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. 2017 Nov 28;15(1):209.
doi: 10.1186/s12916-017-0975-5.

Depression comorbid with tuberculosis and its impact on health status: cross-sectional analysis of community-based data from 48 low- and middle-income countries

Ai Koyanagi  1   2 , Davy Vancampfort  3   4 , André F Carvalho  5 , Jordan E DeVylder  6 , Josep Maria Haro  7   8 , Damiano Pizzol  9 , Nicola Veronese  10   11 , Brendon Stubbs  12   13   14
Affiliations

Depression comorbid with tuberculosis and its impact on health status: cross-sectional analysis of community-based data from 48 low- and middle-income countries

Ai Koyanagi et al. BMC Med. .

Abstract

Background: Depression in tuberculosis increases the risk for adverse health outcomes. However, little is known about comorbid depression and tuberculosis in the general population. Thus, we assessed the association between depression and tuberculosis, and the decrements in health status associated with this comorbidity in 48 low- and middle-income countries.

Methods: Cross-sectional, community-based data from the World Health Survey on 242,952 individuals aged ≥ 18 years were analyzed. Based on the World Mental Health Survey version of the Composite International Diagnostic Interview, past 12-month depression was categorized into depressive episode, brief depressive episode, subsyndromal depression, and no depression. Health status across six domains (cognition, interpersonal activities, sleep/energy, self-care, mobility, pain/discomfort) was assessed. Multivariable logistic and linear regression analyses were performed to assess the associations.

Results: The prevalence of depressive episode among those with and without tuberculosis was 23.7% and 6.8%, respectively (P < 0.001). Tuberculosis was associated with a 1.98 (95% CI 1.47-2.67), 1.75 (95% CI 1.26-2.42), and 3.68 (95% CI 3.01-4.50) times higher odds for subsyndromal depression, brief depressive episode, and depressive episode, respectively. Depressive episode co-occurring with tuberculosis was associated with significantly worse health status across all six domains compared to tuberculosis alone. Interaction analysis showed that depression significantly amplifies the association between TB and difficulties in self-care but not in other health domains.

Conclusions: Depression is highly prevalent in adults with tuberculosis, and is associated with worse health status compared to tuberculosis without depression. Public health efforts directed to the recognition and management of depression in people with tuberculosis may lead to better outcomes.

Keywords: Depression; Epidemiology; Low- and middle-income countries; Tuberculosis.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approval was obtained from each of the following committees in the respective countries for the World Health Survey:

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1
Fig. 1
Prevalence of each type of depression by the presence or absence of tuberculosis. Bars denote 95% confidence intervals. Estimates are based on weighted sample
See this image and copyright information in PMC

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