Effect of depression on treatment adherence among elderly tuberculosis patients: A prospective interventional study

Abstract

BackgroundTuberculosis is a major public health concern, especially in the geriatric age group. Up to one-third of the population with serious medical illness are prone to depression and risk increases with increased severity of underlying illness. Treatment nonadherence is another major concern in elderly tuberculosis patients. Hence this study was focused to assess depression and non-adherence due to depression in elderly tuberculosis patients, and reassessing treatment adherence by giving intervention to improve depression. Materials and methodsThis prospective interventional study was done on 100 elderly TB patients. Depression was assessed by using Hamilton Depression Rating Scale (HDRS) and medication adherence by using Morisky's 8-item Medication Adherence Questionnaire (MMAS-8). Risk for low to medium adherence was expressed in odds ratio (OR) with an appropriate 95% confidence interval (CI). ResultsThe overall prevalence of depression among the participants was 55% and 28% of the participants had low adherence. A significantly higher proportion of depressed patients (41.8% > 11.1%) were with lower adherence to the medication. On the regression model, participants with depression (adjusted OR 43.6, 95% CI 9.5–199) have a significantly higher chance of low to medium adherence with medication. With intervention for depression, the risk of low to medium adherence was reduced by 50.9% (95% CI: 35.9%–65.9%). ConclusionAlmost one in every two elderly TB patients suffers from comorbid depression. Around 90% will have low to moderate treatment adherence, which makes them treatment defaulters and increases the risk of drug-resistant tuberculosis.