Tuberculosis - Depression syndemic: A public health challenge.
Tuberculosis - Depression syndemic: A public health challenge.
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DOI：
10.1016/j.ijtb.2019.02.007
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发表时间：
2019-01-01
期刊：
影响因子：
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通讯作者：
Arora, Vijay Kumar
中科院分区：
文献类型：
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作者：
Chandra, Mina;Rana, Proteesh;Arora, Vijay Kumar
简介：抑郁症在结核病 (TB) 中很常见，并通过致病机制和自我保健行为受损（包括治疗依从性降低）与不良后果相关。尽管公共卫生投资巨大，但未确诊的抑郁症仍可能威胁到 DOTS 模型的稳健性。抑郁症结核综合症需要与心理健康专业人员的合作伙伴关系。目的：研究抑郁症结核综合症的证据基础。方法：使用关键词“抑郁”、“结核病”和“综合症”进行 Pubmed 和 Google Scholar 搜索，并筛选摘要的适当性和相关性。结果：抑郁症结核综合症很常见，具有双向关系。抑郁症与较高的风险比和结核病患病率增加有关。抑郁症与较高的发病率、死亡率、耐药性、结核病再激活风险和社区结核病传播独立相关。抑郁-结核病综合征的潜在生物心理社会机制包括炎症级联、HPA轴失调等生物因素和耻辱感和不依从治疗等心理社会因素。讨论：抑郁是结核病的不良预后因素。国家精神卫生计划（NMHP）和国家消除结核病战略计划（NSP）（2017-2025）在独立的垂直领域开展工作，没有在政策或基层层面进行整合。这导致尽管与 DOTS 中心的医护人员反复接触，但结核病患者的抑郁症仍缺乏识别和适当的治疗。对结核病患者抑郁症进行早期诊断和管理（二级预防）的协作方法有助于减轻疾病负担并改善结果。结论：抑郁症结核病综合征需要在项目层面和服务提供点采取协作方法。
INTRODUCTION: Depression is common in Tuberculosis (TB) and associated with adverse outcomes through pathogenic mechanisms and impaired self-care behaviours including reduced treatment adherence. Undiagnosed depression can threaten the robustness of DOTS model despite large public health investment. The Depression-Tuberculosis Syndemic requires collaborative partnership with mental health professionals.AIM: To study the evidence base for Depression-Tuberculosis Syndemic.METHODOLOGY: A Pubmed and Google Scholar search was conducted using the key words "Depression", "Tuberculosis" and "Syndemic" and abstracts screened for appropriateness and relevance.RESULT: Depression-TB Syndemic is common with a bidirectional relationship. Depression is associated with higher hazard ratio and increased prevalence of TB. Depression is independently associated with higher morbidity, mortality, drug resistance, risk of TB reactivation and community TB transmission. The underlying biopsychosocial mechanism of Depression- Tuberculosis Syndemic includes biological factors like inflammatory cascade, HPA axis dysregulation and psychosocial factors like perceived stigma and treatment non-adherence.DISCUSSION: Depression is a poor prognostic factor in TB. The National Mental Health Programme (NMHP) and National Strategic Plan (NSP) for Tuberculosis Elimination (2017-2025) work in independent verticals with no integration at policy or at ground level. This results in lack of identification and appropriate management of depression in patients with Tuberculosis despite repeated contact with health care personnel in DOTS centres. A collaborative approach for early diagnosis and management of depression in patients with Tuberculosis (Secondary Prevention) can help decrease the burden of disease and improve outcomes.CONCLUSION: Depression-TB Syndemic requires collaborative approaches at the program level and at the point of service delivery.