Almost one in three tuberculosis patients treated at a federal hospital in Addis Ababa showed signs of depression, according to a study by Ethiopian psychiatrists published in July 2019 in the journal Neuropsychiatric Disease and Treatment. The authors urged TB clinics to screen patients for depression as a routine part of care.
The researchers, Alemayehu Molla and Birhanie Mekuriaw of Dilla University and Habtamu Kerebih of the University of Gondar, interviewed 415 patients aged 15 and over at the outpatient TB clinic of Saint Peter’s Specialized Hospital in Gulele sub-city. The sample included 308 patients with ordinary TB and 107 with multidrug-resistant TB. Two psychiatric nurses conducted face-to-face interviews in Amharic using the PHQ-9, a nine-item depression questionnaire that has been validated in Ethiopia. A score of 10 or more was counted as depression.
The study found depression in 31.1 percent of patients. Three factors were strongly linked to it. Patients with poor social support were about 3.3 times as likely to be depressed, those who felt stigmatised because of TB about twice as likely, and those with TB outside the lungs about 1.8 times as likely. Nearly 43 percent of participants reported poor social support and 45 percent reported feeling stigma. About 10 percent were also living with HIV.
The rate was well above that in the general population, the authors wrote, and in line with findings elsewhere in Africa: about 33 percent in a South African study and between 28 and 46 percent in two Nigerian studies. An earlier Ethiopian study had reported depression in 54 percent of TB patients.
The findings matter for treatment. TB is a major public health problem in Ethiopia, and drug-resistant forms are a growing threat. Depression can make it harder for patients to stick to the long course of medication and can worsen outcomes and quality of life. The authors said hospitals that screen and treat TB should also assess patients for depression and offer help, with particular attention to those who lack support or feel stigmatised.
Sources: Neuropsychiatric Disease and Treatment (Dove Medical Press)