Depression among multidrug-resistant tuberculosis patients in Punjab, Pakistan: a large cross-sectional study

Walker, Ian; Khan, Ahmar M.; Khan, Amir Mohammad; Khan, Nashmia; Ayub, Romana; Ghias, Kulsoom; Walley, John

doi:10.5588/ijtld.17.0788

Cited by 29 publications

(36 citation statements)

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“…The prevalence of depression among this patient group is much higher than that found in the general Bangladesh population, estimated at 4.1% [30]. Our findings are similar to those from a recent assessment of MDR-TB patients in Pakistan using the PHQ-9 screening tool where 42.8% (95% CI: 40.1, 45.5) were found to be depressed at the lower cut-off of 6, and 16.2% (95% CI: 14.3, 18.3) at a cut-off of 10 on the PHQ-9 [5]. An area for further exploration is the extent to which patients continue to experience depression even after successful treatment for their TB, as indicated within our qualitative findings, particularly in relation to the changes in their family and social situation, occupation and experiences of stigma and self-worth.…”

Section: Discussionsupporting

confidence: 87%

“…There is a growing body of evidence of the prevalence of mental ill-health among those with MDR-TB. A recent large cross-sectional study of 1279 MDR-TB patients in routine care in Pakistan found 42.8% (95% CI 40.1; 45.5) to be depressed [5]. Smaller studies have found a range of levels of depression, including 16% among MDR-TB patients with co-morbid HIV infection in India [6] to 52% depressed at baseline and 13% incident cases during treatment in a review of 75 patients' case notes following screening for psychiatric disorders in Peru [7].…”

Section: Introductionmentioning

confidence: 99%

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“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

et al. 2020

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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.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

“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

et al. 2020

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“…Given that our study was powered to identify the prevalence of depression to a modest precision only and not to identify correlates of depression these results are strictly exploratory, and it is very unlikely that we have identi ed all important variables that are associated with depression in this patient group. The assessment of depression in the Pakistan MDR-TB population did not nd signi cant associations with new as opposed to previously treated cases or co-morbidity (5).…”

Section: Discussionmentioning

confidence: 65%

“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.

Huque

Elsey

Fieroze

et al. 2020

Preprint

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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 is 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 in-patients (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, socio-economic status and home location. Conclusions Patients with multi-drug resistant tuberculosis are at high risk of depression, particularly those with co- and multi-morbidities. Screening for depression and psycho-social support should be integrated within routine TB services and provided throughout treatment.

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“…Given that our study was powered to identify the prevalence of depression to a modest precision only and not to identify correlates of depression these results are strictly exploratory, and it is very unlikely that we have identified all important variables that are associated with depression in this patient group. The assessment of depression in the Pakistan MDR-TB population did not find significant associations with new as opposed to previously treated cases or co-morbidity (5).…”

Section: Discussionmentioning

confidence: 67%

“…There is a growing body of evidence of the prevalence of mental ill-health among MDR-TB. A recent large cross-sectional study of 1279 MDR-TB patients in routine care in Pakistan found 42.8% (95% CI 40.1; 45.5) to be depressed (5). Smaller studies have found a range of levels of depression, including 16% among MDR-TB patients with co-morbid HIV infection in India (6) to 52% depressed at baseline and 13% incident cases during treatment in a review of 75 patients' case notes following screening for psychiatric disorders in Peru (7).…”

mentioning

confidence: 99%

“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.

Huque

Elsey

Fieroze

et al. 2020

Preprint

View full text Add to dashboard Cite

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 in-patients (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, socio-economic status and home location. Conclusions: Patients with multi-drug resistant tuberculosis are at high risk of depression, particularly those with co- and multi-morbidities. Screening for depression and psycho-social support should be integrated within routine TB services and provided throughout treatment.

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Depression among multidrug-resistant tuberculosis patients in Punjab, Pakistan: a large cross-sectional study

Abstract: Depression is common in MDR-TB patients, and should be screened for and treated within MDR-TB treatment programmes.

Cited by 29 publications

References 0 publications

“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

“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

“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.

“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.

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