Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study.


Background: Tuberculosis (TB) remains a social infectious disease. Stigma towards people with TB (TB-Stigma) is recognised as a key challenge to TB elimination, which is associated with other psychosocial consequences of TB including mental illness and reduced quality of life (QoL). We evaluated TB-Stigma, depression, QoL, and the need for psychosocial support among adults with TB in Indonesia, a high TB burden country.

Methods: This was a primary health facility-based survey in seven provinces of Indonesia, conducted from February to November 2022. We interviewed adults receiving (a) intensive phase treatment for drug-susceptible (DS) TB at public facilities, (b)treatment at private facilities, (c) those lost to follow up (LTFU) to treatment, and (d) receiving TB retreatment at either public or private facilities. We used our previously-validated Indonesian TB-Stigma Scale to measure TB-Stigma, Patient Health Questionnaire-9 (PHQ-9) to assess depression, and EQ-5D-5L to quantify QoL. Additional questions assessed what psychosocial support was received or needed by participants. We applied general linear models and regression analyses to identify factors associated with TB-Stigma and assess the correlation between TB-Stigma, depression, and QoL.

Findings: Of 612 study participants, 60.6% experienced moderate TB-Stigma. TB-Stigma scores were higher among people receiving treatment at private facilities (adjusted B [aB] 2.48; 0.94-4.03), those LTFU (aB 2.86; 0.85-4.87), males (aB 1.73; 0.59-2.87), those losing or changing job due to TB (aB 2.09; 0.31-3.88) and those living in a rural area (aB 1.41; 0.19-2.63). Depression was identified in 41.5% participants: 35.9% mild to moderate 5.6% moderately severe to severe. Experiencing TB-Stigma was associated with moderately severe to severe depression (adjusted odds ratio [aOR] 1.23; 1.15-1.32) and both stigma and depression were associated with lower QoL (aB -0.013; [-0.016]-[-0.010]). Informational (20.8%), emotional (25.9%) and instrumental (10.6%) support received from peers or peer-groups was limited, and unmet need for such support were high.

Interpretation: There is a sizeable and intersecting burden of TB-Stigma and depression among adults with TB in Indonesia, which is associated with lower QoL. Participants reported a substantial unmet need for psychosocial support including peer-led mutual support groups. Based on these findings, we are working with TB-affected people and key multisectoral stakeholders to co-develop a community-based peer-led psychosocial support intervention to defray the psychosocial impact of TB in Indonesia.

Keywords: Tuberculosis, stigma, social isolation, quality of life, mental health disorders, depression, social support, psychosocial support, peer groups, Indonesia


Fuady, A., Arifin, B., Yunita, F., Rauf, S., Fitriangga, A., Sugiharto, A., ... & Wingfield, T. (2024). Stigma, depression, quality of life, and the need for psychosocial support among people with tuberculosis in Indonesia: A multi-site cross-sectional study. PLOS Global Public Health4(1), e0002489.
Geographies Indonesia

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