Association of major depressive episode with negative outcomes of tuberculosis treatment

Coping efforts made: Psychological burden of people living with tuberculosis due to social stigma in society. A qualitative phenomenology study

The psychological burden is greatly felt by people living with tuberculosis because the characteristics of the disease are very visible and very contagious, and the obligation to take the right dose of medication with long treatment. This is what makes tuberculosis a very stigmatic disease. The aim of this research is to explore the psychological burden felt by people living with tuberculosis due to social stigma by society and how coping efforts are made. This research uses a qualitative phenomenological design through in-depth face-to-face interviews which take place in a semi-structured manner with the hope of obtaining complete data. The purposive sampling method was used in this research with Participatory Interpretative Phenomenology analysis involving 25 participants consisting of 16 men and 9 women. This research produced several themes, including 1) "The Perception of stigma limiting space and time", 2) "The Opportunities for interpersonal interaction become narrow", 3) "The mental stress as a challenging emotion", and 4) " Expanding coping efforts". The psychological burden is felt by people living with tuberculosis because society's treatment is felt to be very discriminatory due to the social stigma that has developed in society so they lose the opportunity to interact with society. For that reason, they tried to explore some of the personal and environmental resources used to modify adaptive coping in resolving perceived psychological burdens. Given the possibility of ongoing stigma and discrimination during tuberculosis treatment programs, it is important to consider the psychological burden in this context, both on the general population and on groups affected by stigma.

Programmatic implementation of depression screening and remote mental health support sessions for persons recently diagnosed with TB in Lima, Peru during the COVID-19 pandemic

Background

Few studies have explored a stepped care model for delivering mental health care to persons with tuberculosis (TB). Here, we evaluated depression screening and remote low-intensity mental health interventions for persons initiating TB treatment in Lima, Peru during the COVID-19 pandemic.

Methods

We used the Patient Health Questionnaire 9 (PHQ-9) to screen participants for depressive symptoms (PHQ-9 ≥ 5). Participants with PHQ-9, 5-14 received remote Psychological First Aid (PFA) or Problem Management Plus (PM+). Participants were reevaluated 6 months after intervention completion. We then compared the change in median PHQ-9 scores before and after intervention completion. Those with PHQ-9 ≥ 15 were referred to higher-level care.

Findings

We found that 62 (45.9%) of the 135 participants had PHQ-9 ≥ 5 at baseline. Then, 54 individuals with PHQ-9, 5-9 received PFA, of which 44 (81.5%) were reevaluated. We observed significant reductions in median PHQ-9 scores from 6 to 2 (r = 0.98; p < 0.001). Four participants with PHQ-9, 10-14 received PM+ but were unable to be reevaluated. Four participants with PHQ-9 ≥ 15 were referred to higher-level care.

Conclusions

Depressive symptoms were common among persons recently diagnosed with TB. We observed improvements in depressive symptoms 6 months later for most participants who received remote sessions of PFA.

Anxiety, stress, and quality of life in patients with tuberculosis: A systematic review and meta-analysis

Anxiety symptoms when coexisting with tuberculosis (TB), can have deleterious effects on treatment continuation that could contribute to the development of treatment resistance in TB. It is essential to understand the prevalence of anxiety in TB to develop clinical recommendations for its management. The primary objective of our review was to estimate the pooled prevalence of anxiety in TB patients along with the estimation of stress and quality of life in such patients. The relevant literature search on observational studies published in the English language till the year 2020 was carried out. A total of 8086 participants from 29 studies were included, of which 24 were cross-sectional studies and the remaining were case-control, and cohort studies. The estimated pooled prevalence of anxiety, comorbid depression, stress, and poor quality of life in TB patients was 32.54% [24.95, 41.18], 32.87% [25.79, 40.82], 52.68% [48.60, 56.72], and 79.51% [45.67, 94.72] respectively. When comparing the prevalence of anxiety across World Health Organization (WHO) regions, there was a statistically significant difference, with the African Region (AFR) having the highest prevalence i.e. 37.87% [29.59, 46.92], and the Western Pacific Region (WPR) having the lowest prevalence i.e. 15.83 % [12.72, 19.53]. The higher prevalence of anxiety in TB in the AFR and South-East Asian Region (SEAR) suggests a strong correlation with the developing status of these regions which calls for efforts to identify and treat the risk factors common to both anxiety and TB.

Influencing Factors of Treatment Outcomes Among Patients with Pulmonary Tuberculosis: A Structural Equation Model Approach

BACKGROUND

Pulmonary tuberculosis (PTB) is a serious infectious disease, and the factors and pathways that influence final treatment outcomes are unclear. Here, we aimed to assess the factors that influence treatment outcomes in patients with PTB using a structural equation model.

METHODS

Participants completed a questionnaire covering demographics, understanding of PTB, psychological status, and history of medical treatment. Exploratory factor analysis and reliability testing were performed, and a structural equation model was constructed using the SPSS and Amos software.

RESULTS

A total of 251 participants were enrolled. Symptoms of depression were observed in 94.4% of participants, whereas 6% showed mild or greater anxiety. Through factor rotation, four common factors were extracted with a total variation of 66.15%. The structural equation model indicated that regular tuberculosis-related follow-up behaviour had a direct and positive effect on the final treatment outcome, with a path coefficient value of 0.20; the level of PTB understanding had a direct positive effect on the testing behaviour for PTB, with a path coefficient of 0.26; patients' psychological characteristics had a direct negative impact on regular testing behaviour, with a path coefficient of -0.13. The psychological characteristics and level of disease understanding of patients exerted indirect effects on the treatment outcome by affecting the way patients approached tuberculosis detection behaviour.

CONCLUSION

Interventions aimed at improving the treatment outcomes of patients with PTB should mainly focus on financial support and improvements in psychological status in addition to a greater understanding and knowledge of PTB. Furthermore, patients should be encouraged to undergo regular PTB testing during the follow up period, as this mediates the effect of other factors on treatment outcomes and also helps in achieving favourable treatment outcomes.

Are trajectories of depressive symptoms during the first half of drug-sensitive pulmonary tuberculosis treatment associated with loss to follow-up? A secondary analysis of longitudinal data

OBJECTIVE

The objective of this study was to identify trajectories of depressive symptoms (DSs) during the first half of drug-sensitive pulmonary tuberculosis (PTB) treatment and examine their association with loss to follow-up (LTFU) in the second half.

DESIGN

This study involved a secondary analysis of longitudinal data to identify potential trajectories of DS and their relationship with LTFU.

SETTING

The study was conducted in first and second-level health centres located in San Juan de Lurigancho, Lima, Peru.

PARTICIPANTS

Anonymised data from 265 individuals, including monthly measures of DSs from diagnosis to the completion of treatment, initiation of treatment for multidrug resistant TB, LTFU or death, were collected.

RESULTS

Three trajectories were identified: 'declining', 'growth' and 'high'. These trajectories were observed in 182 (68.7%), 53 (20%) and 30 (11.3%) of the 265 individuals, respectively, during the first half of PTB treatment. Compared with those with a 'declining' trajectory, individuals with a 'growth' trajectory had a higher likelihood of experiencing LTFU during the second half of PTB treatment, after controlling for sociodemographic factors and at least weekly alcohol use (OR 3.9; 95% CI 1.09 to 13.97, p=0.036).

CONCLUSIONS

The findings suggest that a trajectory of increasing DSs during the first half of PTB treatment is associated with a higher risk of LTFU during the second half.

