Factors associated with depression among tuberculosis patients with HIV co-infection in rural community Thailand

BACKGROUND: Depression is a significant comorbidity among patients with tuberculosis (TB) and HIV co-infection. Factors associated with depression in this vulnerable population remain inadequately characterised. This study had two primary objectives: (1) to identify demographic, clinical, and psychological factors including rumination associated with clinically significant depressive symptoms among TB patients in rural Thailand; and (2) to estimate the effect of HIV co-infection on depression risk using propensity score methods to address confounding. METHODS: This retrospective propensity score-matched study was conducted among 9,289 TB patients (2014–2023) in Sakon Nakhon Province, Thailand. Data were retrieved from the National TB Information System (NTIP), including 1,952 (21.0%) with HIV co-infection. Depressive symptoms were assessed using the validated Thai 9-Question (9Q) Depression Screening Tool, with a score ≥ 30 indicating clinically significant depressive symptoms. Multiple logistic regression and propensity score matching were employed to examine associations between demographic characteristics, clinical variables, rumination, and depression outcomes. RESULTS: The prevalence of high depression was 28.8% (n = 2,671). Mean age was 52.6 ± 16.7 years, with 63.6% male. HIV-positive patients were younger (47.2 ± 16.8 vs. 54.0 ± 16.4 years, p < 0.001) and showed higher depression rates (32.5% vs. 27.6%, p = 0.001). In multivariable analysis, HIV-positive status (adjusted OR 1.28, 95% CI: 1.14–1.44, p < 0.001), female sex (aOR 1.18, 95% CI: 1.07–1.30, p = 0.001), older age (aOR 1.04 per 10 years, 95% CI: 1.01–1.07, p = 0.012), and higher rumination scores (aOR 1.08 per 5-point increase, 95% CI: 1.05–1.11, p < 0.001) were independently associated with high depression. CONCLUSIONS: Clinically significant depressive symptoms (9Q score ≥ 30) are highly prevalent among TB patients in rural Thailand. HIV co-infection, female sex, older age, and higher rumination scores are independently associated with elevated depressive symptom burden. These findings support integrated mental health screening targeting high-risk subgroups within TB care programmes, with referral for formal psychiatric evaluation when indicated.