PSYCHOLOGICAL DISTRESS AND ASSOCIATED FACTORS AMONG ADULT TUBERCULOSIS PATIENTS ATTENDING AT HEALTH INSTITUTIONS IN DIRE DAWA AND HARAR CITIES, EASTERN ETHIOPIA

Abstract

Background: Psychological distress is unpleasant subjective state of depression and anxiety that interferes with activities of daily living. In developing countries the prevalence of psychological distress among tuberculosis patients higher. In middle and low income countries depressive episode among patients with tuberculosis higher than that of without tuberculosis disease. Those with tuberculosis was 23.7% while without tuberculosis was 6.8%. Yet little studies were conducted in on psychological distress among tuberculosis patients in Ethiopia. Objective: To assess psychological distress and associated factors among tuberculosis patients attending Dire Dawa and Harar cities Health Institutions, Eastern Ethiopia. Method and materials: Institution based cross-sectional study was conducted in four hospitals and six health centers in Dire Dawa and Harar cities, Eastern Ethiopia from January 10 to February 10, 2018. All Tuberculosis patients attending treatment follow up in all selected Health institution included in the study. A structured questionnaire was used for data collection on sociodemographic factors, psychological distress, health related factors, stigma experience and alcohol use. Data was coded, entered and cleaned using Epi Data version 3.1 software and finally exported into SPSS version 20 software for analysis. The goodness of the modelfittedness was assessed by Hosmer and Lemeshow test and the model was fit. Bivariate and multivariate logistic regression was carried out. All variables with p value ≤ 0.25 were taken into the multivariate model and P- Value less than 0.05 was taken as statistically significant. Results: The prevalence of psychological distress among tuberculosis in this study population was 63.3% (95% CI: 58.1, 68.1). The multivariate logistic regression analyses showed that rural residence (AOR: 1. 98 ; 95% CI: 1.01,3.86), co-infection TB- HIV (AOR: 2.15; 95% CI:1.02, 4.56) one or more chronic disease (AOR:3.04; 95% CI:1.59,5.79), experience of stigma (AOR: 1.71; 95% CI:1.01, 2.90), Pulmonary and MDR-TB (AOR:2.53; 95% CI:1.50,4.28) and smoking cigarette (AOR:2.53; 95% CI:1.06,6.03) were associated with psychological distress. Conclusion: The prevalence of psychological distress in this study was higher among tuberculosis patients. Sixty three percent of the study participants were found psychologically distressed. Chronic disease morbidities, HIV and TB co-infection and TB discrimination were associated with Psychological distress. The co-morbid diagnosis of chronic diseases and TB- HIV co-infection needs more psychological care.