{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:56:32Z","timestamp":1787021792188,"version":"build-2736575974"},"reference-count":98,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T00:00:00Z","timestamp":1656460800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100020171","name":"Foreign, Commonwealth and Development Office","doi-asserted-by":"publisher","award":["PO6407"],"award-info":[{"award-number":["PO6407"]}],"id":[{"id":"10.13039\/501100020171","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020171","name":"Foreign, Commonwealth and Development Office","doi-asserted-by":"publisher","award":["PO6407"],"award-info":[{"award-number":["PO6407"]}],"id":[{"id":"10.13039\/501100020171","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100020171","name":"Foreign, Commonwealth and Development Office","doi-asserted-by":"publisher","award":["PO6407"],"award-info":[{"award-number":["PO6407"]}],"id":[{"id":"10.13039\/501100020171","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>The intersections between NTDs, disability, and mental ill-health are increasingly recognised globally. Chronic morbidity resultant from many NTDs, particularly those affecting the skin\u2014including lymphatic filariasis (LF), leprosy, Buruli ulcer (BU) and onchocerciasis\u2014is well known and largely documented from a medicalised perspective. However less is known about the complex biosocial interaction shaping interconnected morbidities. We apply syndemic theory to explain the biosocial relationship between NTDs and mental distress in the context of structural violence in Liberia. By advancing syndemic theory to include intersectional thought, it is apparent that structural violence becomes embodied in different ways through interacting multi-level (macro, meso and micro) processes. Through the use of in-depth qualitative methods, we explore the syndemic interaction of NTDs and mental distress from the vantage point of the most vulnerable and suggest that: 1) the post-conflict environment in Liberia predisposes people to the chronic effects of NTDs as well as other \u2018generalised stressors\u2019 as a consequence of ongoing structural violence; 2) people affected by NTDs are additionally exposed to stigma and discrimination that cause additional stressors and synergistically produce negative health outcomes in relation to NTDs and mental distress; and 3) the impact and experience of consequential syndemic suffering is shaped by intersecting axes of inequity such as gender and generation which are themselves created by unequal power distribution across multiple systems levels. Bringing together health systems discourse, which is focused on service integration and centred around disease control, with syndemic discourse that considers the biosocial context of disease interaction offers new approaches. We suggest that taking a syndemic-informed approach to care in the development of people-centred health systems is key to alleviating the burden of syndemic suffering associated with NTDs and mental distress currently experienced by vulnerable populations in resource-limited settings.<\/jats:p>","DOI":"10.1371\/journal.pgph.0000551","type":"journal-article","created":{"date-parts":[[2022,6,29]],"date-time":"2022-06-29T13:23:45Z","timestamp":1656509025000},"page":"e0000551","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":26,"title":["A syndemic born of war: Combining intersectionality and structural violence to explore the biosocial interactions of neglected tropical diseases, disability and mental distress in Liberia"],"prefix":"10.1371","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4910-9707","authenticated-orcid":true,"given":"Laura","family":"Dean","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9053-211X","authenticated-orcid":true,"given":"Sally","family":"Theobald","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gartee","family":"Nallo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony","family":"Bettee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karsor","family":"Kollie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Tolhurst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,6,29]]},"reference":[{"issue":"10072","key":"pgph.0000551.ref001","first-page":"941","volume":"389","author":"M Singer","year":"2017","journal-title":"Syndemics and the biosocial conception of health"},{"issue":"10072","key":"pgph.0000551.ref002","first-page":"951","volume":"389","author":"E Mendenhall","year":"2017","journal-title":"Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations"},{"key":"pgph.0000551.ref003","first-page":"117","article-title":"Medicine","volume":"206","author":"ACJSS Tsai","year":"2018","journal-title":"Syndemics: a theory in search of data or data in search of a theory?"},{"issue":"10","key":"pgph.0000551.ref004","doi-asserted-by":"crossref","first-page":"e0004744","DOI":"10.1371\/journal.pntd.0004744","article-title":"Blue Marble Health and the Global Burden of Disease Study 2013","volume":"10","author":"PJ Hotez","year":"2016","journal-title":"PLoS neglected tropical diseases"},{"issue":"2","key":"pgph.0000551.ref005","first-page":"328","volume":"36","author":"M Singer","year":"2012","journal-title":"Interlocked infections: the health burdens of syndemics of neglected tropical diseases"},{"issue":"1","key":"pgph.0000551.ref006","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1016\/j.pt.2018.11.001","article-title":"Neglected Tropical Diseases and Mental Health: Progress, Partnerships, and Integration","volume":"35","author":"F Bailey","year":"2019","journal-title":"Trends in Parasitology"},{"issue":"5","key":"pgph.0000551.ref007","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.pt.2012.03.001","article-title":"Neglected tropical diseases and mental health: a perspective on comorbidity","volume":"28","author":"E Litt","year":"2012","journal-title":"Trends in parasitology"},{"issue":"suppl_1","key":"pgph.0000551.ref008","doi-asserted-by":"crossref","first-page":"i7","DOI":"10.1093\/inthealth\/ihw001","article-title":"Neglected Tropical Diseases, Cross-Cutting Issues Workshop, 4\u20136 February 2015, Utrecht, the Netherlands: meeting report","volume":"8","author":"LF Mieras","year":"2016","journal-title":"International Health"},{"issue":"5","key":"pgph.0000551.ref009","first-page":"509","volume":"28","author":"O Ferlatte","year":"2018","journal-title":"Combining intersectionality and syndemic theory to advance understandings of health inequities among Canadian gay, bisexual and other men who have sex with men"},{"issue":"8","key":"pgph.0000551.ref010","first-page":"2010","volume":"63","author":"MC Singer","year":"2006","journal-title":"Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context"},{"key":"pgph.0000551.ref011","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1186\/1478-4505-9-3","article-title":"Does mass drug administration for the integrated treatment of neglected tropical diseases really work? 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