Association of Major Depressive Episode with Negative Outcomes of Tuberculosis Treatment.docVIP

AssociationofMajorDepressiveEpisodewithNegative OutcomesofTuberculosisTreatment CesarUgarte-Gil1*,PauloRuiz2,CarlosZamudio1,LuzCanaza1,LarissaOtero1,HeverKruger2, CarlosSeas1,3 1Instituto deMedicinaTropicalAlexander VonHumboldt,Universidad PeruanaCayetanoHeredia, Lima,Peru, 2Mental HealthWorking Group- Universidad Peruana CayetanoHeredia,Lima,Peru,3DepartamentodeEnfermedadedInfecciosas,TropicalesyDermatolo′gicas,HospitalNacionalCayetanoHeredia,Lima,Peru Abstract Background: Pulmonary tuberculosis (TB) persists an important contributor to the burden of diseases in developing countries. TB control success is based on the patient’s compliance to the treatment. Depressive disorders have been negatively associated with compliance of therapeutic schemes for chronic diseases. This study aimed to estimate the significanceandmagnitudeofmajordepressiveepisodeasahazardfactorfornegativeoutcomes(NO),includingabandon ordeathinpatientsreceivingTBtreatment. Methodology/Principal Findings: A longitudinal study was conducted to evaluate the association of major depressive episode(MDE),asmeasuredbya5-itemversionoftheCenterforEpidemiologicalStudiesDepressionScale(CES-D)withNO to TB treatment. Patients with confirmed TB were enrolled before the start of TB treatment. Baseline measurements included socio-demographic variables as well as the CES-D, which was also applied every month until the end of the treatment.Deathandtreatmentdefaultwereassessedmonthly.Survivorfunction(SF)forNOaccordingtoMDEstatus(CES- D$6) at baseline (MDEb) was estimated. Cox’s Regression was performed for bivariate analyses as well as for the multivariatemodel.Atotalof325patientsacceptedtoparticipateinthestudy,ofwhich34whereexcludedfordiagnosisof MDR-TB.NOwasobservedin24patients(8.2%);109(37%)presentedMDEb.Statisticallysignificantdifferencewasfoundon theSFofpatientswithandwithoutMDEb(0.85vs.0.96,p-value=0.002).ThehazardratioforNO,controlledforage,sex, maritalstatusandinstructionlevelwas3.54(95%CI1.43–8.75;p-va