Mental Health: Global Challenges Journal
https://www.sciendo.com/journal/MHGCJ
ISSN 2612-2138
or group home residence, and potential
contributors to disease progression such as
smoking, poor nutrition, diabetes, and HIV
infection (Doherty et al., 2013). Social stressors like
discrimination, reduced income, divorce, and
stigma are prevalent among individuals with TB,
significantly affecting their quality of life and
treatment outcomes (Alene et al., 2018).
The relationship between TB and
socioeconomic conditions is intricate, with social
vulnerability and mental disorders acting as
intertwined factors. Both conditions are influenced
by upstream health determinants, often
coexisting in a substantial portion of the
population. Poverty emerges as a formidable
determinant of TB, shaping its various stages, from
exposure risk to susceptibility, diagnosis, treatment
compliance, and successful treatment (Knut
Lönnroth, Ernesto Jaramillo, Brian Williams, 2010;
Hargreaves et al., 2011; World Health
Organisation, 2013; Duarte et al., 2018; Janse
Van Rensburg et al., 2020). Overcrowded and
poorly ventilated living and working environments
directly increase TB transmission risk, while
undernutrition contributes significantly to the
development of active disease (World Health
Organisation, 2013). Poverty is also associated
with limited health knowledge and a lack of
empowerment to address health-related risks
(World Health Organisation, 2013).
Moreover, research consistently underscores
the robust connection between social
disadvantage and poor MH (Patel, Saxena, Lund,
Thornicroft, Baingana, Bolton, Chisholm, Pamela
Y. Collins, et al., 2018). Factors such as poverty,
childhood adversity, and violence emerge as
critical risk factors for the onset and persistence of
mental disorders. These MH challenges, in turn,
often result in income loss due to limited
educational attainment and reduced
employment opportunities and productivity. This
intricate interplay between social determinants,
mental disorders, and economic disadvantage
creates a vicious cycle that perpetuates poverty
across generations (Patel, Saxena, Lund,
Thornicroft, Baingana, Bolton, Chisholm, Pamela
Y. Collins, et al., 2018).
Possible causal mechanisms
Psychiatric disorders may be connected with
an infection in various periods of life (Rybakowski,
2022). Depression appears to be the
predominant mental illness associated with TB
patients in existing studies. However, the exact
nature of the relationship between depression
and TB remains unclear, and it seems to have
bidirectional association. Understanding this
mechanism is crucial for directing research efforts
to enhance TB therapy effectiveness and reduce
comorbidity with depression (Zhang et al., 2019).
The causal pathways connecting TB and
depression are complex and multidirectional,
encompassing biological, social, behavioral,
pharmaceutical, and psychosocial factors
(Ugarte-Gil et al., 2013; Janse Van Rensburg et
al., 2020).
Biological factors likely contribute to this
bidirectional relationship. TB infection or
reactivation may trigger depression, possibly due
to the host's inflammatory response and
alterations in the hypothalamic-pituitary-adrenal
axis. TB infection can induce chronic
inflammation, releasing pro-inflammatory
cytokines that affect central nervous system
enzymes. Additionally, certain anti-TB medications
might contribute to mental health issues like
depression (Duko, Bedaso and Ayano, 2020).
Conversely, depression may raise the risk of TB
through immuno-inflammatory responses and
lipid metabolism. Increased pro-inflammatory
cytokines seen in depression can dampen
cellular and humoral immune system activation,
potentially aiding TB progression (Zhang et al.,
2019).
Social determinants also play a significant
role. Poverty, as mentioned earlier, is a shared risk
factor for both TB and depression. Overcrowded
and poorly ventilated conditions facilitate TB
transmission, while exposure to violence, social
exclusion, drug abuse, and malnutrition may
contribute to both diseases (Janse Van Rensburg
et al., 2020). Moreover, depression can mimic TB
symptoms and exacerbate them. When
combined with negative coping behaviors,
depression can lead to non-adherence to TB
treatment, posing a considerable challenge
(Sweetland et al., 2018).
Psychosocial factors, including perceived
stigma and treatment nonadherence, are vital in
this relationship. Stigma associated with TB
diagnosis can heighten the risk of depression due
to the fear it engenders (Chandra et al., 2019).
Multidrug-resistant TB patients often experience
stigma, discrimination, isolation, and a lack of
social support, which can lead to negative
emotions, social rejection, low self-esteem, and
impaired psychosocial well-being (C. et al., 2014;
Alene et al., 2018).
The discussion surrounding the link between
stigma and health outcomes is often
compartmentalized within specific disease
categories, hindering the identification of
common moderators or mechanisms. This
separation limits our understanding of stigma's
overall impact on individual well-being and
global disease burden (Kane et al., 2019).
Additionally, pharmacological issues must be
considered. Psychiatric side effects of anti-TB
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