The relationship between mental health and risk of active tuberculosis: a systematic review

Abstract

ObjectivesTuberculosis (TB) and mental illnesses are highly prevalent globally and often coexist. While poor mental health is known to modulate immune function, whether mental disorders play a causal role in TB incidence is unknown. This systematic review examines the association between mental health and TB disease risk to inform clinical and public health measures.DesignSystematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.Search strategy and selection criteriaMEDLINE, PsycINFO and PsycEXTRA databases were searched alongside reference list and citation searching. Inclusion criteria were original research studies published 1 January 1970–11 May 2020 reporting data on the association between mental health and TB risk.Data extraction, appraisal and synthesisData were extracted on study design and setting, sample characteristics, measurement of mental illness and TB, and outcomes including effect size or prevalence. Studies were critically appraised using Critical Appraisal Skills Programme (CASP) and Appraisal Tool for Cross-Sectional Studies (AXIS) checklists.Results1546 records published over 50 years were screened, resulting in 10 studies included reporting data from 607 184 individuals. Studies span across Asia, South America and Africa, and include mood and psychotic disorders. There is robust evidence from cohort studies in Asia demonstrating that depression and schizophrenia can increase risk of active TB, with effect estimates ranging from HR=1.15 (95% CI 1.03 to 1.28) to 2.63 (95% CI 1.74 to 3.96) for depression and HR=1.52 (95% CI 1.29 to 1.79) to RR=3.04 for schizophrenia. These data align with evidence from cross-sectional studies, for example, a large survey across low-income and middle-income countries (n=242 952) reports OR=3.68 (95% CI 3.01 to 4.50) for a depressive episode in those with TB symptoms versus those without.ConclusionsIndividuals with mental illnesses including depression and schizophrenia experience increased TB incidence and represent a high-risk population to target for screening and treatment. Integrated care for mental health and TB is needed, and interventions tackling mental illnesses and underlying drivers may help reduce TB incidence globally.PROSPERO registration numberCRD42019158071.

Characteristics of Comorbid Physical Disease in Patients with Severe Mental Illness in South Korea: A Nationwide Population-Based Study (2014-2019)

“…According to the results, schizophrenia increases the risk of active tuberculosis, ranging from HR = 1.52 (95% CI: 1.29-1.79) to RR = 3.04 [39,47]. Considering that these results are from an Asian cohort study, it is likely that the risk of tuberculosis itself is higher in Asia, consistent with the results of this study.…”

Social Support and Depression Among Pulmonary Tuberculosis Patients in Anhui, China

“… 40 In summary, the association between pulmonary TB and mental disorders may be bidirectional. 41 , 42 …”

Characteristics and outcomes of in-hospital patients with Covid-19 and history of tuberculosis: A matched Case-Control from the Brazilian Covid-19 Registry

“…The rate of psychiatric diseases at baseline was also higher in patients with history of TB when compared to control (10% vs 3.5%, p=0.034). Despite the fact that the role of psychiatric diseases as a risk factor for developing TB is still under debate, schizophrenia and depression have shown to be possible risk factors for its development [29]. Both diseases share a strong relationship with social determinants, such as homelessness and poverty [29].…”

“…Despite the fact that the role of psychiatric diseases as a risk factor for developing TB is still under debate, schizophrenia and depression have shown to be possible risk factors for its development [29]. Both diseases share a strong relationship with social determinants, such as homelessness and poverty [29]. Unfortunately, our data did not retrieve social and economic variables to try to explore these issues in Covid-19 patients and those with a history of TB, but the association between psychiatric diseases and TB can reinforce that theory.…”