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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

Ensure your place at the UFS

2010-10-27

The University of the Free State (UFS) appeals to all prospective South African students who want to come and study at the UFS in 2011 to submit their applications no later than Tuesday, 30 November 2010.

The UFS is aware of the fact that learners will not have received their final Grade 12 results by Tuesday, 30 November 2010; therefore provisional admission will be granted based on learners’ most recent Grade 12 results. Final admission will take place upon receipt of the final Grade 12 results, which will be available early in January 2011.

Prospective students can obtain application forms for admission at the following places:

The UFS’s web site at www.ufs.ac.za,
The Information Office (Unit for Prospective Students) at the Thakaneng Bridge on the UFS’s Main Campus in Bloemfontein,
You may also send an e-mail to info@ufs.ac.za or
Phone 051 401 3000 and the necessary forms will be posted to you.

Senior undergraduate students (that is all students who were registered up to and during 2010 at the UFS) as well as post-graduate students, must self-register electronically on-line from Monday, 1 November 2010 until Tuesday, 4 January 2011. This includes master’s and doctoral students.

In order to encourage senior students to register online, the UFS offers 20 laptops as incentives for the senior students who successfully register online from 1 November 2010. These laptops will be handed over to the winners after the registration process in 2011.

Registration of first-year students:

The Rector and Vice-Chancellor, Prof. Jonathan Jansen, will welcome first-year students on Friday, 14 January and Saturday, 15 January 2011, respectively, in the Callie Human Centre. The Faculties of Economic and Management Sciences, the Humanities and Education will be welcomed on 14 January 2011 and the students of the Faculties of Natural and Agricultural Sciences, Law and Theology shall be welcomed on 15 January 2011. The compulsory orientation programme for new first-years will also then commence.

From 17 to 21 January 2011 first-year students will receive academic advice at the Callie Human Centre, whereafter they will be referred for self-registration. These processes will take place according to the set timetable. This timetable is available in the Kovsie Guide that will be sent to learners as soon as we have received their applications, as well as on the web site of the UFS at www.ufs.ac.za/register2011.

First-year students’ fees must be paid prior to arrival on 14 and 15 January 2011.

Registration of senior students:

Senior students who experience problems with the electronic on-line self-registration process have the opportunity to resolve problems within a programme on campus from Wednesday, 5 January until Wednesday, 12 January 2011. This programme will be sent out to students and is also available at www.ufs.ac.za/register2011. The specific scheduled day for senior students to resolve problems is the last and only day to resolve the problem.

Senior students can also contact 051 401 9111 for more information in this regard.

Students may register for prescribed modules for 2011, even though the November 2010 examination results are not yet available. Changes resulting from examination results that are made available later can be done up to and including 28 January 2011.

In terms of applications for senior students, only students who have interrupted a calendar year of study need to re-apply for admission.

Registration of students at the UFS’s Qwaqwa Campus:

Senior and first-year students of the UFS’s Qwaqwa Campus register from Wednesday, 12 January until Friday, 28 January 2011 in the Nelson Mandela Hall on this campus.

Registration of students at the UFS South Campus:

First-year students from the UFS’s South Campus in the University Preparation Programme and the Extended Programme (only Natural and Agricultural Sciences) register from Monday, 24 January till Friday, 28 January 2011 in the Arena Hall on the South Campus.

Students who have successfully completed the University Preparation Programme register with the first-year students on the UFS Main Campus on Friday, 14 and Saturday, 15 January 2011 – according to faculties (cf. paragraph 6).

Lectures for all students shall commence on Monday, 24 January 2011.

MEDIA RELEASE
Issued by: Lacea Loader
Director: Strategic Communication (actg)
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: loaderl@ufs.ac.za
26 October 2010

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