Prevalence of depression and anxiety in pulmonary tuberculosis patients and its association with unsuccessful treatment outcome: A prospective cohort study

BACKGROUND

Pulmonary tuberculosis (TB) remains a major public health problem in Thailand. TB causes chronic disease which may cause physical disability, mental and socioeconomic problems in TB patients. Mental disorders may occur after TB infection or co-exist with the disease. This study assessed the prevalence of depression and anxiety among pulmonary TB patients and its association with treatment outcome.

METHODS

This is a single-center prospective study. Pulmonary TB patients who were treated at a tertiary hospital, in both outpatient and in-patient settings, were enrolled into the study. Demographic data and Thai Hospital Anxiety and Depression Scale (HADS) score at baseline and at least 2 months after diagnosis were collected to evaluate the probability of depression and anxiety. Logistic regression model was used to analyze the data. Association between suspicious mental disorder and treatment outcome were evaluated at the end of each participant's treatment.

RESULTS

One hundred and three participants were enrolled into the study on March 2018 to October 2019. The prevalence of probable depression and anxiety (Thai HADS score ≥11 from both test) were 7.8% and 6.8%, respectively. Unsuccessful treatment outcome rate was 10.7% (11/103). From the multivariate analysis, people previously treated/relapsed (aOR (95%CI): 7.04 (1.19-41.85), p = 0.03) and probable depression/anxiety with Thai HADS score ≥11 (10.12 (1.54-66.45), p = 0.02) were associated with unsuccessful treatment outcome.

CONCLUSIONS

In this study, Thai HADS score could identify probable depression and anxiety among pulmonary TB patients, and its association with unfavorable treatment outcome. Clinicians should keep in mind that pulmonary TB can affect the mental status of the patients and therefore, should evaluate them and provide appropriate treatment.

Depression, anxiety and medication adherence among tuberculosis patients attending treatment centres in Fako Division, Cameroon: cross-sectional study

BACKGROUND

Tuberculosis remains a public health problem, particularly in developing countries. Patients with tuberculosis often suffer from anxiety and depression, which is likely to affect adherence to the long course of tuberculosis treatment.

AIMS

This study sought to investigate depression, anxiety and medication adherence among Cameroonian tuberculosis patients.

METHOD

A cross-sectional study was conducted from March to June 2022 across five treatment centres in Fako Division, Southwest Region, Cameroon. Data were collected via face-to-face interviews with tuberculosis patients using a structured questionnaire. Sociodemographic information was obtained, and the following tools were administered to participants: the Hospital Anxiety and Depression Scale, the Oslo Social Support Scale, and the Medication Adherence Rating Scale. Multiple logistic regression models were fitted to investigate determinants of depression and anxiety.

RESULTS

A total of 375 participants were recruited (mean age: 35 ± 12.2 years; 60.5% male). The prevalence rates of depression and anxiety among tuberculosis patients were 47.7% and 29.9%, respectively. After adjusting for confounders, the odds of depression were significantly increased by having extrapulmonary tuberculosis, non-adherence to treatment, having no source of income, household size <5 and poor social support. Predictors for anxiety included extrapulmonary tuberculosis, defaulting tuberculosis treatment for ≥2 months, family history of mental illness, HIV/tuberculosis co-infection, being married, poor social support and non-adherence to treatment.

CONCLUSIONS

The prevalence of depression and anxiety in tuberculosis patients is relatively high, and diverse factors may be responsible. Therefore, holistic and comprehensive care for tuberculosis patients by mental health practitioners is highly encouraged, especially for the high-risk groups identified.

Mental Health Status and Its Impact on TB Treatment and Its Outcomes: A Scoping Literature Review

Background

Tuberculosis (TB) infection interferes with the health-related quality of life (HRQOL), including physical, social, mental, emotional and financial domains of individuals. The goal of this scoping review is to outline the most frequent mental issues encountered by TB patients and evaluate the effects of mental health on TB treatment outcomes. Our findings identify research gaps that could help bridge the overall treatment outcomes in the near future.

Method

A systematic stepwise approach was adopted to search online resource databases like PubMed, Web of science, and gray literature to retrieve published scientific articles for the review. Titles and abstracts of selected studies were examined for their possible eligibility. The studies matching our eligibility criteria were taken into account for this scoping review.

Results

One hundred and ninety three articles were retrieved out of which 26 met the final inclusion criteria. We found that studies adopting interventional approaches reported good mental wellbeing outcomes and better medical compliance as compared with studies that just investigated the subjects. The data represented 15 countries including three low-income countries (LICs), four low-middle-income-countries (LMICs), seven upper-middle-income countries (UMICs), and one high-income country (HIC).

Conclusion

Depression, anxiety, and poor social support, and stigma affect the wellbeing of individuals across the globe irrespective of age, race, demographic characteristics, geographical location, and social status.

Risk Factors for Depression in Tuberculosis Patients: A Meta-Analysis

Purpose

Tuberculosis (TB) is a life threatening global infection. However, not only does TB have a high global prevalence, but it is also associated with several comorbidities. Depression is one of the most common and lethal comorbidities of TB patients. Therefore, in order to prevent depression in TB patients more effectively, it is necessary to investigate the factors associated with depression in TB patients by studying the pooled effect of each factor statistically. By concluding the associated factors through statistical analysis, it not only offers accurate guidance for further studies about programs targeted at preventing depression in TB patients, but provides health-care workers useful suggestions and warnings when treating TB patients.

Methods

We searched the published literatures from PubMed, Web of Science, EMBASE, and Cochrane Library to collect studies. The meta-analysis included articles from observational studies, including cross-sectional studies, cohort studies and case control studies that had information about factors associated with depression in tuberculosis patients. When the heterogeneity is defined as significant (I2>50%), a random-effect model with 95% confidence interval (CI) was used to estimate risk factors; otherwise, a fixed-effect model was used to combine the effect. A sensitivity test was conducted to examine which one of the studies may have potential bias that can affect the validity and reliability of the result. The funnel plots and Begg's and Egger's statistical tests were performed to assess the publication bias. Subgroup analysis was performed according to the prespecified variables in each group.

Results

Totally, 25 studies were included in the meta-analysis. The studies were conducted in various countries around the world between 2011 and 2021, representing the situation in the previous ten years. The final associated factors include female gender [OR=1.319, 95% CI=1.132-1.536, p<0.001], poor social support [OR=4.109, 95% CI=1.431-11.799, p<0.01], marriage status [OR=1.362, 95% CI=1.154-1.608, p<0.001], low education level [OR=1.921, 95% CI=1.475-2.503, p<0.001], residence in rural areas [OR=1.408, 95% CI=1.122-1.767, p<0.01], retreatment status [OR=2.515, 95% CI=1.226-5.159, p<0.01], and having perceived stigma[OR=4.131, 95% CI=1.412-12.088, p<0.05].

Conclusion

Depression prevention programs targeted at women TB patients are supposed to be carried out. Patients in retreatment status are supposed to be paid more attention of their psychological health by caring about their mental status. More social support is ought to be given to tuberculosis patients to reduce their chance of getting depressed. It is necessary to provide patients with a lower education level with psychological related courses to help them learn about their mental status. For patients living in rural areas, governments are supposed to offer psychotherapy for treatment as well as enhancing living condition. Suitable psychotherapy programs and plans is ought to be studied to eradicate perceived stigma of TB patients.

Social Support and Depression Among Pulmonary Tuberculosis Patients in Anhui, China

Introduction

Pulmonary tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis affecting multiple tissues and organs. It is one of the leading causes of death and is a social disease in China. Increasing studies have revealed that the state of mental health and the social support are associated with the morbidity, mortality and community transmission of pulmonary TB patients. However, the previous global TB control and research strategy focused almost solely on the biomedical aspects. Therefore, in this study, we evaluated the level of depression and explored potential factors, including social support domains and socio-demographic characteristics in pulmonary TB patients to research the mental health state and the association between social support and pulmonary TB, ultimately implementing a multilevel intervene.

