Impact of mental disorders on active TB treatment outcomes: a systematic review and meta-analysis.

Impact of mental disorders on active TB treatment outcomes: a systematic review and meta-analysis.
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精神障碍对主动结核病治疗结果的影响:系统评价和荟萃分析。

DOI:
10.5588/ijtld.20.0458
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发表时间:
2020-12-01
期刊:
The international journal of tuberculosis and lung disease : the official journal of the International Union against Tuberculosis and Lung Disease
影响因子:
--
通讯作者:
Sweetland AC
Sweetland AC
中科院分区:
其他
文献类型:
--
作者:
Lee G;Scuffell J;Galea JT;Shin SS;Magill E;Jaramillo E;Sweetland AC

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结核病患者的共病精神障碍可能会加重结核病治疗的效果。我们系统地回顾了目前关于精神障碍与结核病结局之间关系的证据。我们检索了1990-2018年发表的8个数据库,这些数据库比较了患有和不患有精神障碍的患者的结核病治疗结果。我们排除了没有系统评估精神障碍的研究和仅限于物质使用的研究。我们提取了研究和患者的特征和效应指标,并使用随机效应模型进行了荟萃分析,以计算总结优势比(OR)和95%置信区间(CI)。在确定的7,687项研究中,10项被纳入系统综述,9项被纳入荟萃分析。精神障碍和结核病结果的测量在研究中是异质的。精神障碍与任何不良结局、失访和不依从性之间的合并相关性分别为OR 2.13(95%CI:0.85-5.37)、1.90(0.33-10.91)和1.60(0.81-3.02)。存在高度统计学异质性。我们的综述表明,结核病患者的精神障碍增加了结核病不良结局的风险,但由于合格研究数量较少,汇总估计值并不准确。心理和结核病服务的整合可能会改善结核病的结果和消除结核病的进展。
Comorbid mental disorders in patients with tuberculosis (TB) may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes. We searched eight databases for studies published from 1990-2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (OR) with 95% confidence intervals (CI). Of 7,687 studies identified, ten were included in the systematic review and nine in the meta-analysis. Measurement of mental disorders and TB outcomes were heterogeneous across studies. The pooled association between mental disorders and any poor outcome, loss to follow-up, and non-adherence were OR 2.13 (95% CI: 0.85-5.37), 1.90 (0.33-10.91), and 1.60 (0.81-3.02), respectively. High statistical heterogeneity was present. Our review suggests that mental disorders in TB patients increase the risk of poor TB outcomes, but pooled estimates were imprecise due to small number of eligible studies. Integration of psychological and TB services might improve TB outcomes and progress towards TB elimination.
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