Mental Health Shadows: Accompanying Medication Compliance Towards Healing Tuberculosis Patients
Abstract
Introduction: Mental health disturbances may adversely affect treatment adherence and outcomes among pulmonary tuberculosis (TB) patients, but there is a lack of consensus on the relationship. Despite TB being one of the top ten causes of death worldwide, particularly in low and middle-income countries, the comorbidity between TB and mental health disorders has been relatively neglected. Evidence shows that TB and mental health have a bidirectional relationship, so we aimed to elucidate the challenges linked with integrating mental health into TB care with an emphasis on novel suggestions for improving treatment success.
Methods: This qualitative study utilized a phenomenological design and was implemented in hospitals and community health centers in Makassar City for six months. We enrolled 10 patients of coexisting pulmonary TB and mental health disturbances. We collected data through participant observations and in-depth semi-structured interviews. Ethics approval was obtained from the Health Research Ethics Commission, Faculty of Public Health Hasanuddin University No.583/UN4. 14. 1/TP. 01.02/2024 and written informed consent was obtained from participants.
Result: Mental health disturbances related to poor TB treatment adherence. Both depression and anxiety patients cited disengagement from treatment because of apathy, lack of motivation, and social isolation due to stigma. Inadequately treated mental health symptoms also aggravated physical TB symptom's severity causing further increased non-adherence. Themes of stigma, limited mental health support and positive effects of social networks were identified through statistical analyses. To our surprise, those with the most solid family support fared better despite serious mental illnesses.
Conclusion: Collectively, our findings underscore the importance of mental health disturbances on treatment adherence in TB. The findings from this research highlight the critical importance of incorporating mental health screening and psychosocial support into TB programmes. Studies to come should assess the effectiveness of such interventions, paving the way for integrated care of TB patients.
References
World Health Organization. Global tuberculosis report 2022. Geneva: WHO; 2022.
World Health Organization. Tuberculosis key facts [Internet]. 2021 [cited 2024 Nov 19]. Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis
Sweetland AC, Kritski A, Oquendo MA, Sublette ME, Norcini Pala A, Silva L, et al. Addressing the tuberculosis–depression syndemic to end the TB epidemic. Int J Tuberc Lung Dis. 2020;24(8):802–10.
Courtwright A, Turner AN. Tuberculosis and stigmatization: pathways and interventions. Public Health Rep. 2021;136(6):657–67.
Tola HH, Shojaeizadeh D, Garmaroudi G, Tol A, Yekaninejad MS, Kebede A, et al. Psychological and educational intervention to improve tuberculosis treatment adherence in Ethiopia based on health belief model: a cluster randomized control trial. PLoS One. 2020;15(2)
United Nations. Transforming our world: the 2030 agenda for sustainable development [Internet]. New York: United Nations; 2021 [cited 2024 Nov 19]. Available from: https://sdgs.un.org/goals/goal3
Duko B, Bedaso A, Ayano G, Yohannis Z. Perceived stigma and associated factors among patient with tuberculosis, Wolaita Sodo, Ethiopia: cross-sectional study. Can J Infect Dis Med Microbiol. 2020;2020:7808361.
Silva DR, Mello FCQ, Migliori GB, Duarte R, Dalcolmo M, Arbex FF, et al. Mental health and tuberculosis: a close relationship. Ann Clin Microbiol Antimicrob. 2021;20(1):21.
Indonesian Ministry of Health. National tuberculosis prevalence survey 2021: findings and implications. Jakarta: Ministry of Health; 2021.
Creswell JW, Poth CN. Qualitative inquiry and research design: choosing among five approaches. 4th ed. Thousand Oaks: SAGE Publications; 2018.
Giorgi A. The descriptive phenomenological method in psychology. Duquesne University Press; 2009.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2020;3(2):77–101.
World Health Organization. Ethical considerations in health research involving human participants. Geneva: WHO; 2021.
Denzin NK, Lincoln YS. The SAGE handbook of qualitative research. 5th ed. Thousand Oaks: SAGE Publications; 2020.
Kvale S, Brinkmann S. Interviews: learning the craft of qualitative research interviewing. 3rd ed. Thousand Oaks: SAGE Publications; 2019.
Patton MQ. Qualitative research & evaluation methods: integrating theory and practice. 4th ed. Thousand Oaks: SAGE Publications; 2019.
Silverman D. Interpreting qualitative data: methods for analyzing talk, text, and interaction. 6th ed. Thousand Oaks: SAGE Publications; 2019.
Guest G, Bunce A, Johnson L. How many interviews are enough? An experiment with data saturation and variability. Field Methods. 2020;18(1):59–82.
Duko B, Ayano G, Tessema F. Depression, anxiety, and treatment adherence among tuberculosis patients: a systematic review. Glob Health Action. 2020;13(1):1778469.
Gibson N, O’Connor R. Stigma and Tuberculosis: A Health Promotion Perspective. Health Promot Int. 2019;35(2):198–210. doi:10.1093/heapro/daz017
Mitchison D. Mental health and tuberculosis outcomes: a comparative study. Tuberculosis. 2020;120:87–92.
Kang S, Lee S. The impact of depression and anxiety on tuberculosis treatment adherence: a study among TB patients in South Korea. Int J Tuberc Lung Dis. 2021;25(4):289–97.
Pachi A, Bratis D, Moussas G. Mental Health and Tuberculosis Treatment Compliance. Front Psychiatry.
Roberts L, Kueny A, Barrera J, et al. The role of stigma in tuberculosis treatment adherence: a qualitative exploration. Public Health. 2020;183:116–21.
Kadir M, Othman H. Reducing stigma in tuberculosis patients: the role of community-based interventions. J Community Health. 2021;46(2):334–41.
Bakibinga P, Mulogo E. The protective role of family support in tuberculosis treatment adherence in East Africa. Trop Med Health. 2021;49(1):1–8.
Dinesh B, Oyetunde T, Sharma S, et al. Family-centered care in tuberculosis treatment: evidence from a randomized controlled trial in India. Lancet Infect Dis. 2021;21(5):630–9.
Singh K, Ramesh M. Integrating mental health into tuberculosis treatment: challenges and opportunities in low-resource settings. J Psychosom Res. 2021;138:110248.
Rajan M, Chauhan K. Training healthcare workers to address mental health issues in tuberculosis care. J Health Care Disparities. 2021;19(3):280–8.
Lee J, Jang Y, Kim Y, et al. The psychological distress of younger tuberculosis patients: a qualitative study. J Adolesc Health. 2021;68(3):507–13.
Copyright (c) 2025 Journal of Public Health and Pharmacy
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
Authors who publish with Journal of Public Health and Pharmacy retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:
-
Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.
-
Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Journal of Public Health and Pharmacy.
-
License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.
