The ARK Foundation, Suite C-3 & C-4, House 06, Road 109, Gulshan-2, Dhaka-1212, Dhaka, Bangladesh.
Department of Health Sciences, University of York, Seebohm Rowntree Building, York, YO10 5DD, UK.
BMC Public Health. 2020 Jun 3;20(1):848. doi: 10.1186/s12889-020-08986-x.
Understanding of the relationship between multi-drug resistant tuberculosis and mental health is limited. With growing prevalence of multi-drug resistant tuberculosis, addressing mental ill-health has potential to improve treatment outcomes and well-being. In several low and middle-income contexts hospitalisation during treatment is common. Understanding of the impact on mental ill-health are required to inform interventions for patients with multi-drug resistant tuberculosis. Our aim was to identify the prevalence of comorbid depression among in-patients being treated for multi-drug resistant tuberculosis and to explore their experiences of comorbid disease and the care they received in a large specialist chest hospital in Dhaka, Bangladesh.
We conducted a quantitative cross-sectional survey among 150 multi-drug resistant tuberculosis in-patients (new cases = 34%, previously treated = 66%) in 2018. A psychiatrist assessed depression was assessed with the Structured Clinical Interview for Depression (SCID DSM-IV). We used multi-level modelling to identify associations with depression. Experience Bangladeshi researchers conducted qualitative interviews with 8 patients, 4 carers, 4 health professionals and reflective notes recorded. Qualitative data was analysed thematically.
We found 33.8% (95% CI 26.7%; 41.7%) of patients were depressed. While more women were depressed 39.3% (95% CI 27.6%; 52.4%) than men 30.4% (95% CI 22%; 40.5%) this was not significant. After controlling for key variables only having one or more co-morbidity (adjusted odds ratio [AOR] = 2.88 [95% CI 1.13; 7.33]) and being a new rather than previously treated case (AOR = 2.33 [95% CI 1.06; 5.14]) were associated (positively) with depression. Qualitative data highlighted the isolation and despair felt by patients who described a service predominantly focused on providing medicines. Individual, familial, societal and health-care factors influenced resilience, nuanced by gender, socio-economic status and home location.
Patients with multi-drug resistant tuberculosis are at high risk of depression, particularly those with co- and multi-morbidities. Screening for depression and psycho-social support should be integrated within routine TB services and provided throughout treatment.
对耐多药结核病与心理健康之间关系的了解有限。随着耐多药结核病发病率的不断上升，解决心理健康问题有可能改善治疗效果和幸福感。在一些中低收入国家，住院治疗在治疗期间很常见。为了为耐多药结核病患者提供信息干预措施，有必要了解其对心理健康的影响。我们的目的是确定在一家孟加拉国达卡的大型胸科医院接受耐多药结核病治疗的住院患者中并发抑郁症的患病率，并探讨他们对并发疾病的体验以及接受的护理。
我们于 2018 年对 150 名耐多药结核病住院患者（新发病例=34%，既往治疗=66%）进行了一项横断面调查。精神病医生使用DSM-IV 结构临床访谈（SCID）评估抑郁症。我们使用多水平模型确定与抑郁症相关的因素。经验丰富的孟加拉国研究人员对 8 名患者、4 名照顾者、4 名卫生专业人员进行了定性访谈，并记录了反思性笔记。定性数据采用主题分析法进行分析。
我们发现 33.8%（95%CI 26.7%；41.7%）的患者患有抑郁症。尽管更多的女性（39.3%（95%CI 27.6%；52.4%））比男性（30.4%（95%CI 22%；40.5%））更抑郁，但这并不显著。在控制了关键变量后，只有一种或多种合并症（调整后的优势比[OR] = 2.88 [95%CI 1.13；7.33]）和新发而非既往治疗病例（OR = 2.33 [95%CI 1.06；5.14]）与抑郁症呈正相关。定性数据突出了患者的孤立和绝望感，他们描述了一项主要侧重于提供药物的服务。个人、家庭、社会和医疗保健因素影响了韧性，其性别、社会经济地位和家庭所在地等因素各不相同。
耐多药结核病患者患抑郁症的风险很高，特别是那些患有合并症和多种疾病的患者。应在常规结核病服务中纳入抑郁症筛查和心理社会支持，并在整个治疗过程中提供这些服务。
