Prevalence and risk factors of depression in patients with drug-resistant tuberculosis in Nepal: A cross-sectional study

Sailesh Kumar Shrestha; Sulochana Joshi; Ratna Bahadur Bhattarai; Lok Raj Joshi; Nilaramba Adhikari; Suvesh Kumar Shrestha; Rajendra Basnet; Kedar Narsingh Kc

doi:10.1016/j.jctube.2020.100200

Prevalence and risk factors of depression in patients with drug-resistant tuberculosis in Nepal: A cross-sectional study

J Clin Tuberc Other Mycobact Dis. 2020 Oct 29:21:100200. doi: 10.1016/j.jctube.2020.100200. eCollection 2020 Dec.

Authors

Sailesh Kumar Shrestha¹, Sulochana Joshi², Ratna Bahadur Bhattarai¹, Lok Raj Joshi¹, Nilaramba Adhikari¹, Suvesh Kumar Shrestha³, Rajendra Basnet¹, Kedar Narsingh Kc¹

Affiliations

¹ National Tuberculosis Control Center, 44811 Thimi, Bhaktapur, Nepal.
² Department of Psychiatry, Patan Academy of Health Sciences, 44700 Lalitpur, Nepal.
³ Save the Children/Global Fund, 44604 Kathmandu, Nepal.

Abstract

Background: Patients with drug-resistant tuberculosis (DR TB) have a protracted course of illness and the available treatment has a low success rate. These factors combined with the associated stigma and financial implications put the patients with DR TB at an increased risk of depression. The psychiatric side effects of anti-tuberculosis drugs further aggravate the problem. This study aimed to estimate the prevalence of depression among patients with DR TB in Nepal and identify risk factors.

Methods: We conducted this cross-sectional study in April 2018 at all the functioning 11 programmatic DR TB treatment centers across Nepal. We selected 129 patients aged ≥ 16 years receiving treatment for DR TB by non-probability quota sampling. Six trained data collectors conducted face-to-face interviews and administered the Nepali language version of Patient Health Questionnaire 9 (PHQ-9) to screen for depression. We summarized sociodemographic and treatment characteristics with median (Interquartile Range [IQR]) and proportions as appropriate. We performed univariate analysis for the variables hypothesized as risk factors for depression. We fitted a multivariable binary logistic regression model with depression as the outcome variable and the variables with a significance level of < 0.25 as explanatory variables. We regarded a p-value of < 0.05 as significant for individual variables in the logistic regression model.

Results: Of the 129 patients studied, 92 (71.3%) were male and the median age was 36 years (IQR 25-48). The majority (109, 84.4%) had multi-drug resistant tuberculosis (MDR TB). We identified 81 patients (62.7%, 95% Confidence Interval [CI] 53.7-71) with the PHQ-9 score of 10 or more signifying probable depressive disorder. In univariate analyses, age, treatment center location, DR TB treatment duration, and duration of current illness had a p-value lower than the pre-specified cut-off of 0.25. In the multivariable logistic regression model, we found a statistically significant association of depression with the duration of illness (adjusted Odds Ratio 1.15, 95% CI 1.07-1.26, p < 0.001).

Conclusion: This study has found that a large proportion of the patients with DR TB screened have depression suggesting the need for screening and management of comorbid depression within the National TB Control Program.

Keywords: Depression; Drug-Resistant Tuberculosis; Patient Health Questionnaire 9; Prevalence.