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Tuberculosis and Mental Health
Context:
The intersection of tuberculosis (TB) and mental health issues presents a significant public health challenge, often referred to as a “syndemic.”
More on News:
- In 2022, 2.42 million Indians were diagnosed with tuberculosis (TB). TB is associated with a significant stigma, leading to ostracisation and mistreatment, which impacts the mental health of those affected.
- TB and mental illness are co-epidemics, with mental health challenges linked to both the stigma surrounding TB and the disease’s long treatment process.
The Bidirectional Relationship:
- TB is stigmatised due to its contagious nature, association with poverty, and perceived unhealthy behaviours.
- This stigma leads to both social and self-stigma, resulting in mental health challenges such as hopelessness, despair, and impaired decision-making skills.
- Conversely, individuals with mental health issues are more likely to develop TB due to weakened immune systems and higher susceptibility to infections.
Impact of TB Treatment:
- TB treatment is long and comes with severe side effects, leading to depression and other mental health issues in patients.
- Mental Toll of TB: Up to 84% of TB patients have concomitant depression, significantly diminishing their quality of life.
- Physical changes and side effects (e.g., rashes, psychosis) during treatment also worsen mental health, affecting self-confidence.
Global Efforts and Recommendations:
- Recognising the importance of mental health in TB care, the World Health Organisation (WHO) has emphasised the need for holistic, people-centred approaches.
- This includes routine screening for mental health conditions, providing mental health support, and addressing stigma and discrimination.
- India is encouraged to create a comprehensive framework and policy that integrates mental health screening into TB care.
Challenges:
- Current TB care standards screen for diabetes and HIV but not for mental health issues.
- Only a few countries’ National TB Programs (NTPs) include routine mental health screening or co-management of TB and mental disorders.
Way Forward:
- Psychological Support and Treatment Adherence: Mental health disorders can lead to poor treatment adherence, increased dropout rates, and poorer outcomes. Providing remote digital therapies, like cognitive behavioural therapy via smartphone apps, could help overcome the challenge of limited mental health professionals.
- Community Engagement and Support: Support groups and informational support for patients and families can help. There is a need for broader community involvement in TB and mental health programs.
- Early Referral to Mental Health Professionals: Pathways for early referral to psychiatrists and prompt treatment initiation need to be established. However, the shortage of psychiatrists in India presents a challenge. Training more mental health professionals should be prioritised to address this gap.
- Policymakers must prioritise mental health services within TB programs and allocate adequate resources to create integrated care systems.
