Skip to main content Skip to main navigation menu Skip to site footer

Workplace interventions to overcome stigma and depression in patients with Multiple drug-resistant tuberculosis (MDR TB)

  • Feytie Magda Mawey ,
  • Azimatul Karimah ,
  • Tutik Kusmiati ,


Introduction: MDR-TB is an infectious disease that can cause death and stigma for those infected. MDR-TB patients with depression are at risk for LTFU, which will worsen their condition and strengthen the stigma they receive.

Case report: A 52-year-old female psychiatric interview and assessment using the Beck Depression Inventory (BDI) found that BDI score of 4 (no depression), and the patient adhered to TB treatment. She was found to be laid off, and an assessment using the BDI to detect depression in the patient found potential stigma in the patient, such as being laid off from work, prohibited from teaching face-to-face, and shunned by colleagues. Interventions given were prescribing Fluoxetine 20 mg per day and Clobazam 10 mg per day, a brief intervention using the FRAMES technique, psychoeducation about disease and drug effects and the duration of treatment, and an office visit. A worksite intervention was performed by the patient's husband. Antituberculosis drugs were monitored by both a pulmonologist and a psychiatrist. Her work-related problems were resolved through interventions at the school with psychoeducation about drug-resistant tuberculosis, the transmission method, the duration of treatment, and the side effects of the treatment. The results of the last sputum examination after one month of treatment showed drug resistance, and the patient was advised to undergo 18 months of treatment. The patient could finally work offline with fewer responsibilities after getting negative laboratory test results twice in a row.

Conclusion Work-related psychosocial interventions are required to address rejection at work, which results in depression and nonadherence to treatment. Liaison services with social interventions at work in drug-resistant tuberculosis-infected patients are necessary to improve their quality of life and maintain their treatment adherence.


