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  • Perspective
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Syndemics and clinical science

Nature Medicine volume 28, pages 1359–1362 (2022) Cite this article

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Abstract

The theory of syndemics has received increasing attention in clinical medicine since the onset of the COVID-19 pandemic, due to the synergistic interactions of the disease with pre-existing political, structural, social and health conditions. In simple terms, syndemics are synergistically interacting epidemics that occur in a particular context with shared drivers. When policymakers ask why some communities have higher death rates from COVID-19 compared with other communities, those working from a syndemics framework argue that multiple factors synergistically work in tandem, and populations with the highest morbidity and mortality experience the greatest impact of these interactions. In this Perspective, we use specific case examples to illustrate these concepts. We discuss the emergence of syndemics, how epidemics interact, and what scientists, clinicians and policymakers can do with this information.

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Fig. 1: Syndemic relationships.
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References

  1. Horton, R. Offline: COVID-19 is not a pandemic. Lancet 396, 874 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Mendenhall, E. The COVID-19 syndemic is not global: context matters. Lancet 30, 17848 (2020).

    Google Scholar 

  3. Islam, N. et al. Social inequality and the syndemic of chronic disease and COVID-19: county-level analysis in the USA. J. Epidemiol. Community Health 75, 496–500 (2021).

    Article  Google Scholar 

  4. Singer, M., Bulled, N., Ostrach, B. & Mendenhall, E. Syndemics and the biosocial conception of health. Lancet 389, 941–950 (2017).

    Article  PubMed  Google Scholar 

  5. Gravlee, C. C. Systemic racism, chronic health inequities, and COVID-19: a syndemic in the making? Am. J. Hum. Biol. 32, e23482 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Singer, M. C. Aids and the health crisis of the U.S. urban poor: the perspective of critical medical anthropology. Soc. Sci. Med. 39, 931–948 (1994).

    Article  CAS  PubMed  Google Scholar 

  7. Singer, M. Dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic. Free Inq. Creative Sociol. 24, 99–110 (1996).

    Google Scholar 

  8. Stall, R. et al. Association of co-occurring psychosocial health problems and increased vulnerability to HIV/AIDS among urban men who have sex with men. Am. J. Public Health 93, 939–942 (2003).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Tsai, A. C. & Burns, B. F. O. Syndemics of psychosocial problems and HIV risk: a systematic review of empirical tests of the disease interaction concept. Soc. Sci. Med. 139, 26–35 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Mendenhall, E. & Singer, M. What constitutes a syndemic? Methods, contexts, and framing from 2019. Curr. Opin. HIV AIDS 15, 213–217 (2020).

    PubMed  Google Scholar 

  11. Rudd, K., Mair, C. & Angus, D. Applying syndemic theory to acute illness. JAMA 327, 33–34 (2022).

    Article  CAS  PubMed  Google Scholar 

  12. Gandhi, M., Spinelli, M. & Mayer, K. Addressing the sexually transmitted infection and HIV syndemic. JAMA 321, 1356–1358 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  13. Tsai, A. C. Syndemics: a theory in search of data or data in search of a theory?. Soc. Sci. Med. 206, 117–122 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Link, B. G. & Phelan, J. C. Conceptualizing stigma. Annu. Rev. Sociol. 27, 363–385 (2001).

    Article  Google Scholar 

  15. Ranney, M. L., Betz, M. E. & Dark, C. #ThisIsOurLane: firearm safety as health care’s highway. N. Engl. J. Med. 380, 405–407 (2019).

    Article  PubMed  Google Scholar 

  16. Tsai, A. C., Mendenhall, E., Trostle, J. & Kawachi, I. Co-occurring epidemics, syndemics, and population health. Lancet 389, 978–982 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  17. Stall, R., Coulter, W. S., Reuel Friedman, R. & Plankey, W. M. Commentary on ‘Syndemics of psychosocial problems and HIV risk: a systematic review of empirical tests of the disease interaction concept’ by A. Tsai and B. Burns. Soc. Sci. Med. 145, 129–131 (2015).

    Article  PubMed  Google Scholar 

  18. Tsai, A. & Venkataramani, A. Syndemics and health disparities: a methodological note. AIDS Behav. 20, 423–430 (2016).

