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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

OSM opening concert 2012

2012-03-02

The OSM Camerata is going to shine in the very first annual OSM opening concert.
1 March 2012

OSM opening concert 2012 with the OSM Camerata
Conductor: Nicholas Nikolaidis
Date: 1 March 2012
Venue: Odeion
Time: 19:30

The OSM opening concert 2012 with the OSM CAMERATA will be streamed live on the internet with the generous support of OSM partner, LA MUSE AUDIO & LIGHTING (www.ufs.ac.za/ufslivestreaming) in collaboration with the UFS LIVE STREAMING UNIT.

The OSM Camerata is going to shine in the very first annual OSM opening concert. The ensemble will be conducted by Nicholas Nikolaidis. The programme includes excerpts from Stabat Mater (Pergolesi), Romanian Folk Dances (Bartók), Pelimannit (Rautavaara), Elegy (Grové) and Purple Haze (Hendrix). since 2011, the Odeion School of Music has embarked on a new, innovative strategy striving towards uncompromising excellence and internationalisation, which includes the A-List scholarship programme and a new flagship chamber ensemble, the OSM Camerata. Talented South African, conductor/tenor Nicholas Nicolaidis, (runner-up in the First National Len van Zyl Orchestral Conducting Competition) will take the stage for the inaugural concert of the OSM.

Nicholas started his conducting career at an early age while still in the Drakensberg Boys’ Choir School. Professionally his first conducting post was as choirmaster and conductor of the choir and band at Pridwin Preparatory School (Melrose, Johannesburg) in 1996.

Following his appointment in April 1997 as the Musical Director of Côr Meibion Cymru de Affrig (The Welsh Male Voice Choir of South Africa), he conducted the choir for seven years, producing three albums. One of the highlights was the performance at the Royal Albert Hall in London in October 2000 for the Millennium Festival of Male Voice Choirs.

His orchestral conducting debut was in 1998 at the Johannesburg City Hall where he conducted the Johannesburg Festival Orchestra and the Symphony Choir of Johannesburg in a few items of ‘Last Night of the Proms’. Selected conducting performances include the Chanticleer Singers in a performance of Schubert’s Mass in G at the Holy Trinity Church (Braamfontein, Johannesburg) in 2002, and the Johannesburg Camerata, a chamber orchestra consisting of talented young performers, during their winter season in 2005.

In 2006, Nicholas enrolled at Stellenbosch University for a Master’s degree in Choral Conducting under the direction of the Norwegian pedagogue, Kåre Hanken. During this time, he also conducted the Johannesburg-based chamber choir, Collegium Vocale. He conducted the Johannesburg Chamber Wind Ensemble from 2006 to 2008.

In 2009, he conducted the Johannesburg Festival Orchestra in a programme of music by Leroy Anderson, the vocal ensemble, In Verse, and the Chanticleer Singers during their Christmas season. Nicholas was also the winner of the inaugural Young Choral Conductors Competition held during the Stellenbosch International Choral Conducting Symposium in March 2009.

In February 2010, he was awarded the Silver Medal in the inaugural Len van Zyl Conducting Competition held in conjunction with the Cape Philharmonic Orchestra. During the Easter period of 2010 he conducted Cantamus Corde in a performance of JS Bach’s St John’s Passion, whilst also singing the role of the Evangelist.

Nicholas has also appeared as guest conductor of the Philharmonia Choir of Cape Town in a concert with music by Ramirez and Klatzow. In that year he also conducted the gala Concert of the Brooklyn Theatre (Pretoria).

Refreshments will be on sale before and after the concert.

Admission:
R60 (adults)
R40 (pensioners, students and learners)
Tickets available at Computicket.

Enquiries:
Ninette Pretorius (Tel: +27(0)51 401 2504)

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