Psychological distress and its effect on tuberculosis treatment outcomes in Ethiopia

It is a leading contributor to the total burden of disease globally and its comorbidity with other medical conditions is common. The combination of psychological distress with other medical conditions has several health outcomes, including treatment nonadherence and risky behaviors such as unsafe sexual practices, tobacco smoking, and alcohol misuse. The magnitude of psychological distress among tuberculosis (TB) patients on treatment in developing countries is high. Studies have shown that depression and anxiety rates among TB patients are higher than among the general population. For example, in Pakistan, 72% of TB patients manifest severe or moderate forms of depression and anxiety, while in Nigeria, 51.9% of TB patients show symptoms of psychological distress. Various social, medical, and individual behavioral factors are associated with psychological distress among TB patients. These include poverty or low social status, overcrowding in the home, being TB-HIV coinfected, low educational level, and hazardous alcohol consumption. Additionally, TB drug-related psychological reactions, TB disease perception, clinical conditions, marital status, drug adverse reaction, and perceived social support are also associated with psychological distress among TB patients on treatment. In Ethiopia, which is among 22 high TB burden countries, the estimated incidence of TB is 258 per 100,000 population and the prevalence is 224 per 100,000. However, only one study was conducted in the Oromia Region of Ethiopia to assess common mental disorders (CMDs) among TB patients coinfected with HIV, and this study reported that 64% of TB patients with HIV manifested CMDs. A study conducted in Addis Ababa, Ethiopia, from May to December 2014, aimed to determine the magnitude of psychological distress and its effect on treatment outcome among TB patients on treatment. The study enrolled 330 patients diagnosed with all types of TB who had been on treatment for 1-2 months. Data on socio-demographic variables and economic status were collected using a structured questionnaire, and the presence of psychological distress was assessed at baseline (within 1-2 months after treatment initiation) and end point (6 months after treatment initiation) using the 10-item Kessler (K-10) scale. The overall psychological distress was 67.6% at 1-2 months and 48.5% at 6 months after treatment initiation. Multiple logistic regression analysis revealed that past TB treatment history, being on anti-TB and anti-HIV treatments, being unmarried, having alcohol use disorder, and having low economic status were significantly associated with psychological distress at baseline. However, at 6 months after treatment initiation, only being a multidrug-resistant tuberculosis (MDR-TB) patient and having low economic status were able to predict psychological distress significantly. Past TB treatment history, employment status, and existence of psychological distress symptoms at 6 months after treatment initiation were found to be associated with treatment outcome. The study concluded that the overall magnitude of psychological distress was high across the follow-up period, and that screening and treatment of psychological distress among TB patients across the whole treatment period is needed. Focusing more on patients who have been economically deprived, previously treated for TB, and on MDR-TB treatment are important.