Untreated depression and tuberculosis treatment outcomes, quality of life and disability, Ethiopia

Abstract

ObjectiveTo investigate the association between comorbid depression and tuberculosis treatment outcomes, quality of life and disability in Ethiopia.MethodsThe study involved 648 consecutive adults treated for tuberculosis at 14 primary health-care facilities. All were assessed at treatment initiation (i.e. baseline) and after 2 and 6 months. We defined probable depression as a score of 10 or above on the nine-item Patient Health Questionnaire. Data on treatment default, failure and success and on death were obtained from tuberculosis registers. Quality of life was assessed using a visual analogue scale and we calculated disability scores using the World Health Organization’s Disability Assessment Scale. Using multivariate Poisson regression analysis, we estimated the association between probable depression at baseline and treatment outcomes and death.ResultsUntreated depression at baseline was independently associated with tuberculosis treatment default (adjusted risk ratio, aRR: 9.09; 95% confidence interval, CI: 6.72 to 12.30), death (aRR: 2.99; 95% CI: 1.54 to 5.78), greater disability (β: 0.83; 95% CI: 0.67 to 0.99) and poorer quality of life (β: −0.07; 95% CI: −0.07 to −0.06) at 6 months. Participants with probable depression had a lower mean quality-of-life score than those without (5.0 versus 6.0, respectively; P < 0.001) and a higher median disability score (22.0 versus 14.0, respectively; P < 0.001) at 6 months.ConclusionUntreated depression in people with tuberculosis was associated with worse treatment outcomes, poorer quality of life and greater disability. Health workers should be given the support needed to provide depression care for people with tuberculosis.

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

“…Analysis of TB treatment outcomes revealed a higher risk of negative outcomes, lower success rate, and worse adherence to treatment among patients who presented DS. One study reported an adjusted hazard ratio of 3.46 for treatment default or death in patients with symptoms suggestive of a major depressive episode (MDE) at baseline visit [3], while another also found an increased risk for loss to follow-up and death (RR = 9.09 and 2.99, respectively) in persons with an MDE score suggestive of depression at baseline [20]. In the largest study measuring depression, the authors showed that in comparison with individuals with low depression scores, those with high scores had a greater chance of poor medication adherence (OR = 3.67) [18].…”

“…Furthermore, within each measurement of exposure, different psychometric instruments and cut-off scores were employed. In the case of studies that measured DS, there was notable variability between the scales used: a brief 5-item and the full 20-item version of the CES-D scale, and the PHQ-9 scale [3,18,20]. Others reported results using the exposure as a numeric variable alone [22,23].…”

Prevalence of tuberculosis among mentally ill patients in conflict-stricken Afghanistan: A cross-sectional study

“…Post-traumatic disorder among TB patients was 29.6% in South Africa (Peltzer et al, 2013). Mental illnesses are also a cause of poor quality of life, TB treatment interruption, and poor treatment outcomes (Ambaw et al, 2018;Pachi et al, 2013;Sikjaer et al, 2018;Theron et al, 2015).…”

Prevalence of depressive symptoms and associated factors among people with Tuberculosis in Ethiopia: meta-analysis

“…This co-morbidity depression is related to the nature of the illness, biological factors, social (stigma, poverty), and behavioral factors (substance use) (5)(6)(7)(8)(9). In Ethiopia, epidemiological evidence showed that the prevalence of depression among individual with TB ranged from 18% to 67% (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). This co-morbid depression was associated with poor treatment adherence, MRD-TB, suicide, substance use and poor quality of life (9,10,22).…”

“…In Ethiopia, epidemiological evidence showed that the prevalence of depression among individual with TB ranged from 18% to 67% (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21). This co-morbid depression was associated with poor treatment adherence, MRD-TB, suicide, substance use and poor quality of life (9,10,22). Although, these individual studies are important, the variation in reported prevalence of depression and its determinant factors need comprehensive up to date information.…”