Depression among patients with tuberculosis: determinants, course and impact on pathways to care and treatment outcomes in a primary care setting in southern Ethiopia—a study protocol
Open accessAbstract
Introduction: Depression is commonly comorbid with chronic physical illnesses and is associated with a range of adverse clinical outcomes. Currently, the literature on the role of depression in determining the course and outcome of tuberculosis (TB) is very limited. Aim: Our aim is to examine the relationship between depression and TB among people newly diagnosed and accessing care for TB in a rural Ethiopian setting. Our objectives are to investigate: the prevalence and determinants of probable depression, the role of depression in influencing pathways to treatment of TB, the incidence of depression during treatment, the impact of anti-TB treatment on the prognosis of depression and the impact of depression on the outcomes of TB treatment. Methods and analysis: We will use a prospective cohort design. 703 newly diagnosed cases of TB (469 without depression and 234 with depression) will be consecutively recruited from primary care health centres. Data collection will take place at baseline, 2 and 6 months after treatment initiation. The primary exposure variable is probable depression measured using the Patient Health Questionnaire-9. Outcome variables include: pathways to treatment, classical outcomes for anti-TB treatment quality of life and disability. Descriptive statistics, logistic regression and multilevel mixed-effect analysis will be used to test the study hypotheses. Ethics and dissemination: Ethical approval has been obtained from the Institutional Review Board (IRB) of the College of Health Sciences, Addis Ababa University. Findings will be disseminated through scientific publications, conference presentations, community meetings and policy briefs. Anticipated impact: Findings will contribute to a sparse evidence base on comorbidity of depression and TB. We hope the dissemination of findings will raise awareness of comorbidity among clinicians and service providers, and contribute to ongoing debates regarding the delivery of mental healthcare in primary care in Ethiopia.
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Depression is associated with adverse outcomes in TB such as poor functional impairment, poor adherence to medication and self-care regimens, increased medical symptom burden and increased mortality.
“Depression is associated with a range of adverse outcomes in TB such as poor functional impairment, poor adherence to medication and self-care regimens, increased medical symptom burden and increased mortality.7,8”
From Pharmacological or non-pharmacological interventions for treatment of common mental disorders associated with Tuberculosis: A systematic review (2021) · cites this paper as [8]
The Introduction lists functional impairment, poor adherence, increased symptom burden and mortality as outcomes associated with depression comorbid with chronic physical illness generally. It says evidence about depression’s impact on TB treatment outcomes is very limited; the Hypotheses section proposes testing worse TB outcomes rather than reporting them as established. The claim extends the general association to TB without that qualification. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe relationship between depression and TB is bidirectional.
“The relationship between depression and TB is bidirectional.”
From Pharmacological or non-pharmacological interventions for treatment of common mental disorders associated with Tuberculosis: A systematic review (2021) · cites this paper as [8]
The “Possible mechanisms for the association between TB and depression” section describes pathways between TB and depression in both directions, but says they are “likely” multidirectional and that their contributions remain unclear. The claim presents that tentative relationship as established. (LLM, conf=0.84)
Experimental — accuracy not yet measured
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Depression in Tuberculosis Patient: A literature Review
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Abate, A. W., Tedla, A., Wubet, G. M., Legas, G., Belete, A., Shiferaw, K., Beyene, G. M., Teshome, A. A., Addis, W. D., Agidew, M. M., et al. (2026) · PLoS ONE · doi:10.1371/journal.pone.0360738
- Authors
- Ambaw, F., Mayston, R., Hanlon, C., & Alem, A.
- Affiliations
- Addis Ababa University (ET)
- King's College London (GB)
- Corresponding author
- Ambaw, Fentie
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2015-07
- Volume
- 5
- Issue
- 7
- Pages
- e007653
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC4499723
- OpenAlex
- W1921850448
- Cited by
- 75
- References
- 45
- Citations by year
- 2026: 7 · 2025: 2 · 2024: 10 · 2023: 6 · 2022: 11 · 2021: 6 · 2020: 12 · 2019: 5 · 2018: 6 · 2017: 5 · 2016: 4 · 2015: 1
- FWCI
- 4.14
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, cc-by-nc)
- Funders
- European Commission (2007–2013, FP7 2007-2013, 305968, FP7/2007)
- Addis Ababa University
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Health Sciences › Medicine › Surgery › Infectious Diseases and Tuberculosis
- Keywords
- depression, tuberculosis, comorbidities, pathways to care, tuberculosis treatment outcomes, medication adherence, quality of life, disability, rural Ethiopia, newly diagnosed tuberculosis
- MeSH terms
- Antidepressive Agents, Antitubercular Agents, Depression, Depressive Disorder, Ethiopia, Humans, Primary Health Care, Prospective Studies, Psychotherapy, Quality of Life, Social Support, Tuberculosis, Cohort Studies, Logistic Models, Case-Control Studies, Treatment Outcome, Medication Adherence, Social Stigma
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