ABSTRACT
BACKGROUND: Depression is common among persons with TB and is associated with poor clinical outcomes. However, little is known about the relationship between latent TB infection (LTBI) and depression. We assessed the association between LTBI and depressive symptoms among household contacts (HHCs) of patients receiving TB treatment.METHODS: We enrolled 1,009 HHCs of 307 patients receiving TB treatment in Lima, Peru, during 2016-2018. At enrollment, HHC LTBI status was assessed using the interferon-gamma release assay (IGRA). Depressive symptoms were assessed at baseline and 12 months later using the Patient Health Questionnaire-9 (PHQ-9) with a cut-off of
Subject(s)
Latent Tuberculosis , Tuberculosis , Humans , Depression/diagnosis , Depression/epidemiology , Latent Tuberculosis/diagnosis , Latent Tuberculosis/epidemiology , Interferon-gamma Release Tests , Odds RatioABSTRACT
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.
Subject(s)
Mental Disorders , Substance-Related Disorders , Tuberculosis , Humans , Mental Disorders/epidemiology , Odds Ratio , Treatment Outcome , Tuberculosis/drug therapyABSTRACT
INTRODUCTION: When tuberculosis (TB) and depression co-occur, there is greater risk for comorbidities, disability, suffering, and health-related costs. Depression is also associated with poor treatment adherence in patients with TB. The major aim of this study was to assess the symptoms of depression and associated factors among TB patients currently receiving directly observed treatment short-course (DOTS) treatment. METHODS: A cross-sectional study was conducted among TB patients currently undergoing treatment in 27 DOTS centers in three districts of Kathmandu Valley. The study included 250 TB patients within 2 months of treatment initiation, aged 18 years and above. The previously validated Nepali Patient Health Questionnaire (PHQ-9) was used to screen for depression and semi-structured interviews were conducted to collect socio-demographic information and other factors related to TB and/or depression. Data analysis was conducted using IBM SPSS Statistics version 20. RESULTS: The study found the mean PHQ Score to be 2.84 (s.d. 4.92, range 0-25). Among the respondents, 10% (n = 25) had PHQ-9 scores ⩾10, suggestive of probable depression. Multivariate linear regression indicated that depressive symptoms were significantly associated with being separated/widowed/divorced (p = 0.000) and having lower education (0.003). In addition, smoking (p = 0.02), alcohol use (p = 0.001), and experience of side effects from TB medications (p = 0.001) were risk factors for higher PHQ-9 scores. CONCLUSIONS: Our findings suggest that patients on TB treatment have higher risk of depression and efforts should be made by the National Tuberculosis Program to address this issue.
ABSTRACT
Subject(s)
Delivery of Health Care/organization & administration , Mental Disorders/therapy , Mental Health Services/organization & administration , Tuberculosis/therapy , Cross-Sectional Studies , Delivery of Health Care/statistics & numerical data , Global Health , HIV Infections/epidemiology , Humans , Incidence , Mass Screening/statistics & numerical data , Mental Health Services/statistics & numerical data , Practice Guidelines as Topic , Social Stigma , Substance-Related Disorders/therapy , Surveys and Questionnaires , Tuberculosis/psychology , Tuberculosis, Multidrug-Resistant/psychology , Tuberculosis, Multidrug-Resistant/therapyABSTRACT
Tuberculosis (TB) and depression act synergistically via social, behavioral, and biological mechanisms to magnify the burden of disease. Clinical depression is a common, under-recognized, yet treatable condition that, if comorbid with TB, is associated with increased morbidity, mortality, community TB transmission, and drug resistance. Depression may increase risk of TB reactivation, contribute to disease progression, and/or inhibit the physiological response to anti-tuberculosis treatment because of poverty, undernutrition, immunosuppression, and/or negative coping behaviors, including substance abuse. Tuberculous infection and/or disease reactivation may precipitate depression as a result of the inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Clinical depression may also be triggered by TB-related stigma, exacerbating other underlying social vulnerabilities, and/or may be attributed to the side effects of anti-tuberculosis treatment. Depression may negatively impact health behaviors such as diet, health care seeking, medication adherence, and/or treatment completion, posing a significant challenge for global TB elimination. As several of the core symptoms of TB and depression overlap, depression often goes unrecognized in individuals with active TB, or is dismissed as a normative reaction to situational stress. We used evidence to reframe TB and depression comorbidity as the 'TB-depression syndemic', and identified critical research gaps to further elucidate the underlying mechanisms. The World Health Organization's Global End TB Strategy calls for integrated patient-centered care and prevention linked to social protection and innovative research. It will require multidisciplinary approaches that consider conditions such as TB and depression together, rather than as separate problems and diseases, to end the global TB epidemic.
Subject(s)
Antitubercular Agents/therapeutic use , Depression/epidemiology , Tuberculosis/psychology , Antitubercular Agents/administration & dosage , Antitubercular Agents/adverse effects , Cost of Illness , Depression/complications , Disease Progression , Drug Resistance, Bacterial , Health Behavior , Humans , Medication Adherence/psychology , Patient-Centered Care/organization & administration , Social Stigma , Tuberculosis/drug therapy , Tuberculosis/epidemiologyABSTRACT
This detailed case history traces the first 5 years of a psychosocial support group intervention aimed to improve adherence to individualized drug regimens for multidrug-resistant tuberculosis (MDR-TB) in Peru. A total of eight groups were established in metropolitan Lima and two provinces of Peru led by teams of psychiatrists and nurses. The intervention consisted of bi-monthly support groups, recreational excursions, symbolic celebrations, and periodic family workshops. Notably, of the 285 patients who participated in this intervention, only 3.5% defaulted from treatment. Details include the description of services, patient data, major psychosocial difficulties faced by this population, key challenges, and implications. Psychosocial support is a crucial component of treatment for MDR-TB in order to ensure completion of complicated treatment regimens and enable psychosocial rehabilitation after treatment.
Subject(s)
Drug Resistance, Multiple, Bacterial , Social Support , Tuberculosis, Multidrug-Resistant , Adolescent , Adult , Aged , Child , Female , Focus Groups , Humans , Male , Middle Aged , Peru , Young AdultABSTRACT
INTRODUCTION: Psychiatric issues present a challenge in the treatment of patients with multidrug-resistant tuberculosis (MDR-TB). Both baseline psychiatric disorders and development of psychiatric complications related to anti-tuberculosis drugs and psychosocial factors require aggressive management. SETTING: A community-based non-governmental health organization in Lima, Peru. OBJECTIVE: To review the literature for psychiatric complications associated with anti-tuberculosis medications, to describe the incidence and prevalence of depression, anxiety and psychosis among individuals receiving MDR-TB therapy, and to detail the management approach used in this cohort. METHODS: A retrospective case series was performed among the first 75 patients to receive individualized MDR-TB therapy in Lima, Peru, between 1996 and 1999. RESULTS: Baseline depression and baseline anxiety were observed in respectively 52.2% and 8.7% of this cohort. Most individuals with baseline depression experienced improvement of depressive symptoms during the course of TB therapy. The incidence of depression, anxiety and psychosis during MDR-TB treatment was 13.3%, 12.0% and 12.0%, respectively. While the majority of individuals with depression, anxiety and psychosis required psychiatric pharmacotherapy, cycloserine was successfully continued in all but one case. CONCLUSION: Psychiatric comorbidities are not a contra-indication to MDR-TB therapy. Management of psychiatric complications is possible without compromising anti-tuberculosis treatment.