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Undiagnosed depression in tuberculosis patients threatens control of the disease

24 March 2023 | Story Profs Gladys Kigozi-Male, Christo Heunis, and Michelle Engelbrecht | Photo Supplied

Prof Christo Heunis, Prof Michelle Engelbrecht, Prof Gladys Kigozi-Male — From the left, Prof Christo, Prof Michelle Engelbrecht, and Prof Gladys Kigozi-Male.

Opinion article by Profs Gladys Kigozi-Male, Christo Heunis, and Michelle Engelbrecht, Centre for Health Systems Research and Development, University of the Free State.

Each year on 24 March, the world commemorates World TB (Tuberculosis) Day. This date coincides with the day in 1882 when Robert Koch announced his discovery of the Mycobacterium Tuberculosis, the germ that causes TB. This infectious disease is transmitted through airborne droplets when an infected person coughs, sings, shouts, or sneezes. TB primarily affects the lungs (i.e., pulmonary TB), but other organs in the body such as the pleura, lymph nodes, abdomen, genitourinary tract, skin, joints and bones, or meninges (i.e., extra-pulmonary TB) can also be affected. TB can be cured; effective anti-TB drugs have been available for almost eight decades. Despite this, TB continues to wreak havoc across the world and in South Africa. According to a report released by the World Health Organisation (WHO), an estimated 304 000 new TB cases were reported in South Africa in 2021 and 56 000 people succumbed to the disease in the same year

A world without TB

In 2014, the sixty-seventh World Health Assembly endorsed a global strategy and targets for TB prevention, care, and control. The strategy envisions a world without TB, aiming to end the epidemic by 2035. By this target date, a reduction in TB deaths of 95% and new infections of 90% – compared to the respective levels in 2015 – are anticipated. Further to this, the United Nations’ Stop TB Partnership was mandated to drive activities to end the global TB epidemic. In 2015, the partnership launched the 90-(90)-90 targets; to reach at least 90% of people with TB and place them on appropriate treatment, including at least 90% of vulnerable populations such as people living with HIV, and to ensure that at least 90% of people with TB are successfully treated. Despite commendable progress, persisting high TB infection and death rates are adversely affecting global and national efforts to end the TB epidemic. With a treatment success rate of only 78% in 2020, South Africa is sorely challenged to attain the global target of 95%.

TB with mental health illness

One of the challenges confronting TB control is the frequent comorbidity of TB with mental health illness. There is compelling evidence linking TB to common mental health problems such as depression, anxiety, and alcohol misuse. Research indicates that TB patients can experience mental health problems at any time during the course of their TB treatment. Undiagnosed mental illness among TB patients may result in poor health-seeking behaviour and non-adherence to treatment, subpar quality of life, and negative treatment outcomes. The WHO's Global End TB Strategy thus recommends integrated patient-centred TB care. This implies that TB care should be provided in close collaboration with other primary health-care (PHC) programmes such as mental health. However, in many countries – South Africa included – efforts to integrate mental health and TB care are confronted by challenges such as limited capacity, nonrecognition of mental health as a problem, insufficient resources, and TB-related social stigma. Consequently, mental health conditions in TB patients are often un-/under-/mis-diagnosed.

Taking depression as a compelling example, a scoping review reported the prevalence of depression as high as 84% among people with TB in studies conducted internationally. However, little is known about the prevalence of depression among TB patients in South Africa. Using a nine-item Patient Health Questionnaire, we assessed probable depression among a sample of TB patients attending PHC facilities in the Free State. We found that almost half (46,1%) of the 208 patients interviewed had probable depression, with 22,6%, 18,8%, and 4,8% having mild, moderate, and severe symptoms, respectively. Probable depression was almost four times more likely among patients diagnosed with extra-pulmonary TB compared to pulmonary TB patients. HIV-infected TB patients undergoing antiretroviral therapy were more than twice as likely to experience symptoms of depression compared to their counterparts who were not undergoing such therapy. This could possibly be attributed to non-adherence to antiretroviral therapy. Studies elsewhere have established a significant association between depression and ART non-adherence. We further found that the longer patients were retained on TB treatment, the less likely they were to display symptoms of depression.

