DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20214585

Challenges and perceptions of depression amongst multi drug resistant TB cases: qualitative study among medical officers of tuberculosis units across the Ahmedabad city, India

Rashmi Sharma, Harsh Bakshi, Shailesh Prajapati, Gneyaa Bhatt, Rajesh Mehta, Kiran Rami, Prakash Mehta, Tejas Shah, Roshni Dave, Azbah Pirzada

Abstract


Background: Drug resistant tuberculosis (DR-TB), is usually associated with adverse socioeconomic and psychological outcomes. Such patients with co-morbid depression have lower treatment adherence and poor outcomes. Programmatic management of drug resistant tuberculosis (PMDT) guidelines recommend screening of DR-TB patients for mental illnesses at baseline and Follow-up (FU). The objectives were to explore perceptions and experiences of service providers about depression amongst MDR TB cases, review current strategies for screening for depression at Tuberculosis units (TUs) and recommend measures to address depression among MDR TB cases.

Methods:This qualitative study was conducted across all TUs of Ahmedabad Municipal Corporation wherein 26 Key informant interviews (KIIs) were conducted using thematic guidelines and subsequently categorized in to subtheme for thematic analysis.

Results: MOs had mixed experiences about encountering depression among MDR-TB cases, ranging from 1%-50%. Long duration and side effects of treatment, financial burden due to unemployment and societal stigma were contributory factors. Ensuring compliance was a major challenge. Counselling is an effective intervention for this but lack of counsellors in the program was another challenge. MOs stated that pre-treatment screening for depression is done at DR TB centre, but there is no structured, process. However, most of them don’t do subsequent follow up for depression.

Conclusions:More counsellors need to be included in the program and a structured method needs to be devised for screening of depression among MDR TB patients. Both MO TUs and Counsellors need to be sensitized and trained for screening and monitoring depression amongst MDR TB in a systematic way.


Keywords


Perceptions and challenges, Mental illness, Depression, Drug resistant tuberculosis, MDR TB, Tuberculosis unit

Full Text:

PDF

References


Mahadev B, Kumar P, Agarwal SP, Chauhan LS, Srikantaramu N. Surveillance of drug resistance to antituberculosis drugs in districts of Hoogli in West Bengal and Mayurbhanj in Orissa. Indian J Tuberc. 2005;52(1):5

Paramasivan CN, Venkataraman P, Chandrasekaran V, Bhat S, Narayanan PR. Surveillance of drug resistance in tuberculosis in two districts of South India. Int J Tuberc Lung Dis. 2002;6(6):479-84.

WHO. Global tuberculosis report. Geneva: WHO; 2020.

Mitnick C, Bayona J, Palacios E, Shin S, Furin J, Alcántara F, et al. Community-based therapy for multidrug-resistant tuberculosis in Lima, Peru. N Engl J Med. 2003;348(2):119-28.

Government of India. 5. Ahmedabad City Census, 2011. Available at: https://www.census2011.co.in / census/city/314-ahmedabad. Accessed on 09 September 2021.

Chandra M, Rana P, Chandra K, Arora VK. Tuberculosis - Depression syndemic: A public health challenge. Indian J Tuberc. 2019;66(1):197-202.

Singer M, Clair S. Syndemics and public health: reconceptualizing disease in bio-social context. Med Anthropol Q. 2003;17(4):423-41.

Katon WJ. Epidemiology and treatment of depression in patients with chronic medical illness. Dialogues Clin Neurosci. 2011;13(1):7-23.

Katon W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry. 2007;29(2):147-55.

Mikkelsen RL, Middelboe T, Pisinger C, Stage KB. Anxiety and depression in patients with chronic obstructive pulmonary disease (COPD). A review. Nord J Psychiatry. 2004;58(1):65-70.

Glaser JK, Glaser R. Depression and immune function: central pathways to morbidity and mortality. J Psychosom Res. 2002;53(4):873-6.

Reiche EM, Nunes SO, Morimoto HK. Stress, depression, the immune system, and cancer. Lancet Oncol. 2004;5(10):617-25.

Huque R, Elsey H, Fieroze F, Hicks JP, Huque S, Bhawmik P, Walker I, et al. "Death is a better option than being treated like this": a prevalence survey and qualitative study of depression among multi-drug resistant tuberculosis in-patients. BMC Public Health. 2020;20(1):848.

Deshmukh RD, Dhande DJ, Sachdeva KS, Sreenivas A, Kumar AM, Satyanarayana S, et al. Patient and Provider Reported Reasons for Lost to Follow Up in MDRTB Treatment: A Qualitative Study from a Drug Resistant TB Centre in India. PLoS One. 2015;10(8):135802.

Baral SC, Aryal Y, Bhattrai R, King R, Newell JN. The importance of providing counselling and financial support to patients receiving treatment for multi-drug resistant TB: mixed method qualitative and pilot intervention studies. BMC Public Health. 2014;14:46.