• Users Online: 480
  • Print this page
  • Email this page


 
 
Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 23  |  Issue : 3  |  Page : 159-165

Temperament and character profile assessment of anxiety and depression in tuberculosis patients


1 Department of Chest Diseases, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
2 Department of Infectious Diseases, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
3 Department of Psychiatry, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaraş, Turkey
4 Department of Biostatistics, Faculty of Medicine, Akdeniz University, Antalya, Turkey

Date of Submission25-Feb-2021
Date of Decision23-May-2021
Date of Acceptance08-Jun-2021
Date of Web Publication21-Dec-2021

Correspondence Address:
Dr. Fulsen Bozkus
Faculty of Medicine, Kahramanmaras Sutcu Imam University, Avsar Campus, 46100, Kahramanmaraş
Turkey
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ejop.ejop_28_21

Rights and Permissions
  Abstract 


BACKGROUND AND AIM: Tuberculosis (TB) is a terminal disease, which ranks first among infectious diseases throughout the world. Various psychosocial disorders, including anxiety and depression, first and foremost, and their undesired consequences are observed frequently in TB patients. In various studies, the psychosocial aspects of the disease have been investigated on several accounts, yet their temperament and character profile have not been examined. We intended to identify personality traits through temperament and character profiles of TB patients and compare them with healthy individuals in this study.
MATERIALS AND METHODS: In this study, a 240-item self-administered temperament and character inventory (TCI) and a 14-item Hospital Anxiety and Depression Scale were employed. Forty-five TB patients and 48 healthy volunteers participated in the study.
RESULTS: While average harm avoidance (HA) scores in TB patients were significantly higher than the scores of healthy controls, their average social acceptance scores, in turn, were significantly lower. Depression scores were significantly higher in TB patients than those of the control group (P = 0.049), whereas anxiety scores were insignificantly higher. TCI profiles were not correlated with anxiety and depression scores of TB patients.
CONCLUSION: The current study found that HA scores in TB patients were higher, while social acceptance scores were lower. Prospective studies may lead to specific and in focus interventions designed for TCI in TB patients. Consequently, the assessment and treatment of TB in clinical practice should also include psychosomatic approaches.

Keywords: Character, personality, temperament, tuberculosis


How to cite this article:
Bozkus F, Ateş S, Orhan FO, Samur A. Temperament and character profile assessment of anxiety and depression in tuberculosis patients. Eurasian J Pulmonol 2021;23:159-65

How to cite this URL:
Bozkus F, Ateş S, Orhan FO, Samur A. Temperament and character profile assessment of anxiety and depression in tuberculosis patients. Eurasian J Pulmonol [serial online] 2021 [cited 2022 Jan 25];23:159-65. Available from: https://www.eurasianjpulmonol.com/text.asp?2021/23/3/159/332989




  Introduction Top


Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium TB and is one of the leading causes of mortality throughout the world. According to the World Health Organization, it is estimated that 1.7 billion people have latent TB infection, and approximately 3 million people all around the world, mostly in low- and middle-income countries where the incidence and prevalence of the disease have been increasing, die every year due to TB, which is ancient disease.[1]

The need to approach common mental disorders along with other pathologies related to low income and poverty,[2] and the assumption that these disorders are an important source of intercultural disabilities[3] are topics that have been discussed for quite a long time. Nonetheless, the relationship between mental disorders and TB has been investigated only recently. Today, it is evident that anxiety, depression, and emotional distress are important aspects affecting the burden and inhibitory effects of the disease,[4] and they are closely related to the intensity of symptoms, the number of reported symptoms, the more frequent use of health-care services, low compliance with medication, more comprehensive treatment processes, and the reduction in disease and mortality control.[4],[5] In conjunction with the rising interest in psychiatric comorbidity in medical and surgical patients, the results of TB have come to be better understood.[6] The high prevalence of depression and other psychiatric disorders among TB patients has been shown in many studies.[7] Hence, it was suggested that the prevention and immediate treatment of psychological disorders might be useful to increase treatment compliance and reduce TB relapse in TB patients.

