Addressing the tuberculosis-depression syndemic to end the tuberculosis epidemic
Addressing the tuberculosis-depression syndemic to end the tuberculosis epidemic
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DOI：
10.5588/ijtld.16.0584
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发表时间：
2017-08-01
影响因子：
4
通讯作者：
Wainberg, M. L.
中科院分区：
文献类型：
--
作者：
Sweetland, A. C.;Kritski, A.;Wainberg, M. L.
结核病和抑郁症通过社会、行为和生物机制协同作用，放大了疾病的负担。临床抑郁症是一种常见的、未被认识到的但可治疗的疾病，如果与结核病并存，则与发病率、死亡率、社区结核病传播和耐药性增加有关。由于贫困、营养不良、免疫抑制和/或消极的应对行为，包括药物滥用，抑郁症可能会增加结核病重新激活的风险，导致疾病进展，和/或抑制抗结核治疗的生理反应。由于炎症反应和/或下丘脑-垂体-肾上腺轴的失调，结核感染和/或疾病复发可能导致抑郁。临床抑郁也可能由与结核病有关的污名引发，加剧其他潜在的社会脆弱性，和/或可能归因于抗结核治疗的副作用。抑郁症可能会对饮食、寻求医疗保健、坚持服药和/或完成治疗等健康行为产生负面影响，对全球消除结核病构成重大挑战。由于结核病和抑郁症的几个核心症状重叠，患有活动性结核病的人往往没有意识到抑郁症，或者被认为是对情景压力的正常反应。我们使用证据将结核病和抑郁的共病重新定义为“结核病-抑郁综合征”，并确定了关键的研究差距，以进一步阐明潜在的机制。世界卫生组织的全球结束结核病战略呼吁将以患者为中心的综合护理和预防与社会保护和创新研究联系起来。它将需要多学科的方法，将结核病和抑郁症等疾病放在一起考虑，而不是将其作为单独的问题和疾病来考虑，以结束全球结核病流行。
Tuberculosis (TB) and depression act synergistically via social, behavioral, and biological mechanisms to magnify the burden of disease. Clinical depression is a common, under-recognized, yet treatable condition that, if comorbid with TB, is associated with increased morbidity, mortality, community TB transmission, and drug resistance. Depression may increase risk of TB reactivation, contribute to disease progression, and/or inhibit the physiological response to anti-tuberculosis treatment because of poverty, undernutrition, immunosuppression, and/or negative coping behaviors, including substance abuse. Tuberculous infection and/or disease reactivation may precipitate depression as a result of the inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Clinical depression may also be triggered by TB-related stigma, exacerbating other underlying social vulnerabilities, and/or may be attributed to the side effects of anti-tuberculosis treatment. Depression may negatively impact health behaviors such as diet, health care seeking, medication adherence, and/or treatment completion, posing a significant challenge for global TB elimination. As several of the core symptoms of TB and depression overlap, depression often goes unrecognized in individuals with active TB, or is dismissed as a normative reaction to situational stress. We used evidence to reframe TB and depression comorbidity as the 'TB-depression syndemic', and identified critical research gaps to further elucidate the underlying mechanisms. The World Health Organization's Global End TB Strategy calls for integrated patient-centered care and prevention linked to social protection and innovative research. It will require multidisciplinary approaches that consider conditions such as TB and depression together, rather than as separate problems and diseases, to end the global TB epidemic.