Prevalence and associated factors of depression & anxiety among drug-sensitive TB patients at urban BRAC DOTS TB program in Dhaka city with a focus on facilitators and barriers of integrating mental health services – a mixed-methods convergent study

Abstract

Introduction: Tuberculosis (TB) remains a major public health concern in Bangladesh, with significant challenges in addressing the psychological well-being of patients. Depression among TB patients is often underdiagnosed and untreated, despite its impact on treatment adherence and outcomes. This study aimed to assess the prevalence and associated factors of depression among drug-sensitive TB patients and explore their experiences with mental health challenges, as well as the facilitators and barriers to integrating mental health services into TB programs at BRAC DOTS centers in Dhaka, Bangladesh. Method: This mixed-methods convergent study utilized quantitative and qualitative approaches to investigate mental health challenges among drug-sensitive TB patients and identify facilitators and barriers to integrating mental health services. Quantitative data were collected through structured surveys at the Kamrangirchar BRAC DOTS-TB center, analyzed using descriptive statistics and multivariable logistic regression. Qualitative data were gathered via in-depth and key informant interviews with patients and healthcare providers and analyzed using thematic inductive analysis. Findings: The study found that 50.4% of drug-sensitive TB patients experienced mild to severe depression, and a similar proportion had mild to severe anxiety. Depression was significantly associated with female gender (OR = 3.1, p = 0.023), short sleep duration (OR = 4.2, p = 0.003), and anxiety (OR = 8.39, p < 0.001). Anxiety was linked to financial deficits (OR = 4.63, p = 0.001), comorbidities (OR = 2.81, p = 0.037), and dissatisfaction with sleep (OR = 3.25, p = 0.011). Patients reported stigma, lack of social support, and a need for urgent psychosocial interventions. Both patients and providers emphasized that integrating mental health services into TB care could improve treatment adherence, reduce relapses, and enhance outcomes, though challenges such as stigma, resource constraints, and systemic barriers were noted. Conclusion: This study emphasizes the high level of depression and anxiety among DSTB patients and stresses the need for improving mental health services for DSTB patients addressing the barriers and leveraging the factors could improve patient outcomes and augment TB management in Bangladesh.