Examining personality traits, Cloninger et al. set forth temperament and character aspects through the temperament and character inventory (TCI), the usefulness of which is known in clinical practice.[8] Temperament, which comprises four dimensions, was defined homogenously in genetic terms and independently hereditary. Character, in turn, comprises three dimensions and exhibits individual differences in self-conception on values pertaining to social experiences. While temperament was assumed to persist for a lifetime, character was assumed to be affected by the environment. It was asserted that the effect of genetic factors on character dimensions is 10%–15% and the effect of environmental factors is 30%–35%,[9],[10] whereas temperament dimensions were suggested to be genetically independent and 40%–60% hereditary and remain constant throughout the lifetime.

Even though various aspects of the psychosocial state of TB patients have been investigated in many studies, as far as we are aware of, the personality traits of these patients have not been investigated with the Cloninger temperament and character model thus far. The primary purpose of this study is to investigate the personality traits of TB patients with Cloninger temperament and character model and to compare them with healthy control patients. Furthermore, anxiety and depressive disorders are observed more frequently in TB patients than normal individuals.[7] The relationship of anxiety and depression with various properties of temperament and character is well known.[11],[12] Thus, we intended to investigate whether TB patients exhibit specific common personality traits (by assessing the self-reported TCI questionnaire) and whether there is a correlation between TCI scores and depression and anxiety.


  Materials and Methods Top


Study population

Forty-five patients with pulmonary and extrapulmonary TB who applied to University Department of Chest Diseases and other clinics between January 2014 and January 2016, diagnosed clinically, radiologically, and bacteriologically, and who were diagnosed and visited the hospital for control purposes were admitted to the study. Persons who were unwilling to participate in the study; had an education of <8 years; had other infectious or systemic diseases; displayed significant pathologies in routine blood counts and biochemistry examinations; were pregnant; or received antidepressant treatment during the last month were not admitted to the study. The control group was composed of 48 healthy individuals, whose age, gender, and level of education were similar to the patients. These individuals were selected among those who visited the hospital with the subject or among the general public through face-to-face interviews. Control patients were also questioned in terms of the existence of any chronic disease. Individuals who were diagnosed with depression and on antidepressant medication within the last month were also excluded from the study. After patients were informed about the study, and the informed consent of all participants was received in line with the ethics committee approval. The study was approved by the decision of the Faculty of Medicine ethics committee dated November 26, 2013 and numbered 2013/16-33 and carried out in accordance with the Helsinki Declaration published in 2000.

The scales used

This self-reported scale consists of 240 items that include “true” or “false” choices, and can be applied to persons at 18 years of age or older. It has been utilized in psychological and psychiatric research as well as in various fields of application. The scale was developed by Cloninger et al. Moreover, the accuracy and reliability of its Turkish version was confirmed.[13],[14] The Cloninger model investigates the character dimension with three scales: Self-Directedness (SD, 44 items in total), Cooperativeness (C, 42 items in total), and Self-Transcendence (ST, 33 items in total). The SD scale is examined under five subscales including: Responsibility (SD1, 8 items), Purposefulness (SD2, 8 items), Resourcefulness (SD3, 5 items), Self-Acceptance (SD4, 11 items), and Congruent Second Nature (SD5, 12 items). The C scale is examined under five subscales including social acceptance (C1, 8 items), empathy (C2, 7 items), helpfulness (C3, 8 items), compassion (C4, 10 items), and Virtuousness-Scrupulousness (C5, 9 items). The ST scale is examined under three subscales including self-forgetfulness (ST1, 11 items), transpersonal identification (ST2, 9 items), and spiritual acceptance (ST3, 13 items). The temperament dimension, in turn, is examined through four scales: Novelty Seeking (NS, 40 items in total), Harm Avoidance (HA, 35 items in total), Reward Dependence (RD, 38 items in total), and Persistence (P, 8 items). Among these scales, NS is examined under four subscales including exploratory excitability (NS1, 11 items), impulsiveness (NS2, 10 items), extravagance (NS3, 9 items), and disorderliness (NS4, 10 items). HA is examined under four subscales including anticipatory worry (HA1, 11 items), fear of uncertainty (HA2, 7 items), shyness with strangers (HA3, 8 items), and fatigability and asthenia (HA4, 9 items). RD is examined under three subscales including sentimentality (RD1, 10 items), attachment (RD3, 8 items), and dependence (RD4, 6 items); there are no subscales for P.[10],[15]

