Socio-psychological features in patients with pulmonary tuberculosis
Authors: Novozhylova I.O. 
Published: June 2023

BACKGROUND. The effectiveness of the therapy of patients with pulmonary tuberculosis (TB) of various categories is largely related to the psychotraumatic nature of the disease and treatment, however, their social and psychological features and the need for psychological help have not been sufficiently studied.

OBJECTIVE. To study the socio-psychological features of patients with pulmonary TB depending on the category of the case and the terms of treatment.

MATERIALS AND METHODS. 200 patients with pulmonary TB were interviewed anonymously, including 45 (22.5 %) – with new cases, 27 (13.5 %) – with repeated treatment, 128 (64.0 %) – with multiple drug resistance (MDR-TB), according to the special form of primary social and psychological assessment of a patient with TB – Patient Health Questionnaire (PHQ-9).

RESULTS AND DISCUSSIONS. The difference in the presence of unfavorable social factors among TB patients of different categories was revealed: low income, unemployment, disability, bad habits, retirement age, negative social history (were in prisons, migrants or internally displaced, lack of permanent work) met 2-3 times more often among repeated cases of the disease and MDR-TB, than in patients with new cases of the disease. Depressive disorders at the initial stage of treatment were found in 95.0 % of all TB patients, and mostly the signs of depression were pronounced, as evidenced by: very low interest or satisfaction in ordinary things in 52.0 %; bad mood, depression or a feeling of helplessness in 91.5 %; difficulty falling asleep, interrupted or too long sleep in 90.0 %; a feeling of fatigue or exhaustion – loss of strength in 94.5 %; poor appetite or, on the contrary, overeating in 89.5 %; negative thoughts about oneself in 57.5 %; difficulty concentrating in 57.0 %. The duration of these symptoms for more than 7 days during the last 2 weeks in many interviewees indicates a significant expressiveness of depressive disorders in the vast majority of TB patients. The dependence of the psychological state of TB patients on the category of the case and the duration of treatment was established and statistically proven. In patients with repeated treatment and MDR-TB, symptoms of depressive disorders were not only more frequent, but also more severe than in patients with new cases. If 74.8 % of patients with repeated cases and 57.0 % of patients with MDR-TB had mild and moderate depression, then 77.8 % of patients with new cases had mild (subclinical) depression. In patients who were treated for more than 4 months, signs of depressive disorders were more pronounced compared to those who were treated for less.

CONCLUSIONS. This study not only confirms the need for differentiated psychological support of the treatment process in phthisiology (depending on the category of the case and the duration of treatment), but also encourages the search for new approaches to the medical, social and psychological rehabilitation of TB patients, taking into account the negative impact of the war in Ukraine on the social and psychological condition of such patients and the characteristics of their management in wartime conditions. There is a need to introduce rates of psychologists and psychiatrists for constant counseling of TB patients.