Tuberculosis (TB) remains a leading infectious cause of morbidity and mortality throughout the world. In 2010, there were an estimated 8.8 million incident cases of TB globally, with most cases occurring in Asia (59%) and Africa (26%). A major drawback in the successful management of the disease has been non-adherence to medication treatment. While there has been some success using the Directly Observed Therapy Short course (DOTS) programme to ensure medication compliance, it has been suggested that psychological factors may play a role in determining whether a patient continues the treatment or not. For example, the presence of depression has been suggested as a cause of poor compliance and increased risk of morbidity and mortality from TB. Comorbid depression is common among TB patients. A recent study of the occurrence of depression in chronic respiratory disorders in central India has shown that 65% of patients with pulmonary TB also suffered from depression.
The treatment program for TB may benefit from screening for depression and providing effective interventions to improve mood and feelings of helplessness and hopelessness, where appropriate. Treating psychological problems in patients with TB may substantially improve treatment adherence and enhancing quality of life, as well as reducing the burden of TB as an infectious disease.
Operation ASHA is carrying out a study in collaboration with the Mental Health Department of the Medical School of the University College of London to investigate the prevalence of symptoms of depression in individuals who either have symptoms of TB or are bacteriologically to be suffering from TB. The data will be analyzed to ascertain whether depression status is related to adherence to the DOTS programme. If the predicted association is demonstrated, an intervention programme developed in the UK but readily transferable to an Indian community context, could be implemented at a later stage to test the hypothesis that improvement in depression also improves patients’ adherence to TB treatment.
This study is being done in collaboration with University College of London. Till date, more than 540 patients have joined the study.