Ambaw F, Mayston R, Hanlon C, Alem A
School of Public Health, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Psychiatry, College of Health Sciences, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
Glob Ment Health (Camb). 2019 Aug 23;6:e20. doi: 10.1017/gmh.2019.17. eCollection 2019.
Co-morbid depression is common in people with tuberculosis (TB). Symptoms of depression (low energy, impaired concentration, decreased motivation and hopelessness) may affect help-seeking; however, this impact has not been studied so far. The objectives of this study were to assess the impact of co-morbid depression on diagnostic delay, pathways to care, and to identify if it mediates other factors associated with diagnostic delay.
We analyzed cross-sectional data collected from 592 adults with newly diagnosed TB. We assessed probable depression using Patient Health Questionnaire, nine items (PHQ-9) at a cut-off 10. Data on diagnosis delay, pathways to TB care, socio-demographic variables, stigma, types of TB, substance use, co-morbid chronic illnesses, and perception about TB were assessed using a structured questionnaire. Generalized structural equation modelling was used to analyze the data.
A total of 313 (52.9%) participants had probable depression. Pathway to TB care was direct for 512 (86.5%) of the participants and indirect for 80 (13.5%) of them. The median diagnosis delay was 12.0 weeks. Depression did not have a statistically significant association with pathways to TB care ( = -0.45; 95% CI-1.85 to 0.96) or diagnostic delay [adjusted odds ratio (AOR) = 0.90; 0.77-1.06]. Indirect pathway to TB care was positively associated with diagnosis delay (AOR = 2.72; 95% CI 1.25-5.91).
People with TB who had co-morbid probable depression visited the modern health care as directly as and as soon as those without co-morbid depression. How socio-demographic factors influence pathways to care and diagnosis delay require qualitative exploration.
合并抑郁症在结核病患者中很常见。抑郁症状（精力不足、注意力受损、动力下降和绝望感）可能会影响患者寻求帮助；然而，目前尚未对这种影响进行研究。本研究的目的是评估合并抑郁症对诊断延迟、就医途径的影响，并确定其是否介导与诊断延迟相关的其他因素。
我们分析了从592名新诊断为结核病的成年人中收集的横断面数据。我们使用患者健康问卷九项版（PHQ-9），以10分为临界值来评估可能存在的抑郁症。使用结构化问卷评估诊断延迟、结核病就医途径、社会人口统计学变量、耻辱感、结核病类型、物质使用、合并慢性病以及对结核病的认知等数据。采用广义结构方程模型对数据进行分析。
共有313名（52.9%）参与者可能患有抑郁症。512名（86.5%）参与者的结核病就医途径为直接途径，80名（13.5%）为间接途径。诊断延迟的中位数为12.0周。抑郁症与结核病就医途径（β = -0.45；95%CI -1.85至0.96）或诊断延迟[调整比值比（AOR） = 0.90；0.77 - 1.06]无统计学显著关联。结核病间接就医途径与诊断延迟呈正相关（AOR = 2.72；95%CI 1.25 - 5.91）。
合并可能患有抑郁症的结核病患者与未合并抑郁症的患者一样直接且及时地前往现代医疗保健机构就诊。社会人口统计学因素如何影响就医途径和诊断延迟需要进行定性探索。
