背景:耐多药结核病(MDR-TB)患者的心理健康状况不成比例地恶化,对坚持的影响,结果,和家庭。对共病抑郁/焦虑和相关因素的综合评估仍然有限。
目的:本研究旨在评估患病率,预测因子,耐多药结核病患者和家庭接触者抑郁和焦虑的定性经验。
方法:在古吉拉特邦进行了一项顺序解释性混合方法研究,印度,403名涂片阳性耐多药结核病患者和403名接触者。定量阶段管理关于社会人口因素的结构化问卷,临床病史,抑郁/焦虑症状,和心理社会压力源(如耻辱和社会支持)。采用Logistic回归模型。定性阶段包括对30名有意抽样的患者进行深入访谈,以进行主题内容分析。结果被整合以将定量结果情境化。
结果:抑郁症的发生率很高(37.5%,n=151)和焦虑(45.2%,n=182)记录在耐多药结核病患者中,显著高于家庭接触者(20.1%,n=81和25.1%,分别为n=101)。对于抑郁症,年龄较大(调整后优势比(AOR)2.03,95%CI1.01-4.05),女性(AOR2.5,95%CI1.1-6.0),离婚/丧偶状态(AOR3.8,95%CI1.1-8.0),财政限制,药物滥用(AOR1.7,95%CI1.1-2.7),疾病严重程度更高(AOR1.8,95%CI1.5-2.2),药物副作用(AOR2.4,95%CI1.2-4.6),感知的病耻感(AOR3.2,95%CI1.1-5.3)是显著的危险因素。对于焦虑,显著的预测因素是较低的社会支持(AOR0.81,95%CI0.71-0.86),更高的感知污名(AOR2.2,95%CI1.1-6.3),疾病严重程度更高(AOR2.6,95%CI1.3-4.0),和更多的药物副作用(AOR3.3,95%CI1.1-5.5)。突出的主题包括抑郁和焦虑等心理影响,耻辱和照顾挑战的经历,以及全面病人支援服务的建议。
结论:耐多药结核病患者经历了更高的抑郁和焦虑双重疾病负担,提高不良后果和传播的风险。改善社会心理支持对于弱势群体以患者为中心的护理途径至关重要。混合方法为综合身心健康服务提供了全面的证据。
BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) patients experience disproportionately worse mental health, with implications for adherence, outcomes, and families. Comprehensive assessments of comorbid depression/anxiety and related factors remain limited.
OBJECTIVE: This study aimed to assess the prevalence, predictors, and qualitative experiences of depression and anxiety in MDR-TB patients and household contacts.
METHODS: A sequential explanatory mixed methods study was conducted in Gujarat, India, with 403 smear-positive MDR-TB patients and 403 contacts. The quantitative phase administered structured questionnaires on sociodemographic factors, clinical history, depression/anxiety symptoms, and psychosocial stressors (like stigma and social support). Logistic regression models were used. The qualitative phase included in-depth interviews with 30 purposively sampled patients for thematic content analysis. Results were integrated to contextualize quantitative findings.
RESULTS: High rates of depression (37.5%, n = 151) and anxiety (45.2%, n = 182) were documented among the MDR-TB patients, significantly greater than household contacts (20.1%, n = 81 and 25.1%, n = 101, respectively). For depression, older age (adjusted odds ratio (AOR) 2.03, 95% CI 1.01-4.05), female gender (AOR 2.5, 95% CI 1.1-6.0), divorced/widowed status (AOR 3.8, 95% CI 1.1-8.0), financial constraints, substance abuse (AOR 1.7, 95% CI 1.1-2.7), greater disease severity (AOR 1.8, 95% CI 1.5-2.2), medication side effects (AOR 2.4, 95% CI 1.2-4.6), and perceived stigma (AOR 3.2, 95% CI 1.1-5.3) emerged as significant risk factors. For anxiety, significant predictors were less social support (AOR 0.81, 95% CI 0.71-0.86), higher perceived stigma (AOR 2.2, 95% CI 1.1-6.3), greater disease severity (AOR 2.6, 95% CI 1.3-4.0), and more medication side effects (AOR 3.3, 95% CI 1.1-5.5). Prominent themes included psychological impacts like depression and anxiety, experiences of stigma and caretaking challenges, and recommendations for comprehensive patient support services.
CONCLUSIONS: MDR-TB patients experience a substantially higher dual disease burden of depression and anxiety, elevating the risk for adverse outcomes and transmission. Improving psychosocial support is vital to patient-centric care pathways for vulnerable groups. Mixed methods provide comprehensive evidence to inform integrated physical and mental health services.