Psychological distress and its effect on tuberculosis treatment outcomes in Ethiopia

Abstract

BackgroundPsychological distress is the major comorbidity among tuberculosis (TB) patients. However, its magnitude, associated factors, and effect on treatment outcome have not been adequately studied in low-income countries.ObjectiveThis study aimed to determine the magnitude of psychological distress and its effect on treatment outcome among TB patients on treatment.DesignA follow-up study was conducted in Addis Ababa, Ethiopia, from May to December 2014. Patients (N=330) diagnosed with all types of TB who had been on treatment for 1–2 months were enrolled consecutively from 15 randomly selected health centers and one TB specialized hospital. Data on sociodemographic variables and economic status were collected using a structured questionnaire. The presence of psychological distress was assessed at baseline (within 1–2 months after treatment initiation) and end point (6 months after treatment initiation) using the 10-item Kessler (K-10) scale. Alcohol use and tobacco smoking history were assessed using WHO Alcohol Use Disorder Identification Test and Australian Smoking Assessment Checklist, respectively. The current WHO TB treatment outcome definition was used to differentiate the end result of each patient at completion of the treatment.ResultsThe overall psychological distress was 67.6% at 1–2 months and 48.5% at 6 months after treatment initiation. Multiple logistic regression analysis revealed that past TB treatment history [adjusted odds ratio (AOR): 3.76; 95% confidence interval (CI): 1.67–8.45], being on anti-TB and anti-HIV treatments (AOR: 5.35; 95% CI: 1.83–15.65), being unmarried (AOR: 4.29; 95% CI: 2.45–7.53), having alcohol use disorder (AOR: 2.95; 95% CI: 1.25–6.99), and having low economic status (AOR: 4.41; 95% CI: 2.44–7.97) were significantly associated with psychological distress at baseline. However, at 6 months after treatment initiation, only being a multidrug-resistant tuberculosis (MDR-TB) patient (AOR: 3.02; 95% CI: 1.17–7.75) and having low economic status (AOR: 3.75; 95% CI: 2.08–6.74) were able to predict psychological distress significantly. Past TB treatment history (AOR: 2.13; 95% CI: 1.10–4.12), employment status (AOR: 2.06; 95% CI: 1.06–7.00), and existence of psychological distress symptoms at 6 months after treatment initiation (AOR: 2.87; 95% CI: 1.05–7.81) were found to be associated with treatment outcome.ConclusionsThe overall magnitude of psychological distress was high across the follow-up period; this was more pronounced at baseline. At baseline, past TB treatment history, being on anti-TB and anti-HIV treatments, being unmarried, and having symptoms of alcohol use disorder were associated with psychological distress. However, both at baseline and end point, low economic status was associated with psychological distress. Screening and treatment of psychological distress among TB patients across the whole treatment period is needed, and focusing more on patients who have been economically deprived, previously treated for TB, and on MDR-TB treatment are important.

Perceived stigma and depression in initially diagnosed pulmonary tuberculosis patients

“…Most of the patients in this study were males older than 60 years, with lower incomes and education, and unemployed. These patient characteristics are similar to those reported in previous international articles (Beck et al., ; Tola et al., ; Virenfeldt et al., ; Wang et al., ; WHO, , Wu et al., ; Xiao, Zhou, Jiang, Zhao, & Xu, ), with the exception that patients in Kibrisli et al. 's () and Nikbakht et al.…”

“…() and Tola et al. (), who found a 44%–67.6% rate of depression among patients, of whom 65.2% were over 35 years old. The current study also showed no significant statistical correlation between demographic characteristics (gender, age, income, education, comorbidities) and depression, which is different from the results reported by Issa, Yussuf, and Kuranga () and Peltzer et al.…”

HIV-Related Stigma, Social Support, and Psychological Distress Among Individuals Initiating ART in Ethiopia

“…All analyses accounted for clustering by health facility using surveylogistic options of SAS Version 9.3. Based on previous literature, adjusted analyses controlled a priori for age, sex, relationship status, and time since HIV diagnosis (31, 32). Because internalized stigma was highly correlated with anticipated (rho = 0.422, p<0.0001) and enacted stigma (rho = 0.196; p < 0.0001), multivariable regression models were run separately to examine the relationship between each type of HIV-related stigma and psychological distress.…”

Perceived Stress and Its Relationship With Chronic Medical Conditions and Multimorbidity Among 229,293 Community-Dwelling Adults in 44 Low- and Middle-Income Countries

“…Chronic conditions may cause stress as a consequence of their symptoms, longterm prognosis, and other related issues such as treatment and its costs. Among people with chronic conditions, such as asthma, arthritis or diabetes, stress can intensify the effect of illness by increasing pain, functional limitations, and disability and decreasing adherence to medical treatment protocols, all of which may lead to psychological distress (i.e., a state of emotional suffering characterized by symptoms of depression and anxiety (10)), poorer health outcomes as well as increased risks of severe and chronic psychiatric and somatic complications (11)(12)(13). Moreover, perceived stress contributes significantly to higher mortality rates in a dose-response pattern (14), with even more stress-associated deaths evident among people with multimorbidity (15).…”