TB and depression are linking up to devastate SA
Researchers went to SA’s depression hot spots and found a second epidemic
Bongani Mthwakazi has always considered himself mentally strong. But when the 50-year-old father from Dutywa in the Eastern Cape was diagnosed with tuberculosis four years ago, his psychological state also took a knock.
Mthwakazi’s initial optimism was quickly tempered by ill-informed gossip in his village that “no one should have any contact with or eat with me because I’m going to give them TB”.
His mental wellbeing took further strain six months later when he was diagnosed with multidrug-resistant TB and HIV.
“I didn’t take the news well,” he said.
“I was so ill and weak that I had to give up my job as a builder. Not being able to do anything for myself or provide for my family drove me into depression.”
Mthwakazi is by no means the only TB sufferer struggling mentally. South Africans diagnosed with TB are more likely to be depressed, according to a new study, and areas with high TB numbers are considered depression “hot spots”.
Researchers from the universities of KwaZulu-Natal and Cincinnati identified a clear link between TB and depression when they went back to “clusters” identified as depression hot spots a decade ago.
Reporting their findings in the journal Scientific Reports, they called for systematic interventions to diminish the risk of mental illness among people with infectious diseases, particularly in parts of North West, KZN, Free State and the Eastern Cape.
Rural areas of Tabazimbi, Bela-Bela, Potchefstroom, Vryburg and Rustenburg, all in the north-west of SA, had the highest prevalence of depression, at 64%. The overall prevalence of depression in the 14 clusters surveyed was 34.7%.
People in Eastern Cape clusters were 1.44 times more likely to be depressed than those outside the areas, and in North West the risk was elevated by a factor of 2.32.
Being poor, black, less educated and rural added to the likelihood of depression.
Lead researcher Diego Cuadros, from the University of Cincinnati, said the new data highlighted “growing evidence of a strong link between pathogens and mental illness”, and the importance of treating infectious diseases and mental disorders holistically.
According to existing research, depression is the single largest contributor to global disability, with more than 300 million cases worldwide in 2015.
In SA, about 10% of adults have lived with clinical depression but only one in four sought treatment – one of the largest treatment gaps reported.
UKZN researcher André Janse van Rensburg said stigma by communities, medical professionals and patients themselves did not help the management of TB-related depression.
However, research had shown that investing in depression care produced good financial returns, and treating it alongside conditions such as TB and HIV improved outcomes.
While public campaigns and advocacy were important, Janse van Rensburg said they were not enough to reduce stigma. “Depression should be normalised in the system, and this makes integration so important,” he said.
“Depression and other mental health disorders should be part of packages of care for other diseases … otherwise we are fighting a forest fire with a water bucket.”
Mthwakazi could relate to the latest research, and confessed that the stigma of seeking treatment for depression drove him into alcoholism.
“I started to drink heavily, not because I didn’t care about my health or family, but I used alcohol to escape from my problems,” he said.
“The more I drank the more I thought less of my life problems. Being rejected by your own community is not easy.”