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J Infect. 2018 Nov;77(5):357-367. doi: 10.1016/j.jinf.2018.07.007. Epub 2018 Jul 20.

Mental health disorders, social stressors, and health-related quality of life in patients with multidrug-resistant tuberculosis: A systematic review and meta-analysis.

Author information

1
Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia; Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia. Electronic address: kefyalew.alene@anu.edu.au.
2
Faculty of Health Sciences, Curtin University, Western Australia, Australia.
3
Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia.
4
Global TB Programme, World Health Organization, Geneva, Switzerland.
5
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
6
Department of Medicine, University of Melbourne, Melbourne, Australia.
7
Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.
8
Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.

Abstract

BACKGROUND:

Mental health disorders, social stress, and poor health-related quality of life are commonly reported among people with tuberculosis (TB). We conducted a systematic review and meta-analysis to quantify mental health disorders, social stressors, and health-related quality of life in patients with multidrug-resistant tuberculosis (MDR-TB).

METHODS:

We searched PubMed, SCOPUS, ProQuest, Web of Science, and PsycINFO databases for studies that reported data on mental health disorders, social stressors, and health-related quality of life among MDR-TB patients. Hand-searching the reference lists of included studies was also performed. Studies were selected according to pre-defined selection criteria and data were extracted by two authors. Pooled prevalence and weighted mean difference estimates were performed using random-effects meta-analysis. Heterogeneity was explored using meta-regression, and subgroup analyses were performed.

RESULTS:

We included a total of 40 studies that were conducted in 20 countries. Depression, anxiety, and psychosis were the most common mental health disorders reported in the studies. The overall pooled prevalence was 25% (95% confidence interval (CI): 14, 39) for depression, 24% (95% CI: 2, 57) for anxiety, and 10% (95% CI: 7, 14) for psychosis. There was substantial heterogeneity in the estimates. The stratified analysis showed that the prevalence of psychosis was 4% (95% CI: 0, 22) before MDR-TB treatment commencement, and 9% (95% CI: 5, 13) after MDR-TB treatment commencement. The most common social stressors reported were stigma, discrimination, isolation, and a lack of social support. Health-related quality of life was significantly lower among MDR-TB patients when compared to drug-susceptible TB patients (Q = 9.88, p = 0.01, I2 = 80%).

CONCLUSIONS:

This review found that mental health and social functioning are compromised in a significant proportion of MDR-TB patients, a finding confirmed by the poor health-related quality of life reported. Thus, there is a substantial need for integrating mental health services, social protection and social support into the clinical and programmatic management of MDR-TB.

KEYWORDS:

MDR-TB; Mental health; Meta-analysis; Multidrug resistant tuberculosis; Quality of life; Social stressors; Systematic review

PMID:
30036607
DOI:
10.1016/j.jinf.2018.07.007

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