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Health outcomes associated with  Blastocystis  sp .  and  Dientamoeba fragilis  are disparate and controversial, ranging from health benefits, to years of asymptomatic carriage, through to severe illness. Evidence that  Blastocystis  sp .  and  D. fragilis  are commensal members of the gut microbiota is growing. Despite this, little to no research exists investigating the potential effect of these protozoa on psychological symptom expression. As such, the aim of this retrospective cross-sectional study was to be the first to investigate the effect of protozoan carriage on severity of Depressive, Neurocognitive, Stress and Anxiety, and Sleep and Fatigue symptoms, and whether this effect changes as a function of sex. The prevalence of  D. fragilis  was significantly higher in females compared to males, however there were no sex differences in prevalence for  Blastocystis  sp. (data used in the current study contained ST1, ST3, and  Blastocystis  ST unspecified) or co-carriage of the two. Females reported significantly more severe symptoms across all four psychological domains compared to males. There was no significant interaction between sex and  Blastocystis  sp .  carriage on psychological symptom severity, and no significant main effect of  Blastocystis  sp .  on symptom severity compared to those who tested negative for protozoa. When investigating the sexes separately, there was no effect of protozoan carriage on psychological symptom expression in either males or females. These findings add weight to the argument that  Blastocystis  sp .  and  D. fragilis  are not necessarily pathogenic and are likely to be part of a diverse gut (which is typically associated with better health outcomes). Further research is required given that protozoan members of the gut microbiota have been largely ignored in brain-gut-microbiota axis research.

The effect of Blastocystis sp. and Dientamoeba fragilis on psychological symptom severity in a sample of clinically diverse males and females