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Free Content Addressing the tuberculosis–depression syndemic to end the tuberculosis epidemic

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Tuberculosis (TB) and depression act synergistically via social, behavioral, and biological mechanisms to magnify the burden of disease. Clinical depression is a common, under-recognized, yet treatable condition that, if comorbid with TB, is associated with increased morbidity, mortality, community TB transmission, and drug resistance. Depression may increase risk of TB reactivation, contribute to disease progression, and/or inhibit the physiological response to anti-tuberculosis treatment because of poverty, undernutrition, immunosuppression, and/or negative coping behaviors, including substance abuse. Tuberculous infection and/or disease reactivation may precipitate depression as a result of the inflammatory response and/or dysregulation of the hypothalamic-pituitary-adrenal axis. Clinical depression may also be triggered by TB-related stigma, exacerbating other underlying social vulnerabilities, and/or may be attributed to the side effects of anti-tuberculosis treatment. Depression may negatively impact health behaviors such as diet, health care seeking, medication adherence, and/or treatment completion, posing a significant challenge for global TB elimination. As several of the core symptoms of TB and depression overlap, depression often goes unrecognized in individuals with active TB, or is dismissed as a normative reaction to situational stress. We used evidence to reframe TB and depression comorbidity as the ‘TB–depression syndemic', and identified critical research gaps to further elucidate the underlying mechanisms. The World Health Organization's Global End TB Strategy calls for integrated patient-centered care and prevention linked to social protection and innovative research. It will require multidisciplinary approaches that consider conditions such as TB and depression together, rather than as separate problems and diseases, to end the global TB epidemic.
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Keywords: biomarkers; comorbidity; immunosuppression; poverty; social determinants

Document Type: Research Article

Affiliations: 1: Department of Psychiatry, Columbia College of Physicians and Surgeons, New York, New York, USA; New York State Psychiatric Institute, New York, New York, USA 2: Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil TB Research Network (REDE-TB), Rio de Janeiro, Rio de Janeiro, Brazil 3: Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania, USA 4: Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, Rio de Janeiro, Brazil 5: Vital Strategies, New York, New York, USA 6: State University of North Fluminense Darcy Ribeiro, Rio de Janeiro, Rio de Janeiro, Brazil 7: Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

Publication date: August 1, 2017

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease (IJTLD) is for clinical research and epidemiological studies on lung health, including articles on TB, TB-HIV and respiratory diseases such as COVID-19, asthma, COPD, child lung health and the hazards of tobacco and air pollution. Individuals and institutes can subscribe to the IJTLD online or in print – simply email us at [email protected] for details.

    The IJTLD is dedicated to understanding lung disease and to the dissemination of knowledge leading to better lung health. To allow us to share scientific research as rapidly as possible, the IJTLD is fast-tracking the publication of certain articles as preprints prior to their publication. Read fast-track articles.

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