Psychological distress and its relationship with non-adherence to TB treatment: a multicentre study

Abstract

BackgroundThe successful cure of tuberculosis (TB) is dependent on adherence to treatment. Various factors influence adherence, however, few are easily modifiable. There are limited data regarding correlates of psychological distress and their association with non-adherence to anti-TB treatment.MethodsIn a trial of a new TB test, we measured psychological distress (K-10 score), TB-related health literacy, and morbidity (TBscore), prior to diagnosis in 1502 patients with symptoms of pulmonary TB recruited from clinics in Cape Town (n = 419), Harare (n = 400), Lusaka (n = 400), Durban (n = 200), and Mbeya (n = 83). Socioeconomic, demographic, and alcohol usage-related data were captured. Patients initiated on treatment had their DOTS cards reviewed at two-and six-months.Results22 %(95 % CI: 20 %, 25 %) of patients had severe psychological distress (K-10 ≥ 30). In a multivariable linear regression model, increased K-10 score was independently associated with previous TB [estimate (95 % CI) 0.98(0.09-1.87); p = 0.0304], increased TBscore [1(0.80, 1.20); p <0.0001], and heavy alcohol use [3.08(1.26, 4.91); p = 0.0010], whereas male gender was protective [-1.47(−2.28, −0.62); p = 0.0007]. 26 % (95 % CI: 21 %, 32 %) of 261 patients with culture-confirmed TB were non-adherent. In a multivariable logistic regression model for non-adherence, reduced TBscore [OR (95 % CI) 0.639 (0.497, 0.797); p = 0.0001], health literacy score [0.798(0.696, 0.906); p = 0.0008], and increased K-10 [1.082(1.033, 1.137); p = 0.0012], and heavy alcohol usage [14.83(2.083, 122.9); p = 0.0002], were independently associated. Culture-positive patients with a K-10 score ≥ 30 were more-likely to be non-adherent (OR = 2.290(1.033-5.126); p = 0.0416].ConclusionSevere psychological distress is frequent amongst TB patients in Southern Africa. Targeted interventions to alleviate psychological distress, alcohol use, and improve health literacy in newly-diagnosed TB patients could reduce non-adherence to treatment.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-015-0964-2) contains supplementary material, which is available to authorized users.

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“…Though awareness on TB was good in an Indian urban slum population, information on access to proper medical care was not known (Chinnakali et al, 2013). It is suggested that TB patients with low health related literacy had higher psychological distress (Theron et al, 2015). Thus it appears that health literacy, morbidity due to TB and psychological well-being are interlinked.…”

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“…A number of factors, including social stigmatization, financial situation, malnutrition, human immunodeficiency virus (HIV)‐coinfection during treatment, and TB misconceptions and treatment adherence are associated with a lower chance of recovery from TB . Adherence itself is influenced by the type of regimen‐specific setting, financial status, social and behavioral factors, and the presence of caregivers, but many now consider that it may be strongly mediated by the effects of comorbid depression …”

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