Tuberculosis: an opportunity to integrate mental health services in primary care in low-resource settings

Sweetland, Annika C.; Jaramillo, Ernesto; Wainberg, Milton L.; Chowdhary, Neerja; Oquendo, María A.; Medina‐Marino, Andrew; Dua, Tarun

doi:10.1016/s2215-0366(18)30347-x

Cited by 31 publications

(41 citation statements)

References 8 publications

(11 reference statements)

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“…18 Treating comorbid depression/anxiety among individuals with TB and TB-HIV coinfection at the primary care level may increase economic gains, which in turn could stimulate political commitment to treat these and other psychiatric disorders, including substance use disorders. 19…”

mentioning

confidence: 99%

Integrating tuberculosis and mental health services: global receptivity of national tuberculosis program directors

Sweetland¹,

Galea

Shin

et al. 2019

int j tuberc lung dis

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SUMMARY SETTING: A global survey of National Tuberculosis Program (NTP) directors. OBJECTIVES: To assess the perceived mental health needs of persons with tuberculosis (TB), current practices, and receptivity to integrating evidence-based mental and substance use treatment into national TB guidelines. DESIGN: Semi-structured survey of NTP directors from 26 countries of all income levels using a standardized questionnaire. RESULTS: Of the 26 countries, 21 were classified as high incidence and/or burden countries for TB, TB and human immunodeficiency virus coinfection, and/or drug-resistant TB. Two NTPs included routine screening for any mental disorder, four assessed alcohol or drug use, and five had standard protocols for the co-management of disorders. If effective and low-cost integrated care models were available, 17 NTP directors felt that it was highly likely, and five somewhat likely, that their NTPs would integrate mental health treatment into national TB guidelines and services. The main perceived barriers to service integration were limited capacity, not recognizing mental health as a problem, insufficient resources, and TB-related social stigma. CONCLUSIONS: NTPs currently do not address mental disorders as part of routine practice. Nevertheless, receptivity is high, which creates a ripe opportunity to integrate the management of TB and mental disorders into the policies and guidelines of NTPs worldwide.

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mentioning

confidence: 99%

Integrating tuberculosis and mental health services: global receptivity of national tuberculosis program directors

Sweetland¹,

Galea

Shin

et al. 2019

int j tuberc lung dis

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“…9.8 ± 2.5; 3-14 TB stigma score 27.0 ± 7.6; 10-48 was estimated to be 49/100000/year for women and 31/100000/ year for men in 2000 (Ustun et al, 2004), incomparably lower than that observed in TB suggesting that TB care guidelines should include mental health components. Sweetland and colleagues (Sweetland et al, 2018) have proposed that TB care is an appropriate component of the existing health services to integrate mental health in primary care in low-resource settings. Higher incidence of depression in people with TB compared to the general population had been reported in Taiwan (Shen et al, 2014, Yen et al, 2015.…”

Section: Discussionmentioning

confidence: 99%

“…Understanding whether incident depression occurs in people with TB after starting anti-TB care is critically required to improve the national guideline for clinical and programmatic management of TB in Ethiopia and similar settings that lack mental health component (Federal Ministry of Health of Ethiopia, April 2012), and to target depression interventions in the integration of mental health care into primary care which is being scaled up in Ethiopia (FMOH, 2012 a , 2012 b ). It also provides a strong base to conduct well designed studies on the relationship between depression and anti-TB medications, specifically isoniazid (Doherty et al ., 2013) and ethambutol (Yen et al ., 2015), TB-related stigma or behavioral factors specific to this population (Sweetland et al ., 2018).…”

Section: Introductionmentioning

confidence: 99%

Incidence of depression in people with newly diagnosed tuberculosis in Ethiopia: a cohort study

et al. 2020

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Background Cross-sectional studies show that the prevalence of comorbid depression in people with tuberculosis (TB) is high. The hypothesis that TB may lead to depression has not been well studied. Our objectives were to determine the incidence and predictors of probable depression in a prospective cohort of people with TB in primary care settings in Ethiopia. Methods We assessed 648 people with newly diagnosed TB for probable depression using Patient Health Questionnaire, nine-item (PHQ-9) at the time of starting their anti-TB medication. We defined PHQ-9 scores 10 and above as probable depression. Participants without baseline probable depression were assessed at 2 and 6 months to measure incidence of depression. Incidence rates per 1000-person months were calculated. Predictors of incident depression were identified using Poisson regression. Results Two hundred and ninety-nine (46.1%) of the participants did not have probable depression at baseline. Twenty-two (7.4%) and 26 (8.7%) developed depression at 2 and 6 months of follow up. The incidence rate of depression between baseline and 2 months was 73.6 (95% CI 42.8–104.3) and between baseline and 6 months was 24.2 (95% CI 14.9–33.5) per 1000 person-months respectively. Female sex (adjusted β = 0.22; 95% CI 0.16–0.27) was a risk factor and perceived social support (adjusted β = −0.14; 95% CI −0.24 to −0.03) was a protective factor for depression onset. Conclusion There was high incidence of probable depression in people undergoing treatment for newly diagnosed TB. The persistence and incidence of depression beyond 6 months need to be studied. TB treatment guidelines should have mental health component.

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“…The limited number of psychiatrists can thus focus on patients with the most serious mental disorders, leaving most rou-tine/non-urgent care to non-specialized personnel. As a community-based care model using task shifting is frequently employed for TB care in LMICs, 6 it is already primed not only for the detection of depression and anxiety but, for many patients, also for providing evidence-based treatment for depression and anxiety.…”

mentioning

confidence: 99%

“…Although most TB programs struggle with limited resources, integrating mental health services may prove a wise investment to improve outcomes, prevent further drug resistance, and enhance TB control. 6 Context-specific data, such as those from Walker et al, support the possibility that local responses can be initiated using existing care packages like those from the WHO. 4 Other resources include The TB and Mental Health Working Group at the International Union Against Tuberculosis and Lung Disease, which produced a video on how MDR-TB and mental health is managed in Peru showing psychiatrist, care giver and patient perspectives.…”

mentioning

confidence: 99%

Beyond screening: a call for the routine integration of mental health care with tuberculosis treatment

Galea

Monedero-Recuero

Sweetland

2019

public health action

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Tuberculosis: an opportunity to integrate mental health services in primary care in low-resource settings

Cited by 31 publications

References 8 publications

Integrating tuberculosis and mental health services: global receptivity of national tuberculosis program directors

Integrating tuberculosis and mental health services: global receptivity of national tuberculosis program directors

Incidence of depression in people with newly diagnosed tuberculosis in Ethiopia: a cohort study

Beyond screening: a call for the routine integration of mental health care with tuberculosis treatment

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