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Psychological distress and its relationship with non-adherence to TB treatment: a multicentre study.

Theron G, Peter J, Zijenah L, Chanda D, Mangu C, Clowes P, Rachow A, Lesosky M, Hoelscher M, Pym A, Mwaba P, Mason P, Naidoo P, Pooran A, Sohn H, Pai M, Stein DJ, Dheda K - BMC Infect. Dis. (2015)

Bottom Line: The successful cure of tuberculosis (TB) is dependent on adherence to treatment.In a multivariable linear regression model, increased K-10 score was independently associated with previous TB [estimate (95 % CI) 0.98(0.09-1.87); p = 0.0304], increased TBscore [1(0.80, 1.20); p <0.0001], and heavy alcohol use [3.08(1.26, 4.91); p = 0.0010], whereas male gender was protective [-1.47(-2.28, -0.62); p = 0.0007]. 26 % (95 % CI: 21 %, 32 %) of 261 patients with culture-confirmed TB were non-adherent.In a multivariable logistic regression model for non-adherence, reduced TBscore [OR (95 % CI) 0.639 (0.497, 0.797); p = 0.0001], health literacy score [0.798(0.696, 0.906); p = 0.0008], and increased K-10 [1.082(1.033, 1.137); p = 0.0012], and heavy alcohol usage [14.83(2.083, 122.9); p = 0.0002], were independently associated.

View Article: PubMed Central - PubMed

Affiliation: Lung Infection and Immunity Unit, Division of Pulmonology & UCT Lung Institute, Department of Medicine, University of Cape Town, H47 Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa. grant.theron@uct.ac.za.

ABSTRACT

Background: The successful cure of tuberculosis (TB) is dependent on adherence to treatment. Various factors influence adherence, however, few are easily modifiable. There are limited data regarding correlates of psychological distress and their association with non-adherence to anti-TB treatment.

Methods: In a trial of a new TB test, we measured psychological distress (K-10 score), TB-related health literacy, and morbidity (TBscore), prior to diagnosis in 1502 patients with symptoms of pulmonary TB recruited from clinics in Cape Town (n = 419), Harare (n = 400), Lusaka (n = 400), Durban (n = 200), and Mbeya (n = 83). Socioeconomic, demographic, and alcohol usage-related data were captured. Patients initiated on treatment had their DOTS cards reviewed at two-and six-months.

Results: 22 %(95 % CI: 20 %, 25 %) of patients had severe psychological distress (K-10 ≥ 30). In a multivariable linear regression model, increased K-10 score was independently associated with previous TB [estimate (95 % CI) 0.98(0.09-1.87); p = 0.0304], increased TBscore [1(0.80, 1.20); p <0.0001], and heavy alcohol use [3.08(1.26, 4.91); p = 0.0010], whereas male gender was protective [-1.47(-2.28, -0.62); p = 0.0007]. 26 % (95 % CI: 21 %, 32 %) of 261 patients with culture-confirmed TB were non-adherent. In a multivariable logistic regression model for non-adherence, reduced TBscore [OR (95 % CI) 0.639 (0.497, 0.797); p = 0.0001], health literacy score [0.798(0.696, 0.906); p = 0.0008], and increased K-10 [1.082(1.033, 1.137); p = 0.0012], and heavy alcohol usage [14.83(2.083, 122.9); p = 0.0002], were independently associated. Culture-positive patients with a K-10 score ≥ 30 were more-likely to be non-adherent (OR = 2.290(1.033-5.126); p = 0.0416].

Conclusion: Severe psychological distress is frequent amongst TB patients in Southern Africa. Targeted interventions to alleviate psychological distress, alcohol use, and improve health literacy in newly-diagnosed TB patients could reduce non-adherence to treatment.

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Correlation between psychological distress (Kessler K-10 score) and increased morbidity, measured using a TB-symptom score (TBscore)
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Fig2: Correlation between psychological distress (Kessler K-10 score) and increased morbidity, measured using a TB-symptom score (TBscore)

Mentions: Twenty two percent of patients with symptoms of pulmonary TB (335/1502) had a severe level of psychological distress (K-10 score ≥30 [32]) and this was higher in Harare (50 %) and Mbeya (51 %), compared to Lusaka (12 %), Cape Town (8 %) and Durban (8 %). K-10 score strongly positively correlated with TBscore (Spearnman’s Rho 0.1264, p <0.0001; Fig. 2). Women had a higher level of psychological distress than men [median (IQR) K-10 score of 24 (18–30) vs. 21 (15–27); p <0.0001]. HIV-infected patients had a higher level of psychological distress compared to those who were HIV-uninfected [24 (17–30) vs. 20 (14.25-25.0); p <0.0001]. In a multivariate linear regression model for psychological distress (Table 2), female gender [estimate (95 % CI) = 1.47 (2.28, 0.62); p = 0.0007], previous TB [estimate = 0.98 (0.09-1.87); p = 0.0304], increased TBscore [estimate = 1 (0.80, 1.20); p <0.0001], and heavy alcohol usage [estimate = 3.08 (1.26, 4.91); p = 0.0010], were associated with increased K-10 score. Culture-confirmed TB was not associated with increased K-10 score [23 (16, 29) vs. 22 (15–29) in culture-negative patients; p = 0.2727]. In a multivariate logistic regression model for severe psychological distress (K-10 ≥ 30), TBscore [OR (95 % CI) = 1.30 (1.20, 1.41); p <0.0001] and site [7.96 (3.61, 18.26) for Mbeya (p <0.0001), and 15.77 (8.81, 30.17) for Harare (p <0.0001)] were the only independent predictors.Fig. 2


Psychological distress and its relationship with non-adherence to TB treatment: a multicentre study.

