Depression care integration in tuberculosis services: A feasibility assessment in Pakistan.
LMIC
Pakistan
depression
integrated care
tuberculosis
Journal
Health expectations : an international journal of public participation in health care and health policy
ISSN: 1369-7625
Titre abrégé: Health Expect
Pays: England
ID NLM: 9815926
Informations de publication
Date de publication:
Feb 2024
Feb 2024
Historique:
revised:
30
12
2023
received:
10
11
2023
accepted:
23
01
2024
medline:
5
8
2024
pubmed:
5
8
2024
entrez:
5
8
2024
Statut:
ppublish
Résumé
The co-occurrence of depression among tuberculosis (TB) patients is a critical issue, contributing to poor treatment outcomes, prolonged hospitalisations and increased healthcare expenses. The objective of this study was to assess the feasibility of delivering a co-designed depression care pathway within TB services in Pakistan. Mixed-method study. Routine depression screening for TB patients was conducted at three TB facilities in Peshawar, Pakistan, encompassing primary, secondary and tertiary care settings. All patients aged 18 or above (male and female) attending the three TB facilities between November 2021 and February 2022 were included in the study using the consecutive sampling technique. A total of 301 people with confirmed TB, within the past 4 weeks, visited the three TB care facilities; 191/301 patients were screened for depression. Approximately 35% of the 191 TB patients screened positive for depression, with varying severity levels. Qualitative findings highlighted the acceptability of integrated depression care, emphasising the importance of open communication and empathetic attitudes. Barriers to integration include stigma, logistical challenges, patient noncompliance and cost burdens. Facilitators included the empathetic attitude of healthcare providers and the availability of mental health services within the same facility. There is a high burden of depression in patients with TB, highlighting the pressing need for mental health support in this population. Acceptability of integrated care was evident, with factors such as co-located mental health services, training healthcare providers and provider empathetic attitudes playing a crucial role. Further research is required to evaluate the effectiveness of the integrated TB-depression screening systems towards improved health outcomes, implementation, scalability and impact on the broader healthcare system. To create a more inclusive and comprehensive TB and depression care pathway, we gathered input from both service providers and service users (TB patients, their carers). Reflective meetings with community leaders, social activists and health professionals from various sectors were also conducted during pathway delivery to get their insights. Power, gender and age imbalances were addressed by encouraging participation of patients and carers across gender and age groups. This approach ensured that the perspectives of all stakeholders were considered in the development of the care pathway.
Sections du résumé
BACKGROUND
BACKGROUND
The co-occurrence of depression among tuberculosis (TB) patients is a critical issue, contributing to poor treatment outcomes, prolonged hospitalisations and increased healthcare expenses.
OBJECTIVE
OBJECTIVE
The objective of this study was to assess the feasibility of delivering a co-designed depression care pathway within TB services in Pakistan.
DESIGN
METHODS
Mixed-method study.
SETTING AND PARTICIPANTS
METHODS
Routine depression screening for TB patients was conducted at three TB facilities in Peshawar, Pakistan, encompassing primary, secondary and tertiary care settings. All patients aged 18 or above (male and female) attending the three TB facilities between November 2021 and February 2022 were included in the study using the consecutive sampling technique.
RESULTS
RESULTS
A total of 301 people with confirmed TB, within the past 4 weeks, visited the three TB care facilities; 191/301 patients were screened for depression. Approximately 35% of the 191 TB patients screened positive for depression, with varying severity levels. Qualitative findings highlighted the acceptability of integrated depression care, emphasising the importance of open communication and empathetic attitudes. Barriers to integration include stigma, logistical challenges, patient noncompliance and cost burdens. Facilitators included the empathetic attitude of healthcare providers and the availability of mental health services within the same facility.
CONCLUSION
CONCLUSIONS
There is a high burden of depression in patients with TB, highlighting the pressing need for mental health support in this population. Acceptability of integrated care was evident, with factors such as co-located mental health services, training healthcare providers and provider empathetic attitudes playing a crucial role. Further research is required to evaluate the effectiveness of the integrated TB-depression screening systems towards improved health outcomes, implementation, scalability and impact on the broader healthcare system.
PATIENT AND PUBLIC CONTRIBUTION
UNASSIGNED
To create a more inclusive and comprehensive TB and depression care pathway, we gathered input from both service providers and service users (TB patients, their carers). Reflective meetings with community leaders, social activists and health professionals from various sectors were also conducted during pathway delivery to get their insights. Power, gender and age imbalances were addressed by encouraging participation of patients and carers across gender and age groups. This approach ensured that the perspectives of all stakeholders were considered in the development of the care pathway.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e13985Subventions
Organisme : National Institute for Health and Care Research
ID : 17/63/130
Informations de copyright
© 2024 The Authors. Health Expectations published by John Wiley & Sons Ltd.
Références
TB Alliance. Pathway to patients: charting the dynamics of the global TB drug market. Global Alliance for TB Drug Development; 2007.