The symptoms of anxiety and depression were assessed with the verified Turkish version of the Hospital Anxiety and Depression Scale (HADS), a tool for which the reliability has been proven for the investigation of anxiety and depression. This scale consists of two parts, which include seven questions assessing anxiety and seven questions assessing depressive symptoms. It is accepted that a HADS anxiety score equal to or higher than 11 indicates anxiety, whereas a HADS depression score equal to or higher than eight indicates depression.[16]

Statistical analysis

The characteristics of the patients were expressed in terms of averages (SD) or numbers (%). The compliance of numeric data to normal distribution was confirmed, and Student's t-test or Mann–Whitney U-test were used to compare the variables between groups. Categorical data were analyzed with the Chi-square test or Fisher's exact Chi-square test. All statistical analyses were conducted with the SPSS for Windows version 18.0 (SPSS Inc., Chicago, IL, USA) software. Values that have P < 0.05 were accepted as statistically significant.


  Results Top


Demographic data such as the age distribution, level of education, occupational status, and marital status of both the patient and control groups are presented in [Table 1]. Both groups are similar in terms of age and gender distribution.
Table 1: Sociodemographic variables of patients and controls

Click here to view


While 24 patients (53.3%) were diagnosed with pulmonary TB, 38 patients (84.4%) were in new TB category, 13 patients (28.9%) had a period of disease between 6 and 12 months, 10 patients (42.2%) were in the intensive TB treatment phase, 34 patients (75.6%) received social support at a satisfactory level, and 13 patients (28.9%) had a TB stigma perception. Seventeen patients (37.8%) out of all patients who participated in the study displayed comorbid chronic diseases, whereas 22 (48.9%) were currently smoking, using substances such as chewing tobacco or alcohol. Clinical variables of TB patients are given [Table 2].
Table 2: Description of clinical, psychosocial and substance use factors among patients with tuberculosis

Click here to view


The prevalence of depression in our study was 44% in TB patients and 6.2% in the control group. The HADS-D scores in TB patients were significantly higher than those of the control group (P = 0.049). Furthermore, this study revealed that the prevalence of anxiety in TB patients was 40%, whereas it was 2.1% in the control group. However, the HASD-A scores of the TB subject group were not significantly higher than the control group (P > 0.05) [Table 3].
Table 3: Comparison of average hospital anxiety and depression scores between tuberculosis patients and healthy controls

Click here to view


The HA score in TB patients was significantly higher than the control patients (P = 0.002). Concurrently, the sub-score of Fear of Uncertainty (HA2) was also significantly higher in TB patients than the control group (P = 0.002) [Table 4]. On the other hand, among the character traits, Social Acceptance (C1) was significantly lower in TB patients (P = 0.001) [Table 4]. HADS-D and HADS-A scores of TB patients were not correlated with any of the temperament and character dimensions.
Table 4: Comparison of the temperament and character subdimensions in tuberculosis patients, and healthy controls

Click here to view



  Discussion Top


TB is a chronic disease that may reduce the subject's quality of life and have negative physical, emotional, and social impacts.[17],[18],[19] Many other studies have indicated that TB affects the general perception of well-being, physical faculties, mental health, physical and social functionality, and other aspects of quality of life; moreover, it may lead to additional problems such as social stigmatization, isolation, difficulties in the use of medication, lengthiness of the treatment, sexual dysfunctions, loss of income, and fear.[17],[18]

The studies carried out by Thomas Holmes in the United States in 1950s suggested that it is necessary to understand the personal narratives of the patients, and the emotional states caused by the hardships of life may lead to a predisposition to TB.[20] In the epidemiology of the disease, in addition to the virulence of the germ, the strength and efficacy of the host's immune system is also decisive.[21] Each infected case does not become a TB patient. The popular belief of “getting TB because of grief” may be a hypothesis worth to consideration and investigation, since today, it has been understood that depression severely affects the immune system. In this respect, studies indicating that stress causes marked changes over the immune system may provide guidance.[22] Furthermore, the effect of depression and anxiety in a disease such as TB, which is known to be a result of the host's reaction to the germ, is a question that should be answered. To this end, this study aimed to identify the temperament and character dimensions with anxiety and depression levels in TB patients, and to specify the correlation between these psychological fields and sociodemographic and clinical variables. To our knowledge, this is the first study that compares the personality traits of TB patients to healthy control individuals using TCI personality questionnaire, the accuracy of which has been well established.

