Pradhan Anmol, Koirala Prakash, Bhandari Samrat Singh, Dutta Sanjiba, García-Grau Pau, Sampath Harshavardhan, Sharma Indralal
Department of Psychiatry, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, India.
Department of Respiratory Medicine, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Gangtok, India.
Front Psychiatry. 2022 May 19;13:869647. doi: 10.3389/fpsyt.2022.869647. eCollection 2022.
Adherence to medication for tuberculosis (TB) has been found to be deleteriously affected by psychosocial issues, including internalized and perceived stigma (IPS) and depression, usually resulting in the emergence of multidrug-resistant TB (MDR-TB). The objective of the study was to find the prevalence of depression among patients receiving treatment for pulmonary TB, and how stigma and depression affect the relationship between drug sensitivity status (DSS) and treatment adherence.
It was a cross-sectional observational study conducted between January 2019 and July 2020 in two centers in Sikkim, India. The Patient Health Questionnaire-9 (PHQ-9), Internalized Social Stigma Scale (ISSS), and Tuberculosis Medication Adherence Scale were used to assess depression, IPS, and medication adherence, respectively. A path analysis was performed with DSS, treatment adherence, IPS, and depression. Education in years was included in the model as it was significantly correlated with IPS.
A total of 71 patients who were on drug-sensitive TB (DS-TB) regimen ( = 26) and MDR-TB regimen ( = 45) participated in the study. Notably, 56.3% ( = 40) of the participants were found to have depression. Among the depressed participants, 32.5% were on the DS-TB regimen and 67.5% were on the MDR-TB regimen. The path analysis indicated that IPS and depression were serially mediating the relationship between DSS and treatment adherence (β = -0.06, < 0.05, 95% CI = -3.20, -0.02). Finally, years of education had an exogenous predictor role, not only directly affecting IPS (β = -0.38, < 0.001, 95% CI = -0.99, -0.31) but also affecting treatment adherence through IPS and depression (β = 0.08, = 0.02, 95% CI = 0.03, 0.47). This indicated that with more years of education, the IPS decreases, which decreases depression and ultimately leads to better adherence.
We found an important relationship between different psychosocial factors which may affect treatment adherence. Patients who have higher IPS are more likely to develop depression which negatively affect adherence. Patients on the MDR-TB regimen have higher stigma. There is an urgent need to integrate mental health services with TB Control Programs.
已发现结核病（TB）药物治疗的依从性受到社会心理问题的有害影响，包括内化和感知耻辱感（IPS）以及抑郁症，这通常会导致耐多药结核病（MDR-TB）的出现。本研究的目的是确定接受肺结核治疗的患者中抑郁症的患病率，以及耻辱感和抑郁症如何影响药物敏感性状态（DSS）与治疗依从性之间的关系。
这是一项于2019年1月至2020年7月在印度锡金的两个中心进行的横断面观察性研究。分别使用患者健康问卷-9（PHQ-9）、内化社会耻辱感量表（ISSS）和结核病药物治疗依从性量表来评估抑郁症、IPS和药物治疗依从性。对DSS、治疗依从性、IPS和抑郁症进行了路径分析。由于受教育年限与IPS显著相关，因此将其纳入模型。
共有71名接受药物敏感结核病（DS-TB）治疗方案（n = 26）和耐多药结核病治疗方案（n = 45）的患者参与了研究。值得注意的是，发现56.3%（n = 40）的参与者患有抑郁症。在抑郁的参与者中，32.5%接受DS-TB治疗方案，67.5%接受MDR-TB治疗方案。路径分析表明，IPS和抑郁症在DSS与治疗依从性之间起连续中介作用（β = -0.06，p < 0.05，95%CI = -3.20，-0.02）。最后，受教育年限具有外生预测作用，不仅直接影响IPS（β = -0.38，p < 0.001，95%CI = -0.99，-0.31），还通过IPS和抑郁症影响治疗依从性（β = 0.08，p = 0.02，95%CI = 0.03，0.47）。这表明，受教育年限越长，IPS越低，抑郁症也会减轻，最终导致更好的依从性。
我们发现不同社会心理因素之间存在可能影响治疗依从性的重要关系。IPS较高的患者更容易患抑郁症，这对依从性有负面影响。接受MDR-TB治疗方案的患者耻辱感更高。迫切需要将心理健康服务与结核病控制项目相结合。
