“Death is a better option than being treated like this”: a prevalence survey and qualitative study of depression among multi-drug resistant tuberculosis in-patients

Abstract

Background: Understanding of the relationship between multi-drug resistant tuberculosis and mental health is limited. With growing prevalence of multi-drug resistant tuberculosis, addressing mental ill-health has potential to improve treatment outcomes and well-being. In several low and middle-income contexts hospitalisation during treatment is common. Understanding of the impact on mental ill-health are required to inform interventions for patients with multi-drug resistant tuberculosis. Our aim was to identify the prevalence of comorbid depression among in-patients being treated for multi-drug resistant tuberculosis and to explore their experiences of comorbid disease and the care they received in a large specialist chest hospital in Dhaka, Bangladesh. Methods: We conducted a quantitative cross-sectional survey among 150 multi-drug resistant tuberculosis inpatients (new cases = 34%, previously treated = 66%) in 2018. A psychiatrist assessed depression was assessed with the Structured Clinical Interview for Depression (SCID DSM-IV). We used multi-level modelling to identify associations with depression. Experience Bangladeshi researchers conducted qualitative interviews with 8 patients, 4 carers, 4 health professionals and reflective notes recorded. Qualitative data was analysed thematically. Results: We found 33.8% (95% CI 26.7%; 41.7%) of patients were depressed. While more women were depressed 39.3% (95% CI 27.6%; 52.4%) than men 30.4% (95% CI 22%; 40.5%) this was not significant. After controlling for key variables only having one or more co-morbidity (adjusted odds ratio [AOR] = 2.88 [95% CI 1.13; 7.33]) and being a new rather than previously treated case (AOR = 2.33 [95% CI 1.06; 5.14]) were associated (positively) with depression. Qualitative data highlighted the isolation and despair felt by patients who described a service predominantly focused on providing medicines. Individual, familial, societal and health-care factors influenced resilience, nuanced by gender, socioeconomic status and home location.

Between Curing and Torturing: Burden of Adverse Reaction in Drug-Resistant Tuberculosis Therapy

“…Otherwise, in DR-TB therapy, the existing therapeutics regimen was shown to be extremely burdensome for most patients owing to ADR. 36 , 39 , 45 Some studies reported that ADR more likely reduced HR-QoL. 20 , 22 ADR is included in the burden of medicine, a term that refers to workloads that are withstood by a person who undergoes therapy and can affect their QoL, especially in a long-term therapy.…”

“…Qualitative data indicated that the majority of patients feel depressed owing to side effects. 45 Another study revealed that the side effects were the most significant factors of depression among MDR-TB patients (aOR 20.7, 95% CI 1.2–355.7). 44 Patients were often depressed.…”

“… 44 Patients were often depressed. 45 Some patients felt that their lives were only about disease and treatment. 40 Patients were very tortured and even some of them said that they would rather die than experience this type of terrible feeling.…”

“… 46 The worthless feeling and disability also made them feel depressed. 45 Furthermore, psychiatric disorders were included in the major ADR of some drugs. A prior study reported that it occurred in 13.2% of patients.…”

“… 48 Depression and other mental problems as a consequence of DR-TB therapy may exacerbate non-adherences. 45 …”