As the overall prevalence of TB remains high among certain population groups, there is growing awareness of psychiatric comorbidity, especially depression and its role in the outcome of the disease. The paper attempts a holistic approach to the effects of psychiatric comorbidity to the natural history of tuberculosis. In order to investigate factors associated with medication nonadherence among patients suffering from tuberculosis, with emphasis on psychopathology as a major barrier to treatment adherence, we performed a systematic review of the literature on epidemiological data and past medical reviews from an historical perspective, followed by theoretical considerations upon the relationship between psychiatric disorders and tuberculosis. Studies reporting high prevalence rates of psychiatric comorbidity, especially depression, as well as specific psychological reactions and disease perceptions and reviews indicating psychiatric complications as adverse effects of anti-TB medication were included. In sum, data concerning factors affecting medication nonadherence among TB patients suggested that better management of comorbid conditions, especially depression, could improve the adherence rates, serving as a framework for the effective control of tuberculosis, but further studies are necessary to identify the optimal way to address such issues among these patients. 1. Introduction Tuberculosis (TB) is a chronic infectious multisystemic disease caused by mycobacterium tuberculosis [1] and is one of the leading causes of mortality worldwide [2–4]. The World Health Organization (WHO) has estimated that 2 billion people, almost a third of the world’s population, have latent TB [5, 6]. Every year about eight million people develop this disease, and some three million die of it, over 95% of these from developing countries [7, 8]. In 2005 the highest rates per capital were from Africa (28% of all TB cases), and half of all new cases were from six Asian countries, namely, Bangladesh, China, India, Indonesia, Pakistan, and the Philippines [9, 10]. Beginning in 1985, a resurgence [11–14] of TB was observed, primarily in certain groups, including the homeless [15], those who are HIV seropositive [16], individuals with a history of alcohol or drug abuse [17], and immigrants from a country in which TB is endemic [18]. Many recipients of psychiatric services possess one or more of these risk factors [19, 20], and, consequently, TB may be overrepresented in this population. Conversely, psychiatric illness may develop subsequent to TB infection, and mood disorders
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