RESUMO
BACKGROUND: Comorbid mental disorders in patients with TB may exacerbate TB treatment outcomes. We systematically reviewed current evidence on the association between mental disorders and TB outcomes.METHODS: We searched eight databases for studies published from 1990 to 2018 that compared TB treatment outcomes among patients with and without mental disorders. We excluded studies that did not systematically assess mental disorders and studies limited to substance use. We extracted study and patient characteristics and effect measures and performed a meta-analysis using random-effects models to calculate summary odds ratios (ORs) with 95% confidence intervals (CIs).RESULTS: Of 7687 studies identified, 10 were included in the systematic review and nine in the meta-analysis. Measurement of mental disorders and TB outcomes were heterogeneous across studies. The pooled association between mental disorders and any poor outcome, loss to follow-up, and non-adherence were OR 2.13 (95%CI 0.85-5.37), 1.90 (95%CI 0.33-10.91), and 1.60 (95%CI 0.81-3.02), respectively. High statistical heterogeneity was present.CONCLUSION: Our review suggests that mental disorders in TB patients increase the risk of poor TB outcomes, but pooled estimates were imprecise due to small number of eligible studies. Integration of psychological and TB services might improve TB outcomes and progress towards TB elimination.
Assuntos
Transtornos Mentais , Transtornos Relacionados ao Uso de Substâncias , Tuberculose , Humanos , Transtornos Mentais/epidemiologia , Razão de Chances , Resultado do Tratamento , Tuberculose/tratamento farmacológicoRESUMO
Mental disorders and alcohol/drug use worsen treatment outcomes for multidrug-resistant tuberculosis (TB), but data are lacking for extensively drug-resistant (XDR) TB. We investigated the association of baseline mental disorders and alcohol/drug use on XDR-TB treatment outcomes in a retrospective study of 53 XDR-TB Peruvian patients during 2010-2012. Logistic regression estimated the odds ratios for unfavourable XDR-TB treatment outcomes. Overall treatment success was 25%. Mental disorders and drug/alcohol use were found in respectively 22.4% and 20.4% of patients; neither were associated with unfavourable treatment outcomes. Future research should explore the relationship between mental health and drug/alcohol use in XDR-TB treatment outcomes.
Les troubles mentaux et la consommation d'alcool/de drogue entravent le résultat du traitement de la tuberculose multirésistante (TB-MDR), mais on manque de données pour la TB ultrarésistante (TB-XDR). Nous avons examiné l'association de troubles mentaux préexistants et de consommation d'alcool/de drogue sur le résultat du traitement de la TB-XDR dans une étude rétrospective de 53 patients péruviens atteints de TB-XDR en 20102012. Une régression logistique a estimé les odds ratios de résultat défavorable du traitement de la TB-XDR. Le taux d'ensemble de succès du traitement a été de 25%. Des troubles mentaux et une consommation d'alcool/de drogue ont été constatés chez respectivement 22,4% et 20,4% des patients ; aucun n'a été associé à un résultat défavorable du traitement. Des recherches ultérieures devraient explorer la relation entre santé mentale et consommation de drogue/alcool et leur impact sur le traitement de la TB-XDR.
Los trastornos mentales y el consumo de alcohol y de drogas agravan los desenlaces terapéuticos de la tuberculosis multidrogorresistente (TB-MDR), pero no existen datos en cuanto a la TB extremadamente resistente (TB-XDR). En un estudio retrospectivo en 53 pacientes peruianos que padecieron TB-XDR del 2010 al 2012, se investigó la asociación de la presencia inicial de trastornos mentales y consumo de alcohol o drogas con los desenlaces del tratamiento de la TB-XDR. Mediante un modelo de regresión logística se calcularon los cocientes de posibilidades de desenlaces terapéuticos desfavorables. La tasa global de éxito terapéutico fue de 25%. Se encontró que el 22,4% de los pacientes sufría trastornos mentales y el 20,4% consumía alcohol o drogas; ninguna de estas características se asoció con desenlaces desfavorables del tratamiento. Nuevas investigaciones tendrán que explorar la correlación que existe entre la salud mental y el consumo de alcohol o drogas y los desenlaces terapéuticos de la TB-XDR.