    Article  PubMed  PubMed Central  Google Scholar 

  19. Taft, T. & Keefer, L. A systematic review of disease-related stigmatization in patients living with inflammatory bowel disease. Clin. Exp. Gastroenterol. 9, 49–58 (2016).

    PubMed  PubMed Central  Google Scholar 

  20. Ghinai, I., Willott, C., Dadari, I. & Larson, H. J. Listening to the rumours: what the northern Nigeria polio vaccine boycott can tell us ten years on. Glob. Public Health 8, 1138–1150 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  21. Wonodi, C. et al. Conspiracy theories and misinformation about COVID-19 in Nigeria: implications for vaccine demand generation communications. Vaccine 40, 2114–2121 (2022).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Dhanani, L. Y. & Franz, B. A meta-analysis of COVID-19 vaccine attitudes and demographic characteristics in the United States. Public Health 207, 31–38 (2022).

    Article  CAS  PubMed  Google Scholar 

  23. Corona, G. et al. Diabetes is most important cause for mortality in COVID-19 hospitalized patients: systematic review and meta-analysis. Rev. Endocr. Metab. Disord. 22, 275–296 (2021).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  24. Jindal, H. A. et al. Higher coronavirus disease-19 mortality linked to comorbidities: a comparison between low-middle income and high-income countries. J. Educ. Health Promot. 10, 377 (2021).

    PubMed  PubMed Central  Google Scholar 

  25. Remien, R. H. et al. Mental health and HIV/AIDS: the need for an integrated response. AIDS 33, 1411–1420 (2019).

    Article  PubMed  Google Scholar 

  26. Mendenhall, E., Kohrt, B. A., Norris, S. A., Ndetei, D. & Prabhakaran, D. Non-communicable disease syndemics: poverty, depression, and diabetes among low-income populations. Lancet 389, 951–963 (2017).

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ikeda, D. J., Kidia, K., Agins, B. D., Haberer, J. E. & Tsai, A. C. Roll-out of HIV pre-exposure prophylaxis: a gateway to mental health promotion. BMJ Glob. Health 6(12), e007212 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  28. Logie, C. H. et al. A longitudinal study of associations between HIV‐related stigma, recent violence and depression among women living with HIV in a Canadian cohort study. J. Int. AIDS Soc. 22(7), e25341 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  29. Metzi, J. M. & Hansen, H. Structural competency: theorizing a new medical engagement with stigma and inequality. Soc. Sci. Med. 103, 126–133 (2014).

    Article  Google Scholar 

  30. Mendenhall, E. Syndemic Suffering: Social Distress, Depression, and Diabetes among Mexican Immigrant Women (Routledge, 2012).

  31. Mendenhall, E. Beyond comorbidity: a critical perspective of syndemic depression and diabetes in cross-cultural contexts. Med. Anthropol. Q. 30, 462–478 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  32. Logie, C. H., James, L., Tharao, W. & Loutfy, M. R. HIV, gender, race, sexual orientation, and sex work: a qualitative study of intersectional stigma experienced by HIV-positive women in Ontario, Canada. PLoS Med. 8(11), e1001124 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  33. McDaid, L. M. et al. Informing theoretical development of salutogenic, asset-based health improvement to reduce syndemics among gay, bisexual and other men who have sex with men: empirical evidence from secondary analysis of multi-national, online cross-sectional surveys. SSM Popul. Health 10, 100519 (2019).

    Article  PubMed  PubMed Central  Google Scholar 

  34. Schwartz, S. R. et al. The immediate effect of the Same-Sex Marriage Prohibition Act on stigma, discrimination, and engagement on HIV prevention and treatment services in men who have sex with men in Nigeria: analysis of prospective data from the TRUST cohort. Lancet HIV 2, E299–E306 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  35. Ogunbajo, A. et al. Poor sleep health is associated with increased mental health problems, substance use, and HIV sexual risk behavior in a large, multistate sample of gay, bisexual and other men who have sex with men (GBMSM) in Nigeria, Africa. Sleep Health 6, 662–670 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Ogunbajo, A. et al. Experiences of minority stress among gay, bisexual, and other men who have sex with men (GBMSM) in Nigeria, Africa: the intersection of mental health, substance use, and HIV sexual risk behavior. Glob. Public Health 16, 1696–1710 (2021).

