Factors associated with depression among tuberculosis patients attending tuberculosis clinic at Webuye County Hospital

Abstract

Background: Tuberculosis (TB) remains a major global health problem and an infectious killer disease globally. Depression has been one of the psychiatric co-morbidities causing major sufferings to tuberculosis patients. Several studies show high and varying prevalence rates of depression among TB patients. Literature evidence indicates that early recognition of depression seems to improve overall health outcomes among TB patients. However, there are limited studies that examined the prevalence and factors associated with depressive symptoms among tuberculosis patients in Kenya. Therefore, there is a need to conduct more studies on depression among tuberculosis patients to provide more evidence in different contexts. Most of the studies done in the Kenyan context have concentrated in Nairobi and Kisumu counties. A literature search yielded scarce data for such studies in Bungoma county, western Kenya. Objective: To establish the prevalence and factors associated with depressive symptoms among tuberculosis patients attending the TB clinic at Webuye County Hospital. Methods: This was a cross-sectional study with a sample size of 180 participants conducted at the TB clinic at Webuye County Hospital. The study targeted adult TB patients who had been registered at the TB clinic. Patients who met the criteria were consecutively sampled. A pretested structured questionnaire designed to capture socio-demographic characteristics was administered followed by the administration of a Patient Health Questionnaire-9 (PHQ-9) questionnaire to assess for depressive symptoms among the participants. Data was coded into Statistical Package for Social Sciences (SPSS) and all statistical analysis was done using SPSS version 23. Descriptive statistics such as measures of central tendencies were used for continuous data while frequencies were used for categorical data. The study used the chi-square test to test for association at a 95% confidence interval and used logistic regression to adjust for confounders and covariates. Results: The median age was 37 years (IQR 28,50), 66.7% were married. The prevalence of depressive symptoms among tuberculosis patients was 37.80%. The prevalence of depressive symptoms was high among HIV-positive patients (67.5%) followed by those in the intensive phase of TB treatment (62.7%) (p =0.000). On multiple logistic regression, for participants who were on the intensive phase of tuberculosis treatment, their odds of having depressive symptoms were 4.588 times compared to those on the maintenance phase. (p=0.000; 95% CI: 2.199-9.572). The odds of having depressive symptoms among HIV-positive patients were 3.708 times compared to those who were HIV negative (p=0.001; 95% CI: 1.736-7.923). Conclusions: This study indicates that more than one-third of tuberculosis patients attending TB clinic at Webuye County Hospital have depressive symptoms. HIV/TB co-infection and TB treatment phase are significant factors associated with depressive symptoms among TB patients at Webuye County Hospital. Recommendations: All TB patients should be screened for depression and monitored more carefully for depression during treatment. Moreover, patients with depressive symptoms should be referred to mental health professionals when possible.