Study links mental health to TB risk
New research presented at this year’s European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) online (July 9-12) shows people with mental illnesses, including depression and schizophrenia, are experiencing an increased incidence tuberculosis (TB).
Tuberculosis and mental illness are two urgent global health priorities with high prevalence across the world, and often coexist. Although poor mental health is known to affect the immune system, it is not known whether mental illness plays a causal role in TB infection and an individual’s risk of developing the active disease.
This study by Sally Hayward and colleagues at the Institute for Infection and Immunity, St George’s, University of London, UK, in collaboration with the London School of Hygiene and Tropical Medicine, University of Nottingham and University Columbia, New York, reviewed the evidence for an association between mental health and the risk of developing tuberculosis to better inform clinical and public health measures to control the disease.
The authors performed a systematic review of research studies from the MEDLINE, PsycINFO, and PsycEXTRA medical databases. The inclusion criteria were a publication date in the period January 1, 1970 to May 11, 2020, and that the study contained data on the association between mental health and the risk of active TB.
The researchers looked at a total of 1,546 studies, resulting in data from 607,184 people in Asia, South America and Africa over a 50-year period. These looked at both mood disorders such as depression, as well as psychotic disorders that include schizophrenia.
The team found strong evidence from studies in Asia that depression and schizophrenia are associated with an increased risk of developing active tuberculosis. People with depression were between 15% and 2.6 times more likely to have TB than those without depression, while schizophrenia was associated with a 52% increased risk and a tripling of the risk of having TB .
Further analysis of data from a large study of 242,952 subjects in low- and middle-income countries also found that people with tuberculosis were more than three times more likely to experience an episode of depression than those with tuberculosis. people without the disease.
The authors conclude: “Our data show that people with mental illnesses, including depression and schizophrenia, have an increased incidence of tuberculosis and therefore represent a high-risk population that could be targeted for screening and treatment.”
They add: “Integrated programs providing care for mental health and tuberculosis are needed, and interventions that address mental illnesses and their underlying factors can help reduce the incidence of tuberculosis globally.” .
Sally Hayward, lead author of the study from St George’s, University of London, said: “It is clear that mental health problems and tuberculosis often coexist, but this study shows that mental health could play a causal role in increased risk of tuberculosis, potentially through its effect on the immune system. This underscores the importance of work to address the global burden of mental illness and to approach physical and mental health in a holistic way.
** Note that this is a first special version of the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2021). Please credit the conference if you use this story **
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