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

Kefyalew Addis Alene a,b , Archie C A Clements c , Emma S McBryde d , Ernesto Jaramillo e , Knut Lönnroth f , Debebe Shaweno g , Amelia Gullivera Kerri Viney a,f.. Mental health disorders, social stressors, and health-related quality of life in patients with multidrug-resistant tuberculosis: A systematic review and meta-analysis. Journal of Infection, Volume 77, Issue 5, November 2018, Pages 357 -367, https://doi.org/10.1016/j.jinf.2018.07.007


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.

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
Faculty of Health Sciences, Curtin University, Western Australia, Australia
Australian Institute of Tropical Health and Medicine, James Cook University, Townsville, Australia
Global TB Programme, World Health Organization, Geneva, Switzerland
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
Department of Medicine, University of Melbourne, Melbourne, Australia