TB Alliance. Cycle of Poverty—Archbishop Desmond Tutu. TB Alliance; 2015. https://www.tballiance.org/why-new-tb-drugs/cycle-poverty
Waheed MS. Tuberculosis. World Health Organization—Regional Office for the Eastern Mediterranean. https://www.emro.who.int/pak/programmes/stop-tuberculosis.html
CMT, TAC, TAG & i‐Base. TB Cases on the Rise in Pakistan. TB Online. https://www.tbonline.info/posts/2019/4/21/tb-cases-rise-pakistan/
Alvi MH, Ashraf T, Naz F. Burden of mental disorders by gender in Pakistan: analysis of Global Burden of Disease Study data for 1990–2019. BJPsych Bull. Published online, 2023:1‐8.
Nisar M, Mohammad RM, Fatima S, Shaikh PR, Rehman M. Perceptions pertaining to clinical depression in Karachi, Pakistan. Cureus. 2019;11:e5094.
Rao AA. Depression Prevalence and Causes in Pakistan. https://www.linkedin.com/pulse/depression-prevalence-causes-pakistan-asad-ahmad-rao (1678669440000).
Todowede O, Afaq S, Adhikary A, et al. Barriers and facilitators to integrating depression care in tuberculosis services in South Asia: a multi‐country qualitative study. BMC Health Serv Res. 2023;23:818.
Farooq S, Tunmore J, Comber R. Pharmacological or non‐pharmacological interventions for treatment of common mental disorders associated with tuberculosis: a systematic review. Chron Respir Dis. 2021;18:147997312110039.
Salodia U, Sethi S, Khokhar A. Depression among tuberculosis patients attending a DOTS centre in a rural area of Delhi: a cross‐sectional study. Indian J Public Health. 2019;63:39‐43.
Husain MO, Dearman SP, Chaudhry IB, Rizvi N, Waheed W. The relationship between anxiety, depression and illness perception in tuberculosis patients in Pakistan. Clin Pract Epidemiol Mental Health. 2008;4:4.
Walker IF, Khan AM, Khan AM, et al. Depression among multidrug‐resistant tuberculosis patients in Punjab, Pakistan: a large cross‐sectional study. Int J Tuberc Lung Dis. 2018;22:773‐778.
Ruiz‐Grosso P, Cachay R, de la Flor A, Schwalb A, Ugarte‐Gil C. Association between tuberculosis and depression on negative outcomes of tuberculosis treatment: a systematic review and meta‐analysis. PLoS ONE. 2020;15:e0227472.
Hurst JR, Dickhaus J, Maulik PK, et al. Global alliance for chronic disease researchers' statement on multimorbidity. Lancet Glob Health. 2018;6:e1270‐e1271.
Toro N. Who global strategy on integrated people‐centred health services (IPCHS)/Estrategia mundial en servicios de salud integrada centrado en las personas (IPCHS). Int J Integr Care. 2015;15. https://storage.googleapis.com/jnl-up-j-ijic-files/journals/1/articles/2413/submission/proof/2413-1-9820-1-10-20151116.pdf
Smith SM, Wallace E, O'Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev. 2021;1:CD006560.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. Int J Nurs Stud. 2013;50:587‐592.
MacMahon S. Multimorbidity: A Priority for Global Health Research. The Academy of Medical Sciences; 2018.
World Health Organization. The End TB Strategy. WHO; 2019. https://www.who.int/teams/global-tuberculosis-programme/the-end-tb-strategy
Ullah S, Daud H, Dass S, Fanaee‐T H, Kausarian H, Khalil A. Space–time clustering characteristics of tuberculosis in Khyber Pakhtunkhwa Province, Pakistan, 2015–2019. Int J Environ Res Public Health. 2020;17:1413.
Shah SK, Dogar OF, Siddiqi K. Tuberculosis in women from Pashtun region: an ecological study in Pakistan. Epidemiol Infect. 2015;143:901‐909.
Azīz M. A Study to Explore the Causes of Higher Notification of Tuberculosis in Adult Females in the Province of Khyber Pakhtunkhwa, Pakistan. Thesis. University of Manchester; 2017.
The Impact Group. IMPACT South Asia: Welcome to the Centre for IMPACT. NIHR; 2020. https://www.impactsouthasia.com/
Kroenke K, Spitzer RL, Williams JBW. The Patient Health Questionnaire‐2: validity of a two‐item depression screener. Med Care. 2003;41:1284‐1292.
Kroenke K, Spitzer RL, Williams JBW. The PHQ‐9: validity of a brief depression severity measure. J Gen Intern Med. 2001;16:606‐613.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3:77‐101.
Kiger ME, Varpio L. Thematic analysis of qualitative data: AMEE Guide No. 131. Med Teach. 2020;42:846‐854.
Amreen, Rizvi N. Frequency of depression and anxiety among tuberculosis patients. J Tuberc Res. 2016;4:183‐190.
