Burden and factors associated with depressive symptoms among adults receiving tuberculosis treatment in South India: A cross-sectional study

Purpose Depression is a common but under-recognized comorbidity among persons with tuberculosis (PwTB), adversely affecting treatment adherence, clinical outcomes, and quality of life. This study estimated the prevalence and factors associated with moderate-to-severe depressive symptoms among adults receiving anti-tuberculosis treatment in Bengaluru, India. Methods We conducted a cross-sectional study between May 2023 and October 2024 among adult PwTB attending tuberculosis units under urban Bengaluru. Participants who had completed the intensive phase of treatment were enrolled using a multistage sampling strategy. Data were collected through structured interviews and review of treatment records. Depressive symptoms were assessed using the Patient Health Questionnaire-9 (PHQ-9). Moderate-to-severe depressive symptoms was defined as PHQ-9 ≥ 10. Logistic regression with cluster-robust standard errors was used to identify associations. Results Among 200 participants (median age:34 years; 53.5% female), the overall prevalence of moderate-to-severe depressive symptoms was 56.5% (95% CI:50.2–63.1). Moderate depressive symptoms were most common (30.5%), followed by moderately severe (17.5%) and severe depressive symptoms (8.5%). Females had higher prevalence across all severity categories. In adjusted analysis, female gender (aOR 3.2; 95%CI:1.8–12.3), belonging to upper-lower to lower socioeconomic class (aOR 2.5; 95%CI:1.9–6.7), and perceived partial financial dependence (aOR 1.8; 95%CI:1.4–8.1) were associated with moderate-to-severe depressive symptoms. None of the participants had receipt of Ni-kshay Poshan Yojana benefits recorded in the Ni-kshay portal at the time of interview. Conclusion More than half of PwTB had moderate-to-severe depressive symptoms. Exploratory adjusted analysis suggested associations with gender and socioeconomic vulnerabilities that require confirmation in larger studies. Integrating routine mental health screening, strengthening counselling services, and ensuring social protection support within TB care programs are urgently needed to improve outcomes and advance person-centred TB care.