Methods

A cross-sectional study was carried out to describe the status of depression and social support, and explore related factors associated with depression among pulmonary TB patients in Anhui Province, China. Five counties (districts) in Anhui Province, China were selected by simple random sampling method. Patients diagnosed with pulmonary TB eligible to the study criteria were investigated. A structured questionnaire composed of information on socio-demographic characteristics, self-rating depression scale (SDS) and social support rating scale (SSRS) was used to collect the data.

Results

In this study, a total of 250 questionnaires were issued, and the effective questionnaires 237 were actually returned. Of the 237 patients with pulmonary TB, 71.3% of them were male and the mean age was 46.16 years (SD = 13.09). Depression symptoms were observed in 125 (52.7%) participants. Objective support (β = −0.192, P=0.002) and subjective support (β = −0.158, P = 0.015) had significantly negative effects on depression, while the effect of support utilization was not statistically significant. In contrast, being female (β = 0.119, P = 0.036) and patients with positive sputum smear results (β = 0.140, P = 0.014) were positively related to depression. Patients with monthly income between 500 and 999 were less likely to suffer from depression (β = −0.134, P = 0.024) than those who were poorer. Additionally, both education level and marital status were found to be correlated with social support and depression state (all P<0.05).

Discussion

In summary, the prevalence of depressive symptoms in pulmonary TB patients were high in Anhui Province, China. Low levels of social support can be an important predictor of depression symptoms. Therefore, screening for depression among pulmonary TB patients in the primary care setting is greatly warranted. Furthermore, psychological interventions should focus on providing available and adequate social support in order to improve mental health of them.

Magnitude of Depression and Associated Factors Among Patients on Tuberculosis Treatment at Public Health Facilities in Harari Regional State, Eastern Ethiopia: Multi-Center Cross-Sectional Study

BACKGROUND

Depression among tuberculosis patients remains a significant public health concern. Its burden and severity is increasing in low-income countries, especially in sub-Saharan Africa. Although it has negative impacts on quality of life, depression among tuberculosis patients is rarely studied in Ethiopia, particularly in the study area. Therefore, this study aimed to determine the magnitude of depression and associated factors among tuberculosis patients in Eastern Ethiopia.

METHODS

A facility-based cross-sectional study was conducted from April 15 to May 15, 2021, among 213 tuberculosis patients in public health facilities of the Harari Regional State, Eastern Ethiopia. Study participants were selected using a systematic sampling technique. Data were collected using interviewer-administered questionnaire. Depression was assessed using Patients Health Questionnaire-9 (PHQ-9). Epi-data and SPSS were used for data processing and analysis. Bi-variable and multivariable logistic regressions were employed to determine the effects of predictors on depression. Statistical significance was considered at a p-value <0.05.

RESULTS

The magnitude of depression among tuberculosis patients was 52.1% [95% CI (45.4, 58.8%)]. Patient's age of 25-34 years [AOR = 0.31, 95% CI (0.128, 0.75)], female sex [AOR = 5.04; 95% CI (2.18, 11.62)], intensive phase of tuberculosis treatment [AOR = 2.56; 95% CI (1.118, 5.876)], HIV-positive status [AOR = 7.143; 95% CI (1.55, 32.93)], smoking history [AOR = 9.08; 95% CI (3.35, 24.61)] and having poor social support [AOR = 4.13; 95% CI (1.29, 13.22)] were factors statistically associated with depression.

CONCLUSION

In this study, the magnitude of depression was relatively high as more than half of the participants had depression. Advanced age, female sex, intensive phase of tuberculosis treatment, HIV-positive status, smoking history, and poor social support were identified as associated factors with depression. Therefore, this result calls all stakeholders to give duly emphasis on incorporating and integrating mental health support programs as routine practice in tuberculosis follow-up clinics, as screening, early detection and treatment, and training for all health care providers are very crucial in tackling depression among tuberculosis patients.

Tuberculosis and comorbidities: treatment challenges in patients with comorbid diabetes mellitus and depression

Tuberculosis is one of the leading causes of death worldwide, primarily affecting low- and middle income countries and individuals with limited-resources within fractured health care systems. Unfortunately, the COVID-19 pandemic has only served to aggravate the already existing diagnostic gap, decreasing the number of people who get diagnosed and thereby complete successful treatment. In addition to this, comorbidities act as an external component that when added to the TB management equation, renders it even more complex. Among the various comorbidities that interact with TB disease, diabetes mellitus and depression are two of the most prevalent among non-communicable diseases within the TB population and merits a thoughtful consideration when the healthcare system provides care for them. TB patients with diabetes mellitus (TB-DM) or depression both have an increased risk of mortality, relapse and recurrence. Both of these diseases when in presence of TB present a ‘vicious-circle-like’ mechanism, meaning that the effect of each disease can negatively add up, in a synergistic manner, complicating the patient’s health state. Among TB-DM patients, high glucose blood levels can decrease the effectiveness of anti-tuberculosis drugs; however, higher doses of anti-tuberculous drugs could potentially decrease the effects of DM drugs. Among the TB-depression patients, not only do we have the adherence to treatment problems, but depression itself can biologically shift the immunological profile responsible for TB containment, and the other way around, TB itself can alter the hormonal balance of several neurotransmitters responsible for depression. In this paper, we review these and other important aspects such as the pharmacological interactions found in the treatment of TB-DM and TB-depression patients and the implication on TB care and pharmacological considerations.

Depression among Tuberculosis patients and its association with treatment outcomes in district Srinagar

BACKGROUND

Tuberculosis (TB) is among the top 10 causes of death worldwide and there are estimated 10.4 million new (incident) patients, of which about one fourth are in India. There has been calls for rigorous investigations and interventions that may address other factors known to have effect on adherence of treatment like Depression but the amount of research into comorbidity is surprisingly low. The aim of the study was to assess magnitude and impact of depression among TB patients and determine the treatment outcomes of TB in District Srinagar.

METHODS

In this prospective study the adults with newly diagnosed TB were recruited within one month of initiating treatment and were followed upto the end of treatment. Data collection was done at three time-points: baseline, after 2 months and after 6 months of treatment initiation. The sample size of 200 was calculated using OpenEpi, V3 and identified 202 TB patients were interviewed in their local language and PHQ-9 scale was used to measure Depression.

RESULTS

The prevalence of Depression at baseline was 50.5% with CI (43.7%-57.3%). After two months of treatment the prevalence reduced to 9.4% with CI (5.9%-14.0%) and at the end of treatment to 2.5% with CI (0.91%-5.4%). Association between Depression in TB patients and treatment failure was found to be small to medium as revealed by Cramer's V test (0.29-0.59). Binary logistic regression estimated that at baseline TB patients with Depression were at 4.46 times at more risk of treatment failure than patients without Depression and those patients who continued Depression even after intensive phase were 34.5 times at higher risk.

CONCLUSION

Our findings indicate Depression is associated with poor treatment outcome in these patients, despite TB treatment. TB treatment strategies should consider screening and managing the psychologically distressed individuals among TB patients.

Effect of a Nurse-Led Community Health Worker Intervention on Latent Tuberculosis Medication Completion Among Homeless Adults

BACKGROUND

Tuberculosis (TB) disproportionately affects marginalized and impoverished homeless adults. Although active TB can be prevented by treating latent TB infection (LTBI), individual factors, such as high prevalence of depression and anxiety, drug and alcohol use, and unstable housing, lead to poor LTBI treatment adherence and completion among homeless adults.