  1. Yan S, Zhang S, Tong Y, Yin X, Lu Z, Gong Y. Nonadherence to Antituberculosis Medications: The Impact of Stigma and Depressive Symptoms. Am J Trop Med Hyg. 2018;98(1):262-265. doi: 10.4269/ajtmh.17-0383.
  2. Soedarsono S, Mertaniasih NM, Kusmiati T, Permatasari A, Juliasih NN, Hadi C, Alfian IN. Determinant factors for loss to follow-up in drug-resistant tuberculosis patients: the importance of psycho-social and economic aspects. BMC Pulm Med. 2021;21(1):360. doi: 10.1186/s12890-021-01735-9.
  3. Cremers AL, de Laat MM, Kapata N, Gerrets R, Klipstein-Grobusch K, Grobusch MP. Assessing the consequences of stigma for tuberculosis patients in urban Zambia. PLoS One. 2015;10(3):e0119861. doi: 10.1371/journal.pone.0119861.
  4. Abebe G, Deribew A, Apers L, Woldemichael K, Shiffa J, Tesfaye M, Abdissa A, Deribie F, Jira C, Bezabih M, Aseffa A, Duchateau L, Colebunders R. Knowledge, health seeking behavior and perceived stigma towards tuberculosis among tuberculosis suspects in a rural community in southwest Ethiopia. PLoS One. 2010;5(10):e13339. doi: 10.1371/journal.pone.0013339.
  5. Lara-Espinosa J.V, Hernández-Pando R. Psychiatric Problems in Pulmonary Tuberculosis: Depression and Anxiety. J. Tuberc Res. 2021;9(1):31-50. doi: 10.4236/JTR.2021.91003.
  6. AY P, Hidiroglu S. Tuberculosis related stigma. Marmara Med. J. 2021;34(2):1-6. doi: 10.5472/marumj.854373.
  7. Qiu L, Yang Q, Tong Y, Lu Z, Gong Y, Yin X. The Mediating Effects of Stigma on Depressive Symptoms in Patients With Tuberculosis: A Structural Equation Modeling Approach. Front Psychiatry. 2018;9:618. doi: 10.3389/fpsyt.2018.00618.
  8. Van Der Walt M, Keddy KH. The Tuberculosis-Depression Syndemic and Evolution of Pharmaceutical Therapeutics: From Ancient Times to the Future. Front Psychiatry. 2021;12:617751. doi: 10.3389/fpsyt.2021.617751.
  9. Redwood L, Mitchell EMH, Nguyen TA, Viney K, Nguyen VN, Fox GJ. Psychometric evaluation of a new drug-resistant tuberculosis stigma scale. J Clin Epidemiol. 2021;133:101-110. doi: 10.1016/j.jclinepi.2021.01.007.
  10. Courtwright A, Turner AN. Tuberculosis and stigmatization: pathways and interventions. Public Health Rep. 2010;125(4):34-42. doi: 10.1177/00333549101250S407.
  11. Kolte IV, Pereira L, Benites A, de Sousa IMC, Basta PC. The contribution of stigma to the transmission and treatment of tuberculosis in a hyperendemic indigenous population in Brazil. PLoS One. 2020;15(12):e0243988. doi: 10.1371/journal.pone.0243988.
  12. Daftary A, Mitchell EMH, Reid MJA, Fekadu E, Goosby E. To End TB, First-Ever High-Level Meeting on Tuberculosis Must Address Stigma. Am J Trop Med Hyg. 2018;99(5):1114-1116. doi: 10.4269/ajtmh.18-0591.
  13. Wang D, Wang H, Gao H, Zhang H, Zhang H, Wang Q, Sun Z. P2X7 receptor mediates NLRP3 inflammasome activation in depression and diabetes. Cell Biosci. 2020;10:28. doi: 10.1186/s13578-020-00388-1.
  14. van Sloten TT, Sedaghat S, Carnethon MR, Launer LJ, Stehouwer CDA. Cerebral microvascular complications of type 2 diabetes: stroke, cognitive dysfunction, and depression. Lancet Diabetes Endocrinol. 2020;8(4):325-336. doi: 10.1016/S2213-8587(19)30405-X.
  15. Datiko DG, Jerene D, Suarez P. Stigma matters in ending tuberculosis: Nationwide survey of stigma in Ethiopia. BMC Public Health. 2020;20(1):190. doi: 10.1186/s12889-019-7915-6.
  16. Liguarda RF, Bock W, Caga-Anan RL. Optimal Control for Tuberculosis with Exogenous Reinfection and Stigmatization. 2021. doi: 0.13140/RG.2.2.34348.08321
  17. Wiltsey Stirman S, Baumann AA & Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence-based interventions. Implementation Sci. 2019; 14(58). doi: 10.1186/s13012-019-0898-y
  18. Miller C, Barnett ML, Baumann AA. The FRAME-IS: a framework for documenting modifications to implementation strategies in healthcare. Implementation Sci. 2021;16(36). doi: 0.1186/s13012-021-01105-3
  19. Faisal, F. O. ., Algristian, H., & Azizah, N. (2022). Anticipating suicide act of patient with borderline personality disorder and history of severe depression. Bali Medical Journal, 11(2), 910–912.
  20. Irawati, K., Ningrat, F. N., & Dewi, E. U. (2021). The correlation between dysfunctional family process and self-neglect of street children at Special Region of Yogyakarta. Bali Medical Journal, 10(3), 1127–1131.
  21. Arman Yurisaldi Saleh, & Miky Endro Santoso. (2022). Research map in the field of psychoneuroimmunology therapy, a bibliometric analysis. Bali Medical Journal, 12(1), 11–43.

How to Cite

Mawey, F. M., Karimah, A. ., & Kusmiati, T. . (2023). Workplace interventions to overcome stigma and depression in patients with Multiple drug-resistant tuberculosis (MDR TB) . Bali Medical Journal, 12(2), 1353–1357.




Search Panel