Phase-wise comparison of depression and stigma among tuberculosis patients undergoing treatment in Dhaka, Bangladesh

Tuberculosis (TB) remains a significant global health concern with established links to depression and stigma. Both outcomes have been found to vary between treatment phases of TB. This study compared depression and stigma among patients with TB in the intensive and continuation treatment phases in Dhaka, Bangladesh.

A cross-sectional comparative study was conducted during August and September 2023 among 111 patients in the intensive phase and 113 in the continuation phase of TB treatment (a total of 224) at directly observed treatment short-course centers. Depression was assessed using the Patient Health Questionnaire-9, and stigma was measured using Van Rie's TB/HIV Stigma Scale. Multivariable logistic regression identified associated factors.

The prevalence of depression was 56.2% overall, with no significant difference between the intensive (59.5%) and continuation phases (53.1%). Anticipated stigma was more prevalent (74.6%) than social stigma (37.5%), with neither showing significant phase variation. Pulmonary TB was associated with both social stigma (odds ratio [OR] = 3.27, 95% confidence interval [CI]: 1.69-6.52) and anticipated stigma (OR = 3.29, 95% CI: 1.70-6.59). Living with family increased the odds of experiencing anticipated stigma, while patient counseling demonstrated protective effects. Depression was associated with treatment adherence difficulties (OR = 3.55, 95% CI: 1.75-7.51), persistent TB symptoms (OR = 2.23, 95% CI: 1.04-4.91), and social stigma (OR = 2.06, 95% CI: 1.02-4.22).

The high prevalence of depression and persistent stigma throughout treatment highlight the need for continuous mental health support across all phases. TB care should integrate depression screening, stigma reduction strategies, and enhanced counseling to improve outcomes.