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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 Centenary 2004 / 2005 October (centenary) fest Activities

2004-10-08

Friday, 08 October 2004
17:00 – 24:00
Callie Human Centre, UFS
Macufe Rock Concert
With: Rooibaardt, Karen Zoid, The Narrow, F****polisiekar, Stuurbaard Bakkebaard (from the Netherlands), DJ Bob, Ready D, Neva Me.
Cost : R50-00
Bookings : Pacofs (051-447 7772)

Sunday, 10 October 2004
16:00 – 18:00
Callie Human Centre, UFS
Macufe Three Tenors Concert
With: Phillip Kotze, Chris Coetzer and Du Preez Stolz, as well as Angela Kerrison. Free State Symphony Orchestra conducted by Chris Dowdeswell.
Cost :R60-00 (adults), R40-00 (children, scholars, students and pensioners)
Bookings : Pacofs (051-447 7772)

Tuesday, 12 October 2004
11:00 – 15:00
Centenary Complex, UFS
Inauguration of Centenary Complex
Open day with a variety of musical recitals in different rooms
Cost : Free
Enquiries : Elize Rall (051-401 3382)

15:00 – 17:00
Parking area next to the Centenary Complex, UFS
Kovsie Mosaic Day
Collage of the Century, Dance to the beat, Cultural Cartoon,
Who’s line is it anyway?
Cost : Free
Enquiries : Louis Botha (051-401 2819) or
AC Geldenhuys (084 585 3338)

Wednesday, 13 October 2004
19:00
Centenary Complex, UFS
Première of documentary film : The Life and Legacy of King Moshoeshoe
Note : By invitation only
Enquiries : Elize Rall (051-401 3382)

Thursday, 14 October 2004
18:45 – 21:00
Red Square (in front of Main Building), UFS
Centenary Honorary Doctorate Degree Graduation Ceremony
Conferred on: Me. Antjie Krog, Prof. Jakes Gerwel, Mr. Karel Schoeman, Dr. Frederick van Zyl Slabbert, Prof. Saleem Badat, Dr. Khotso Mokhele, Prof. Robert Bringle, Prof. Leo Quayle, Prof. Jack de Wet, Prof. Kerneels Nel (posthumously), Prof. Boelie Wessels and Prof. Jaap Steyn .
Cost : Free. Please RSVP if you would like to attend.
Enquiries : Elize Rall (051-401 3382)

Friday, 15 October 2004
18:30
Centenary Complex, UFS
Alumni Dinner and Centenary Award Ceremony
Approximately 140 centenary medals will be awarded in acknowledgement of exceptional contributions to the development of the University. The award ceremony is followed by the Alumni dinner in the Callie Human Centre.
Cost : R100-00/person
Enquiries : Elize Rall (051-401 3382)

15:00 (to 12:00, Saturday, 16 October 2004),
UFS campus
Reunion : Momentum Adventure and Expedition Association
Including : Setting up of the Kovsie Momentum base camp, champagne breakfast and abseiling.
Cost : R50-00/person for breakfast
Enquiries : Gerrit van der Merwe (072 4317 153) or
Niel Fraser (082 772 5642)
Website : www.uovs.ac.za/associations/momentum_hrcc.

19:00 (to 11:00 Sunday, 17 October 2004)
Reunion : Cantare Revue Group
Including : Formal dinner, budget show, bring and braai, church service.
Cost : R100-00/person for the dinner
Enquiries : Louis Botha (051-401 2819)

19:00 (to 24:00 Saturday, 16 October 2004
Reunion : House NJ van der Merwe
Including : Senior Student’s Association and concerts
Cost : R5-00/person
Enquiries : Tutu Ntlathi (051-401 4122 / 072 865 2227)

Saturday, 16 October 2004
09:00 – 10:00
Committee Room 120, Faculty of Theology
Founding of Theology Alumni Association
Enquiries: Henna Nel (051-401 2669)

10:00 – 12:00
Parking area, CR Swart Building, UFS
Alumni Campus Tour
Including : Visits to the new physical developments on campus
Cost : Free
Enquiries : Jeanette Jansen (051-401 3594)

10:00 – 12:00
Sonnedou gazellie (next to NJ van der Merwe Residence), UFS
Reunion : Ladies’ Tea
Visit our new gazellie and find out what Sonnedou is up to these days.
Cost : R25-00/person
Enquiries : Anne-Marie Delport (072 109 0507)

12:00 – 16:00
JBM Hertzog Residence (garden in front of Senior Student’s Association), UFS
Reunion : Braai
Cost : Approximately R20-00/person
Enquiries : Hattingh Bornman (084 240 5226)

12:00 Vergeet-my-nie Residence, UFS
Reunion : Braai
Bring and braai. We supply the facilities. Bring old photographs and stories. Enjoy Aunt Juls’ last visit.
Cost : Free
Enquiries : Mari Jordaan (051-444 2832/072 392 4444)

12:00 HF Verwoerd Residence Senior Student’s Association, UFS
Reunion : Spit roast
Cost : R60-00/person
Enquiries : Jan-Chris Landman (051-401 3613 / 082 664 6062)

18:30 Floreat Hall, Bloemfontein Civic Centre (Braam Fisher Building)
Irawa 60 Reunion
For all former editors, former and current main editorial staff and coworkers
Cost : R100-00/person
Enquiries : Sanri van Wyk (072 333 1011)
Elzette Boucher (072 180 6265)

19:00 – 24:00 Red Square (in front of Main Building), UFS
Informal Alumni Reunion
Spit roast and stories in a marquee
Cost : R60-00/person
Enquiries : Elize Rall (051-401 3382)

Sunday, 17 October 2004
10:00 – 11:00
Kovsie Church
Church Service

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