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.
Highlights
Tuberculosis is the principal cause of death due to infectious disease worldwide;[1] it accounts for 2.0% of the global disease burden, as measured in disability-adjusted life–years.[2]
Systematic reviews have shown that depression is associated with poor medication adherence in people with human immunodeficiency virus (HIV) infections and acquired immune deficiency syndrome (AIDS).[10]
Data on treatment outcomes at 6 months were available for 88.7% (575/648) of participants
Summary
Tuberculosis is the principal cause of death due to infectious disease worldwide;[1] it accounts for 2.0% of the global disease burden, as measured in disability-adjusted life–years.[2] In Ethiopia, tuberculosis is the fourth highest contributor to the disease burden.[3] The World Health Organization’s (WHO’s) End-TB Strategy, launched in 2015, aims to achieve a treatment success rate of 90% by 2030 in all people with tuberculosis, including those with multidrug-resistant disease.[1] People with tuberculosis often suffer from depression,[4,5,6] which can reduce the likelihood of successful tuberculosis treatment,[7] impair functioning[8] and decrease quality of life.[9] Systematic reviews have shown that depression is associated with poor medication adherence in people with human immunodeficiency virus (HIV) infections and acquired immune deficiency syndrome (AIDS).[10] in chronic noncommunicable diseases, depression has been observed to lead to poor treatment adherence and to lower immunity through neuroendocrine and behavioural mechanisms.[11,12] These mechanism may have a detrimental effect on responses to tuberculosis treatment
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