Various studies reported that the incidence of treatment compliance, and personality traits and psychological factors that affect the outcomes of the treatment in TB patients is high (50%–80%).[23] Another study evaluated the potential impact of psychiatric morbidity and personality traits on treatment completion and negligence of taking medications in the directly observed short-term treatments of TB patients. In the mentioned study, 53.4% of the patients were neurotic, 26.2% were introverts, 18.2% were extroverts, and 2.2% displayed other personality traits. It was also stated that the moods of most patients displayed unstable, submissive, mild-mannered, and overprotective (i.e. oversensitive and delusional) characteristics.[24] Similar observations were made by other researchers.[25] The use of TCI, which allows the assessment of temperament and character with a psychobiological model, in studies in order to understand the relationship between TB and personality, plays an important role.[9] Cloninger's psychobiological personality model, which has been used widely in studies recently, provides an opportunity to deal with this necessity.

The current study revealed that TB patients exhibit higher HA scores as well as higher Fear of Uncertainty subscores. Persons who have higher HA scores tend to be deliberate, careful, apprehensive, tense, nervous, skeptical, passive, and negativistic or inclined to be pessimistic even about events that does not worry others.[26] Such persons are also inclined to fear rejection and embarrassed in social situations.[27] Persons with high HA scores react to stressful events with depressive symptoms at a higher rate, and expect hazardous outcomes even when there is no danger.[8],[9] High HA scores are related to depression and anxiety symptoms. Various studies have indicated higher HA scores in patients with depression and anxiety.[28] In the current study, in turn, even though TB patients were more depressive than the control group, a significant correlation between HA and anxiety could not be detected.

Evidence indicating that emotional distress expressed in terms of anxiety and depression in TB patients is quite high has been increasing. In the case of Ethiopia, while 46.7% of HIV negative TB patients exhibited significant levels of distress, this ratio was 63.7% in HIV positive TB patients.[29] In a study conducted in South Africa, it was reported that 87% of TB patients had distress.[30] In a recent study conducted in Pakistan, anxiety and depression were identified according to HADS in 37.1% of TB patients in an outpatient clinic.[31] In another study conducted in Brazil, the ratio of depressive mood and prevalent mental disorders were observed to be 34% higher in the presence of pulmonary TB.[7] In our study, the prevalence of depression was determined as 44.4%, which is similar to the results of other studies. The prevalence of depression in the healthy control group, on the other hand, was 6.2%. According to the HADS-D scores in the current study, TB patients were much more depressed than control patients, with a difference that was statistically significant.

Cooperativeness indicates social approval, empathy, helpfulness, compassion, and virtuousness-scrupulousness. Individuals with a high level of cooperativeness are viewed as reasonable, compassionate, empathic, helpful, and principled.[8],[9] As shown in many previous studies, there is a negative correlation between depression and anxiety and cooperativeness. In our study, social acceptance was lower in TB patients than the control group. This can be interpreted as an indication of the withdrawal of the individual from society due to stigmatization because of the subject's clinical condition. In recent years, an issue that has been drawing attention in TB patients was self-inflicted discrimination, isolation, and stigmatization.[32] Conventionally, TB patients are known to feel that they are alienated from the society mainly due to concerns related to the spread of the disease. In various studies, it was shown that the stigma is not a subjective feeling inflicted by the patients upon themselves, but rather that the individuals in their environment actually behave in a manner to isolate them.[33] In our study, 13 patients (28.9%) perceived stigmatization. Several previous studies have suggested that feelings of embarrassment, discomfort, or social isolation were observed among TB patients.[34] Nevertheless, social anxiety, which is mainly a psychiatric condition that is characterized by these feelings, has not been studied in depth. In another study focusing on the stigma of TB, the authors concluded that the stigma associated with TB may have a negative impact that can result in the individual and his/her family withdrawing from society due to embarrassment and fear.

