Abstract
BackgroundDepression in tuberculosis increases the risk for adverse health outcomes. However, little is known about comorbid depression and tuberculosis in the general population. Thus, we assessed the association between depression and tuberculosis, and the decrements in health status associated with this comorbidity in 48 low- and middle-income countries.MethodsCross-sectional, community-based data from the World Health Survey on 242,952 individuals aged ≥ 18 years were analyzed. Based on the World Mental Health Survey version of the Composite International Diagnostic Interview, past 12-month depression was categorized into depressive episode, brief depressive episode, subsyndromal depression, and no depression. Health status across six domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort) was assessed. Multivariable logistic and linear regression analyses were performed to assess the associations.ResultsThe prevalence of depressive episode among those with and without tuberculosis was 23.7% and 6.8%, respectively (P < 0.001). Tuberculosis was associated with a 1.98 (95% CI 1.47–2.67), 1.75 (95% CI 1.26–2.42), and 3.68 (95% CI 3.01–4.50) times higher odds for subsyndromal depression, brief depressive episode, and depressive episode, respectively. Depressive episode co-occurring with tuberculosis was associated with significantly worse health status across all six domains compared to tuberculosis alone. Interaction analysis showed that depression significantly amplifies the association between TB and difficulties in self-care but not in other health domains.ConclusionsDepression is highly prevalent in adults with tuberculosis, and is associated with worse health status compared to tuberculosis without depression. Public health efforts directed to the recognition and management of depression in people with tuberculosis may lead to better outcomes.
Highlights
Depression in tuberculosis increases the risk for adverse health outcomes
We assessed the association between TB and depression, and whether the co-occurrence of TB and depression confers a more pronounced decrement in health status and function compared to TB alone using community-based, predominantly nationally representative data from 48 low- and middle-income countries (LMIC) that participated in the World Health Survey (WHS)
The results of the multivariable multinomial logistic regression using the overall sample showed that TB is associated with a 1.98, 1.75, and 3.68 times higher odds for subsyndromal depression, brief depressive episode, and depressive episode, respectively (Table 2)
Summary
Depression in tuberculosis increases the risk for adverse health outcomes. Little is known about comorbid depression and tuberculosis in the general population. We assessed the association between depression and tuberculosis, and the decrements in health status associated with this comorbidity in 48 low- and middle-income countries. Depression often coexists with TB [2], and this comorbidity is associated with poor adherence to TB treatment and higher mortality [3]. In low- and middle-income countries (LMICs), the prevalence of depression is high and may be increasing [6]. The few previous studies on the association between depression and TB from LMICs have only been conducted in clinical settings with small sample sizes, and information from the general population is lacking. Epidemiological data on the TB/depression comorbidity and its effect on health outcomes are crucial to provide a more accurate assessment of the public health significance of this comorbidity
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
