Comorbidities

Globally, tuberculosis (TB) remains a significant cause of ill health and is a leading cause of death due to an infectious agent (1). The TB epidemic is attributable to five main health-related risk factors globally, namely, diabetes mellitus (diabetes), HIV, smoking, undernutrition, and disorders due to alcohol use. The contribution of these risk factors to the global TB burden is reported annually in the WHO global tuberculosis report (1).

Mental health guidelines

• Management of physical health conditions in adults with severe mental disorders: WHO guidelines (1)
• WHO Website: WHO Mental Health Gap Action Programme (mhGAP) (2)
• mhGAP Intervention Guide for mental, neurological and substance use disorders in non-specialized health settings: mental health Gap Action Programme - Version 2.0 (3)

Brief biological interventions

1. Global tuberculosis report 2022. Geneva: World Health Organization; 2022 (https://www.who.int/publications/i/item/9789240061729).
2. Framework for collaborative action on tuberculosis and comorbidities. Geneva: World Health Organization; 2022 (https://www.who.int/publications/i/item/9789240055056).
3. The End TB Strategy.

TB often occurs along with other illnesses – not only mental disorders but also HIV, diabetes, hypertension and other conditions (70). These comorbidities are also independently associated with a higher risk of mental health problems (71). Health workers in TB and mental health services should endeavor to understand each person’s main priorities and concerns and support the treatment of both TB and mental disorders in order to comprehensively address the person’s needs.

Individuals who are homeless or in temporary housing have a significantly greater risk of exposure to TB, developing active TB and acquiring drug resistance (68); as well as an increased likelihood of having a mental health condition (69). Assessment of their situation and related socioeconomic risk factors is required (such as poor quality or no housing, low or no income), followed by referral to the necessary support (such as social care or financial, housing or employment support). Ongoing close monitoring then is needed to provide people-centred services.

Psychological support is a critical element of palliative care where the overall goal is to relieve pain and distress and sustain a person’s well-being. Psychological support needs to be tailored to local settings with a culturally sensitive approach and respect for individual values and beliefs. Moreover, caregivers and healthcare providers providing palliative care frequently experience psychological distress themselves, for which psychological support can be beneficial (67).

Stigma refers to negative attitudes that involve discriminatory actions towards, for example, people who are receiving treatment for TB or towards those living with mental health conditions. Unfortunately, this is very common, and this stigma can result in serious violations of human rights (66). Since TB and mental health conditions can affect people who are socially vulnerable, health-related stigma and discrimination can exacerbate other social stigmas which can adversely affect a person’s personal, social, health and financial well-being.