Important to monitor TB patients for depression

Based on these findings, it is important to monitor TB patients for symptoms of depression – particularly those with comorbid HIV – in PHC settings. At the same time, ensuring that patients stay on treatment by providing adequate support for treatment adherence may help to mitigate depression during TB treatment.

The theme for this year’s World TB Day is ‘Yes! We can end TB’. It is a call for concerted multi-sectoral collaboration between governments, civil society, communities, academia and technical partners, international aid and scientific organisations, the private sector, and disease control programmes in the country to eliminate the TB epidemic. To this end, TB patients attending PHC facilities in South Africa need to be routinely screened for mental health illness. Given the critical shortage of mental health specialists, screening for mental illnesses could be undertaken by trained and well-supervised non-specialist healthcare cadres such as community health workers.

News Archive

Exciting open day and Albert Einstein program at Boyden Observatory

2005-05-06

National Science Week, which will be held from 7-14 May 2005, is an annual country-wide celebration of science, led by the Department of Science and Technology. The department selected a proposal by the Boyden Science Centre to coordinate a week of activities in the Bloemfontein area as one of the many projects in the country.

The project for Bloemfontein and surrounding areas will be delivered though a collaboration between the National Museum in Bloemfontein and the University of the Free State (UFS), including the Research Institute for Education Planning, the Department of Physics and other departments in the Faculty of Natural and Agricultural Sciences.

The purpose of National Science Week is:

to create awareness of the important role that science play in people’s daily lives;
to encourage our youth to consider studying and improving their performance in mathematics and science; and
to attract more of our youth into science, engineering and technology (SET) careers.

World Year of Physics and Albert Einstein Program at Boyden Observatory

The International Union of Pure and Applied Physics (IUPAP) declared the year 2005 as the World Year of Physics (WYP). In recognition of this declaration, the great contribution of Physics to the development of technology, and its importance in our everyday lives will be featured strongly during the National Science Week 2005.

On Saturday 7 May 2005 there will be a public programme at Boyden Observatory from 15:30 as a contribution to the World Year of Physics. The programme will be presented in collaboration with the Bloemfontein branch of the Astronomical Society of Southern Africa and will include short presentations on astronomy, space exploration and the sun.

The main presentation will be at 19:00 the evening on the life and work of Albert Einstein. The programme will also include observing sessions through telescopes of objects like the sun, Jupiter and Saturn. There will also be an exhibit on Albert Einstein. Attendance is free but booking is required. For bookings, phone 051-4012561.

Public lecture programme:

Next week the following exciting public lectures will be presented as part of the Science Week activities:

Monday 9 May 2005

National Museum:

A discussion on Apocalypse Then: the greatest mass extinction of all time. The lecture will be presented by Dr Jennifer Botha, Paleontologist at the National Museum.
Bookings: 051-4479609 (entrance is free).

UFS campus:

All lectures at Kine 2, Medical Faculty, UFS campus. Follow directions from the DF Malherbe Road entrance.
Bookings: 051-4012561 (entrance is free).

Tuesday 10 May 2005:

A discussion on the Tsunami disaster of 26 December 2004 at 19:30 (UFS campus, Kine 2 Medical Faculty).

Wednesday 11 May 2005:

A discussion on Is there life out there? at 19:30 (UFS campus, Kine 2 Medical Faculty).

Friday 13 May 2005:

A discussion on Hunting Black Holes at 19:30 (UFS campus, Kine 2 Medical Faculty). The lecture will be presented by Dr Phil Charles, Director: South African Astronomical Observatory.

Science awareness day at the National museum

The science week will be concluded on Saturday 14 May 2005 with a special Science Awareness Day at the National Museum, Aliwal Street, Bloemfontein.

The excellent exhibits at the museum will be supplemented with activities, career information and video shows. The duration of the programme will be from 10:00-16:00. For enquiries, please call 051-4479609.

Issued by:  Lacea Loader
   Media Representative
   Tel: (051) 401-2584
   Cell: 083 645 2454
   E-mail: loaderl.stg@mail.uovs.ac.za

6 May 2005

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