Workplace interventions to overcome stigma and depression in patients with Multiple drug-resistant tuberculosis (MDR TB)

Abstract

Introduction: MDR-TB is an infectious disease that can cause death and stigma for those infected. MDR-TB patients with depression are at risk for LTFU, which will worsen their condition and strengthen the stigma they receive. Case report: A 52-year-old female psychiatric interview and assessment using the Beck Depression Inventory (BDI) found that BDI score of 4 (no depression), and the patient adhered to TB treatment. She was found to be laid off, and an assessment using the BDI to detect depression in the patient found potential stigma in the patient, such as being laid off from work, prohibited from teaching face-to-face, and shunned by colleagues. Interventions given were prescribing Fluoxetine 20 mg per day and Clobazam 10 mg per day, a brief intervention using the FRAMES technique, psychoeducation about disease and drug effects and the duration of treatment, and an office visit. A worksite intervention was performed by the patient's husband. Antituberculosis drugs were monitored by both a pulmonologist and a psychiatrist. Her work-related problems were resolved through interventions at the school with psychoeducation about drug-resistant tuberculosis, the transmission method, the duration of treatment, and the side effects of the treatment. The results of the last sputum examination after one month of treatment showed drug resistance, and the patient was advised to undergo 18 months of treatment. The patient could finally work offline with fewer responsibilities after getting negative laboratory test results twice in a row. Conclusion Work-related psychosocial interventions are required to address rejection at work, which results in depression and nonadherence to treatment. Liaison services with social interventions at work in drug-resistant tuberculosis-infected patients are necessary to improve their quality of life and maintain their treatment adherence.