"death is a better option than being treated like this": A prevalence survey and qualitative study of depression among multi-drug resistant tuberculosis in-patients

R. Huque, H. Elsey*, F. Fieroze, J. P. Hicks, S. Huque, P. Bhawmik, I. Walker, J. Newell

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)

Abstract

Background: Understanding of the relationship between multi-drug resistant tuberculosis and mental health is limited. With growing prevalence of multi-drug resistant tuberculosis, addressing mental ill-health has potential to improve treatment outcomes and well-being. In several low and middle-income contexts hospitalisation during treatment is common. Understanding of the impact on mental ill-health are required to inform interventions for patients with multi-drug resistant tuberculosis. Our aim was to identify the prevalence of comorbid depression among in-patients being treated for multi-drug resistant tuberculosis and to explore their experiences of comorbid disease and the care they received in a large specialist chest hospital in Dhaka, Bangladesh. Methods: We conducted a quantitative cross-sectional survey among 150 multi-drug resistant tuberculosis in-patients (new cases = 34%, previously treated = 66%) in 2018. A psychiatrist assessed depression was assessed with the Structured Clinical Interview for Depression (SCID DSM-IV). We used multi-level modelling to identify associations with depression. Experience Bangladeshi researchers conducted qualitative interviews with 8 patients, 4 carers, 4 health professionals and reflective notes recorded. Qualitative data was analysed thematically. Results: We found 33.8% (95% CI 26.7%; 41.7%) of patients were depressed. While more women were depressed 39.3% (95% CI 27.6%; 52.4%) than men 30.4% (95% CI 22%; 40.5%) this was not significant. After controlling for key variables only having one or more co-morbidity (adjusted odds ratio [AOR] = 2.88 [95% CI 1.13; 7.33]) and being a new rather than previously treated case (AOR = 2.33 [95% CI 1.06; 5.14]) were associated (positively) with depression. Qualitative data highlighted the isolation and despair felt by patients who described a service predominantly focused on providing medicines. Individual, familial, societal and health-care factors influenced resilience, nuanced by gender, socio-economic status and home location. Conclusions: Patients with multi-drug resistant tuberculosis are at high risk of depression, particularly those with co- and multi-morbidities. Screening for depression and psycho-social support should be integrated within routine TB services and provided throughout treatment.

Original languageEnglish
Article number848
JournalBMC Public Health
Volume20
Issue number1
DOIs
Publication statusPublished - 3 Jun 2020
Externally publishedYes

Bibliographical note

Funding Information:
This study was conducted as part of the research programme consortium COMDIS-HSD, which was funded by UK Aid from the UK government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Funding Information:
This study was conducted as part of the research programme consortium Comdis-HSD, which is funded by UK Aid from the UK government. The funders had no role in study design, data collection and analysis, decision to publish, or preparation or the manuscript.

Publisher Copyright:
© 2020 The Author(s).

Keywords

  • Bangladesh
  • Co-morbidities
  • Depression
  • Low and middle income countries (LMIC)
  • Mental health
  • Multi-drug resistant (MDR-TB)
  • Tuberculosis (TB)

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