The prevalence of depression among patients with tuberculosis: a systematic review and meta-analysis

Abstract

Background: Evidence has shown that the prevalence of depression is much higher among patients with tuberculosis (TB) and this, in turn, may adversely impact compliance with anti-TB medications. Therefore, this systematic review and meta-analysis aimed to quantitatively summarize epidemiologic evidence on the prevalence of depression among patients with TB and formulate a recommendation for future clinical practice as well as research. Methods: We followed the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines to conduct this review. We searched PubMed, EMBASE, SCOPUS and Psych INFO to identify relevant studies that investigated the prevalence of depression among TB patients. We also supplemented our electronic search with manual searching to include all pertinent studies in the analysis. We used a Comprehensive Meta-Analysis software version 3.0 (CMA 3.0) to conduct a meta-analysis. We conducted a subgroup and sensitivity analysis and Cochran's Q-and the I 2-statistics were used to assess heterogeneity. The evidence for the presence of publication bias was checked by using Egger's test and visual inspection of the symmetry in funnel plots. Results: We identified a total of 25 studies that included 4903 participants across seven countries. In our analysis, the pooled estimated prevalence of depression among TB patients was found to be 45.19% (95% CI 38.04-52.55). The prevalence was higher in MDR-TB 52.34% (95% CI 38.09-66.22) than non-MDR-TB 43.47% (95% CI 35.88-51.37) patients. We also found that the pooled prevalence of depression was higher among females 51.54% (95% CI 40.34-62.60) when compared to males 45.25% (95% CI 35.19-55.71). The pooled prevalence of depression was 45.45% as measured by HRDS, and it was 55.62%, 45.52%, and 38.36% as measured by BDI, HADS and PHQ-9, respectively. Conclusion: Our finding suggested that the pooled estimated prevalence of depression among tuberculosis patients was relatively high. Screening and management of depression among TB patients were warranted to alleviate suffering. Moreover, the integration of tuberculosis program with regular psychiatry services may substantially reduce the burden.

Operational research as an instrument to address the critical gaps for effective treatment of tuberculosis in eastern Europe and central Asia

“…A rare study on mental health and TB from Romania, "Depression and anxiety symptoms among people with rifampicinresistant tuberculosis receiving inpatient care in the National Pulmonology Reference Institute in Romania", reveals the high prevalence (46%) of depression and anxiety among MDR/RR-TB patients, which is comparable with evidence from other studies [26]. An additional research is needed to determine correlation between the prevalence of depression, anxiety and treatment outcomes.…”

Depression and anxiety symptoms among people with rifampicin-resistant tuberculosis receiving in-patient care in the National Pulmonology Reference Institute in Romania

“…The prevalence estimate is comparable to other studies. In a meta-analysis of 4,903 patients with TB from seven countries, pooled estimated prevalence of depression was 45% (95% CI 38.04-52.55), with higher prevalence among MDR-TB 52.34% (95% CI 38.09-66.22) patients [18]. Other observational studies report the prevalence of depression and depressive symptoms ranging from 19-65% [13][14][15][16][17].…”

“…Among them two were conducted in Romania and the reported prevalence of depression among hospitalized TB patients was 38.9% [15] and 65% [17]. Results of a meta-analysis study showed that among TB patients the pooled estimated prevalence of depression is 45% [ (18]. The prevalence of depression is higher among RR/MDR-TB patients [19].…”

A qualitative Study of TB Health Workers’ and Stakeholders’ Conceptualisation, Screening and Treatment of Mental Distress Experienced by TB Patients in Zambia

“…The literature points to varying prevalence rates of depression amongst TB patients. A global metaanalysis that aimed to quantitatively summarize the prevalence of depression among TB patients found a pooled estimate of 49.2% from 25 studies (10). 8 of 25 studies in the meta-analysis were from sub-Saharan Africa, namely Nigeria, Cameroon, and Ethiopia, which like Zambia have high TB burdens.…”