Tuberculosis (TB) is not only a major infectious disease causing significant morbidity and mortality but also a condition with profound psychosocial implications. ^[1] In India, where the burden of pulmonary TB remains high, the disease continues to pose challenges despite advances in diagnostic and therapeutic strategies. ^[2] Beyond the physical symptoms, TB patients often suffer from psychological distress owing to the chronicity of the disease, side effects of medications, fear of transmission, and prolonged social isolation. ^[3]

Psychiatric comorbidities, particularly depression and anxiety, are increasingly being recognized as prevalent among TB patients. ^[4] These psychiatric disorders may arise from biological changes, such as chronic inflammation, or psychosocial stressors like stigma, unemployment, and familial disruption. ^[5] Yet, mental health remains under-addressed in TB care settings. ^[6] This study seeks to fill the gap by systematically evaluating psychiatric morbidity among patients with pulmonary TB in a tertiary care hospital setting in India, focusing on the prevalence, types of psychiatric disorders, and their relationship with socio-demographic and clinical factors. ^[7]

Numerous studies across the globe have documented a high burden of psychiatric comorbidities in TB patients. ^[8] A study in Ethiopia reported a 54% prevalence of depression among TB patients, while Brazilian and Indian studies also identified elevated rates of anxiety and depressive disorders. ^[9] The use of standardized tools such as the MINI International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale (HADS) has enabled more accurate diagnoses in these settings. ^[10]

Stigma associated with TB is a recurring theme, contributing to social withdrawal and emotional suffering. ^[11] Adverse treatment effects, long treatment duration, fear of infecting others, and financial hardships are key drivers of psychiatric morbidity. ^[12] Indian literature, although limited, aligns with global findings, emphasizing the need for integrated TB and mental health services to address these dual burdens. ^[13]

OBJECTIVES: To estimate the prevalence of psychiatric disorders among patients hospitalized for pulmonary tuberculosis. To examine associations between psychiatric morbidity and socio-demographic variables (age, gender, education, socioeconomic status).

This cross-sectional study was carried out in the Department of Respiratory Medicine at Government Medical College and Hospital, Nizamabad. A total of 100 patients diagnosed with pulmonary tuberculosis and hospitalized during the study period were enrolled using purposive sampling.

 Inclusion Criteria:

• Confirmed diagnosis of pulmonary TB
• Currently hospitalized in the respiratory medicine department
• Aged 18 years and above
• Provided informed consent

 Exclusion Criteria:

• Pre-existing psychiatric illness
• Coexisting chronic diseases (e.g., cancer, HIV, diabetes)

 Assessment Tools:

• Socio-demographic and clinical data form
• Sodhi and Sharma Socioeconomic Status Scale
• MINI International Neuropsychiatric Interview (MINI) for psychiatric diagnosis

Statistical Analysis:

Descriptive statistics were used to assess prevalence. Chi-square tests analyzed associations between psychiatric morbidity and variables such as age, education, treatment type, and complications. SPSS software was used for data processing.

Out of the 100 patients evaluated, 46% were found to have psychiatric morbidity. Depression was the most common disorder, followed by anxiety. About 16% of patients exhibited comorbid depression and anxiety. Notably, the study found no statistically significant association between psychiatric morbidity and socioeconomic status (p = 0.34), education level (p = 0.997), type of treatment (p = 0.40), or presence of complications (p = 0.72). These findings suggest that psychiatric conditions in TB patients may arise independently of commonly measured socio-demographic and clinical variables.

The present study highlights a concerningly high prevalence (46%) of psychiatric morbidity among patients hospitalized with pulmonary tuberculosis (TB), echoing findings from international and national studies. The most commonly observed psychiatric conditions were depression and anxiety, with 16% of the subjects experiencing both simultaneously. ^[14] These results are clinically significant, suggesting that nearly one in two TB patients may endure psychological distress severe enough to merit a psychiatric diagnosis. ^[15]

The high rate of depression aligns with prior studies from Ethiopia, Brazil, and India, which report similar trends using diagnostic tools such as the MINI and the Hospital Anxiety and Depression Scale (HADS). ^[16] For example, Deribew et al. (2010) in Ethiopia found depressive symptoms in over 50% of TB patients, attributing this to prolonged illness duration, treatment burden, and stigma. ^[17] Likewise, Pachi et al. (2013) identified anxiety and depression as common comorbidities in TB patients globally. ^[18]

One important finding in this study is the absence of statistically significant associations between psychiatric morbidity and socio-demographic or clinical variables. Depression did not correlate significantly with socioeconomic status (p = 0.34), nor did anxiety show any association with education level (p = 0.997). This suggests that psychological distress in TB is not limited to disadvantaged populations but may affect individuals across a broad social and clinical spectrum. This reinforces the notion that psychiatric comorbidities in TB are multifactorial, involving both intrinsic and extrinsic stressors.

The lack of correlation between depression and treatment type (p = 0.40), and between anxiety and complications (p = 0.72), further supports the complexity of psychiatric manifestations. These findings deviate from some earlier studies that found associations between longer treatment durations or disease severity and increased psychiatric

symptoms. The discrepancy might be due to sample size, regional variations, different tools of assessment, or unmeasured confounders such as social support, substance use, and cultural perceptions of illness.

Another key aspect is the potential bidirectional relationship between TB and mental health. ^[19] On one hand, TB and its chronic, debilitating nature may precipitate psychiatric disorders through biological mechanisms like systemic inflammation or psychosocial stress. ^[20] On the other hand, existing psychiatric issues can hinder treatment adherence, delay diagnosis, and worsen clinical outcomes. ^[21] Depression, in particular, has been associated with poor adherence to TB medications, leading to relapse and drug resistance, as reported in previous studies by Sweetland et al. (2017). ^[21]

Given the public health implications, the integration of mental health services into TB care is imperative. ^[22] The current TB programs in many countries, including India, are heavily focused on biomedical interventions. ^[23] However, mental health remains a neglected dimension. ^[24] The World Health Organization’s (WHO) End TB Strategy explicitly acknowledges the need for patient-centered care, including psychosocial and mental health support. Despite this, mental health screening is rarely part of routine TB management in Indian public hospitals. ^[25]

This study supports the integration of psychiatric evaluation and counseling into TB treatment frameworks. Routine screening using standardized instruments such as the MINI or PHQ-9 can aid in early identification of at-risk patients. ^[26] Counseling, antidepressant therapy, or referral to mental health professionals may then be initiated as needed. ^[27,28] Furthermore, TB control programs should emphasize patient education, social support mechanisms, and stigma reduction initiatives to enhance psychological well-being and improve overall treatment outcomes.

In summary, psychiatric morbidity in pulmonary TB patients is a serious, under-recognized issue that transcends demographic and clinical boundaries. The absence of statistically significant associations with measured variables underscores the need for universal screening rather than selective evaluation. Holistic TB care must address not only the pathogen but also the person affected by it.

This study underscores the high prevalence of psychiatric morbidity among patients hospitalized with pulmonary tuberculosis. Depression and anxiety were the dominant disorders, yet no clear socio-demographic or clinical predictors were identified. The psychological burden of TB demands urgent attention, not as a secondary concern but as an integral part of comprehensive care. Mental health screening and interventions should be embedded within TB treatment protocols to enhance therapeutic adherence and long-term recovery.

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