- Design
- Systematic review and meta-analysis of observational studies
- Population
- 23 studies, 5,734 people with MDR-TB in low- and lower-middle-income countries
- Primary outcome
- Prevalence of depression
- Effect
- Pooled prevalence 41.9% (95% CI 32.6 to 51.2); I² = 98.5%
A meta-analysis gathered 23 studies of 5,734 people with multidrug-resistant tuberculosis in low- and lower-middle-income countries. The pooled prevalence of depression was 41.9% (95% CI 32.6 to 51.2), though heterogeneity between studies was very high.
Depression was associated with female sex (adjusted OR 2.00), financial hardship (2.56), other illnesses (3.72), more severe disease (2.13), drug side effects (2.77) and perceived stigma (3.58). These are cross-sectional associations, so they flag who to watch rather than proving cause.
MDR-TB treatment is long, isolating and often costly to the family even when drugs are free, and depression is a known threat to completing it. India carries the largest share of the world's MDR-TB, so the finding applies directly to the programme here. Some second-line drugs, notably cycloserine, can themselves cause mood change and should be considered in any patient whose mood falls on treatment.
- Screen for depression at the start of MDR-TB treatment and at follow-up, using a short tool such as the PHQ-9
- Ask directly about stigma, income loss and family support at each visit
- Consider cycloserine or terizidone as a cause of new low mood, anxiety or psychosis
- Refer or co-manage with mental health services where screening is positive
- Link patients to nutritional and financial support schemes available under the national programme
Why it matters
Depression in MDR-TB is common enough to be routine care, and it threatens completion of a two-year regimen.
Don't overread it
Very high heterogeneity means the true prevalence in any one clinic could be well above or below 42%.
The statistics, in plain English
An I² of 98.5% means the studies differed far more than chance would explain, so the pooled 42% is an average across very different settings. Adjusted odds ratios show which groups were more likely to be depressed, not that the factor caused it.
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