Prevalence of depression among drug-resistant tuberculosis patients in South Asia: A systematic review and meta-analysis

Background: Drug-resistant tuberculosis (DR-TB) significantly increases the risk of depression, yet research on mental health in this population remains limited. Aim: This meta-analysis aimed to evaluate the prevalence of depression among multidrug-resistant TB (MDR-TB) patients, emphasizing the necessity for integrated mental health care. Methods: A systematic search across PubMed, Cochrane, EBSCOhost, and Google Scholar identified 536 articles, which were screened for eligibility after removing duplicates. Prevalence data were analyzed using R programming, with back-transformation applied to enhance accuracy. The methodological quality of the included studies was assessed with the JBI Critical Appraisal Checklist, and the study protocol is registered in PROSPERO (CRD42023449156). Results: Ultimately, twelve studies involving 3,258 participants were included in the analysis. The pooled prevalence of depression among MDR-TB patients was found to be 54% (95% CI: 42%-65%). Although substantial heterogeneity was noted (I-2 = 72%; P < 0.01), excluding one study (Walker et al.) due to high Cook's distance revised the prevalence to 55% (95% CI: 43%-68%), with reduced heterogeneity (I-2 = 68%; P < 0.01). Subgroup analyses indicated minimal variability among studies using the Hamilton Depression Rating Scale (52%, 95% CI: 40%-64%) and substantial variability among those employing the Patient Health Questionnaire (54%, 95% CI: 30%-79%). Funnel plot analysis and Egger's test revealed no significant publication bias (P = 0.2105). Conclusion: This study highlights a high prevalence of depression among MDR-TB patients, underscoring the urgent need for integrated mental health care strategies tailored for this vulnerable population. Further research is essential to refine these strategies effectively.