Prevalence and predictors of depression in tuberculosis patients in india: a systematic review and meta-analysis

TB and common mental disorders pose significant global health challenges that considerably impact human health. The combination of depression with TB can lead to a poor quality of life, low medication adherence, progression to drug-resistant tuberculosis, and ultimately, mortality.

This study aimed to estimate the pooled prevalence of depression in TB patients and identify the predictors of depression in this population in India.

The preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for reporting this systematic review and meta-analysis. Data were extracted from October to December 2024 using the PUBMED, Scopus, EMBASE, and DOAJ databases. A total of 25 articles were selected, and the included articles underwent quality assessment using the Joanna Briggs Institute Critical Appraisal checklist. The pooled prevalence of depression in TB patients was estimated at a 95% confidence interval using a random effects model, assuming potential heterogeneity. STATA 18 (Stata Corp LLC, College Station, TX, USA) was used for analysis.

The total sample across 25 studies included 12,033 (Mean(SD) = 481(1377), Median = 169, IQR = 106-302). The pooled prevalence of depression in TB patients in India was estimated at 37% (95% CI: 26- 49%). A subgroup analysis based on the types of TB cases indicated that the prevalence of depression in different kinds of TB cases did not vary substantially, with 39% (95% CI: 26- 54%) in both Drug-Resistant (DR) and Drug-Sensitive (DS) Tuberculosis (TB) cases, followed by DR-TB cases [36% (95% CI: 09-68%)] and DS-TB cases [32% (95% CI: 14- 53%)]. Of the nine assessment tools used to assess depression, the pooled prevalence utilising the Patient Health Questionnaire (PHQ)-9 tool was highest [43% (95% CI: 31-56%)]. There was considerable heterogeneity (I² = 99.10%) observed in the random-effects model. Factors associated with depression in TB patients included gender, demographics, education, occupation, marital and relationship issues, religion, socio-economic status, habitat, disease-related factors, treatment-related factors, and social and Behavioural factors.

The study found that over one-third of TB patients experienced depression. The coexistence of depression and TB constitutes a significant public health issue that needs addressing at both the community and health facility levels.