Sweetland AC, Kritski A, Oquendo MA, et al. Addressing the tuberculosis‐depression syndemic to end the tuberculosis epidemic. Int J Tuberc Lung Dis. 2017;21:852‐861.
Saqib SE, Ahmad MM, Panezai S. Care and social support from family and community in patients with pulmonary tuberculosis in Pakistan. Fam Med Community Health. 2019;7:e000121.
Chen X, Wu R, Xu J, et al. Prevalence and associated factors of psychological distress in tuberculosis patients in Northeast China: a cross‐sectional study. BMC Infect Dis. 2021;21:563.
Pachi A, Bratis D, Moussas G, Tselebis A. Psychiatric morbidity and other factors affecting treatment adherence in pulmonary tuberculosis patients. Tuberc Res Treat. 2013;2013:1‐37.
Janmeja AK, Das SK, Bhargava R, Chavan BS. Psychotherapy improves compliance with tuberculosis treatment. Respiration. 2005;72:375‐380.
van Hoorn R, Jaramillo E, Collins D, Gebhard A, van den Hof S. The effects of psycho‐emotional and socio‐economic support for tuberculosis patients on treatment adherence and treatment outcomes—a systematic review and meta‐analysis. PLoS ONE. 2016;11:e0154095.
Sweetland AC, Gruber Mann C, Fernandes MJ, et al. Barriers and facilitators to integrating depression treatment within a TB program and primary care in Brazil. Health Promot Pract. 2023:15248399231183400. doi:10.1177/15248399231183400
Mainga T, Gondwe M, Stewart RC, et al. Conceptualization, detection, and management of psychological distress and mental health conditions among people with tuberculosis in Zambia: a qualitative study with stakeholders' and TB health workers. Int J Ment Health Syst. 2022;16:34.
Lovero KL, Lammie SL, van Zyl A, et al. Mixed‐methods evaluation of mental healthcare integration into tuberculosis and maternal–child healthcare services of four South African districts. BMC Health Serv Res. 2019;19(83):83.
Myburgh H, Baloyi D, Loveday M, et al. A scoping review of patient‐centred tuberculosis care interventions: gaps and opportunities. PLoS Glob Public Health. 2023;3:e0001357.
Munro SA, Lewin SA, Smith HJ, Engel ME, Fretheim A, Volmink J. Patient adherence to tuberculosis treatment: a systematic review of qualitative research. PLoS Med. 2007;4:e238.
TB Alliance. Promoting TB Awareness Through Community Engagement—World TB Day 2010. TB Alliance; 2010. https://www.tballiance.org/news/promoting-tb-awareness-through-community-engagement-world-tb-day-2010
World Health Organization. Involvement of Communities and Patients in Tuberculosis Care and Prevention. World Health Organization; 2008.
Prince M, Patel W, Saxena S, et al. No health without mental health. Lancet. 2007;370:859‐877.
Aithal A, Aithal PS. ABCD analysis of task shifting—an optimum alternative solution to professional healthcare personnel shortage. Int J Health Sci Pharm. 2017;1(2):36‐51. doi:10.47992/ijhsp.2581.6411.0017
Whitfield J, Owens S, Bhat A, Felker B, Jewell T, Chwastiak L. Successful ingredients of effective Collaborative Care programs in low‐ and middle‐income countries: a rapid review. Glob Ment Health. 2023;10:e11.
Hanlon C, Luitel NP, Kathree T, et al. Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low‐ and middle‐income countries. PLoS ONE. 2014;9:e88437.
Sweetland AC, Galea J, Shin SS, et al. Integrating tuberculosis and mental health services: global receptivity of national tuberculosis program directors. Int J Tuberc Lung Dis. 2019;23:600‐605.
World Health Organization. Mental Health Gap Action Programme. WHO; 2019 https://www.who.int/teams/mental-health-and-substance-use/treatment-care/mental-health-gap-action-programme
The Union. Management of Tuberculosis: A Guide to Essential Practice. The Union; 2019 https://theunion.org/technical-publications/management-of-tuberculosis-a-guide-to-essential-practice
Kigozi G. Confirmatory factor analysis of the Patient Health Questionnaire‐9: a study amongst tuberculosis patients in the Free State province. South Afr J Infect Dis. 2020;35:242.
Wang X, Li X, Zhang Q, et al. A survey of anxiety and depressive symptoms in pulmonary tuberculosis patients with and without tracheobronchial tuberculosis. Front Psychiatry. 2018;9:308.
Rouf A, Masoodi MA, Dar MM, Khan SMS, Bilquise R. Depression among tuberculosis patients and its association with treatment outcomes in district srinagar. J Clin Tuberc Other Mycobact Dis. 2021;25:100281.
Centre for Innovation in Campus Mental Health. Stepped Care Approach. Centre for Innovation in Campus Mental Health; 2018. https://campusmentalhealth.ca/toolkits/campus-community-connection/models-frameworks/stepped-care-model/