Depression and social support as mediators between coping strategies and quality of life in pulmonary tuberculosis patients

Abstract Background Pulmonary tuberculosis (PTB) is a chronic illness that severely impacts patients’ physical and psychological health and influences their quality of life (QoL). Coping strategies, depression, and social support are critical factors in determining the QoL of PTB patients. This study aims to investigate the relationship between coping strategies and quality of life (QoL) in patients receiving treatment for PTB, with a focus on the mediating roles of depression and social support. Methods A cross-sectional study was conducted between January and September 2024 in Varanasi, Uttar Pradesh, India, comprising 400 patients (mean age 26.06 Years, SD = 7.63) with PTB. Data were collected using a standardized questionnaire to assess patients’ psychological behaviour. Pearson’s product-Moment correlations were used to examine the relationships between coping strategies, depression, social support, and quality of life (QoL). Multiple regression analysis was used to assess direct and mediated relationships among the study variables. Results Regression analyses showed that coping strategies were negatively associated with depression and positively associated with social support among tuberculosis patients. Coping strategies, depression, and social support were significantly associated with quality of life, such that higher levels of coping and social support were associated to improved quality of life, whereas higher levels of depression were associated with reduced quality of life. Parallel mediation analysis indicated a significant direct relationship between coping and quality of life, as well as a substantial overall mediated relationship through depression and social support, with the depressive pathway indicating the strongest mediating role. The findings emphasize the importance of strengthening coping strategies to optimize quality of life among patients with pulmonary TB, as those with strong social support and an adaptive coping style from friends, family, and significant others report significantly healthier quality of life. Conclusions This study reveals that coping strategies are significantly associated with the quality of life (QoL) of patients with pulmonary tuberculosis (PTB), contributing to well-being through both direct and indirect pathways, including lower depressive symptoms and significant social support. The findings emphasize that comprehensive TB care should integrate psychological and social support, including coping skills training and peer support, to address mental health challenges, strengthen treatment adherence, and optimize inclusive quality of life.