Prevalence of depression among tuberculosis patients attending clinics in Temeke municipal, Dar es salaam, Tanzania.

Abstract

Tuberculosis is a chronic, contagious and airborne disease caused by Mycobacterium tuberculosis. Most of people affected are young adults in their most productive years. In 2007, Tanzania ranked 15th out of 22 high burden TB countries in the world. In that year there were 120,191 new TB cases forty seven percent of whom were HIV positive. Studies have shown that the association between TB and depression is influenced by the interaction of social demographic characteristics, psychological factors, physical illness and the nature of the disease itself. The co morbidity of depression and TB has been shown to affect quality of life and treatment outcome.

No retrievable studies were found to determine the prevalence and associated factors for depression among patient with TB in Tanzania. Neither is there any reference to the CMD associated with TB in the Tanzanian TB and Leprosy program. There is a need for better understanding of the magnitude and associated factors for depression among patients with TB in order to integrate mental health care in TB management and thus provide more comprehensive care for patient with TB. Aim: To determine the prevalence and associated factors for depression among patient with TB attending the TB clinics in Temeke Municipal, Dar es Salaam ,Tanzania.

Methods: A descriptive cross sectional study in which 390 eligible study participants were selected using consecutive sampling, quantitative method of data collection was applied using structured questionnaire. The dependable variable (Depression) was measured using PHQ-9 while the independent variables of interest were social demographic characteristics, TB disease characteristics, family and personal history of mental illness, presence of physical illness and substance use history. Data was analyzed using SPSS version 17 software. Chi square test and multivariate logistics regression were used to measure level of associations.

Results: More than half 246 (63.1%) of the participants were men and 144 (36.9%) were women, with a mean age of 32.96 years (SD = 12.5) and the age range was 18 years to 88 years. The prevalence of depression was found to be 46.9 %( n=183) with majority of patients found to have mild depression 33.6 % (n=152) and the magnitude of moderate depression was 13.3 %( n=52). None of the TB patients was found to have moderately severe depression or severe depression. In bivariate analysis the independent variables which showed a statistical significant association with the dependent variable (p <0.05) include age, religion, past or current personal history of mental illness, duration of TB treatment and history of physical illness or chronic pain. In adjusted multivariate analysis for depression and predictors of interest; Christians showed statistical significant association with mild depression (OR 1.69; 95% CI 1.06,2.86: P< 0.05) and moderate depression (OR 3.41; 95% CI 1.63,7.15;P<0.01).Presence of current or past history of mental illness was also associated with moderate depression and having at least one of physical illness showed statistical significance in mild depression (OR 5.91; 95% CI 2.08,16.79;P<0.01) and moderate depression (OR 4.22; 95% CI 1.82,21.21;P< 0.05). Being in the intensive phase of treatment was also associated with mild depression (OR 1.97, 95% CI 1.19, 3.25; P< 0.01) and moderate depression (OR 8.03; 95% CI 3.328, 19.401; P<0.01).

Conclusion and recommendation: The prevalence of depression among TB patients in this study population is higher when compared to the general population. Recognition and management of depression among patients with physical illness including TB is likely to result in more positive treatment outcomes. It is recommended that strategies to address the mental health needs of TB patients be integrated into their care.