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

Introduction: Multidrug-Resistant Tuberculosis (MDR-TB) continues to pose a serious global health challenge, particularly in low-income and lower-middle-income countries where the disease burden, fragile health systems, and socioeconomic hardships are most pronounced. These conditions not only complicate treatment but also worsen patients’ vulnerability to depression. Although numerous primary studies have investigated the prevalence of depression among individuals with MDR-TB, their findings have been inconsistent. To address this gap, the present study seeks to estimate the pooled prevalence of depression and identify its associated factors among MDR-TB patients in low- and lower-middle-income countries. Methods: Relevant studies were sourced from Google Scholar, Scopus, PubMed, and Web of Science. Additionally, the reference lists of selected articles were manually reviewed to identify further eligible publications. A random-effects model was employed to calculate the pooled prevalence of depression among MDR-TB patients in low- and lower-middle-income countries. Results: The meta-analysis incorporated 23 primary studies with a combined sample of 5,734 MDR-TB patients. The pooled prevalence of depression among this population was 41.89% (95% CI: 32.63–51.15; I² = 98.51%, P