Original Article
Demographic/socioeconomic factors in mental disorders associated with tuberculosis in southwest nigeria

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Abstract

In spite of the high prevalence of tuberculosis worldwide, there are few studies on its psychiatric complications. The mental state of 53 patients with pulmonary tuberculosis seen in a Nigerian chest clinic was examined using the 30-item General Health Questionnaire (GHQ-30), the Present State Examination (PSE), and a clinical evaluation based on the International Classification of Disease, tenth edition (ICD-10). Results were compared with two comparison groups: (1) a group of 20 long-stay orthopedic patients with lower limb fractures; and (2) a group of 20 apparently healthy controls. The sociodemographic characteristics of the groups were also compared. A significantly higher prevalence of psychiatric disorders was found in the tuberculosis group (30.2%) than in the orthopedic group (15%) and the apparently healthy controls (5%). The types of psychiatric disorders encountered included mild depressive episode, generalized anxiety disorder, and adjustment disorder (ICD-10). Psychiatric morbidity was higher in tuberculosis patients with low educational attainment, and did not show a statistically significant relationship with other sociodemographic parameters. Ways of improving the mental health of tuberculosis patients are discussed.

Introduction

Tuberculosis remains a major public health problem worldwide in spite of major scientific advancements in its diagnosis and management 1, 2. About one third of the world’s population is infected by mycobacterium tuberculosis, and the majority of those infected are from developing countries [1]. Indeed, it is the world’s leading cause of death from a single infectious agent 3, 4.

There has been a very marked rise in the prevalence of tuberculosis worldwide since the mid-1980s 5, 6. This has been attributed to a decline in immune and nutritional status, which often accompanies adverse social situations. These social situations include: marginal living conditions; social deprivation; overcrowding; and poverty 4, 5, 6. Most of these conditions exist in developing countries including Nigeria. Even in advanced nations, with well-developed tuberculosis control programs, there has been a recent resurgence of this deadly disease [6]. This has been blamed on excessive reliance on scientific advances alone without adequate attention being paid to the sociopolitical contexts in which health and disease are embedded [1].

Tuberculosis constitutes a growing threat to the survival of mankind. Every year, about 8 million people develop this disease, and about 3 million die of it, over 95% of these in developing nations 1, 3. This high rate of mortality has been attributed to inadequate control programs, poor compliance with antituberculosis regimes for various reasons, increasing prevalence of HIV infection, and overpopulation.

The tuberculosis patient is perceived as infectious to others and as a source of infection in the community, and therefore dangerous [2]. This perception has many social consequences, including stigmatization, social isolation, and rejection of the patient and his family members. Due to fear, patients often delay seeking help, deny the diagnosis, and reject the treatment [7].

In spite of the profound social consequences of tuberculosis, there has been little research on the psychiatric complications, especially in sub-Saharan Africa. Yet, 15–25% of all mental disorders encountered in Africa are attributable to physical disorders including infectious disorders 8, 9, 10, and tuberculosis constitutes a significant proportion of infectious diseases in sub-Saharan Africa [1]. It is therefore important to explore the impact of tuberculosis on mental health status, and to determine the relationship between psychopathology and sociodemographic characteristics.

Section snippets

Method

This study, prospective and controlled, was carried out at the Chest Clinic at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, between December 1995 and April 1996. Ile-Ife is a Yoruba town located in southwestern Nigeria some 229 km away from Lagos, the former capital city of Nigeria.

The staff at the Chest Clinic includes a consultant chest physician, a number of resident physicians in respiratory medicine, nurses, and other ancillary staff.

Patients suspected of suffering

Sociodemographic characteristics of pulmonary tuberculosis, orthopedic and healthy control groups

The age range of the tuberculosis patient was 15–66 years (mean 37.6±14.0). The age range of the orthopedic group was 17–65 years (mean 37.5±13.6), whereas that of the apparently healthy control group was 21–60 years (mean 38±13.0).

The tuberculosis population consisted of 53 patients (24 males and 29 females). The orthopedic and healthy control groups consisted of 20 subjects each; 9 males and 11 females. The male/female ratio was 0.83 for the tuberculosis patients and 0.82 for the orthopedic

Discussion

In the present study, it was found that 30.2% of pulmonary tuberculosis patients had diagnosable psychiatric disorders. This value was significantly higher than the levels of psychopathology identified in the comparison groups in this study. The psychiatric disorders that complicated pulmonary tuberculosis included mild depressive episode, generalized anxiety disorder, and adjustment disorder (ICD-10) [14].

Our findings are similar to those of a study conducted on tuberculosis patients in South

Acknowledgements

Acknowledgments—The authors thank Prof. O. Morakinyo, Head of the Department of Mental Health, Obafemi Awolowo University, Ile-Ife, Nigeria, for his useful contributions. We are also grateful to the members of the staff of the Chest Clinic, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria, for their cooperation in carrying out this study.

References (18)

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