The Risk of Depressive Disorder Among Contacts of Tuberculosis Patients in a TB-endemic Area

Abstract

Tuberculosis (TB) disease may be transmitted to close contacts of index cases, causing physical illness. No studies have investigated the risk of developing depressive disorder among TB contacts in a TB-endemic area.Adult participants with a new diagnosis of TB contact (ICD-9-CM codes V01.1 plus chest radiographic order) since January 1, 2008, were identified from the National Health Insurance Research Database in Taiwan. A control cohort matched for age (±5 y), sex, enrolled years, and income level was selected. These 2 cohorts were followed until December 31, 2012, and observed for the development of depressive disorder. The Kaplan-Meier method and the log-rank test were used to examine the difference in cumulative incidences of depressive disorder between groups. Cox proportional-hazard models were used to calculate adjusted hazard ratios (aHRs) for depressive disorder.The TB contact cohort consisted of 9046 patients and matched controls of 36,184 ones. The mean age of TB contacts was 44.7 years, and 56.0% of them were women. During a mean follow-up period of 2.5 years, 127 (1.40%) TB contacts and 521 (1.44%) matched controls developed depressive disorder. TB exposure was found to be an independent risk factor of depressive disorder in women (aHR 1.34, 95% confidence interval [CI] 1.07–1.68), but not in men (aHR 0.71, 95% CI 0.48–1.06) after adjusting for age, comorbidities, and income levels. The risk of depression was significantly higher for female TB contacts than for matched controls in the first and second years (aHR 1.49, 95% CI 1.03–2.14; and aHR 1.53, 95% CI 1.05–2.23, respectively), but not thereafter. Of note, 67 (0.74%) TB contacts and 88 (0.24%) matched controls developed active TB, but none of them had subsequent depressive disorder during follow-up periods.Female TB contacts had an increased risk of depression within the first 2 years after exposure. Clinicians should consider conducting depression evaluations in addition to routine TB contact investigations in this subgroup population.

Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis

“…The high burden of tuberculosis (TB) on morbidity and mortality around the world constitutes a significant public health concern, especially in low and middle-income countries [1][2][3]. The World Health Organization (WHO) estimated that 10 million people developed active TB disease in 2017 [4].…”

Depressive Symptoms Mediate the Associations of Stigma with Medication Adherence and Quality of Life in Tuberculosis Patients in China

“…19 Depressed individuals are unlikely to seek care promptly or adhere to medication regimens consistently or precisely. 20 In addition, when patients with TB are in a depressive status, they experience severe psychological distress, which interferes with their QOL, comprising a person's physical, psychological, and emotional well-being. 5 Several recent studies have demonstrated negative associations between depressive symptoms and specific healthrelated outcomes, such as medication adherence and QOL in patients with TB.…”

Perceived stigma and depression in initially diagnosed pulmonary tuberculosis patients

“…Research indicates that patients with TB often experience psychological distress, for example, stigma and depression, which adversely affects their ability to cope with stress, the side effects of treatment and daily life (Chang & Cataldo, ; Doherty et al., ; Duko, Gebeyehu, & Ayano, ; Gerrish, Naisby, & Ismail, ; Ige & Lasebikan, ; Masumoto et al., ; McArthur, Bali, & Khan, ; Moya & Lusk, ; Pan et al., ; Sagili, Satyanarayana, & Chadha, ; Shen et al., ; Singh, Pardal, & Prakash, ).…”

“…Approximately 16.8%–70% of patients with TB, especially older patients, are also diagnosed with depression. Depression has been determined to be associated with gender, age, comorbidity, financial situation, symptoms (e.g., persistent coughing), body mass index, community attitude and perceived TB stigma, which can affect the patient's quality of life (Chang & Cataldo, , Doherty et al., ; Duko et al., ; Ige & Lasebikan, ; Masumoto et al., ; Pan et al., ; Sagili et al., ; Shen et al., ; Singh et al., ). Patients with insufficient social support, greater stigma (Duko et al., ) and lower levels of body mass index (Masumoto et al., ) were more likely to have higher levels of depression.…”