    Article  PubMed  Google Scholar 

  37. Poteat, T. C., Logie, C. H. & van der Merwe, L. L. A. Advancing LGBTQI health research. Lancet 397, 2031–2033 (2021).

    Article  PubMed  Google Scholar 

  38. Scheim, A. I., Perez-Brumer, A. G. & Bauer, G. R. Gender-concordant identity documents and mental health among transgender adults in the USA: a cross-sectional study. Lancet Public Health 5, 196–203 (2020).

    Article  Google Scholar 

  39. Hatzenbuehler, M. L. et al. Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: a quasi-natural experiment. Am. J. Public Health 102, 285–291 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Huang, Y.-T. & Liang, Z. Effects of same-sex marriage legalization for sexual minority men in Taiwan: findings from a prospective study. Int. J. Public Health 67, 1604489 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  41. Judiciary Committee, Education and Employment Committee, Harding & Grall. CS/CS/HB 1557: Parental Rights in Education (The Florida Senate, 2022).

  42. Karmacharya, R., Kieling, C. & Mondelli, V. Integrating stem cell-based experiments in clinical research. Eur. Psychiatry 63, e62 (2020).

    Article  PubMed  PubMed Central  Google Scholar 

  43. Mendenhall, E. et al. A mixed-methods, population-based study of a syndemic in Soweto, South Africa. Nat. Hum. Behav. 6, 64–73 (2022).

    Article  PubMed  Google Scholar 

  44. Organista, K., Jung, W. & Neilands, T. A structural–environmental model of alcohol and substance-related sexual HIV risk in Latino migrant day laborers. AIDS Behav. 24, 3176–3191 (2020).

    Article  PubMed  Google Scholar 

  45. Safren, S. A. et al. Addressing syndemics and self-care in individuals with uncontrolled HIV: an open trial of a transdiagnostic treatment. AIDS Behav. 24, 3264–3278 (2020).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. Bhardwaj, A. & Kohrt, B. A. Syndemics of HIV with mental illness and other noncommunicable diseases: a research agenda to address the gap between syndemic theory and current research practice. Curr. Opin. HIV AIDS 15, 226–231 (2020).

    PubMed  PubMed Central  Google Scholar 

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Author information

Authors and Affiliations

  1. Edmund A. Walsh School of Foreign Service, Georgetown University, Washington, DC, USA

    Emily Mendenhall

  2. SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Science, University of Witwatersrand, Johannesburg, South Africa

    Emily Mendenhall

  3. Department of Psychiatry, George Washington University, Washington, DC, USA

    Brandon A. Kohrt

  4. Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada

    Carmen H. Logie

  5. Centre for Gender and Sexual Health Equity, Vancouver, British Columbia, Canada

    Carmen H. Logie

  6. United Nations University Institute for Water, Environment and Health, Hamilton, Ontario, Canada

    Carmen H. Logie

  7. Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, MA, USA

    Alexander C. Tsai

  8. Harvard Medical School, Boston, MA, USA

    Alexander C. Tsai

  9. Mbarara University of Science and Technology, Mbarara, Uganda

    Alexander C. Tsai

Authors
  1. Emily Mendenhall
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  2. Brandon A. Kohrt
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  3. Carmen H. Logie
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  4. Alexander C. Tsai
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Corresponding author

Correspondence to Emily Mendenhall.

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Competing interests

E.M., B.A.K. and A.C.T. receive a financial honorarium from Elsevier, Inc. for their work as Co-Editors-in-Chief of the journal SSM – Mental Health. C.H.L. has no competing interests.

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Nature Medicine thanks Inês Fronteira and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Primary Handling Editor: Karen O’Leary, in collaboration with the Nature Medicine team.

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Mendenhall, E., Kohrt, B.A., Logie, C.H. et al. Syndemics and clinical science. Nat Med 28, 1359–1362 (2022). https://doi.org/10.1038/s41591-022-01888-y

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  • DOI: https://doi.org/10.1038/s41591-022-01888-y

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