Depression among multidrug-resistant tuberculosis patients in Punjab, Pakistan: a large cross-sectional study

Background and objectives Depression is likely to be a factor in the low global rates of successful treatment for multidrug-resistant tuberculosis (MDR-TB) due to poor adherence to treatment. We aimed to estimate the prevalence of depression among patients being treated for MDR-TB in Pakistan, explore rates of depression over the course of treatment and identify risk factors for depression. Design This cross-sectional study analysed health care service data from 12 treatment sites following a single screening event using the Patient Health Questionnaire 9 (PHQ-9). Logistic regression models were used to identify associations. Results Data were collected from 1279 patients with MDR-TB. The proportion of MDR-TB patients with depression was 42.8% (95%CI 40.1-45.5). Rates of depression varied according to duration of treatment, with the highest proportion (53.2%) found in those who were in months 10-12 of treatment. The odds of depression in women were higher than for men (adjusted odds ratio [aOR] 1.84, 95%CI 1.46-2.33). The odds of depression were higher in patients living in concrete-built houses than in those living in mud-built houses (aOR 1.37, 95%CI 1.03-1.82). Conclusion Depression is common in MDR-TB patients, and should be screened for and treated within MDR-TB treatment programmes.