HIV, multidrug-resistant TB and depressive symptoms: when three conditions collide
Background: Management of multidrug-resistant TB (MDR-TB) patients co-infected with human immunodeficiency virus (HIV) is highly challenging. Such patients are subject to long and potentially toxic treatments and may develop a number of different psychiatric illnesses such as anxiety and depressive...
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doaj-693c42ca5bbf4c6db6e9146ee7108c082020-11-24T22:41:24ZengTaylor & Francis GroupGlobal Health Action1654-98802014-09-01701510.3402/gha.v7.2491224912HIV, multidrug-resistant TB and depressive symptoms: when three conditions collideMrinalini Das0Petros Isaakidis1Rafael Van den Bergh2Ajay MV Kumar3Sharath Burugina Nagaraja4Asmaa Valikayath5Santosh Jha6Bindoo Jadhav7Joanna Ladomirska8 Médecins Sans Frontières (MSF) OCB, India Médecins Sans Frontières (MSF) OCB, India Médecins Sans Frontières (MSF) OCB,, Brussels, Belgium International Union Against Tuberculosis and Lung Disease (The Union), South-East Asian Regional Office, New Delhi, India ESIC Medical College and PGIMSR,, Bangalore, India Médecins Sans Frontières (MSF) OCB, India Médecins Sans Frontières (MSF) OCB, India K. J. Somaiya Medical College Hospital And Research Centre, Mumbai, India Médecins Sans Frontières (MSF) OCB, IndiaBackground: Management of multidrug-resistant TB (MDR-TB) patients co-infected with human immunodeficiency virus (HIV) is highly challenging. Such patients are subject to long and potentially toxic treatments and may develop a number of different psychiatric illnesses such as anxiety and depressive disorders. A mental health assessment before MDR-TB treatment initiation may assist in early diagnosis and better management of psychiatric illnesses in patients already having two stigmatising and debilitating diseases. Objective: To address limited evidence on the baseline psychiatric conditions of HIV-infected MDR-TB patients, we aimed to document the levels of depressive symptoms at baseline, and any alteration following individualized clinical and psychological support during MDR-TB therapy, using the Patient Health Questionnaire-9 (PHQ-9) tool, among HIV-infected patients. Design: This was a retrospective review of the medical records of an adult (aged >15 years) HIV/MDR-TB cohort registered for care during the period of August 2012 through to March 2014. Results: A total of 45 HIV/MDR-TB patients underwent baseline assessment using the PHQ-9 tool, and seven (16%) were found to have depressive symptoms. Of these, four patients had moderate to severe depressive symptoms. Individualized psychological and clinical support was administered to these patients. Reassessments were carried out for all patients after 3 months of follow-up, except one, who died during the period. Among these 44 patients, three with baseline depressive symptoms still had depressive symptoms. However, improvements were observed in all but one after 3 months of follow-up. Conclusion: Psychiatric illnesses, including depressive symptoms, during MDR-TB treatment demand attention. Routine administration of baseline mental health assessments by trained staff has the potential to assist in determining appropriate measures for the management of depressive symptoms during MDR-TB treatment, and help in improving overall treatment outcomes. We recommend regular monitoring of mental health status by trained counsellors or clinical staff, using simple, validated and cost-effective tools.http://www.globalhealthaction.net/index.php/gha/article/download/24912/pdf_1MDR-TBHIVdepressive symptomsdepressionPHQ-9operational researchcounsellingpsychiatric illnessesIndia |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Mrinalini Das Petros Isaakidis Rafael Van den Bergh Ajay MV Kumar Sharath Burugina Nagaraja Asmaa Valikayath Santosh Jha Bindoo Jadhav Joanna Ladomirska |
spellingShingle |
Mrinalini Das Petros Isaakidis Rafael Van den Bergh Ajay MV Kumar Sharath Burugina Nagaraja Asmaa Valikayath Santosh Jha Bindoo Jadhav Joanna Ladomirska HIV, multidrug-resistant TB and depressive symptoms: when three conditions collide Global Health Action MDR-TB HIV depressive symptoms depression PHQ-9 operational research counselling psychiatric illnesses India |
author_facet |
Mrinalini Das Petros Isaakidis Rafael Van den Bergh Ajay MV Kumar Sharath Burugina Nagaraja Asmaa Valikayath Santosh Jha Bindoo Jadhav Joanna Ladomirska |
author_sort |
Mrinalini Das |
title |
HIV, multidrug-resistant TB and depressive symptoms: when three conditions collide |
title_short |
HIV, multidrug-resistant TB and depressive symptoms: when three conditions collide |
title_full |
HIV, multidrug-resistant TB and depressive symptoms: when three conditions collide |
title_fullStr |
HIV, multidrug-resistant TB and depressive symptoms: when three conditions collide |
title_full_unstemmed |
HIV, multidrug-resistant TB and depressive symptoms: when three conditions collide |
title_sort |
hiv, multidrug-resistant tb and depressive symptoms: when three conditions collide |
publisher |
Taylor & Francis Group |
series |
Global Health Action |
issn |
1654-9880 |
publishDate |
2014-09-01 |
description |
Background: Management of multidrug-resistant TB (MDR-TB) patients co-infected with human immunodeficiency virus (HIV) is highly challenging. Such patients are subject to long and potentially toxic treatments and may develop a number of different psychiatric illnesses such as anxiety and depressive disorders. A mental health assessment before MDR-TB treatment initiation may assist in early diagnosis and better management of psychiatric illnesses in patients already having two stigmatising and debilitating diseases. Objective: To address limited evidence on the baseline psychiatric conditions of HIV-infected MDR-TB patients, we aimed to document the levels of depressive symptoms at baseline, and any alteration following individualized clinical and psychological support during MDR-TB therapy, using the Patient Health Questionnaire-9 (PHQ-9) tool, among HIV-infected patients. Design: This was a retrospective review of the medical records of an adult (aged >15 years) HIV/MDR-TB cohort registered for care during the period of August 2012 through to March 2014. Results: A total of 45 HIV/MDR-TB patients underwent baseline assessment using the PHQ-9 tool, and seven (16%) were found to have depressive symptoms. Of these, four patients had moderate to severe depressive symptoms. Individualized psychological and clinical support was administered to these patients. Reassessments were carried out for all patients after 3 months of follow-up, except one, who died during the period. Among these 44 patients, three with baseline depressive symptoms still had depressive symptoms. However, improvements were observed in all but one after 3 months of follow-up. Conclusion: Psychiatric illnesses, including depressive symptoms, during MDR-TB treatment demand attention. Routine administration of baseline mental health assessments by trained staff has the potential to assist in determining appropriate measures for the management of depressive symptoms during MDR-TB treatment, and help in improving overall treatment outcomes. We recommend regular monitoring of mental health status by trained counsellors or clinical staff, using simple, validated and cost-effective tools. |
topic |
MDR-TB HIV depressive symptoms depression PHQ-9 operational research counselling psychiatric illnesses India |
url |
http://www.globalhealthaction.net/index.php/gha/article/download/24912/pdf_1 |
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