Psychological Distress and Associated Factors Among Adult Tuberculosis Patients in Ethiopia: Systematic Review and...

Tuberculosis (TB) remains a leading global infectious cause of illness and death, despite being preventable and curable, with the highest burden in low- and middle-income countries, particularly in Southeast Asia and Africa. TB is closely linked with mental health, as psychological distress manifested by anxiety, depression, and somatic symptoms is a common and significant comorbidity. However, nationally representative data on the prevalence of psychological distress among TB patients are limited. This systematic review and meta-analysis aimed to estimate the pooled prevalence of psychological distress and identify associated factors in TB patients in Ethiopia. A systematic review and meta-analysis of five studies involving 2117 participants was conducted, showing very high heterogeneity (I² = 99.8%). A comprehensive search of PubMed, Scopus, Web of Science, Google Scholar, PsycINFO, and AJOL identified studies published from June 2000 to August 1, 2025. The review followed PRISMA 2020 guidelines, and study quality was assessed using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies. Data were analysed in STATA version 16 using a random-effects model with 95% confidence intervals. Heterogeneity was evaluated using the I² statistic (p < 0.05 indicating significance). Publication bias was assessed using a funnel plot with asymmetry distribution and Egger's test revealed a statistically significant result (p = 0.007) and meta-regression was conducted to explore potential sources of heterogeneity. The pooled prevalence of psychological distress among 2117 adult tuberculosis patients was 47.47% (95% CI; 11.95, 82.98). In this review, stigma (AOR = 2.21, 95 CI: 1.49, 3.26), and co-infection (AOR = 2.89, 95% CI: 1.57, 5.35) were statistical significant associated with psychological distress. Psychological distress affecting nearly half adult tuberculosis patients in Ethiopia. Stigma and co-infection are statistically significant with psychological distress. Therefore, integrate mental health screening and psychosocial support into tuberculosis programs, strengthen community-based stigma reduction strategies, and provide tailored care for TB-HIV co-infected patients, especially in rural areas with limited resources is essential.