Mental health disorders, social stressors, and health-related quality of life in patients with multidrug-resistant tuberculosis: A systematic review and meta-analysis. Issue 5 (November 2018)

• Record Type: Journal Article
• Authors: Alene, Kefyalew Addis; Clements, Archie C A; McBryde, Emma S; Jaramillo, Ernesto; Lönnroth, Knut; Shaweno, Debebe; Gulliver, Amelia; Viney, Kerri
• Is Part Of: Journal of infection. Volume 77:Issue 5(2018)
• Page Start: 357
• Page End: 367
• Publication Date: 2018-11
• Subjects: Multidrug resistant tuberculosis -- MDR-TB -- Mental health -- Social stressors -- Quality of life -- Systematic review -- Meta-analysis; Infection -- Periodicals; Bacterial Infections -- Periodicals; Communicable Diseases -- Periodicals; Electronic journals; 616.905
• DOI: 10.1016/j.jinf.2018.07.007
• Languages: English
• ISSNs: 0163-4453

Abstract

Highlights: This systematic review and meta-analysis indicates a high burden of mental health disorders, social stressors, and poor health-related quality of life among multidrug-resistant tuberculosis patients. The pooled prevalence estimate showed that one in four multidrug-resistant tuberculosis patients experienced depression (25%) and anxiety (24%), and one in ten multidrug-resistant tuberculosis patient experienced psychosis (10%). Stigma, discrimination, isolation and lack of social support were common among multidrug-resistant tuberculosis patients. Health-related quality of life was significantly lower among multidrug-resistant tuberculosis patients when compared to drug-susceptible tuberculosis patients. Summary: 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, I 2 = 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.