Tuberculosis and Mental Health

What is the link between tuberculosis and mental health?

Tuberculosis (TB) is an airborne infection, caused by bacteria, that is preventable and treatable. However, the treatment requires multiple drugs for multiple months, and many countries are still battling TB. Currently, 95% of deaths due to TB are in low-income countries.

The risk factors for mental illness are very similar to those for TB, including low socioeconomic status, smoking, drug use, HIV, and other diseases. In fact, recent research suggests that those with TB often have concurrent mental illness, with some estimates as high as 70% of TB patients. Mental health can also acutely worsen in the setting of disease—TB itself is a stressful illness with a prolonged course of treatment requiring strict adherence. This can make it difficult to work, forcing many to lose much-needed income during treatment.

Perhaps due to these many stressors, people with TB and concurrent mental illness have higher rates of mortality and morbidity, seek healthcare less often, and have higher rates of ongoing disease transmission than those with TB alone. There are high rates of depression and anxiety in people living with TB, and one of the drugs used to treat the infection, cycloserine, can precipitate or worsen mental health crises. The growing field of mental health research among TB patients aims to inform our efforts to decrease this negative synergy of TB and mental health.

What are the unique barriers to treating mental illness in people living with TB?

Stigma, against both mental health and TB itself, is a major barrier to treatment of mental illness in people living with TB. Secondly, many of the low-income countries where TB is an issue do not have the infrastructure in place to provide mental health care to all those who need it. Finally, resource allocation can be a major issue for countries with high healthcare needs. Prioritizing mental health treatment for people living with TB needs to be economically feasible.

Would treating mental illness in people living with TB help us eradicate this disease?

Currently, a method called DOTS (Directly Observed Therapy Short Course) is a major effort to improve complete treatment of TB. Though it is hard to predict whether or not treating concurrent mental illness in people living with TB would increase adherence, the theory is that treating mental health conditions in conjunction with DOTS will help people adhere to treatment more effectively. This in turn, would decrease ongoing transmission and help fight TB.

Conclusions

Though mental health and tuberculosis seem to be linked, the relationship is still unclear. Are the people who are predisposed to mental health also predisposed to getting tuberculosis? Or is there a direct causal link between having tuberculosis or mental health issues and then getting the other? Irrespective, integrating mental health treatment into TB treatment programs could be an avenue to better health for at-risk populations, both mentally and physically.

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