- Design
- Systematic review and random-effects meta-analysis of 23 studies
- Population
- 5,734 patients with MDR-TB in low- and lower-middle-income countries
- Primary outcome
- Pooled prevalence of depression
- Effect
- 41.89% (95% CI 32.63–51.15), I² 98.51%; stigma AOR 3.58 (2.13–6.02)
This systematic review and meta-analysis pooled 23 studies of 5,734 patients 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), although the studies differed enormously (I² 98.5%).
Depression was more likely in women (adjusted OR 2.00), with financial hardship (2.56), other illness (3.72), more severe disease (2.13), drug side effects (2.77) and perceived stigma (3.58). These are cross-sectional associations, so they describe who is affected rather than what causes it, and some may run both ways.
The treatment burden explains much of this: long regimens, injectables in older protocols, isolation, lost income and drugs with psychiatric side effects. Depression in turn threatens adherence, which matters more in MDR-TB than almost anywhere. India carries the largest share of the world's MDR-TB, so this finding applies directly to clinics here. Screening with a brief tool at diagnosis and during treatment costs little.
- Screen for depression at MDR-TB diagnosis and again during treatment, using a brief tool such as the PHQ-9.
- Ask specifically about stigma, lost income and side effects, the factors most strongly linked to depression here.
- Review regimens for drugs with psychiatric effects, such as cycloserine, when mood changes.
- Women and patients with other illnesses had about twice the odds or more of depression.
- Link patients to counselling or social support through the TB programme where it exists.
Why it matters
Depression in MDR-TB is common enough that not screening for it means missing a threat to adherence in almost half of patients.
Don't overread it
The associations are cross-sectional; they cannot show that stigma or side effects cause depression.
The statistics, in plain English
An I² of 98.5% means almost all the variation between studies was real difference rather than chance, so the 41.9% figure is an average across very different settings, not a prediction for any one clinic. The adjusted odds ratios come from observational studies and cannot show cause.
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