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Depression comorbid with tuberculosis and its impact on health status: cross-sectional analysis of community-based data from 48 low- and middle-income countries
Open accessAbstract
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.
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“Untreated depression at baseline is independently associated with greater disability, poorer quality of life,12,13 TB treatment default12 and negative TB treatment outcomes.14”
From Pharmacological or non-pharmacological interventions for treatment of common mental disorders associated with Tuberculosis: A systematic review (2021) · cites this paper as [13]
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Metadata
- Authors
- Koyanagi, A., Vancampfort, D., Carvalho, A. F., DeVylder, J. E., Haro, J. M., Pizzol, D., Veronese, N., & Stubbs, B.
- Affiliations
- Instituto de Salud Carlos III (ES)
- KU Leuven (BE)
- Fordham University (US)
- University of Padua (IT)
- National Health Service (GB)
- Corresponding author
- Koyanagi, Ai
- ORCID
- Venue
- BMC Medicine
- Published
- 2017-11-28
- Volume
- 15
- Issue
- 1
- Pages
- 209-209
- ISSN
- 1741-7015 (ISSN-L)
- PMC
- PMC5704363
- OpenAlex
- W2768219072
- Cited by
- 131
- References
- 49
- Citations by year
- 2026: 9 · 2025: 12 · 2024: 15 · 2023: 15 · 2022: 25 · 2021: 17 · 2020: 17 · 2019: 14 · 2018: 5 · 2017: 2
- FWCI
- 8.00
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by
- Locations
- BMC Medicine (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RECERCAT (Consorci de Serveis Universitaris de Catalunya) (publishedVersion, other-oa)
- Anglia Ruskin Research Online (Anglia Ruskin University) (submittedVersion)
- Lirias (submittedVersion, cc-by)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Nova Science Publishers (Nova Science Publishers, Inc.) (submittedVersion, other-oa)
- Research Portal (King's College London) (submittedVersion, cc-by)
- Padua Research Archive (University of Padova) (submittedVersion, cc-by)
- Funders
- Instituto de Salud Carlos III
- Topics
- Health Sciences › Medicine › Infectious Diseases › Tuberculosis Research and Epidemiology
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Health Sciences › Medicine › Infectious Diseases › Infectious Diseases and Tuberculosis
- Keywords
- depression, tuberculosis, comorbidities, health status, subthreshold depression, depressive episodes, self-care, low- and middle-income countries, World Health Survey, mental health
- MeSH terms
- Adult, Aged, Cross-Sectional Studies, Depression, Female, Health Status, Health Surveys, Humans, Income, Male, Middle Aged, Pain, Risk Factors, Self Care, Social Class, Tuberculosis, Global Health, Comorbidity, Prevalence
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