Screening and management of depression among patients on TB treatment in Papumpare district, Arunachal Pradesh, India

Abstract

The TB-depression syndemic is a complex health condition. This study demonstrates a collaborative model to screen and manage depression among TB patients and understand the enablers and challenges from the healthcare workers perspective regarding its implementation. The PHQ-9 questionnaire was used to screen for depression and in-depth interviews among five healthcare workers were taken to explore its feasibility. Eight healthcare workers were trained for the screening that was carried out in two tuberculosis units of Papumpare district over a period of three months. Of 46 eligible patients screened, 43 (93.4%) screened positive for depression. Fifteen patients with moderate, moderately severe and severe depression were referred, of which five (33.3%) visited the psychiatric OPD. Two patients were diagnosed with clinical depression by a psychiatrist and started on treatment. The reasons for smaller number of patients being screened were time constraints, lack of manpower, lackadaisical attitude towards TB disease and patients' parents or guardians coming to take medicines. Enablers and challenges were explored under the heads of training, screening tool and PHQ-9 questionnaire, psychiatrist referral and counselling. This study demonstrates implementation of a feasible model for screening of depression among TB patients using the PHQ-9 questionnaire within programmatic settings using available resources.

Keywords: Cascade; Depression; Difficult terrain; Mental health; Operational research; Structured operational research and training initiative (SORT-IT); Tribal.