Association between tuberculosis and psychotic experiences: Mediating factors and implications for patient care in lowand middle-income countries

Background Tuberculosis may play a role in the aetiology of psychosis. However, little is known about the association between tuberculosis and psychotic experiences (PEs) or the mediating factors of this association. Methods We analysed cross-sectional data from 48 lowand middle -income countries of the World Health Survey (WHS). Tuberculosis assessment was based on past 12 -month symptoms of active tuberculosis. We assessed four types of past 12 -month PEs with the Composite International Diagnostic Interview. We performed multivariable multinomial logistic regression and mediation analysis. Results We analysed data on 224 842 individuals aged >= 18 years (mean age = 38.3 years, standard deviation = 16.0; 50.7% women). Tuberculosis was associated with 1.84 (95% confidence interval (CI) = 1.41-2.40), 2.18 (95%CI = 1.58-3.03), and 3.79 (95%CI = 2.88-4.98) times higher odds for 1, 2, and >= 3 PEs, respectively. The mediation analysis showed that the association between tuberculosis and at least one PE is mainly explained by anxiety (31.5%), sleep/energy (27.8%), and pain/discomfort (23.5%). Conclusions Tuberculosis was associated with increased odds of PEs. Factors such as affect, sleep, and pain should be considered in tuberculosis patients to target those who might be particularly vulnerable to PEs, and consequently, to psychotic disorders and other adverse effects of PE.