Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis

Ruíz-Grosso, Paulo; Cachay, Rodrigo; Flor, Adriana de la; Schwalb, Alvaro; Ugarte-Gil, César

doi:10.1371/journal.pone.0227472

Cited by 71 publications

(73 citation statements)

References 33 publications

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“…This may be due to the small sample of patients. This study showed an association of depression with less effective TB therapy, which is also reflected in a systematic review and meta-analysis in 2020 [24].…”

Section: Discussionsupporting

confidence: 70%

Association of psychological status with first diagnosed pulmonary tuberculosis in men

2021

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The aim. Assessment of the initial psychological status of men with first diagnosed pulmonary tuberculosis and the study of its associations with the clinical course of the disease. Materials and methods. The study involved 54 men with first diagnosed pulmonary tuberculosis. Patients had a dynamic complex clinical, laboratory and instrumental examination with an assessment of the psychological status according to the State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI). Results. The evaluating of initial psychological status in patients with first diagnosed pulmonary tuberculosis, depressive states of varying severity were found in 47.05 % of patients, moderate state anxiety – in 74.51 % of patients, moderate trait anxiety – in 35.29 %. We revealed associations of the levels of anxiety and depression with the degree of bacterial excretion and the duration of the intensive phase of therapy. Conclusions. To assess the psychological status of patients with first diagnosed infiltrative pulmonary tuberculosis, it is advisable to use the STAI and the BDI. Patients with first diagnosed infiltrative pulmonary tuberculosis in 100 % of cases have psychological status disorders with a predominance of moderate state anxiety and the absence of depressive disorders in only half of them. More expressed violations of the psychological status (anxiety, depression) identifies patients who are married and have a steady job. In patients with first diagnosed infiltrative pulmonary tuberculosis, an increase in the severity of anxiety and depression is associated with more expressed bacterial excretion, decrease in body weight, greater frequency of destruction of lung tissue, prevalence of the tuberculosis process by more than 2 lung segments, decrease in the effectiveness of standard therapy and prolongation intensive phase of treatment.

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Section: Discussionsupporting

confidence: 70%

Association of psychological status with first diagnosed pulmonary tuberculosis in men

2021

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“…Although we did not formally measure depression, more than one fifth of patients who reported missing doses described feeling depressed as a reason. In a recent systematic review, researchers found that depression is associated with increased loss to follow up and death—but not medication nonadherence—during TB treatment; however, the studies that were included had suboptimal measures of adherence [ 41 ]. Future studies using rigorous measures of both depression and adherence, such as the urine testing we used here, may clarify whether nonadherence mediates the association between depression and treatment outcomes.…”

Section: Discussionmentioning

confidence: 99%

Understanding Nonadherence to Tuberculosis Medications in India Using Urine Drug Metabolite Testing: A Cohort Study

Subbaraman

Thomas

Kumar

et al. 2021

Open Forum Infectious Diseases

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Background Poor adherence to tuberculosis (TB) treatment is associated with disease recurrence and death. Little research has been conducted in India to understand TB medication non-adherence. Methods We enrolled adult drug-susceptible TB patients, about half of whom were people living with HIV (PLHIV), in Chennai, Vellore, and Mumbai. We conducted a single unannounced home visit to administer a survey assessing reasons for non-adherence and collect a urine sample that was tested for isoniazid content. We described patient-reported reasons for non-adherence and identified factors associated with non-adherence (i.e., negative urine test) using multivariable logistic regression. We also assessed the association between non-adherence and treatment outcomes. Results Of 650 participants in the cohort, 77 (11.8%) had a negative urine test. Non-adherence was independently associated with daily wage labor (aOR 2.7, CI: 1.1—6.5, p=0.03), the late continuation treatment phase (aOR 2.0, CI:1.1—3.9, p=0.03), smear-positive pulmonary disease (aOR 2.1, CI: 1.1—3.9, p=0.03), alcohol use (aOR 2.5, CI: 1.2—5.2, p=0.01), and spending >=30 minutes collecting medication refills (aOR 6.6, CI: 1.5—29.5, p=0.01). PLHIV reported greater barriers to collecting medications than non-PLHIV. Among 167 patients reporting missing doses, reported reasons included traveling from home, forgetting, feeling depressed, and running out of pills. The odds of unfavorable treatment outcomes were 4.0 (CI: 2.1—7.6) times higher among patients with non-adherence (p<0.0001). Conclusion Addressing structural and psychosocial barriers will be critical to improve TB treatment adherence in India. Urine isoniazid testing may help identify non-adherent patients to facilitate early intervention during treatment.

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“…The syndemics of HIV and tuberculosis and HIV and depression are well-recognized (10), but that of tuberculosis and depression lags behind both. Up to 70% of tuberculosis patients may present with depression (11,12), associated with poor healthcare seeking behavior and disengagement from treatment, leading to poorer outcomes, including loss to follow-up and death (13). Tuberculosis and depression share common risk factors, including homelessness, HIV co-infection, and alcohol and substance dependency (13): depression thus increases the risk for acquiring tuberculosis.…”

Section: The Interaction Between Tuberculosis and Depressionmentioning

confidence: 99%

The Tuberculosis-Depression Syndemic and Evolution of Pharmaceutical Therapeutics: From Ancient Times to the Future

Walt

Keddy

2021

Front. Psychiatry

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The interplay between tuberculosis and depression has been problematic since the humoralists. Over the centuries similarities in disease management have transpired. With the advent of isoniazid chemotherapy, transformation of tuberculosis patients from morbidly depressive to euphoric was noted. Isoniazid was thereafter widely prescribed for depression: hepatotoxicity ending its use as an antidepressant in 1961. Isoniazid monotherapy led to the emergence of drug resistant tuberculosis, stimulating new drug development. Vastly increased investment into antidepressants ensued thereafter while investment in new drugs for tuberculosis lagged. In the 21st century, both diseases independently contribute significantly to global disease burdens: renewed convergence and the resultant syndemic is detrimental to both patient groups. Ending the global tuberculosis epidemic and decreasing the burden of depression and will require multidisciplinary, patient-centered approaches that consider this combined co-morbidity. The emerging era of big data for health, digital interventions and novel and repurposed compounds promise new ways to treat both diseases and manage the syndemic, but absence of clinical structures to support these innovations may derail the treatment programs for both. New policies are urgently required optimizing use of the current advances in healthcare available in the digital era, to ensure that patient-centered care takes cognizance of both diseases.

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Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis

Cited by 71 publications

References 33 publications

Association of psychological status with first diagnosed pulmonary tuberculosis in men

Association of psychological status with first diagnosed pulmonary tuberculosis in men

Understanding Nonadherence to Tuberculosis Medications in India Using Urine Drug Metabolite Testing: A Cohort Study

The Tuberculosis-Depression Syndemic and Evolution of Pharmaceutical Therapeutics: From Ancient Times to the Future

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