Ambaw Fentie, Mayston Rosie, Hanlon Charlotte, Alem Atalay
Bahir Dar University, School of Public Health, Bahir Dar, Ethiopia.
Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia.
Glob Ment Health (Camb). 2020 Jan 3;7:e1. doi: 10.1017/gmh.2019.27. eCollection 2020.
Cross-sectional studies show that the prevalence of comorbid depression in people with tuberculosis (TB) is high. The hypothesis that TB may lead to depression has not been well studied. Our objectives were to determine the incidence and predictors of probable depression in a prospective cohort of people with TB in primary care settings in Ethiopia.
We assessed 648 people with newly diagnosed TB for probable depression using Patient Health Questionnaire, nine-item (PHQ-9) at the time of starting their anti-TB medication. We defined PHQ-9 scores 10 and above as probable depression. Participants without baseline probable depression were assessed at 2 and 6 months to measure incidence of depression. Incidence rates per 1000-person months were calculated. Predictors of incident depression were identified using Poisson regression.
Two hundred and ninety-nine (46.1%) of the participants did not have probable depression at baseline. Twenty-two (7.4%) and 26 (8.7%) developed depression at 2 and 6 months of follow up. The incidence rate of depression between baseline and 2 months was 73.6 (95% CI 42.8-104.3) and between baseline and 6 months was 24.2 (95% CI 14.9-33.5) per 1000 person-months respectively. Female sex (adjusted = 0.22; 95% CI 0.16-0.27) was a risk factor and perceived social support (adjusted = -0.14; 95% CI -0.24 to -0.03) was a protective factor for depression onset.
There was high incidence of probable depression in people undergoing treatment for newly diagnosed TB. The persistence and incidence of depression beyond 6 months need to be studied. TB treatment guidelines should have mental health component.
横断面研究表明，结核病患者中合并抑郁症的患病率很高。结核病可能导致抑郁症这一假说尚未得到充分研究。我们的目标是确定埃塞俄比亚基层医疗环境中结核病患者前瞻性队列中可能抑郁症的发病率及预测因素。
在开始抗结核治疗时，我们使用患者健康问卷9项版（PHQ-9）对648例新诊断的结核病患者进行可能抑郁症的评估。我们将PHQ-9得分10分及以上定义为可能抑郁症。对基线时无可能抑郁症的参与者在2个月和6个月时进行评估，以测量抑郁症的发病率。计算每1000人月的发病率。使用泊松回归确定抑郁症发病的预测因素。
299名（46.1%）参与者在基线时没有可能抑郁症。在随访的2个月和6个月时，分别有22名（7.4%）和26名（8.7%）出现抑郁症。基线至2个月期间抑郁症的发病率为每1000人月73.6（95%CI 42.8 - 104.3），基线至6个月期间为24.2（95%CI 14.9 - 33.5）。女性（调整后 = 0.22；95%CI 0.16 - 0.27）是抑郁症发病的危险因素，而感知到的社会支持（调整后 = -0.14；95%CI -0.24至-0.03）是抑郁症发病的保护因素。
新诊断结核病患者在治疗期间可能抑郁症的发病率很高。需要研究抑郁症在6个月后的持续情况和发病率。结核病治疗指南应包含心理健康内容。
