Programmatic implementation of depression screening and remote mental health support sessions for persons recently diagnosed with TB in Lima, Peru during the COVID-19 pandemic.

Abstract

Few studies have explored a stepped care model for delivering mental health care to persons with tuberculosis (TB). Here, we evaluated depression screening and remote low-intensity mental health interventions for persons initiating TB treatment in Lima, Peru during the COVID-19 pandemic. We used the Patient Health Questionnaire 9 (PHQ-9) to screen participants for depressive symptoms (PHQ-9≥5). Participants with PHQ-9, 5-14 received remote Psychological First Aid (PFA) or Problem Management Plus (PM+). Participants were reevaluated 6months after intervention completion. We then compared the change in median PHQ-9 scores before and after intervention completion. Those with PHQ-9≥15 were referred to higher-level care. We found that 62 (45.9%) of the 135 participants had PHQ-9≥5 at baseline. Then, 54 individuals with PHQ-9, 5-9 received PFA, of which 44 (81.5%) were reevaluated. We observed significant reductions in median PHQ-9 scores from 6 to 2 (r=0.98; p<0.001). Four participants with PHQ-9, 10-14 received PM+ but were unable to be reevaluated. Four participants with PHQ-9≥15 were referred to higher-level care. Depressive symptoms were common among persons recently diagnosed with TB. We observed improvements in depressive symptoms 6months later for most participants who received remote sessions of PFA.