OBJECTIVES

We hypothesized that the delivery of a tailored nurse-led, community health worker (RN/CHW) program across the LTBI continuum of care (e.g., screening, diagnosis, and treatment) that delivers 3HP treatment (3HP: rifapentine plus isoniazid) for homeless adults (e.g., sheltered and unsheltered) and is tailored to their health and social service needs will overcome existing treatment completion barriers. We also hypothesized that mental health symptoms (e.g., depression and anxiety), drug use score, and problematic alcohol use will decline over time among clients receiving this treatment.

METHODS

We assessed the effect of delivering a theoretically guided, RN/CHW-based, single-arm study among eligible LTBI-positive homeless adults (N = 50) on completion of a weekly, directly observed, 12-dose 3HP LTBI treatment in Central City East (Skid Row). Completing 3HP treatment was compared to the only known historical, clinic-based control that obtained 65% completion among homeless adults. Secondary outcomes included drug and alcohol use, depression, and anxiety.

RESULTS

The RN/CHW program achieved a 91.8% 3HP treatment completion rate among homeless adults. Younger homeless adults (<50 years old) were less likely to complete 3HP treatment compared to those who were older. Neither drug use, depression, nor anxiety was associated with 3HP treatment completion. Decrease in anxiety was observed at 3 months, but not at 6 months, compared to baseline.

DISCUSSION

To our knowledge, the pilot study is the first to evaluate an effective RN/CHW-delivered, community-based intervention, which can reduce the burden of active TB for homeless adults.

Prevalence and associated factors of psychological distress in tuberculosis patients in Northeast China: a cross-sectional study

Background

Psychological distress, a major comorbidities of tuberculosis (TB) patients, has posed a serious threat to the progress being made in global TB programs by affecting treatment adherence and health outcomes. However, the magnitude and associated factors of psychological distress have not been fully studied in China. The aim of the current study was to assess the prevalence of psychological distress in TB patients and to further determine the effects of socio-demographic characteristics, health-related variables, substance use status, social support, and experienced stigma on psychological distress.

Methods

A cross-sectional survey was conducted among TB patients attending three medical institutions in Dalian, Liaoning Province, Northeast China from November 2020 to March 2021. A structured questionnaire was developed to collect data on patients’ socio-demographic characteristics, health-related information, substance use status, psychological distress, family function, doctor-patient relationship, policy support, experienced stigma and so on. The binary logistics regression model was used to determine the associated factors of psychological distress.

Results

A total of 473 TB patients were enrolled in this study, and the prevalence of psychological distress was 64.1%. Binary logistic regression analysis revealed that patients with a middle school education level or above (OR: 0.521, 95%CI: 0.279–0.974), no adverse drug reactions (OR: 0.476, 95%CI: 0.268–0.846), and regular physical exercise (OR: 0.528, 95%CI: 0.281–0.993) were more likely to stay away from psychological distress. However, patients who had a high economic burden (OR: 1.697, 95%CI: 1.014–2.840), diabetes (OR: 2.165, 95%CI: 1.025–4.573), self-rated illness severe (OR: 3.169, 95%CI: 1.081–9.285), perceived poor resistance (OR: 2.065, 95%CI: 1.118–3.815), severe family dysfunction (OR: 4.001, 95%CI: 1.158–13.823), perceived need for strengthen psychological counseling (OR: 4.837, 95%CI: 2.833–8.258), and a high experienced stigma (OR: 3.253, 95%CI: 1.966–5.384) tended to have a psychological distress.

Conclusions

The study found that the proportion of psychological distress among TB patients was high in Northeast China, and it was influenced by a variety of factors. Effective interventions to reduce psychological distress in TB patients urgently need to be developed, and greater attention should be given to patients with risk factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06284-4.

Impact of integrating mental health services within existing tuberculosis treatment facilities

Introduction:

Depression and anxiety among tuberculosis (TB) patients can adversely affect TB treatment adherence and completion.

Aim:

We studied whether integrating mental health services into existing TB treatment programs would reduce symptoms of depression and anxiety and improve treatment completion among patients with drug-susceptible TB.

Methods:

Integrated practice units (IPUs) for TB and mental health were established within six existing TB treatment facilities in Karachi, Pakistan. Patients were screened for depression and anxiety and, if symptomatic, offered a mental health intervention consisting of at least four counseling sessions. We measured changes in reported levels of depression and anxiety symptoms from baseline following completion of counseling sessions, and rates of TB treatment completion.

Results:

Between February 2017 and June 2018, 3500 TB patients were screened for depression and anxiety. 1057 (30.2%) symptomatic patients received a baseline adherence session. 1012 enrolled for a mental health intervention received at least 1 counseling session. 522 (51.5%) reported no symptoms after four to six sessions. Symptomatic patients who completed at least four counseling sessions had higher rates of TB treatment completion than those who did not (92.9% vs 75.1%; p < 0.0001).

Conclusion:

Mental health interventions integrated within TB programs can help reduce symptoms of depression and anxiety and improve TB treatment completion.

The Tuberculosis-Depression Syndemic and Evolution of Pharmaceutical Therapeutics: From Ancient Times to the Future

The interplay between tuberculosis and depression has been problematic since the humoralists. Over the centuries similarities in disease management have transpired. With the advent of isoniazid chemotherapy, transformation of tuberculosis patients from morbidly depressive to euphoric was noted. Isoniazid was thereafter widely prescribed for depression: hepatotoxicity ending its use as an antidepressant in 1961. Isoniazid monotherapy led to the emergence of drug resistant tuberculosis, stimulating new drug development. Vastly increased investment into antidepressants ensued thereafter while investment in new drugs for tuberculosis lagged. In the 21st century, both diseases independently contribute significantly to global disease burdens: renewed convergence and the resultant syndemic is detrimental to both patient groups. Ending the global tuberculosis epidemic and decreasing the burden of depression and will require multidisciplinary, patient-centered approaches that consider this combined co-morbidity. The emerging era of big data for health, digital interventions and novel and repurposed compounds promise new ways to treat both diseases and manage the syndemic, but absence of clinical structures to support these innovations may derail the treatment programs for both. New policies are urgently required optimizing use of the current advances in healthcare available in the digital era, to ensure that patient-centered care takes cognizance of both diseases.

Impact of mental disorders on active TB treatment outcomes: a systematic review and meta-analysis

BACKGROUND: Comorbid mental disorders in patients with TB may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes.METHODS: We searched eight databases for studies published from 1990 to 2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: Of 7687 studies identified, 10 were included in the systematic review and nine in the meta-analysis. Measurement of mental disorders and TB outcomes were heterogeneous across studies. The pooled association between mental disorders and any poor outcome, loss to follow-up, and non-adherence were OR 2.13 (95%CI 0.85-5.37), 1.90 (95%CI 0.33-10.91), and 1.60 (95%CI 0.81-3.02), respectively. High statistical heterogeneity was present.CONCLUSION: Our review suggests that mental disorders in TB patients increase the risk of poor TB outcomes, but pooled estimates were imprecise due to small number of eligible studies. Integration of psychological and TB services might improve TB outcomes and progress towards TB elimination.

Prevalence of depressive symptoms and associated factors among patients with tuberculosis attending public health institutions in Gede'o zone, South Ethiopia

Background

Depression is a common mental disorder among patients with tuberculosis and it is associated with a greater risk of suicide, multidrug-resistant tuberculosis, and poor quality of life. Evidence suggests the early identification of depression among patients with tuberculosis is important to decrease adverse outcomes. However, there are limited studies that examined the prevalence and determinants of depressive symptoms among patients with tuberculosis. This study aimed to assess the prevalence and associated factors of depressive symptoms among patients with tuberculosis attending public health institutions in Gede’o zone, South Ethiopia.

