Soumyadeep Bhaumik , Sudha Kallakuri, Amanpreet Kaur, Siddhardha Devarapalli,3 Mercian Daniel1 To cite: Bhaumik S, ABSTRACT Key questions Kallakuri S, Kaur A, et al. Introduction Snakebite is a neglected tropical disease. Mental health conditions Snakebite causes at least 120 000 death each year What is already known? after snakebite: a scoping and it is estimated that there are three times as many review. BMJ Global Health Snakebite is a neglected tropical disease which amputations. Snakebite survivors are known to suffer ► 2020;5:e004131. doi:10.1136/ causes death and disability, particularly in rural and from long- term physical and psychological sequelae, but bmjgh-2020-004131 tribal people in South Asia, Africa and Latin America. not much is known on the mental health manifestations Snakebite survivors are known to suffer from long- postsnakebite. ► Handling editor Soumitra S term physical and psychological sequala, but not Methods We conducted a scoping review and searched Bhuyan much is known about mental health manifestations five major electronic databases (Ovid MEDLINE(R), Global of snakebite. SB and SK contributed equally. Health, APA PsycINFO, EMBASE classic+EMBASE, Cochrane Central Register of Controlled Trials), contacted experts What are the new findings? Received 7 October 2020 and conducted reference screening to identify primary ► The study, to the best of our knowledge, is the first Revised 8 November 2020 studies on mental health manifestations after snakebite evidence synthesis on the topic. Only 11 studies (four Accepted 11 November 2020 envenomation. Two reviewers independently conducted case reports, one modelling, two cohort, two cross- titles and abstract screening as well as full- text evaluation section, one case–control and one randomised for final inclusion decision. Disagreements were resolved controlled trial) on mental health manifestations of by consensus. We extracted data as per a standardised snakebite were found. form and conducted narrative synthesis. ► A high prevalence of post- traumatic stress disorder Results We retrieved 334 studies and finally included (PTSD) and depression was found in snakebite sur- 11 studies that met our eligibility criteria. Of the 11 vivors. Other conditions like hysteria, and delusional studies reported, post- traumatic stress disorder (PTSD) disorders were also reported. was the most commonly studied mental health condition ► There is only one intervention study to address psy- after snakebite, with five studies reporting it. Estimate of chiatric morbidity after snakebite envenomation. the burden of PTSD after snakebite was available from http://gh.bmj.com/ a modelling study. The other mental health conditions What do the new findings imply? reported were focused around depression, psychosocial ► There is a need for more research on psychiatric impairment of survivors after a snakebite envenomation, morbidity of snakebite, particularly in countries with hysteria, delusional disorders and acute stress disorders. high burden on priority basis. This will also help un- Conclusion There is a need for more research on derstand the true burden of snakebite. understanding the neglected aspect of psychological ► Depression and PTSD are major mental health man- morbidity of snakebite envenomation, particularly in ifestations in snakebite survivors. There is scarcity on September 24, 2021 by guest. Protected copyright. © Author(s) (or their countries with high burden. From the limited evidence of mental health professionals in countries with high employer(s)) 2020. Re- use available, depression and PTSD are major mental health snakebite burden means there is need for research permitted under CC BY-NC. No manifestations in snakebite survivors. to understand how this can be dealt with in these commercial re- use. See rights health systems. and permissions. Published by BMJ. 1The George Institute for Global Health, New Delhi, India BACKGROUND the World Health Assembly passing a reso- 2The George Institute for Global Snakebite is a neglected tropical disease lution to address it in 2018, followed by a Health, Faculty of Medicine, (NTD), with an estimated 4–18 million strategy to decrease the death and disability University of New South Wales, people being bitten, up to 120 000 deaths and due to snakebite to 50% of current levels by Sydney, New South Wales, 2 6 Australia around three times as many amputations and 2030. 