Depression in adolescents on treatment for rifampicin-susceptible TB in Lima, Peru

At least 1 million adolescents develop TB disease annually. Adolescents are also at risk for depression due to TB, but this is poorly understood.

This prospective cohort study aimed to identify the frequency and risk factors for depression amongst adolescents with rifampicin-susceptible TB in Lima, Peru. During weeks 3-5 of treatment, participants completed a survey that included socio-demographic characteristics, symptoms, treatment side effects, and the Patient Health Questionnaire-9 depression scale. Those with depression received psychological evaluation and were referred for treatment, with treatment intensity corresponding to depression severity. Applying k-means cluster analysis, we grouped participants by socio-demographic characteristics. We used generalised linear mixed-effects regression to model the relationship between cluster, symptoms and side effects, and depression.

Of 249 participants, 98 (39%), 62 (25%), and 33 (13%) had mild, moderate, and severe depression, respectively. We identified three clusters; Cluster 1 - adolescents with lower social support and more prior trauma - had the highest frequency of depression. Across all clusters, symptoms and side effects correlated with depression.

Given their high frequency of depression, adolescents on TB treatment - particularly those with trauma history, weak social support, or numerous symptoms and side effects - should be routinely screened for depression.