Depression: a silent driver of the global tuberculosis epidemic

Sweetland, Annika C.; Oquendo, María A.; Wickramaratne, Priya; Weissman, Myrna M.; Wainberg, Milton L.

doi:10.1002/wps.20134

Cited by 59 publications

(73 citation statements)

References 8 publications

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“…13 Data from the Korean Institute of Tuberculosis suggest that the same may be true for TB; in a nationwide population-based cohort involving 64 000 individuals, persons with depression had a 2.63 times greater risk of TB over one decade, and the risk of TB was proportional to the severity of depression. 14 Depression comorbidity among individuals with TB is extremely high; 2,15,16 however, bidirectional risk factors often make it difficult to know which condition arose first.…”

Section: Synergies Between Tuberculosis and Depressionmentioning

confidence: 99%

“…52 Because of these combined risk factors, people with depression are more likely to have more advanced disease upon diagnosis, remain infectious for longer periods of time, and therefore amplify the risk for community transmission of TB, MDR- and XDR-TB. 2 Once in treatment, individuals with TB and depression are less likely to take all their medications and/or complete treatment, 11 amplifying the risk of drug resistance, 5 treatment failure and death. 3,4 …”

Section: Synergies Between Tuberculosis and Depressionmentioning

confidence: 99%

“…Depression is a treatable condition that can affect as many as half of all individuals undergoing treatment for TB, 2 and is associated with greater morbidity, mortality, 3,4 drug resistance, 5 and community transmission. 2 Understanding and addressing the social and biological complexities of TB, including the negative synergies caused by co-occurring poverty and mental illness, is critical to curbing the TB, MDR-TB and XDR-TB epidemics globally.…”

mentioning

confidence: 99%

“…2 Understanding and addressing the social and biological complexities of TB, including the negative synergies caused by co-occurring poverty and mental illness, is critical to curbing the TB, MDR-TB and XDR-TB epidemics globally. 6 …”

mentioning

confidence: 99%

“…11 These individuals therefore not only carry a greater risk for negative TB outcomes, such as drug resistance 5 and death, 3,4 they may be infectious for longer periods of time in the community. 2 The TB–depression syndemic is the product of complex, bidirectional negative synergies between social, biological, and behavioral factors that collectively increase the risk for negative health and mental health outcomes (Figure 1). …”

mentioning

confidence: 99%

See 4 more Smart Citations

Addressing the tuberculosis–depression syndemic to end the tuberculosis epidemic

Sweetland

Kritski

Oquendo

et al. 2017

int j tuberc lung dis

108

126

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Tuberculosis (TB) and depression act synergistically via social, behavioral, and biological mechanisms to magnify the burden of disease. Clinical depression is a common, under-recognized, yet treatable condition that, if comorbid with TB, is associated with increased morbidity, mortality, community TB transmission, and drug resistance. Depression may increase risk of TB reactivation, contribute to disease progression, and/or inhibit the physiological response to anti-tuberculosis treatment because of poverty, undernutrition, immunosuppression, and/or negative coping behaviors, including substance abuse. Tuberculous infection and/or disease reactivation may precipitate depression as a result of the inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Clinical depression may also be triggered by TB-related stigma, exacerbating other underlying social vulnerabilities, and/or may be attributed to the side effects of anti-tuberculosis treatment. Depression may negatively impact health behaviors such as diet, health care seeking, medication adherence, and/or treatment completion, posing a significant challenge for global TB elimination. As several of the core symptoms of TB and depression overlap, depression often goes unrecognized in individuals with active TB, or is dismissed as a normative reaction to situational stress. We used evidence to reframe TB and depression comorbidity as the ‘TB–depression syndemic’, and identified critical research gaps to further elucidate the underlying mechanisms. The World Health Organization’s Global End TB Strategy calls for integrated patient-centered care and prevention linked to social protection and innovative research. It will require multidisciplinary approaches that consider conditions such as TB and depression together, rather than as separate problems and diseases, to end the global TB epidemic.

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Section: Synergies Between Tuberculosis and Depressionmentioning

confidence: 99%

Section: Synergies Between Tuberculosis and Depressionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Addressing the tuberculosis–depression syndemic to end the tuberculosis epidemic

Sweetland

Kritski

Oquendo

et al. 2017

int j tuberc lung dis

108

126

View full text Add to dashboard Cite

show abstract

The interplay between depression and tuberculosis

Zhang

Wang

et al. 2019

Journal of Leukocyte Biology

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Depression is a major mental health condition and is expected be the most debilitating and widespread health disorder by 2030. Tuberculosis (TB) is also a leading cause of morbidity and mortality worldwide and interestingly, is a common comorbidity of depression. As such, much attention has been paid to the association between these 2 pathologies. Based on clinical reports, the association between TB and depression seems to be bidirectional, with a substantial overlap in symptoms between the 2 conditions. TB infection or reactivation may precipitate depression, likely as a consequence of the host's inflammatory response and/or dysregulation of the hypothalamic–pituitary–adrenal axis. Nevertheless, few studies have considered whether patients with depression are at a higher risk for TB. In this review, we discuss the hypotheses on the association between depression and TB, highlighting the immuno‐inflammatory response and lipid metabolism as potential mechanisms. Improving our understanding of the interplay between these 2 disorders should help guide TB clinical care and prevention both in patients with comorbid depression and in the general population.

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Prevalence of Tuberculosis and Mental Disorders Comorbidity: A Systematic Review and Meta-analysis

Njie

Khan

2021

J Immigrant Minority Health

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Persons with tuberculosis (TB) also often have a mental disorder (MD). We examined TB-MD comorbidity prevalence and its impact on TB treatment outcomes as reported in studies set in the United States or in the top five countries of origin (Mexico, the Philippines, India, Vietnam, and China) for non-US-born persons with TB. We searched MEDLINE, EMBASE, OVID, PsycINFO, CINAHL, and Scopus for articles published from database inception through September 2018. Of the 9 studies analyzed, one was set in the United States. The estimated pooled prevalence of comorbid TB-MD from eight non-US studies, with 2921 participants, was 34.0% [95% confidence interval (CI) 21.1%-49.5%]. Comorbid TB-MD prevalence varied by country in the studies evaluated. Additional research might elucidate the extent of TB-MD in the United States and the top five countries of origin.

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Depression: a silent driver of the global tuberculosis epidemic

Cited by 59 publications

References 8 publications

Addressing the tuberculosis–depression syndemic to end the tuberculosis epidemic

Addressing the tuberculosis–depression syndemic to end the tuberculosis epidemic

The interplay between depression and tuberculosis

Prevalence of Tuberculosis and Mental Disorders Comorbidity: A Systematic Review and Meta-analysis

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