Methods

An institution-based a cross-sectional study was conducted from November 1 to December 30, 2018, among a randomly selected sample of 415 patients with tuberculosis attending public health institutions in Gede’o zone, South Ethiopia. Patient Health Questionnaire (PHQ-9) was used to assess depressive symptoms. Logistic regression was used to identify the potential risk factors of depressive symptoms. The strength of the association was presented by crude odds and adjusted odds ratio with their corresponding 95% CI. Finally, the statistical significance was set at p < 0.05.

Results

The prevalence of depressive symptoms was found to be 45.5% (95% CI; 41.1–50.1%) among patients with tuberculosis; 33.3% had moderate, 9.8% had moderately severe, and 2.4% had severe depression. After adjusting for the possible confounders, being on re-treatment for tuberculosis (AOR = 2.47, 95% CI: 1.17–5.22), aged ≥45 years (AOR = 2.41, 95% CI: 1.09–5.32), having poor social support (AOR = 4.21, 95% CI: 2.10–8.47), and Tuberculosis/Human Immunodeficiency Virus (TB/HIV) co-infection) (AOR = 3.96, 95% CI 2.0, 7.84) were significantly associated with depressive symptoms among patients with TB.

Conclusions

This study suggests that a substantial percentage of patients with TB had depressive symptoms (45.5%). TB/HIV coinfection, being on re-treatment for tuberculosis, those having poor social support, patients aged 45 and above were factors associated with depressive symptoms. Routine screening of depression among patients with TB is warranted. Moreover, patients with TB falling into the risk categories should be more carefully monitored for depression and when possible referred to mental health professionals.

Impact of mental disorders on active tuberculosis treatment outcomes: a systematic review and meta-analysis

BACKGROUND

Comorbid mental disorders in patients with tuberculosis (TB) may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes.

METHODS

We searched eight databases for studies published from 1990-2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (OR) with 95% confidence intervals (CI).

FINDINGS

Of 7,687 studies identified, ten were included in the systematic review and nine in the meta-analysis. Measurement of mental disorders and TB outcomes were heterogeneous across studies. The pooled association between mental disorders and any poor outcome, loss to follow-up, and non-adherence were OR 2.13 (95% CI: 0.85-5.37), 1.90 (0.33-10.91), and 1.60 (0.81-3.02), respectively. High statistical heterogeneity was present.

INTERPRETATION

Our review suggests that mental disorders in TB patients increase the risk of poor TB outcomes, but pooled estimates were imprecise due to small number of eligible studies. Integration of psychological and TB services might improve TB outcomes and progress towards TB elimination.

Integrating tuberculosis and mental health services: global receptivity of national tuberculosis program directors

<sec id="st1"> <title>SETTING</title> A global survey of National Tuberculosis Program (NTP) directors. </sec> <sec id="st2"> <title>OBJECTIVES</title> To assess the perceived mental health needs of persons with tuberculosis (TB), current practices, and receptivity to integrating evidence-based mental and substance use treatment into national TB guidelines. </sec> <sec id="st3"> <title>DESIGN</title> Semi-structured survey of NTP directors from 26 countries of all income levels using a standardized questionnaire. </sec> <sec id="st4"> <title>RESULTS</title> Of the 26 countries, 21 were classified as high incidence and/or burden countries for TB, TB and human immunodeficiency virus coinfection, and/or drug-resistant TB. Two NTPs included routine screening for any mental disorder, four assessed alcohol or drug use, and five had standard protocols for the co-management of disorders. If effective and low-cost integrated care models were available, 17 NTP directors felt that it was highly likely, and five somewhat likely, that their NTPs would integrate mental health treatment into national TB guidelines and services. The main perceived barriers to service integration were limited capacity, not recognizing mental health as a problem, insufficient resources, and TB-related social stigma. </sec> <sec id="st5"> <title>CONCLUSIONS</title> NTPs currently do not address mental disorders as part of routine practice. Nevertheless, receptivity is high, which creates a ripe opportunity to integrate the management of TB and mental disorders into the policies and guidelines of NTPs worldwide. </sec>.

Comorbidities between tuberculosis and common mental disorders: a scoping review of epidemiological patterns and person-centred care interventions from low-to-middle income and BRICS countries

Background

There is increasing evidence that the substantial global burden of disease for tuberculosis unfolds in concert with dimensions of common mental disorders. Person-centred care holds much promise to ameliorate these comorbidities in low-to-middle income countries (LMICs) and emerging economies. Towards this end, this paper aims to review 1) the nature and extent of tuberculosis and common mental disorder comorbidity and 2) person-centred tuberculosis care in low-to-middle income countries and emerging economies.

Main text

A scoping review of 100 articles was conducted of English-language studies published from 2000 to 2019 in peer-reviewed and grey literature, using established guidelines, for each of the study objectives. Four broad tuberculosis/mental disorder comorbidities were described in the literature, namely alcohol use and tuberculosis, depression and tuberculosis, anxiety and tuberculosis, and general mental health and tuberculosis. Rates of comorbidity varied widely across countries for depression, anxiety, alcohol use and general mental health. Alcohol use and tuberculosis were significantly related, especially in the context of poverty. The initial tuberculosis diagnostic episode had substantial socio-psychological effects on service users. While men tended to report higher rates of alcohol use and treatment default, women in general had worse mental health outcomes. Older age and a history of mental illness were also associated with pronounced tuberculosis and mental disorder comorbidity. Person-centred tuberculosis care interventions were almost absent, with only one study from Nepal identified.

Conclusions

There is an emerging body of evidence describing the nature and extent of tuberculosis and mental disorders comorbidity in low-to-middle income countries. Despite the potential of person-centred interventions, evidence is limited. This review highlights a pronounced need to address psychosocial comorbidities with tuberculosis in LMICs, where models of person-centred tuberculosis care in routine care platforms may yield promising outcomes.

Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis

Background

Depression is a common comorbidity of tuberculosis (TB) and is associated with poor adherence to treatment of multiple disorders. We conducted a systematic review to synthesize the existing evidence on the relationship between depression and negative outcomes of TB treatment.

Methods

We systematically reviewed studies that evaluated depressive symptoms (DS) directly or indirectly through psychological distress (PD) and measured negative treatment outcomes of drug-sensitive pulmonary TB, defined as death, loss to follow-up, or non-adherence. Sources included PubMed, Global Health Library, Embase, Scopus and Web of Science from inception to August 2019.

Results

Of the 2,970 studies initially identified, eight articles were eligible for inclusion and two were used for the primary outcome meta-analysis. We found a strong association between DS and negative TB treatment outcomes (OR = 4.26; CI95%:2.33–7.79; I² = 0%). DS were also associated with loss to follow-up (OR = 8.70; CI95%:6.50–11.64; I² = 0%) and death (OR = 2.85; CI95%:1.52–5.36; I² = 0%). Non-adherence was not associated with DS and PD (OR = 1.34; CI95%:0.70–2.72; I² = 94.36) or PD alone (OR = 0.92; CI95%:0.81–1.05; I² = 0%).

Conclusions

DS are associated with the negative TB treatment outcomes of death and loss to follow-up. Considerable heterogeneity exists in the definition of depression and outcomes such as non-adherence across the limited number of studies on this topic.

The prevalence of depression among patients with tuberculosis: a systematic review and meta-analysis

BACKGROUND

Evidence has shown that the prevalence of depression is much higher among patients with tuberculosis (TB) and this, in turn, may adversely impact compliance with anti-TB medications. Therefore, this systematic review and meta-analysis aimed to quantitatively summarize epidemiologic evidence on the prevalence of depression among patients with TB and formulate a recommendation for future clinical practice as well as research.

