Researchers searched Google Scholar, Scopus, PubMed and Web of Science, and manually checked reference lists to identify additional eligible studies. They used a random-effects model to combine the prevalence estimates. Statistical heterogeneity was extremely high, with I² = 98.51% (P < 0.001), showing that depression estimates differed markedly across the included studies. The pooled figure therefore describes the overall evidence rather than a uniform prevalence for every country, population or clinical setting.

The analysis also examined factors associated with depression among people with MDR-TB. Female gender was associated with twice the odds of depression, with an adjusted odds ratio of 2.00 (95% CI: 1.66–2.41). Financial hardship was associated with higher odds at 2.56 (95% CI: 1.44–4.55), while greater disease severity was associated with odds of 2.13 (95% CI: 1.42–3.12). These are reported associations and do not establish that the factors directly caused depression.

Additional medical conditions were associated with 3.72 times the odds of depression (95% CI: 2.11–5.38), the largest association among the factors summarized in the meta-analysis. Medication-related side effects were associated with 2.77 times the odds (95% CI: 2.20–3.48), and perceived stigma with 3.58 times the odds (95% CI: 2.13–6.02). The researchers emphasized the importance of routine depression screening and integrating psychosocial support into care for people with MDR-TB in low-income and lower-middle-income countries. However, the analysis did not test whether such screening or support improves clinical outcomes, and the high heterogeneity, broad confidence interval and differences among the underlying studies limit how precisely the pooled results can be applied to individual settings.

Subject of Research: Pooled prevalence and associated factors of depression among people with multidrug-resistant tuberculosis in low-income and lower-middle-income countries

Article Title: The dual burden of disease: Depression among patients with multidrug resistance tuberculosis in low-income and lower- middle-income countries: A systematic review and meta-analysis

Article References: Abate, A. W., Tedla, A., Wubet, G. M., Legas, G., Belete, A., Shiferaw, K., Beyene, G. M., Teshome, A. A., Addis, W. D., Agidew, M. M., Dagnew, S. B., Sitotaw, B. A., & Munie, B. M. (2026). The dual burden of disease: Depression among patients with multidrug resistance tuberculosis in low-income and lower- middle-income countries: A systematic review and meta-analysis. PLOS One, 21(10), e0360738. https://doi.org/10.1371/journal.pone.0360738

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360738

Keywords: MDR-TB, depression, mental health, systematic review, meta-analysis, prevalence, comorbidities, stigma, financial hardship, low-income countries, dual, burden