About four in ten people with drug-resistant TB in lower-income countries have depression

Design

Systematic review and random-effects meta-analysis of 23 primary studies

Population

5,734 people with multidrug-resistant tuberculosis in low- and lower-middle-income countries

Primary outcome

Pooled prevalence of depression and associated factors

Effect

Prevalence 41.89% (95% CI 32.63 to 51.15), I-squared 98.51%

A meta-analysis pooled 23 studies and 5,734 people with multidrug-resistant tuberculosis in low- and lower-middle-income countries. The pooled prevalence of depression was 41.89% (95% CI 32.63 to 51.15), with very high heterogeneity (I-squared 98.51%).

Factors associated with depression were female sex (adjusted OR 2.00, 95% CI 1.66 to 2.41), financial hardship (2.56, 1.44 to 4.55), comorbidities (3.72, 2.11 to 5.38), greater disease severity (2.13, 1.42 to 3.12), medication side effects (2.77, 2.20 to 3.48) and perceived stigma (3.58, 2.13 to 6.02).

The prevalence figure varies a lot between studies, probably because of different screening tools, settings and thresholds, so it is best read as showing that depression is common, not as a precise rate. The authors recommend routine screening and psychosocial support in TB care.

• Ask about mood and sleep at each visit for patients on drug-resistant TB regimens.
• Use a validated screening tool already familiar in your clinic and record the score.
• Review whether a medicine could be contributing; discuss with the TB team before any change.
• Address stigma and financial strain, which were strongly associated with depression.
• Arrange a pathway for those who screen positive rather than screening alone.

Why it matters

It puts a mental health need in front of TB programmes that often treat only the infection.

Don't overread it

Screening tools differ across studies, and associations here do not show that treating the factors would reduce depression.

The statistics, in plain English

An I-squared of 98.5% means almost all the variation between studies is real difference, not chance, so the single pooled figure of about 42% hides a wide spread. The associated factors are adjusted odds ratios from observational studies; they show who is at higher risk, not what causes depression.

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