Agave Regina, Helmi Suryani Nasution, Muhammad Syukri, Rd. Halim, Ashar Nuzulul Putra, Dessy Pratiwi, Roma Yuliana

DEPRESSION-RELATED FACTORS IN PULMONARY TUBERCULOSIS PATIENTS: SECONDARY ANALYSIS OF THE INDONESIAN HEALTH SURVEY 2023

Introduction

Depression-related factors in pulmonary tuberculosis patients: secondary analysis of the indonesian health survey 2023. Depression factors in Indonesian TB patients (SKI 2023) identified. Stress, gender, age, smoking, and early treatment are key. Recommends mental health screening & support.

Abstract

Background: Depression is highly prevalent among tuberculosis (TB) patients, with reported rates reaching 31-61%, and it is strongly associated with poor medication adherence and adverse treatment outcomes. Despite this considerable burden, mental health screening for TB patients has not yet been integrated into routine TB care. Purpose: This study aimed to identify factors associated with depression among TB patients. Methods: This secondary data analysis used the Survei Kesehatan Indonesia (SKI) or Indonesian Health Survey 2023 with a cross-sectional design. A total sampling approach was applied, to all TB patients who met the inclusion criteria, resulting in 1,163 respondents. Statistical analyses included the chi-square test and multiple logistic regression, with a significance level of p < 0.05. Results: The prevalence of depression among TB patients was 5.38% (95% CI: 3.26–8.76%). Multivariate analysis showed that being female [aPOR = 15.90, 95% CI (1.99-143.09)], age 15-40 years [aPOR = 5.80, 95% CI (1.17-28.67)], TB treatment duration ≤6 months [aPOR = 5.22, 95% CI (1.67-16.34)], smoking [aPOR = 11.33, 95% CI (2.07-61.97)], and stress [aPOR = 39.04, 95% CI (11.23-135.66)] were significantly associated with depression in TB patients. Stress was identified as the most influential factor. Conclusion: Depression remains a relevant issue among TB patients in Indonesia, with stress emerging as the strongest associated factor. Routine depression screening and integrated mental health support within TB programs are strongly warranted, particularly for high-risk groups such as women, younger adults, patients in the early phase of treatment, smokers, and those experiencing stress.

Review

This study addresses a critically important yet often overlooked aspect of tuberculosis care: the comorbidity of depression. Leveraging the robust national dataset of the Indonesian Health Survey 2023, the authors conduct a timely secondary analysis to identify factors associated with depression among TB patients. The large sample size of 1,163 respondents and the use of appropriate statistical methods, including multiple logistic regression, lend significant strength to the findings. Identifying specific risk groups such as women, younger adults, smokers, and those experiencing stress, particularly during the early phase of treatment, provides valuable insights for targeted interventions and supports the paper's strong call for integrated mental health screening. While the study offers crucial insights, certain methodological aspects and findings warrant further consideration. The cross-sectional design inherently limits the ability to establish causal relationships, meaning the identified factors are associations rather than direct causes of depression. A notable point of concern is the reported prevalence of depression at 5.38%, which is considerably lower than the 31-61% range cited in the background, raising questions about the diagnostic tools used within the SKI and potential underestimation or differences in population characteristics. Furthermore, while statistically significant, some of the adjusted odds ratios, particularly for factors like being female [aPOR = 15.90, 95% CI (1.99-143.09)], exhibit extremely wide confidence intervals, suggesting high variability and potentially reduced precision in estimating the true effect size of these associations. Despite these points, the study's conclusions are highly relevant for public health policy and clinical practice in Indonesia. The emphasis on integrating mental health screening into routine TB care, especially for the identified high-risk groups, is a strong and actionable recommendation. Future research should aim to explore the causal pathways between the identified factors and depression through longitudinal studies. Additionally, investigating the reasons for the lower-than-expected prevalence of depression in this national survey compared to previous reports, potentially by validating the depression assessment method used, would significantly enhance our understanding of the true burden. This paper serves as an important call to action, highlighting the need for a more holistic approach to TB patient care that encompasses mental well-being.

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