Comorbidity of mental ill-health in tuberculosis patients under treatment in a rural province of South Africa: a cross-sectional survey

Abstract

ObjectivesTuberculosis (TB) remains prevalent despite the availability of effective anti-TB medications, and accumulating evidence suggests a high rate of mental disorders in people with TB. This is because TB and psychiatric disorders share several risk factors, such as poverty, homelessness and substance use disorder. Moreover, psychiatric comorbidities in patients with TB are associated with poor treatment outcomes. This study explored the psychiatric comorbidity and clinical correlates in individuals receiving TB treatment.DesignA cross-sectional survey over 10 months.SettingTwo primary care clinics at King Sabata Dalindyebo district, Mthatha, Eastern Cape, South Africa.ParticipantPatients receiving TB treatment in the two clinics.InterventionThe Mini-International Neuropsychiatric Interview was used to screen for psychiatric disorders.Primary and secondary outcome measuresRates of mental disorders in patients with TB over a 10-month period. Variation in rates by sex, employment status and HIV comorbidity.ResultsIn a sample of 197 participants, most patients were men (62%) and screened positive for a mental disorder (82%) with anxiety (48%), depression (38%) and substance use disorders (43%) being the most common psychiatric conditions. On average, individuals had 4 (SD 2) mental disorders. Females had higher rates of depression (p=0.005) and non-adherence to TB treatment (p=0.003), and alcohol use disorder was more common in males (p<0.001) and in those non-adherent to TB treatment. Additionally, low education levels and unemployment were associated with depressive and anxiety disorders (p<0.05).ConclusionsMental disorders are common in patients with TB, and mental health services need to be integrated into the management of patients with TB. Factors linked to mental disorders in this cohort, such as low education, gender and unemployment, may be useful for compiling a risk profile to help identify those with TB who may require more intensive support for their mental health.

The lived experiences of Tuberculosis survivors during the COVID-19 pandemic and government lockdown in South Africa: a qualitative analysis

“…These socioeconomic factors can therefore create a feedback loop with physical health, in which the absence of one worsens the other and delays recovery. This feedback loop can be compounded by worsened mental health, and unemployment, underemployment, and poverty in TB patients has been associated with multiple mental illnesses, including the anxiety, social anxiety, and depression noted by participants in this study [11].…”

“…Most South Africans live in areas that are subjected to high levels of poverty, unemployment, poor housing, and sanitation [10]. Mental illness and substance use places additional burdens on TB patients, with one recent study nding an 82% prevalence rate for mental disorders, including depression, anxiety, and substance use, among participants [11]. All these factors have a role in driving the status quo of TB in South Africa.…”

Psychiatric morbidity among patients on treatment for tuberculosis at a tertiary referral hospital in Western Kenya

“…The 48.5% prevalence of any mental illness is higher compared to findings of a study in Pakistan with a rate of 31%, Nigeria at 32% and a pooled rate of 34% in a meta-analysis [ 19 , 33 , 34 ]. It is however lower than 82% rate in South Africa [ 35 ]. Prevalence of mental illness among patients on treatment for TB is anticipated to be higher due to shared risk factors including alcohol use, smoking, overcrowding, stigma, association with HIV, psychosocial and economic stressors or due to compromised immunity and neglected self-care associated with mental illness [ 25 , 36 ].…”

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“…For instance, a recent South African study examining patients with TB in primary care found that 83% screened positive for a psychiatric diagnosis, with depression among the most common diagnoses, and 43% screened positive for a SU disorder. Over half of these patients were concurrently living with HIV, with similar rates of psychiatric and SU diagnoses identified in these patients [ 13 ]. In other studies, rates of depression have been estimated to be as high as 41% among people with HIV [ 9 ] and 64% among people with TB in South Africa [ 14 ].…”