Depression among patients with tuberculosis: determinants, course and impact on pathways to care and treatment outcomes in a primary care setting in southern Ethiopia—a study protocol

Ambaw, Fentie; Mayston, Rosie; Hanlon, Charlotte; Alem, Atalay

doi:10.1136/bmjopen-2015-007653

Cited by 57 publications

(76 citation statements)

References 35 publications

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“…Secondary outcome variables were quality of life, disability, and pathways to TB care. Control variables included socio-demographic variables, substance use, perceived social support, perceived cause of TB, perceived barriers to modern TB care, stigma related to TB, and perceived severity of TB (Ambaw et al ., 2015). …”

Section: Methodsmentioning

confidence: 99%

Is depression associated with pathways to care and diagnosis delay in people with tuberculosis in Ethiopia?

et al. 2019

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Background.Co-morbid depression is common in people with tuberculosis (TB). Symptoms of depression (low energy, impaired concentration, decreased motivation and hopelessness) may affect help-seeking; however, this impact has not been studied so far. The objectives of this study were to assess the impact of co-morbid depression on diagnostic delay, pathways to care, and to identify if it mediates other factors associated with diagnostic delay.Methods.We analyzed cross-sectional data collected from 592 adults with newly diagnosed TB. We assessed probable depression using Patient Health Questionnaire, nine items (PHQ-9) at a cut-off 10. Data on diagnosis delay, pathways to TB care, socio-demographic variables, stigma, types of TB, substance use, co-morbid chronic illnesses, and perception about TB were assessed using a structured questionnaire. Generalized structural equation modelling was used to analyze the data.Results.A total of 313 (52.9%) participants had probable depression. Pathway to TB care was direct for 512 (86.5%) of the participants and indirect for 80 (13.5%) of them. The median diagnosis delay was 12.0 weeks. Depression did not have a statistically significant association with pathways to TB care (β = −0.45; 95% CI−1.85 to 0.96) or diagnostic delay [adjusted odds ratio (AOR) = 0.90; 0.77–1.06]. Indirect pathway to TB care was positively associated with diagnosis delay (AOR = 2.72; 95% CI 1.25–5.91).Conclusions.People with TB who had co-morbid probable depression visited the modern health care as directly as and as soon as those without co-morbid depression. How socio-demographic factors influence pathways to care and diagnosis delay require qualitative exploration.

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Section: Methodsmentioning

confidence: 99%

Is depression associated with pathways to care and diagnosis delay in people with tuberculosis in Ethiopia?

et al. 2019

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“…80 A prospective cohort study is underway in Ethiopia to assess the prevalence of depression among individuals with TB, and the evolution of symptoms over time, and to explore the associations with negative TB outcomes. 81 Although not a trial, that study is being conducted in health settings that have trained nurses to follow the WHO’s Mental Health Action Program (mhGAP) guidelines 82 for the treatment of depression, and psychotropic medications are given to patients free of charge; these activities will be systematically tracked. 81 …”

Section: Responding To the Tuberculosis–depression Syndemicmentioning

confidence: 99%

“…81 Although not a trial, that study is being conducted in health settings that have trained nurses to follow the WHO’s Mental Health Action Program (mhGAP) guidelines 82 for the treatment of depression, and psychotropic medications are given to patients free of charge; these activities will be systematically tracked. 81 …”

Section: Responding To the Tuberculosis–depression Syndemicmentioning

confidence: 99%

Addressing the tuberculosis–depression syndemic to end the tuberculosis epidemic

Sweetland

Kritski

Oquendo

et al. 2017

int j tuberc lung dis

126

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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.

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“…Both tuberculosis and depression share common risk factors, which explain the high prevalence of their comorbidity, reported to range from 10-52% [11][12][13]. Their interaction is complex since one disease might contribute to the development of the other.…”

Section: Introductionmentioning

confidence: 99%

Association Between Tuberculosis and Depression on Negative Outcomes of Tuberculosis Treatment: A Systematic Review and Meta-Analysis

Ruíz-Grosso

Cachay

Flor

et al. 2019

Preprint

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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.

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Depression among patients with tuberculosis: determinants, course and impact on pathways to care and treatment outcomes in a primary care setting in southern Ethiopia—a study protocol

Cited by 57 publications

References 35 publications

Is depression associated with pathways to care and diagnosis delay in people with tuberculosis in Ethiopia?

Is depression associated with pathways to care and diagnosis delay in people with tuberculosis in Ethiopia?

Addressing the tuberculosis–depression syndemic to end the tuberculosis epidemic

Association Between Tuberculosis and Depression on Negative Outcomes of Tuberculosis Treatment: A Systematic Review and Meta-Analysis

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