METHODS

We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to conduct this review. We searched PubMed, EMBASE, SCOPUS and Psych INFO to identify relevant studies that investigated the prevalence of depression among TB patients. We also supplemented our electronic search with manual searching to include all pertinent studies in the analysis. We used a Comprehensive Meta-Analysis software version 3.0 (CMA 3.0) to conduct a meta-analysis. We conducted a subgroup and sensitivity analysis and Cochran's Q- and the I ²-statistics were used to assess heterogeneity. The evidence for the presence of publication bias was checked by using Egger's test and visual inspection of the symmetry in funnel plots.

RESULTS

We identified a total of 25 studies that included 4903 participants across seven countries. In our analysis, the pooled estimated prevalence of depression among TB patients was found to be 45.19% (95% CI 38.04-52.55). The prevalence was higher in MDR-TB 52.34% (95% CI 38.09-66.22) than non-MDR-TB 43.47% (95% CI 35.88-51.37) patients. We also found that the pooled prevalence of depression was higher among females 51.54% (95% CI 40.34-62.60) when compared to males 45.25% (95% CI 35.19-55.71). The pooled prevalence of depression was 45.45% as measured by HRDS, and it was 55.62%, 45.52%, and 38.36% as measured by BDI, HADS and PHQ-9, respectively.

CONCLUSION

Our finding suggested that the pooled estimated prevalence of depression among tuberculosis patients was relatively high. Screening and management of depression among TB patients were warranted to alleviate suffering. Moreover, the integration of tuberculosis program with regular psychiatry services may substantially reduce the burden.

More Than Malnutrition: A Review of the Relationship Between Food Insecurity and Tuberculosis

Despite a significant reduction in tuberculosis (TB) mortality over the past decade, TB remains a leading cause of death worldwide. Food insecurity-through pathways such as malnutrition, mental health impact, and high-risk health behaviors-affects the risk of TB disease, treatment failure, and mortality. We searched the literature for studies reporting on the links between food insecurity and TB. In contrast to the well-documented interactions between food insecurity and HIV/AIDS, we found that the association between food insecurity and TB remains largely understudied-this is especially true with regard to non-nutritional correlations. Mental health and behavioral linkages between TB and food insecurity deserve further attention. An improved understanding of the pathways through which food insecurity impacts TB is crucial to inform evidence-based integration of interventions such as psychological counseling, psychiatric care, harm reduction programs, and efforts to address social determinants of disease within current TB programs.

Prevalence and associated factors of depression among tuberculosis patients in Eastern Ethiopia

BACKGROUND

Depression among tuberculosis patients, especially in settings with low economic status is common. Screening for depression in all levels of health facilities can identify patients who need support and treatment for depression.

OBJECTIVE

The aim of this study was to assess the prevalence and associated factors of depression among tuberculosis patients in Eastern Ethiopia.

METHODS

An institutional based cross-sectional study was conducted among 403 tuberculosis patients attending in eleven tuberculosis treatment centers in eastern Ethiopia from February to July 2017. Depression was measured using the Patient Health Questionnaire. Data was collected consecutively until the required sample size was obtained. Tuberclusis  patients who were under anti tuberculosis treatments for more than one month were included. Data were analyzed with Statistical Package for Social Sciences (SPSS) version 20. Bivariate and multivariate logistic regression models were applied to identify independent factors for dependent variable depression and P-values < 0.05 considered statistically significant.

RESULTS

A total of 403 tuberculosis patients were included in the study. The prevalence of depression among tuberculosis patients was 51.9% (95%CI = 42.7, 62.2%) with 34.2% were mild cases. In our logistic regression analysis, odds of developing depression among tuberculosis patients with age less than 25 years were 0.5(50% protective effect) [AOR = 0.5, 95% CI 0.26-0.99] where as patients with a monthly income within the 25^thpercentile were four times higher odds to have depression [AOR = 3.98, 95% CI: 2.15-7.39].

CONCLUSION

The prevalence of depression was high in this study. Age, low monthly income, the category of patients as "new tuberculosis treatment" and the first 3 months of treatment was associated with depression among tuberculosis patients. Health facilities should integrating mental health services with tuberculosis clinics, especially assessing and treating TB patients for depression, is vital.

Untreated depression and tuberculosis treatment outcomes, quality of life and disability, Ethiopia

Objective

To investigate the association between comorbid depression and tuberculosis treatment outcomes, quality of life and disability in Ethiopia.

Methods

The study involved 648 consecutive adults treated for tuberculosis at 14 primary health-care facilities. All were assessed at treatment initiation (i.e. baseline) and after 2 and 6 months. We defined probable depression as a score of 10 or above on the nine-item Patient Health Questionnaire. Data on treatment default, failure and success and on death were obtained from tuberculosis registers. Quality of life was assessed using a visual analogue scale and we calculated disability scores using the World Health Organization’s Disability Assessment Scale. Using multivariate Poisson regression analysis, we estimated the association between probable depression at baseline and treatment outcomes and death.

Results

Untreated depression at baseline was independently associated with tuberculosis treatment default (adjusted risk ratio, aRR: 9.09; 95% confidence interval, CI: 6.72 to 12.30), death (aRR: 2.99; 95% CI: 1.54 to 5.78), greater disability (β: 0.83; 95% CI: 0.67 to 0.99) and poorer quality of life (β: −0.07; 95% CI: −0.07 to −0.06) at 6 months. Participants with probable depression had a lower mean quality-of-life score than those without (5.0 versus 6.0, respectively; P < 0.001) and a higher median disability score (22.0 versus 14.0, respectively; P < 0.001) at 6 months.

Conclusion

Untreated depression in people with tuberculosis was associated with worse treatment outcomes, poorer quality of life and greater disability. Health workers should be given the support needed to provide depression care for people with tuberculosis.

A Survey of Anxiety and Depressive Symptoms in Pulmonary Tuberculosis Patients With and Without Tracheobronchial Tuberculosis

Background and Objective: Anxiety/depression and tuberculosis are global public health problems. The incidence of psychiatric morbidities is high among tuberculosis patients. However, little is known about the prevalence of anxiety and depression among Chinese pulmonary tuberculosis (PTB) patients, especially those with tracheobronchial tuberculosis (TBTB). The goal of the present study was to explore the prevalence of and associated factors of anxiety and depressive symptoms among PTB patients with and without TBTB. Methods: A cross-sectional survey of PTB patients from three hospitals in Liaoning, China, was conducted using a structured questionnaire. Depression and anxiety were evaluated by using the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire-9 (PHQ-9). Results: According to HADS and PHQ-9, 17.73 and 18.13% of 1252 PTB patients, respectively, had significant depressive symptoms and based on HADS scale, 18.37% had significant anxiety symptoms. Approximately 70% of patients with probable depression also had significant anxiety symptoms, and vice versa, and 69.6% patients with anxiety symptoms were also diagnosed with probable depression in our study population. Dyspnea and TBTB were significantly associated with depressive symptoms. Other depressive symptoms-related factors included age, divorce, abnormal body mass index (BMI), and low income. Patients with lower incomes, symptoms of dyspnea, or a combination of ≥3 clinical symptoms had an increased risk of anxiety symptoms, while patients with occasional or frequent alcohol consumption had a reduced risk of anxiety symptoms. Conclusion: Depressive and anxiety symptoms are common among PTB patients, especially those with TBTB. Screening for depression and anxiety is essential for identifying patients who require further psychosocial assessment and support.

Depression comorbid with tuberculosis and its impact on health status: cross-sectional analysis of community-based data from 48 low- and middle-income countries

BACKGROUND

Depression in tuberculosis increases the risk for adverse health outcomes. However, little is known about comorbid depression and tuberculosis in the general population. Thus, we assessed the association between depression and tuberculosis, and the decrements in health status associated with this comorbidity in 48 low- and middle-income countries.

