On World Health Day, Union Working Group highlights need to recognise links between depression and TB

As World Health Day focuses this year on efforts to mobilise action on depression, Union members in the Tuberculosis (TB) and Mental Health Working Group highlight the damaging influence of depression on those suffering from TB.

Depression is the leading cause of ill health and disability worldwide. According to the latest estimates from the World Health Organization (WHO), more than 300 million people live with depression. The combination of TB and depression has a powerful and damaging influence, increasing the burden of disease.

Dr Annika Sweetland, co-chair of The Union’s TB and Mental Health Working Group and Assistant Professor of Clinical Sociomedical Sciences in Psychiatry at Columbia University said during a recent webinar for The Union:

“Depression is a treatable condition that can affect as many as half of all individuals undergoing treatment for TB. It is associated with greater morbidity, mortality, drug-resistance, and community transmission. We think that it is entirely possible that depression may be an unrecognised driver of the TB and multidrug-resistant TB (MDR-TB) epidemics.”

Dr Sweetland describes the relationship between TB and depression as a syndemic, which is “the convergence of two or more conditions that act synergistically to magnify the burden of disease”. She argues that TB and depression act together to make it harder for people to access the health care they need, which means people from these vulnerable groups are more likely to have poor outcomes to treatment. The aim of Dr Sweetland’s work is to ensure that clinicians and researchers see TB and depression as the “TB-depression syndemic,” rather than as two separate conditions.

During the webinar, Dr Sweetland spoke about how providing mental health care and support systems for patients improves TB outcomes. She shared the experience of a patient at a psychosocial support group for patients with MDR-TB, who said: 

“The beginning of treatment is so hard, but it gets easier. The side effects were bad; I was so depressed. Treatment seemed like an eternity. But little by little, things got better. We have to be strong. We can’t give up. The most important thing to know is that you’re not alone. We’re all in this together.” 

One of the current aims of The Union’s TB and Mental Health Working Group is to link frontline TB care providers with researchers, to create an evidence base for best practices and disseminate them globally to National TB Programmes.

The group has been exploring the barriers to TB and mental health treatment integration through interviews with National TB Programme directors globally. These interviews revealed that the barriers are lack of capacity, lack resources and lack of awareness amongst staff. The Working Group is identifying a range of interventions to counter these barriers.

The group is working to identify places in low-resource settings where TB health care providers are finding innovative ways of integrating TB and mental health care. The group will then ensure that researchers are able to develop an evidence base for an integrated treatment approach, which can improve both physical health and mental health outcomes.

“Treating mental health is strongly aligned to every aspect of the End TB strategy”, says Dr Sweetland, “effectively treating depression is essential to the fight to end TB.” 

Watch the webinar