- Design
- Systematic review and random-effects meta-analysis of 23 studies
- Population
- 5734 people with multidrug-resistant tuberculosis in low- and lower-middle-income countries
- Primary outcome
- Pooled prevalence of depression and associated factors
- Effect
- 41.9% (95% CI 32.6% to 51.2%), I² = 98.5%
A meta-analysis pooled 23 studies of 5734 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%), with very high heterogeneity between studies (I² = 98.5%).
Depression was associated with female sex (adjusted OR 2.00), financial hardship (2.56), comorbidity (3.72), more severe disease (2.13), drug side effects (2.77) and perceived stigma (3.58). These are cross-sectional associations, so they identify who to screen rather than what causes the depression.
India carries a large share of the world's drug-resistant tuberculosis, and treatment is long and burdensome. Depression undermines adherence, and some second-line drugs carry neuropsychiatric effects of their own. Psychiatrists asked to see these patients, and physicians running TB clinics, should expect depression to be common rather than exceptional.
- Screen for depression at the start of treatment for drug-resistant tuberculosis and again when side effects appear.
- Ask directly about stigma and money worries — both were among the strongest correlates of depression.
- Review the TB regimen for drugs with neuropsychiatric effects before attributing low mood to the illness alone.
- Check for interactions between antidepressants and second-line TB drugs, especially QT-prolonging combinations.
- Link patients to psychosocial support within the TB programme where it exists.
Why it matters
Depression in drug-resistant TB is common enough that waiting for referral will miss most of it.
Don't overread it
The correlates come from cross-sectional studies; they mark risk, not cause.
The statistics, in plain English
A prevalence of 41.9% means about four in ten patients met study criteria for depression. An I² of 98.5% means the studies varied enormously — the true rate in any one clinic could be well above or below this. An adjusted odds ratio of 3.58 for stigma means depression was several times more likely in those reporting it, after accounting for other measured factors.
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