METHODS

Cross-sectional, community-based data from the World Health Survey on 242,952 individuals aged ≥ 18 years were analyzed. Based on the World Mental Health Survey version of the Composite International Diagnostic Interview, past 12-month depression was categorized into depressive episode, brief depressive episode, subsyndromal depression, and no depression. Health status across six domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort) was assessed. Multivariable logistic and linear regression analyses were performed to assess the associations.

RESULTS

The prevalence of depressive episode among those with and without tuberculosis was 23.7% and 6.8%, respectively (P < 0.001). Tuberculosis was associated with a 1.98 (95% CI 1.47-2.67), 1.75 (95% CI 1.26-2.42), and 3.68 (95% CI 3.01-4.50) times higher odds for subsyndromal depression, brief depressive episode, and depressive episode, respectively. Depressive episode co-occurring with tuberculosis was associated with significantly worse health status across all six domains compared to tuberculosis alone. Interaction analysis showed that depression significantly amplifies the association between TB and difficulties in self-care but not in other health domains.

CONCLUSIONS

Depression is highly prevalent in adults with tuberculosis, and is associated with worse health status compared to tuberculosis without depression. Public health efforts directed to the recognition and management of depression in people with tuberculosis may lead to better outcomes.

Alcohol use disorder and tuberculosis treatment: A longitudinal mixed method study in Thailand

OBJECTIVE

The relationship between tuberculosis (TB) treatment and alcohol use disorders over time is under-researched. The aim of this investigation was to study alcohol use and TB medication adherence and its predictors among TB patients over a period of 6 months.

METHODS

A longitudinal investigation was carried out with new TB and TB retreatment patients systematically selected from two hospitals and had screened positive for hazardous or harmful alcohol use in Sisaket Province in Thailand. Alcohol use disorders were measured with Alcohol Use Disorder Identification Test (AUDIT)-C at baseline, 3 months and 6 months.

RESULTS

Of the 295 TB patients who were screened with AUDIT-C, 72 (24.4%) tested positive for hazardous or harmful alcohol use. At 6 months, 72 TB patients had completed the follow-up. At the 6-month follow-up, hazardous or harmful drinking was reduced by 84.7%. Multivariate logistic regression analysis using generalised estimation equation modelling found that alcohol use significantly reduced over time, whereas there was no change in current tobacco use.

CONCLUSION

The prevalence of alcohol use disorders significantly reduced over a period of 6 months.

Health-Related Quality of Life, Depression and Anxiety in Hospitalized Patients with Tuberculosis

Background

Much of the attention of tuberculosis (TB) programs is focused on outcomes of microbiological cure and mortality, and health related quality of life (HRQL) is undervalued. Also, TB patients have a significantly higher risk of developing depression and anxiety compared with those in the general population. We intend to evaluate the HRQL and the prevalence of symptoms of depression and anxiety in hospitalized patients with TB.

Methods

Cross-sectional study in a tertiary care hospital in Brazil. Adult patients with pulmonary TB that were hospitalized during the study period were identified and invited to participate. HRQL was measured using the Medical Outcomes Study Short Form-36 (SF-36) version 2. Hospital Anxiety and Depression Scale (HADS) was used to record symptoms of anxiety and depression.

Results

Eighty-six patients were included in the analysis. The mean age of all patients was 44.6±15.4 years, 69.8% were male, and 53.5% were white. Thirty-two patients (37.2%) were human immunodeficiency virus positive. Twenty-seven patients (31.4%) met study criteria for depression (HADS depression score ≥11) and 33 (38.4%) had anxiety (HADS anxiety score ≥11). Scores on all domains of SF-36 were significantly lower than the Brazilian norm scores (p<0.001).

Conclusion

The present study shows that TB patients may have a poor HRQL. Additionally, we found a possible high prevalence of depression and anxiety in this population. Health care workers should be aware of these psychological disorders to enable a better management of these patients. The treatment of these comorbidities may be associated with better TB outcomes.

Prevalence and correlates of depressive symptoms in adult patients with pulmonary tuberculosis in the Southwest Region of Cameroon

BACKGROUND

Tuberculosis (TB) remains a global health challenge and depression is a significant contributor to the global burden of disease. Current evidence suggests that there is an association between depressive symptoms and TB, lower adherence to treatment, and increased morbidity and mortality. However, there is paucity of data regarding these associations in Cameroon. This study aimed to determine the prevalence and correlates of depression in adult patients with pulmonary TB (PTB) in the Southwest Region of Cameroon.

METHODS

A hospital-based cross-sectional study involving 265 patients with PTB was conducted from 2(nd) January to 31(st) March 2015 in the Limbe Regional Hospital and the Kumba District Hospital. Depression was diagnosed using the standard nine-item Patient Health Questionnaire, and classified as none, mild or moderate. Logistic regressions were used to investigate correlates of depression in these patients.

RESULTS

Of the 265 patients (mean age 36.9 ± 10 years) studied, 136 (51.3 %) were female. The prevalence of depression was 61.1 % (95 % CI: 55.1-66.8), with a significant proportion (36.6 %) having mild depression. Multivariable logistic regression analysis showed that being female (aOR = 3.0, 95 % CI (1.7-5.5), P < 0.001), having a family history of mental illness (aOR = 2.5, 95 % CI: 1.3-5.4, P > 0.05), being on retreatment for TB (aOR = 11.2, 95 % CI: 5.2-31.1, P < 0.001), having discontinued treatment (aOR = 8.2, 95 % CI: 1.1-23.3, P < 0.05) and having a HIV/TB co-infection (aOR = 2.5, 95 % CI: 1.2-6.5, P < 0.001) were factors associated with having a higher chance of being depressed.

CONCLUSION

Our study suggests that there is a high prevalence of depression among PTB patients, with more than one in two patients affected. Multidisciplinary care for TB patients involving mental health practitioners is highly encouraged, especially for high-risk groups.

Decline of common mental disorders over time in public primary care tuberculosis patients in South Africa

OBJECTIVE

The relationship between tuberculosis and common mental disorders over time is under researched. The aim of this investigation was to estimate the prevalence of common mental disorders and its predictors among tuberculosis patients over a period of six months.

METHODS

A longitudinal investigation was carried out with new tuberculosis and tuberculosis retreatment patients systematically selected from 40 primary health care facilities and had screened positive for hazardous or harmful alcohol use in South Africa. Common mental disorders were measured with the Kessler-10 scale and the Primary Care Posttraumatic Stress Disorder Screen at baseline and at six months.

RESULTS

At six months, 710 tuberculosis patients had completed the follow up. At baseline, 34.1% had severe psychological distress with a higher cut-off score (≥28), 81.1% had moderate psychological distress with a lower cut-off score (≥16), and 29.4% had posttraumatic stress disorder symptoms (two or more). At the six-month follow-up, severe psychological stress significantly reduced by 12.3%, moderate psychological distress reduced by 24.9%, and PTSD reduced by 20.0%. Multivariate logistic regression analysis using generalized estimation equation modeling across the three mental conditions found that moderate psychological distress and PTSD symptoms but not severe psychological distress significantly reduced over time. Having chronic conditions, including HIV, and sociodemographic factors (lower education and poverty) were associated with common mental disorders.

CONCLUSION

The prevalence of moderate psychological distress and posttraumatic stress disorder symptoms significantly reduced over a period of six months. Mental health services should be integrated into tuberculosis treatment programs.

