Comorbidities

TB disproportionately affects people living in poverty and other socially vulnerable populations, which amplifies their risk for mental health conditions. Providers of TB care can undertake various actions to influence both the impact of disease-specific triggers on poor mental health and social determinants of mental health. In particular, social support, including education and facilitating access to psychological and material support, is critical to mitigate the impact of poverty, TB, its treatment, and the related stigma and discrimination, on people’s mental health (28).

Mental disorders¹ are prevalent in all countries (8). Nearly 1 billion people worldwide are living with a mental disorder, which has become the leading cause of years of living with disability. The risk factors for developing a mental disorder are multi-faceted and may include any combination of individual factors (psychological or biological), family or community factors (such as poverty or violence), and structural factors (such as inequality or environmental emergencies) (11).

Comorbidity: A concurrent disease or health condition in a person with TB.

ASSIST      Alcohol, Smoking and Substance Involvement Screening Test

AUDIT        Alcohol Use Disorders Identification Test

GAD           generalized anxiety disorder

GAD-7       Generalized Anxiety Disorder Assessment-7

HIV            human immunodeficiency virus

MDR-TB   multidrug-resistant TB

This section of the operational handbook was prepared by Ernesto Jaramillo, Farai Mavhunga, Marzia Calvi and Annika Sweetland (consultant) from the World Health Organization (WHO) Global Tuberculosis Programme Department (GTB), and Aiysha Malik and Mark van Ommeren from the WHO Department of Mental Health and Substance Use (MSD), under the overall direction of Tereza Kasaeva, Director of the GTB department and Dévora Kestel, Director of the MSD Department.