Psychological Distress Symptoms among Adults with Multidrug-Resistant Versus Drug-Sensitive Pulmonary Tuberculosis: A Comparative Cross-Sectional Study at Mardan Medical Complex, Pakistan

Abstract

Background: Tuberculosis and its treatment are associated with significant psychological burden, especially in multidrug-resistant tuberculosis (MDR-TB) due to treatment regimens, treatment effects, stigma and socio-economic disruption. Evidence from other parts of the world, such as Khyber Pakhtunkhwa, Pakistan, is still scarce.

Objective: To compare the burden and severity of depression, anxiety, and stress symptoms among adults with MDR-TB and drug-sensitive tuberculosis (DS-TB) attending Mardan Medical Complex.

Methods: A comparative cross-sectional study was conducted in the Tuberculosis Services of Mardan Medical Complex, Mardan, Khyber Pakhtunkhwa, Pakistan from January 2022 to December 2025. Total 156 adults were consecutively recruited, there were 104 cases of DS-TB and 52 cases of MDR-TB. The 21 item Depression Anxiety Stress Scales (DASS-21) was used to measure psychological symptoms. Welch's t-test was used to compare group means and Pearson's chi-square or Fisher's exact test (where appropriate) to compare categorical distributions.

Results: Depression, anxiety, and stress scores were higher in the MDR-TB group than in the DS-TB group: 24.0 ± 6.0 vs 12.0 ± 5.0, 20.0 ± 8.0 vs 13.0 ± 5.0, and 26.0 ± 7.0 vs 13.0 ± 5.0, respectively. The corresponding mean differences (MDR-TB minus DS-TB) were 12.0 (95% CI 10.1-13.9), 7.0 (95% CI 4.6-9.4), and 13.0 (95% CI 10.8-15.2); all p<0.001. Severe or extremely severe depression occurred in 65.4% of MDR-TB versus 5.8% of DS-TB participants, extremely severe anxiety in 59.6% versus 11.5%, and severe or extremely severe stress in 57.7% versus 1.0%.

Conclusion: Adults with MDR-TB had significantly higher depression, anxiety and stress symptom burden compared to adults with DS-TB at this tertiary-care facility. It is recommended that routine, confidential mental-health screening, assessment and referral is considered as part of TB care, especially for TB patients undergoing MDR-TB treatment.