3The George Institute for Global other permanent disabilities caused globally Snakebite survivors often suffer perma- Health, Hyderabad, India every year.1–4 Most of the burden of snake- nent or long-term physical and psycholog- bite is concentrated in rural and tribal(in- ical consequences owing to myotoxicity, Correspondence to Dr Soumyadeep Bhaumik; digenous) communities of South Asia, Africa renal damage, neurotoxicity, coagulopathy 5 sbhaumik@ georgeinstitute. and Latin America. Snakebite has garnered and psychiatric manifestations—all of them org. in increased attention in the last few years with not well studied.3 6 7 This is like many other Bhaumik S, et al. BMJ Global Health 2020;5:e004131. doi:10.1136/bmjgh-2020-004131 1 BMJ Global Health BMJ Glob Health: first published as 10.1136/bmjgh-2020-004131 on 30 November 2020. Downloaded from NTDs where the focus has been rather concentrated on Context acute manifestation with chronic care and psycholog- We included studies irrespective of the setting (acute ical manifestations ignored.8 9 Since health comprises care, primary care or the community), geographical loca- of both mental and physical aspects; addressing psycho- tion or cultural context in which the study was conducted. logical and physical manifestations need to go hand in hand to provide an opportunity to snakebite survivors, Types of studies and to create a positive change, enabling them to lead 10 We included primary studies of the following study normal, happy and productive lives. Not only are the design—qualitative studies, randomised controlled trial, direct impacts of NTD-related disability on the indi- non- randomised intervention studies, cohort studies, vidual still neglected in existing programmes, the indi- case–control, cross- sectional studies and individual case rect, yet significant, impacts on caregivers, families and reports. We also included modelling studies. communities are often completely overlooked. Studies which did not have primary data to supplement While there are several systematic reviews on mental mental health conditions after a snakebite envenomation health for different NTDs, there is no evidence synthesis and did not specifically answer the research question was to understand mental health manifestations of snake- excluded from the review. bite.8 9 We, thus, undertook a broad scoping review to understand the current status of evidence for mental health conditions after snakebite globally. Information sources Electronic databases We searched five electronic databases including a specialty mental health database to identify literature METHODOLOGY on 10 April 2020 without any restriction of language or Approach to the study dates. These are We conducted a scoping review with the objective ► Ovid MEDLINE(R). to understand available evidence on mental health ► Global Health. conditions after a snakebite. A scoping review is more ► APA PsycINFO. appropriate than a systematic review since the inten- ► Embase Classic+Embase. tion is to explore the breadth of evidence in the said ► EBM Reviews- Cochrane Central Register of broad topic area rather than answering a more focused Controlled Trials. specific question. We are reporting the study as per Detailed search strategy is available in online supple- the Preferred Reporting Items for Systematic Reviews mental material 2. and Meta- Analyses Scoping Reviews (PRISMA- ScR) reporting guidelines and this checklist is provided in Searching other resources online supplemental material 1). An a priori protocol We contacted experts in the domain of snakebite (through was developed but was not registered. Differences personal communication) and searched the reference http://gh.bmj.com/ between protocol and conduct of scoping review is lists of all included to identify additional studies. noted subsequently. Selection of sources of evidence Eligibility criteria Two review authors independently screened records for Types of participants and condition of interest consideration of inclusion based on title and/or abstracts. on September 24, 2021 by guest. Protected copyright. We included studies that had persons with mental health If decisions about inclusion were unclear at that stage, full conditions following a snakebite irrespective of presence texts of the citation were acquired and assessed for eligi- of envenomation. Considering the broad scope of the bility in the next phase of screening. In the next phase, review all mental health conditions that might be poten- at least two authors assessed full texts independently. tially related to snakebite was considered as conditions of Any disagreement about final eligibility was resolved by interest. This included but was not be limited to: consensus with a third review author acting as an arbiter. 1. Mood disorders (mania, depression). 2. Neurotic, stress-related and somatoform disorders (anxiety disorders, post-traumatic stress disorder Data