Depressive Mood Among Within-Country Migrants in Periurban Shantytowns of Lima, Peru

In low- and middle-income countries, migration to urban settings has reshaped the sprawl and socio demographic profiles of major cities. Depressive episodes make up a large portion of the burden of disease worldwide and are related to socio-demographic disruptions. As a result of terrorism, political upheaval, followed by economic development, Peru has undergone major demographic transitions over the previous three decades including large migrations within the country. We aimed to determine the prevalence of current depressive mood and its relationship with parameters of internal migration, i.e. region of origin, age at migration, and years since migration. A community-wide census was carried out between January and June 2010 within a shantytown immigrant receiving community in Lima, Peru. One male or female adult per household completed a survey. Depressive mood was assessed with a 2-item Center for Epidemiologic Studies Depression (CESD) scale. Migration-related variables included place of birth, duration of residence in Lima, and age at migration. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were calculated. A total of 8,551 out of 9,561 participants, response rate 89%, participated in the census. Of these, 8,091 records were analyzed: 71.8% were women [average age 39.4 (SD 13.9 years)] and 59.3% were immigrants. The overall prevalence of individuals with current depressive mood was 17.1% (95% CI 16.2-17.9%) and varied significantly by all socio-demographic and migration variables assessed. On unadjusted analyses, immigrants to Lima had higher prevalence of depressive mood if they originated in other costal or Andean areas, had lived in Lima for more than 20 years, or were <30 years of age when they out-migrated. When controlling for age, gender and socio-demographic variables the association was no longer significant, the only exception being a 20% lower prevalence of current depressive mood among those who out-migrated aged ≥30 years old (PR = 0.79; 95% CI 0.63-0.98). In conclusion, these results suggest that current depressive mood is very prevalent in this immigrant receiving community. Among all proxies for internal migration explored, in fully adjusted models, there was evidence of an association between age at migration (≥30 years old) and a lower probability of current depressive mood compared to non-migrants.

The Risk of Depressive Disorder Among Contacts of Tuberculosis Patients in a TB-endemic Area: A Population-based Cohort Study

Tuberculosis (TB) disease may be transmitted to close contacts of index cases, causing physical illness. No studies have investigated the risk of developing depressive disorder among TB contacts in a TB-endemic area.Adult participants with a new diagnosis of TB contact (ICD-9-CM codes V01.1 plus chest radiographic order) since January 1, 2008, were identified from the National Health Insurance Research Database in Taiwan. A control cohort matched for age (±5 y), sex, enrolled years, and income level was selected. These 2 cohorts were followed until December 31, 2012, and observed for the development of depressive disorder. The Kaplan-Meier method and the log-rank test were used to examine the difference in cumulative incidences of depressive disorder between groups. Cox proportional-hazard models were used to calculate adjusted hazard ratios (aHRs) for depressive disorder.The TB contact cohort consisted of 9046 patients and matched controls of 36,184 ones. The mean age of TB contacts was 44.7 years, and 56.0% of them were women. During a mean follow-up period of 2.5 years, 127 (1.40%) TB contacts and 521 (1.44%) matched controls developed depressive disorder. TB exposure was found to be an independent risk factor of depressive disorder in women (aHR 1.34, 95% confidence interval [CI] 1.07-1.68), but not in men (aHR 0.71, 95% CI 0.48-1.06) after adjusting for age, comorbidities, and income levels. The risk of depression was significantly higher for female TB contacts than for matched controls in the first and second years (aHR 1.49, 95% CI 1.03-2.14; and aHR 1.53, 95% CI 1.05-2.23, respectively), but not thereafter. Of note, 67 (0.74%) TB contacts and 88 (0.24%) matched controls developed active TB, but none of them had subsequent depressive disorder during follow-up periods.Female TB contacts had an increased risk of depression within the first 2 years after exposure. Clinicians should consider conducting depression evaluations in addition to routine TB contact investigations in this subgroup population.

Psychological distress and its relationship with non-adherence to TB treatment: a multicentre study

BACKGROUND

The successful cure of tuberculosis (TB) is dependent on adherence to treatment. Various factors influence adherence, however, few are easily modifiable. There are limited data regarding correlates of psychological distress and their association with non-adherence to anti-TB treatment.

METHODS

In a trial of a new TB test, we measured psychological distress (K-10 score), TB-related health literacy, and morbidity (TBscore), prior to diagnosis in 1502 patients with symptoms of pulmonary TB recruited from clinics in Cape Town (n = 419), Harare (n = 400), Lusaka (n = 400), Durban (n = 200), and Mbeya (n = 83). Socioeconomic, demographic, and alcohol usage-related data were captured. Patients initiated on treatment had their DOTS cards reviewed at two-and six-months.

RESULTS

22 %(95 % CI: 20 %, 25 %) of patients had severe psychological distress (K-10 ≥ 30). In a multivariable linear regression model, increased K-10 score was independently associated with previous TB [estimate (95 % CI) 0.98(0.09-1.87); p = 0.0304], increased TBscore [1(0.80, 1.20); p <0.0001], and heavy alcohol use [3.08(1.26, 4.91); p = 0.0010], whereas male gender was protective [-1.47(-2.28, -0.62); p = 0.0007]. 26 % (95 % CI: 21 %, 32 %) of 261 patients with culture-confirmed TB were non-adherent. In a multivariable logistic regression model for non-adherence, reduced TBscore [OR (95 % CI) 0.639 (0.497, 0.797); p = 0.0001], health literacy score [0.798(0.696, 0.906); p = 0.0008], and increased K-10 [1.082(1.033, 1.137); p = 0.0012], and heavy alcohol usage [14.83(2.083, 122.9); p = 0.0002], were independently associated. Culture-positive patients with a K-10 score ≥ 30 were more-likely to be non-adherent (OR = 2.290(1.033-5.126); p = 0.0416].

CONCLUSION

Severe psychological distress is frequent amongst TB patients in Southern Africa. Targeted interventions to alleviate psychological distress, alcohol use, and improve health literacy in newly-diagnosed TB patients could reduce non-adherence to treatment.

HIV, multidrug-resistant TB and depressive symptoms: when three conditions collide

Background

Management of multidrug-resistant TB (MDR-TB) patients co-infected with human immunodeficiency virus (HIV) is highly challenging. Such patients are subject to long and potentially toxic treatments and may develop a number of different psychiatric illnesses such as anxiety and depressive disorders. A mental health assessment before MDR-TB treatment initiation may assist in early diagnosis and better management of psychiatric illnesses in patients already having two stigmatising and debilitating diseases.

Objective

To address limited evidence on the baseline psychiatric conditions of HIV-infected MDR-TB patients, we aimed to document the levels of depressive symptoms at baseline, and any alteration following individualized clinical and psychological support during MDR-TB therapy, using the Patient Health Questionnaire-9 (PHQ-9) tool, among HIV-infected patients.

Design

This was a retrospective review of the medical records of an adult (aged >15 years) HIV/MDR-TB cohort registered for care during the period of August 2012 through to March 2014.

Results

A total of 45 HIV/MDR-TB patients underwent baseline assessment using the PHQ-9 tool, and seven (16%) were found to have depressive symptoms. Of these, four patients had moderate to severe depressive symptoms. Individualized psychological and clinical support was administered to these patients. Reassessments were carried out for all patients after 3 months of follow-up, except one, who died during the period. Among these 44 patients, three with baseline depressive symptoms still had depressive symptoms. However, improvements were observed in all but one after 3 months of follow-up.

Conclusion

Psychiatric illnesses, including depressive symptoms, during MDR-TB treatment demand attention. Routine administration of baseline mental health assessments by trained staff has the potential to assist in determining appropriate measures for the management of depressive symptoms during MDR-TB treatment, and help in improving overall treatment outcomes. We recommend regular monitoring of mental health status by trained counsellors or clinical staff, using simple, validated and cost-effective tools.