Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study.
Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study.
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DOI：
10.1371/journal.pgph.0002489
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发表时间：
2024
期刊：
影响因子：
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通讯作者：
Wingfield, Tom
中科院分区：
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作者：
Fuady, Ahmad;Arifin, Bustanul;Yunita, Ferdiana;Rauf, Saidah;Fitriangga, Agus;Sugiharto, Agus;Yani, Finny Fitry;Nasution, Helmi Suryani;Putra, I Wayan Gede Artawan Eka;Mansyur, Muchtaruddin;Wingfield, Tom
对结核病患者的污名(结核病污名)与结核病的其他心理社会后果有关，包括精神疾病和生活质量下降。我们评估了印度尼西亚这个结核病负担高的国家成年结核病患者的结核病污名、抑郁、生活质量和对心理社会支持的需求。在印度尼西亚7个省的这项以初级卫生机构为基础的调查中，从2022年2月至11月，我们采访了正在接受(A)在公共机构接受药物敏感(DS)结核病强化阶段治疗的成年人，(B)在私人机构接受治疗的成年人，(C)失去对治疗的后续行动(LTFU)的人，以及(D)接受结核病再治疗的人。我们使用我们先前验证的印度尼西亚结核病污名量表、患者健康问卷-9和EQ-5D-5L来测量结核病-污名、抑郁和生活质量。其他问题评估了参与者得到或需要哪些心理社会支持。我们招募和采访了612人，其中60.6%(96%可信区间59.6-64.5%)经历了中度结核病污名。结核污名的平均得分为19.0(SD 6.9；最小-最大0-50；表格A-患者视角)和23.4(SD 8.4，最小-最大0-50；表格B-社区视角)。在私人机构接受治疗的人(调整后的B[AB]2.48；0.94-4.03)、LTFU(AB 2.86；0.85-4.87)、男性(AB 1.73；0.59-2.87)、因结核病而失业或跳槽的人(AB 2.09；0.31-3.88)以及农村地区的人(AB 1.41；0.19-2.63)得分较高。41.5%(95%可信区间为37.7-45.3%)的受试者出现抑郁。经历结核病污名与中度到重度抑郁相关(调整后的优势比1.23；1.15-1.32)，耻辱和抑郁都与较低的生活质量相关(AB-0.013；[-0.016]-[-0.010])。从同伴或同伴团体获得的信息支持(20.8%)、情感支持(25.9%)和工具性支持(10.6%)有限，对此类支持的未满足需求很高。在印度尼西亚，成年结核病患者中有相当大的、交叉的结核病污名和抑郁负担，这与较低的生活质量有关。与会者报告了对心理社会支持的大量未得到满足的需求，包括同龄人领导的相互支持小组。在印度尼西亚，以社区为基础、同行领导的心理社会支持干预对于支付结核病的心理社会影响至关重要。
Stigma towards people with tuberculosis (TB-Stigma) is associated with other psychosocial consequences of TB including mental illness and reduced quality of life (QoL). We evaluated TB-Stigma, depression, QoL, and the need for psychosocial support among adults with TB in Indonesia, a high TB burden country. In this primary health facility-based survey in seven provinces of Indonesia, from February to November 2022, we interviewed adults receiving (a) intensive phase treatment for drug-susceptible (DS) TB at public facilities, (b) treatment at private facilities, (c) those lost to follow up (LTFU) to treatment, and (d) those receiving TB retreatment. We used our previously validated Indonesian TB-Stigma Scale, Patient Health Questionnaire-9, and EQ-5D-5L to measure TB-Stigma, depression, and QoL. Additional questions assessed what psychosocial support was received or needed by participants. We recruited and interviewed 612 people, of whom 60.6% (96%CI 59.6–64.5%) experienced moderate TB-Stigma. The average TB-Stigma scores were 19.0 (SD 6.9; min-max 0–50; Form A-Patient Perspective) and 23.4 (SD 8.4, min-max 0–50; Form B-Community Perspective). The scores were higher among people receiving treatment at private facilities (adjusted B [aB] 2.48; 0.94–4.03), those LTFU (aB 2.86; 0.85–4.87), males (aB 1.73; 0.59–2.87), those losing or changing job due to TB (aB 2.09; 0.31–3.88) and those living in a rural area (aB 1.41; 0.19–2.63). Depression was identified in 41.5% (95% CI 37.7–45.3%) of participants. Experiencing TB-Stigma was associated with moderately severe to severe depression (adjusted odds ratio [aOR] 1.23; 1.15–1.32) and both stigma and depression were associated with lower QoL (aB -0.013; [-0.016]-[-0.010]). Informational (20.8%), emotional (25.9%) and instrumental (10.6%) support received from peers or peer-groups was limited, and unmet need for such support was high. There is a sizeable and intersecting burden of TB-Stigma and depression among adults with TB in Indonesia, which is associated with lower QoL. Participants reported a substantial unmet need for psychosocial support including peer-led mutual support groups. A community-based peer-led psychosocial support intervention is critical to defray the psychosocial impact of TB in Indonesia.