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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

UFS changes format of graduation ceremony

2011-04-17

The highest number of qualifications in the history of the University of the Free State (UFS) will be awarded at the autumn diploma and graduation ceremony from 9-11 May 2011, which will be held in the Callie Human Centre on our Main Campus in Bloemfontein.

From this year, the format of the ceremony will change to make it more visible to students and the public. For the first time, all the doctoral and master’s degrees from each respective faculty will be conferred during one ceremony on 11 May 2011, instead of each faculty handling these qualifications individually. Another change in the format is that the procession will gather on the Red Square in front of the Main Building and move to the Callie Human Centre from there. Both academic staff and graduands will partake in the procession.

A total of 3 674 qualifications will be conferred during this year’s graduation ceremony, including 629 diplomas, 2 613 Bachelors and honours degrees, 372 master’s degrees and 58 doctorates.

An honorary doctorate in Drama and Theatre Arts will also be awarded to theatre stalwart Mr Pieter Fourie. He is one of the most acclaimed Afrikaans playwrights in South Africa and probably the only person to have left his mark as an actor, director, artistic director and writer.

Mr Fourie was awarded the Gerhard Beukes prize for drama , was honoured for his contribution to the arts by the South African Academy for Science and Arts and was appointed as trustee of the Arts and Culture Trust of the State President in 1997. He has also served as a committee member of the South African Academy for Science and Arts.

Mr. Fourie has also been the proud recipient of the Hertzog prize for drama, two FNB-Vita awards and a Fleur Du Cap award.

The full programme for the respective ceremonies is as follows:

Monday, 9 May 2011:

At 08:30, certificates and diplomas, excluding PGED and PGES, will be awarded to graduates from the Faculty of Education and at 12:00 PGED, PGED and B and honours degrees will be awarded to students from the same faculty. At 15:30 on the same day, certificates and B and honours degrees will be awarded to students in the Faculty of the Humanities.

At 19:00, the Faculties of Education, the Humanities and Economic and Management Sciences will have their prize-giving ceremonies for outstanding achievers.

Tuesday, 10 May 2011:

At 08:30, students in the Faculty of Economic and Management Sciences will graduate and at and 12:00 the Faculty of Natural and Agricultural Science will join them. This includes students in BML, B.Admin., B.Pub. and related honours degrees. At 15:30, 503 students from the Faculty of Natural and Agricultural Sciences will receive their certificates, diplomas and B and honours degrees.

At 19:00, the Faculties of Health Sciences, Natural and Agriculture Sciences, Law and Theology will have their prize-giving ceremonies.

Wednesday, 11 May 2011:

The Faculty of Health Sciences, the Faculty of Law and the Faculty of Theology will be awarding their certificates, diplomas and B and honours degrees at 08:30. At 12:00, all faculties will award a total of 372 master’s degrees and at 15:30 a total of 58 doctorates will be conferred.

The Chancellor’s Dinner will take place in the Centenary Complex on the Main Campus of the UFS at 19:00.

The graduation ceremony of our Qwaqwa Campus will take place in the Rolihlahla Mandela Hall on the Qwaqwa Campus on 7 May 2011 at 10:00. All the faculties at this campus will confer their degrees, certificates and diplomas at this ceremony.

Media Release
21 April 2011
Issued by: Lacea Loader
Director: Strategic Communication
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: news@ufs.ac.za

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