Institute for Infection and Immunity, St George's, University of London, London, UK
Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
BMJ Open. 2022 Jan 6;12(1):e048945. doi: 10.1136/bmjopen-2021-048945.
Tuberculosis (TB) and mental illnesses are highly prevalent globally and often coexist. While poor mental health is known to modulate immune function, whether mental disorders play a causal role in TB incidence is unknown. This systematic review examines the association between mental health and TB disease risk to inform clinical and public health measures.
Systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
MEDLINE, PsycINFO and PsycEXTRA databases were searched alongside reference list and citation searching. Inclusion criteria were original research studies published 1 January 1970-11 May 2020 reporting data on the association between mental health and TB risk.
DATA EXTRACTION, APPRAISAL AND SYNTHESIS: Data were extracted on study design and setting, sample characteristics, measurement of mental illness and TB, and outcomes including effect size or prevalence. Studies were critically appraised using Critical Appraisal Skills Programme (CASP) and Appraisal Tool for Cross-Sectional Studies (AXIS) checklists.
1546 records published over 50 years were screened, resulting in 10 studies included reporting data from 607 184 individuals. Studies span across Asia, South America and Africa, and include mood and psychotic disorders. There is robust evidence from cohort studies in Asia demonstrating that depression and schizophrenia can increase risk of active TB, with effect estimates ranging from HR=1.15 (95% CI 1.03 to 1.28) to 2.63 (95% CI 1.74 to 3.96) for depression and HR=1.52 (95% CI 1.29 to 1.79) to RR=3.04 for schizophrenia. These data align with evidence from cross-sectional studies, for example, a large survey across low-income and middle-income countries (n=242 952) reports OR=3.68 (95% CI 3.01 to 4.50) for a depressive episode in those with TB symptoms versus those without.
Individuals with mental illnesses including depression and schizophrenia experience increased TB incidence and represent a high-risk population to target for screening and treatment. Integrated care for mental health and TB is needed, and interventions tackling mental illnesses and underlying drivers may help reduce TB incidence globally.
CRD42019158071.
结核病（TB）和精神疾病在全球范围内普遍存在，且常同时存在。虽然不良的心理健康状况已知会影响免疫功能，但精神障碍是否在结核病发病中起因果作用尚不清楚。本系统评价旨在检查心理健康与结核病发病风险之间的关联，以为临床和公共卫生措施提供信息。
系统评价，遵循系统评价和荟萃分析的首选报告项目（PRISMA）指南。
对 MEDLINE、PsycINFO 和 PsycEXTRA 数据库进行了搜索，并结合参考文献列表和引文搜索。纳入标准是 1970 年 1 月 1 日至 2020 年 5 月 11 日期间发表的关于心理健康与结核病风险之间关联的原始研究报告。
数据提取、评估和综合：提取研究设计和背景、样本特征、精神疾病和结核病的测量以及包括效应大小或患病率在内的结果。使用批判性评估技能计划（CASP）和横断面研究评估工具（AXIS）检查表对研究进行批判性评估。
50 多年来共筛选出 1546 篇记录，最终纳入了 10 项研究，这些研究共纳入了 607184 名个体的数据。这些研究横跨亚洲、南美洲和非洲，包括情绪和精神病性障碍。来自亚洲队列研究的强有力证据表明，抑郁症和精神分裂症可增加活动性结核病的风险，其效应估计值范围为 HR=1.15（95% CI 1.03 至 1.28）至 2.63（95% CI 1.74 至 3.96）用于抑郁症和 HR=1.52（95% CI 1.29 至 1.79）至 RR=3.04 用于精神分裂症。这些数据与横断面研究的证据一致，例如，一项针对低收入和中等收入国家（n=242952）的大型调查报告称，在有结核病症状的人群中，出现抑郁发作的 OR=3.68（95% CI 3.01 至 4.50），而在无结核病症状的人群中，出现抑郁发作的 OR=3.68（95% CI 3.01 至 4.50）。
患有抑郁症和精神分裂症等精神疾病的个体结核病发病率增加，代表着需要进行筛查和治疗的高危人群。需要对心理健康和结核病进行综合护理，解决精神疾病和潜在驱动因素的干预措施可能有助于全球降低结核病发病率。
PROSPERO 注册号：CRD42019158071。
