- Design
- Systematic review and meta-analysis of observational studies
- Population
- 5,734 people with MDR-TB in 23 studies from low- and lower-middle-income countries
- Primary outcome
- Pooled prevalence of depression and associated factors
- Effect
- 41.9% (95% CI 32.6–51.2%); stigma AOR 3.58, comorbidity AOR 3.72
A meta-analysis pooled 23 studies of 5,734 people with multidrug-resistant tuberculosis in low- and lower-middle-income countries. It was published on 13 October.
The pooled prevalence of depression was 41.9% (95% CI 32.6–51.2%). Depression was more likely in women (adjusted OR 2.00), and in people with financial hardship (2.56), other illnesses (3.72), more severe disease (2.13), medication side effects (2.77) and perceived stigma (3.58).
MDR-TB treatment is long and arduous, and depression undermines adherence at exactly the point where missed doses cost most. Heterogeneity was very high and the included studies used different screening tools, so the exact figure is uncertain, but even its lower bound is about one in three. India carries a large share of the world's drug-resistant TB, and family physicians often see these patients for intercurrent problems. Asking about mood is cheap, and the risk factors identified, including stigma and side effects, are things a clinician can address.
- Screen every patient on MDR-TB treatment for depression, for example with the PHQ-2 then PHQ-9.
- Ask about drug side effects, since they were strongly linked with depression and may also threaten adherence.
- Ask about stigma and money worries, and link patients to social support available through the TB programme.
- Pay particular attention to women and to those with other chronic illnesses.
Why it matters
Depression in MDR-TB threatens the adherence that the whole treatment depends on.
Don't overread it
The risk factors are associations from cross-sectional studies; they do not show what would prevent depression.
The statistics, in plain English
The pooled prevalence of 42% comes with an interval from about 33% to 51% and an I² of 98.5%, meaning studies varied greatly. The adjusted odds ratios describe associations, not causes; stigma and side effects may cause depression, or depression may make them feel worse.
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