Chandra Mina, Rana Proteesh, Chandra Kalpana, Arora Vijay Kumar
Centre of Excellence in Mental Health, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India.
Department of Pharmacology, PGIMER and Dr Ram Manohar Lohia Hospital, New Delhi, India.
Indian J Tuberc. 2019 Jan;66(1):197-202. doi: 10.1016/j.ijtb.2019.02.007. Epub 2019 Feb 26.
Depression is common in Tuberculosis (TB) and associated with adverse outcomes through pathogenic mechanisms and impaired self-care behaviours including reduced treatment adherence. Undiagnosed depression can threaten the robustness of DOTS model despite large public health investment. The Depression-Tuberculosis Syndemic requires collaborative partnership with mental health professionals.
To study the evidence base for Depression-Tuberculosis Syndemic.
A Pubmed and Google Scholar search was conducted using the key words "Depression", "Tuberculosis" and "Syndemic" and abstracts screened for appropriateness and relevance.
Depression-TB Syndemic is common with a bidirectional relationship. Depression is associated with higher hazard ratio and increased prevalence of TB. Depression is independently associated with higher morbidity, mortality, drug resistance, risk of TB reactivation and community TB transmission. The underlying biopsychosocial mechanism of Depression- Tuberculosis Syndemic includes biological factors like inflammatory cascade, HPA axis dysregulation and psychosocial factors like perceived stigma and treatment non-adherence.
Depression is a poor prognostic factor in TB. The National Mental Health Programme (NMHP) and National Strategic Plan (NSP) for Tuberculosis Elimination (2017-2025) work in independent verticals with no integration at policy or at ground level. This results in lack of identification and appropriate management of depression in patients with Tuberculosis despite repeated contact with health care personnel in DOTS centres. A collaborative approach for early diagnosis and management of depression in patients with Tuberculosis (Secondary Prevention) can help decrease the burden of disease and improve outcomes.
Depression-TB Syndemic requires collaborative approaches at the program level and at the point of service delivery.
抑郁症在结核病患者中很常见，通过致病机制和自我护理行为受损（包括治疗依从性降低）与不良后果相关。尽管有大量公共卫生投资，但未被诊断出的抑郁症可能会威胁到直接观察短程疗法（DOTS）模式的稳健性。抑郁症 - 结核病综合征需要与心理健康专业人员建立合作关系。
研究抑郁症 - 结核病综合征的证据基础。
使用关键词“抑郁症”、“结核病”和“综合征”在PubMed和谷歌学术上进行搜索，并筛选摘要的适用性和相关性。
抑郁症 - 结核病综合征很常见，且存在双向关系。抑郁症与更高的风险比和结核病患病率增加相关。抑郁症独立地与更高的发病率、死亡率、耐药性、结核病复发风险和社区结核病传播相关。抑郁症 - 结核病综合征的潜在生物心理社会机制包括炎症级联反应等生物学因素、下丘脑 - 垂体 - 肾上腺（HPA）轴失调，以及感知耻辱和治疗不依从等心理社会因素。
抑郁症是结核病的一个不良预后因素。国家心理健康计划（NMHP）和结核病消除国家战略计划（NSP）（2017 - 2025年）在独立的垂直领域开展工作，在政策或基层层面没有整合。这导致尽管结核病患者在DOTS中心多次与医护人员接触，但抑郁症仍未得到识别和适当管理。一种针对结核病患者抑郁症的早期诊断和管理的协作方法（二级预防）有助于减轻疾病负担并改善预后。
抑郁症 - 结核病综合征需要在项目层面和服务提供点采取协作方法。
