Department of Health Sciences, University of York, York, UK.
Institute of Public Health & Social Sciences, Khyber Medical University, Peshawar, Pakistan.
Health Expect. 2024 Feb;27(1):e13985. doi: 10.1111/hex.13985.
The co-occurrence of depression among tuberculosis (TB) patients is a critical issue, contributing to poor treatment outcomes, prolonged hospitalisations and increased healthcare expenses.
The objective of this study was to assess the feasibility of delivering a co-designed depression care pathway within TB services in Pakistan.
Mixed-method study.
Routine depression screening for TB patients was conducted at three TB facilities in Peshawar, Pakistan, encompassing primary, secondary and tertiary care settings. All patients aged 18 or above (male and female) attending the three TB facilities between November 2021 and February 2022 were included in the study using the consecutive sampling technique.
A total of 301 people with confirmed TB, within the past 4 weeks, visited the three TB care facilities; 191/301 patients were screened for depression. Approximately 35% of the 191 TB patients screened positive for depression, with varying severity levels. Qualitative findings highlighted the acceptability of integrated depression care, emphasising the importance of open communication and empathetic attitudes. Barriers to integration include stigma, logistical challenges, patient noncompliance and cost burdens. Facilitators included the empathetic attitude of healthcare providers and the availability of mental health services within the same facility.
There is a high burden of depression in patients with TB, highlighting the pressing need for mental health support in this population. Acceptability of integrated care was evident, with factors such as co-located mental health services, training healthcare providers and provider empathetic attitudes playing a crucial role. Further research is required to evaluate the effectiveness of the integrated TB-depression screening systems towards improved health outcomes, implementation, scalability and impact on the broader healthcare system.
To create a more inclusive and comprehensive TB and depression care pathway, we gathered input from both service providers and service users (TB patients, their carers). Reflective meetings with community leaders, social activists and health professionals from various sectors were also conducted during pathway delivery to get their insights. Power, gender and age imbalances were addressed by encouraging participation of patients and carers across gender and age groups. This approach ensured that the perspectives of all stakeholders were considered in the development of the care pathway.
结核病（TB）患者中抑郁的共病是一个关键问题，导致治疗效果不佳、住院时间延长和医疗费用增加。
本研究旨在评估在巴基斯坦的结核病服务中实施共同设计的抑郁护理途径的可行性。
混合方法研究。
在巴基斯坦白沙瓦的三个结核病机构对结核病患者进行常规抑郁筛查，包括初级、二级和三级保健机构。使用连续抽样技术，纳入 2021 年 11 月至 2022 年 2 月期间在这三个结核病设施就诊的所有年龄在 18 岁及以上（男性和女性）的患者。
在过去 4 周内，共有 301 名确诊结核病的患者到三个结核病护理机构就诊；191/301 名患者接受了抑郁筛查。约 35%的 191 例结核病患者筛查出有不同严重程度的抑郁。定性研究结果突出了整合性抑郁护理的可接受性，强调了开放沟通和同理心的重要性。整合的障碍包括耻辱感、后勤挑战、患者不依从和费用负担。促进因素包括医疗保健提供者的同理心态度和在同一设施中提供精神卫生服务。
结核病患者中存在较高的抑郁负担，这突显了该人群对精神卫生支持的迫切需求。整合护理的可接受性明显，共同的精神卫生服务、培训医疗保健提供者和提供者的同理心态度等因素发挥了关键作用。需要进一步研究评估整合性结核病-抑郁筛查系统对改善健康结果、实施、可扩展性和对更广泛的医疗保健系统的影响的有效性。
为了创建一个更具包容性和全面性的结核病和抑郁护理途径，我们从服务提供者和服务使用者（结核病患者及其照顾者）那里收集了意见。在途径实施过程中，还与来自不同部门的社区领导、社会活动家和卫生专业人员进行了反思性会议，以获取他们的见解。通过鼓励不同性别和年龄组的患者和照顾者参与，解决了权力、性别和年龄不平衡的问题。这种方法确保了在制定护理途径时考虑到所有利益相关者的观点。