The results of our study have certain restrictions. First, the sample size is relatively small, which therefore may not be representative for TB patients. We believe that other studies with larger clinical sample sizes should be conducted in order to verify these findings. Furthermore, causal links cannot be established because of the cross-sectional structure of the data. Moreover, self-reported questionnaires were used in this study to assess psychiatric symptoms; therefore, more reliable findings can be achieved through structured interviews and scales to be applied by clinicians.


  Conclusion Top


Consequently, in this study we suggest that TB patients have distinctive temperament dimensions with respect to healthy control patients. Further studies need to be conducted in order to determine the correlation between the patterns of temperament and character dimensions, including successful treatment and longitudinal patient processes, and TB.

Quick look

Current knowledge

Anxiety and depression are mental disorders that are frequently observed in TB patients at a high rate. When depression and anxiety accompany TB, they lead to the global control of TB and insufficient treatment compliance, which increases the risk of morbidity and mortality due to TB. Therefore, in order to increase treatment compliance and reduce TB relapse in TB patients, it might be important to assume that prevention and immediate treatment of psychological disorders can be useful.

What this paper contributes to our knowledge

TCI provides a psychobiological model that has the potential to shed light on human personality traits in multiple levels of analysis. Even though various aspects of TB patients' psychosocial state have been investigated in the past, to our knowledge, the personality traits of these patients have not been examined with Cloninger's temperament and character model. This is the first study that compares TB patients' personality traits with healthy control patients using a TCI personality questionnaire, the accuracy of which is well established. Furthermore, according to this study, it can be suggested that TB patients exhibit distinctive temperament dimensions with respect to healthy control patients.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Global tuberculosis report 2021. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO.  Back to cited text no. 1
    
2.
Walker ZJ, Jones MP, Ravindran AV. Psychiatric disorders among people with cancer in low- and lower-middle-income countries: Study protocol for a systematic review and meta-analysis. BMJ Open 2017;7:e017043.  Back to cited text no. 2
    
3.
India State-Level Disease Burden Initiative Mental Disorders Collaborators. The burden of mental disorders across the states of India: The Global Burden of Disease Study 1990-2017. Lancet Psychiatry 2020;7:148-61.  Back to cited text no. 3
    
4.
Galhenage JS, Rupasinghe JP, Abeywardena GS, de Silva AP, Williams SS, Gunasena B. Psychological morbidity and illness perception among patients receiving treatment for tuberculosis in a tertiary care centre in Sri Lanka. Ceylon Med J 2016;61:37-40.  Back to cited text no. 4
    
5.
Adina MM, Necrelescu OL, Bondor C, Trofor A, Alexandrescu D, Dantes E. Depressive syndrome, anxiety and illness perception in tuberculosis patients. In: Recent Researches in Modern Medicine. Cambridge: WSEAS Press; 2011. p. 243-8.  Back to cited text no. 5
    
6.
Hüfner K, Fuchs D, Blauth M, Sperner-Unterweger B. How acute and chronic physical disease may influence mental health – An Analysis of neurotransmitter precursor amino acid levels. Psychoneuroendocrinology 2019;106:95-101.  Back to cited text no. 6
    
7.
Zhang K, Wang X, Tu J, Rong H, Werz O, Chen X. The interplay between depression and tuberculosis. J Leukoc Biol 2019;106:749-57.  Back to cited text no. 7
    
8.
Cloninger CR, Svrakic DM, Przybeck TR. A psychobiological model of temperament and character. Arch Gen Psychiatry 1993;50:975-90.  Back to cited text no. 8
    
9.
Cloninger CR. A systematic method for clinical description and classification of personality variants. A proposal. Arch Gen Psychiatry 1987;44:573-88.  Back to cited text no. 9
    
10.
Cloninger, C.R., Przybeck, T.R., Svrakic, D.M., Wetzel, R.D. The Temperament and Character Inventory (TCI): A Quide to Its Development and Use. Washington University, St. Louis, MO: Center for Psychobiology of Personality; 1994.  Back to cited text no. 10
    
11.
Lu X, Chen Z, Cui X, Uji M, Miyazaki W, Oda M, et al. Effects of temperament and character profiles on state and trait depression and anxiety: A prospective study of a Japanese youth population. