Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: A systematic review and meta-analysis
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Abstract
BACKGROUND: Depression is a common comorbidity of tuberculosis (TB) and is associated with poor adherence to treatment of multiple disorders. We conducted a systematic review to synthesize the existing evidence on the relationship between depression and negative outcomes of TB treatment. METHODS: We systematically reviewed studies that evaluated depressive symptoms (DS) directly or indirectly through psychological distress (PD) and measured negative treatment outcomes of drug-sensitive pulmonary TB, defined as death, loss to follow-up, or non-adherence. Sources included PubMed, Global Health Library, Embase, Scopus and Web of Science from inception to August 2019. RESULTS: Of the 2,970 studies initially identified, eight articles were eligible for inclusion and two were used for the primary outcome meta-analysis. We found a strong association between DS and negative TB treatment outcomes (OR = 4.26; CI95%:2.33-7.79; I2 = 0%). DS were also associated with loss to follow-up (OR = 8.70; CI95%:6.50-11.64; I2 = 0%) and death (OR = 2.85; CI95%:1.52-5.36; I2 = 0%). Non-adherence was not associated with DS and PD (OR = 1.34; CI95%:0.70-2.72; I2 = 94.36) or PD alone (OR = 0.92; CI95%:0.81-1.05; I2 = 0%). CONCLUSIONS: DS are associated with the negative TB treatment outcomes of death and loss to follow-up. Considerable heterogeneity exists in the definition of depression and outcomes such as non-adherence across the limited number of studies on this topic.
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Untreated depression at baseline is independently associated with greater disability, poorer quality of life, TB treatment default and negative TB treatment outcomes.
“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 [14]
The Results (page unavailable) report that depressive symptoms at baseline were associated with negative TB treatment outcomes, including death and loss to follow-up. However, the paper does not establish that depression was untreated, and the Discussion (page unavailable) identifies unaccounted confounders that limit the claim of an independent association. Citation 14 is attached to negative TB treatment outcomes, not the sentence’s disability, quality-of-life, or default claims. (LLM, conf=0.88)
Experimental — accuracy not yet measuredDepressive symptoms are associated with treatment outcomes, loss to follow-up, and mortality.
“A meta-analysis study suggests that depressive symptoms are associated with treatment outcomes, loss to follow-up, and mortality.25”
From The effects of acceptance and commitment therapy on psychosocial impact and adherence of multidrug-resistant tuberculosis patients (2022) · cites this paper as [25]
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- Authors
- Ruiz-Grosso, P., Cachay, R., de la Flor, A., Schwalb, A., & Ugarte-Gil, C.
- Affiliations
- Universidad Peruana Cayetano Heredia (PE)
- Venue
- PLOS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2020-01-10
- Volume
- 15
- Issue
- 1
- Pages
- e0227472
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC6953784
- OpenAlex
- W3000550843
- Cited by
- 134
- References
- 39
- Citations by year
- 2026: 22 · 2025: 26 · 2024: 30 · 2023: 22 · 2022: 16 · 2021: 13 · 2020: 4 · 2017: 1
- FWCI
- 0.65
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- PLoS ONE (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Figshare (submittedVersion, cc-by)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by)
- Universidad Peruana Cayetano Heredia Institutional Repository (submittedVersion, cc-by-nc-nd)
- Greater South Information System
- Funders
- Consejo Nacional de Ciencia, Tecnología e Innovación Tecnológica (EF033-235-2015)
- Fogarty International Center (D43TW007393)
- 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
- tuberculosis, depression, depressive symptoms, psychological distress, pulmonary tuberculosis, treatment outcomes, medication adherence, loss to follow-up, tuberculosis mortality, comorbidities
- MeSH terms
- Antitubercular Agents, Depression, Humans, Tuberculosis, Odds Ratio, Databases, Factual
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