Theron G, Peter J, Zijenah L, Chanda D, Mangu C, Clowes P, Rachow A, Lesosky M, Hoelscher M, Pym A, Mwaba P, Mason P, Naidoo P, Pooran A, Sohn H, Pai M, Stein DJ, Dheda K - BMC Infect. Dis. (2015)

Correlation between psychological distress (Kessler K-10 score) and increased morbidity, measured using a TB-symptom score (TBscore)
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4487582&req=5

Fig2: Correlation between psychological distress (Kessler K-10 score) and increased morbidity, measured using a TB-symptom score (TBscore)
Mentions: Twenty two percent of patients with symptoms of pulmonary TB (335/1502) had a severe level of psychological distress (K-10 score ≥30 [32]) and this was higher in Harare (50 %) and Mbeya (51 %), compared to Lusaka (12 %), Cape Town (8 %) and Durban (8 %). K-10 score strongly positively correlated with TBscore (Spearnman’s Rho 0.1264, p <0.0001; Fig. 2). Women had a higher level of psychological distress than men [median (IQR) K-10 score of 24 (18–30) vs. 21 (15–27); p <0.0001]. HIV-infected patients had a higher level of psychological distress compared to those who were HIV-uninfected [24 (17–30) vs. 20 (14.25-25.0); p <0.0001]. In a multivariate linear regression model for psychological distress (Table 2), female gender [estimate (95 % CI) = 1.47 (2.28, 0.62); p = 0.0007], previous TB [estimate = 0.98 (0.09-1.87); p = 0.0304], increased TBscore [estimate = 1 (0.80, 1.20); p <0.0001], and heavy alcohol usage [estimate = 3.08 (1.26, 4.91); p = 0.0010], were associated with increased K-10 score. Culture-confirmed TB was not associated with increased K-10 score [23 (16, 29) vs. 22 (15–29) in culture-negative patients; p = 0.2727]. In a multivariate logistic regression model for severe psychological distress (K-10 ≥ 30), TBscore [OR (95 % CI) = 1.30 (1.20, 1.41); p <0.0001] and site [7.96 (3.61, 18.26) for Mbeya (p <0.0001), and 15.77 (8.81, 30.17) for Harare (p <0.0001)] were the only independent predictors.Fig. 2

Bottom Line: The successful cure of tuberculosis (TB) is dependent on adherence to treatment.In a multivariable linear regression model, increased K-10 score was independently associated with previous TB [estimate (95 % CI) 0.98(0.09-1.87); p = 0.0304], increased TBscore [1(0.80, 1.20); p <0.0001], and heavy alcohol use [3.08(1.26, 4.91); p = 0.0010], whereas male gender was protective [-1.47(-2.28, -0.62); p = 0.0007]. 26 % (95 % CI: 21 %, 32 %) of 261 patients with culture-confirmed TB were non-adherent.In a multivariable logistic regression model for non-adherence, reduced TBscore [OR (95 % CI) 0.639 (0.497, 0.797); p = 0.0001], health literacy score [0.798(0.696, 0.906); p = 0.0008], and increased K-10 [1.082(1.033, 1.137); p = 0.0012], and heavy alcohol usage [14.83(2.083, 122.9); p = 0.0002], were independently associated.

View Article: PubMed Central - PubMed

Affiliation: Lung Infection and Immunity Unit, Division of Pulmonology & UCT Lung Institute, Department of Medicine, University of Cape Town, H47 Old Main Building, Groote Schuur Hospital, Observatory, Cape Town, 7925, South Africa. grant.theron@uct.ac.za.

ABSTRACT

Background: The successful cure of tuberculosis (TB) is dependent on adherence to treatment. Various factors influence adherence, however, few are easily modifiable. There are limited data regarding correlates of psychological distress and their association with non-adherence to anti-TB treatment.

Methods: In a trial of a new TB test, we measured psychological distress (K-10 score), TB-related health literacy, and morbidity (TBscore), prior to diagnosis in 1502 patients with symptoms of pulmonary TB recruited from clinics in Cape Town (n = 419), Harare (n = 400), Lusaka (n = 400), Durban (n = 200), and Mbeya (n = 83). Socioeconomic, demographic, and alcohol usage-related data were captured. Patients initiated on treatment had their DOTS cards reviewed at two-and six-months.

Results: 22 %(95 % CI: 20 %, 25 %) of patients had severe psychological distress (K-10 ≥ 30). In a multivariable linear regression model, increased K-10 score was independently associated with previous TB [estimate (95 % CI) 0.98(0.09-1.87); p = 0.0304], increased TBscore [1(0.80, 1.20); p <0.0001], and heavy alcohol use [3.08(1.26, 4.91); p = 0.0010], whereas male gender was protective [-1.47(-2.28, -0.62); p = 0.0007]. 26 % (95 % CI: 21 %, 32 %) of 261 patients with culture-confirmed TB were non-adherent. In a multivariable logistic regression model for non-adherence, reduced TBscore [OR (95 % CI) 0.639 (0.497, 0.797); p = 0.0001], health literacy score [0.798(0.696, 0.906); p = 0.0008], and increased K-10 [1.082(1.033, 1.137); p = 0.0012], and heavy alcohol usage [14.83(2.083, 122.9); p = 0.0002], were independently associated. Culture-positive patients with a K-10 score ≥ 30 were more-likely to be non-adherent (OR = 2.290(1.033-5.126); p = 0.0416].

Conclusion: Severe psychological distress is frequent amongst TB patients in Southern Africa. Targeted interventions to alleviate psychological distress, alcohol use, and improve health literacy in newly-diagnosed TB patients could reduce non-adherence to treatment.

Show MeSH
Related in: MedlinePlus