Psychological distress (PD), is a general term that is used to describe an unpleasant subjective state of depression and anxiety which have both emotional and physiological manifestations that interferes with activities of daily living. It is characterized by symptoms of depression and anxiety and may also somatic symptoms. In normal functioning individuals, psychological distress is the fluctuation of mood. Psychological distress can result in negative views of the environment, self, and others [1].
A state of distress can be caused by many things such as poverty, unemployment, death of a loved one, a relationship break-up, medical illness or physical problems, alcohol and drug use [2, 3]. As a consequence of illness, many patients face psychological challenges [4]. Tuberculosis (TB) is one of those illnesses that result in PD. In addition to this lack of support by the family and community or TB related stigma were some of the risk factors for PD [5]. This affects the quality of life of the patients [6].
The severity of PD is dependent upon the situation and how someone perceives it. No two people experience one event the exact same way [1, 7]. Just as mental illness can impact on areas of the individual’s life, psychological distress can also have direct and indirect effects on the individual’s psychological, social and occupational functioning, affecting many areas of their life, including relationships, work and health [8].
Many people who suffer significant psychological distress do not come into contact with specialized mental health services. While many of these people may seek help from general practitioners, counselors and support groups, significant numbers do not access any type of formal help in the face of psychological distress [8]. In 2015, more than 300 million peoples were estimated to suffer from depression, which accounts for 4.4% of the world’s population. Worldwide the number of peoples with depression and anxiety is increasing especially in low-income countries. More than 80% of this disease burden occurred in low and middle-income countries. Nearly half (48%) of the world’s depressed population were living in South East Asia and Western Pacific regions. The prevalence of depression in the Eastern Mediterranean, Americas, European, and African region were 16%, 15%, 12%, and 9% respectively. In Ethiopia, 4.7% of the total population was suffering from a depressive disorder in the general population[2].
In Europe, 44.4% of tuberculosis (TB) patients had suffered from psychological distress. In the region magnitude of depression among TB patients ranged from 49.4 % to 60.5% while anxiety ranged from 26.0% to 38.3% [9, 10]. In the Eastern Mediterranean, 46.3% of TB patients were suffering from depressive disorder [11]. In Western Pacific Regions, 16.8% to 65.2% of TB patients suffered from psychological distress [12, 13]. In low and middle-income countries depressive episodes among TB patients were more than three times higher than peoples without tuberculosis [14].
Among TB patients in Africa, more than half of the patients were suffering from psychological distress. Two studies from Africa indicated that the prevalence of PD among TB patients was 67.6 % and 81.1 % [15, 16]. The lowest ranged from 8% to 25.4% [17, 18]. While other studies ranged from 40% to 81.1% [15, 16, 19, 20]. The prevalence of depression ranges from 43.4 to 61.1% [20-22].
One study from the capital city of Ethiopia indicated that 67.6 % of TB patients suffer from PD. The Country nationwide study showed that the magnitude of depression among the general population was found at 9.1% [23]. One study indicates that 19.82% of TB patients had PD [24]. In other studies, it ranged from 40.6 % to 67.6% [19, 20]. History of past TB treatment was the risk factor for PD. The majority (87.7%) of past history of TB treatment were found psychologically distressed [16].
Substances like Khat, tobacco, and alcohol use is the most common in the Eastern parts of Ethiopia. The prevalence of chewing Khat in the Harari, eastern Ethiopia was ranged from 48.2- 53.2 % [25, 26] while tobacco and alcohol use were 38.2% and 10.5% respectively [26]. The substances use increased the risk of depression and anxiety disorder [27].
Both Tuberculosis and PD share common risk factors, as a result, both of them are a co-morbid disease [14, 28]. Psychological distress has an effect on TB treatment outcome [16]
Factors associated with Psychological distress in TB were included: Older age, unmarried, grade 8-11 and grade 12 or more educational level [15], low economic status, TB/HIV co-infected [15, 16] history of previously TB treatment, on ART treatment follow-up, and alcohol use [16], perceived her/his illness as a moderate or severe [13], perceived TB stigma [13, 20, 29], co-morbid chronic illness [20], alcohol use [16], current smoking [14]
To the knowledge of these researchers, there are limited studies that assessed the magnitude of psychological distress among TB patients in Ethiopia. Therefore, this study will determine the magnitude of psychological distress and associated factors in Eastern Ethiopia.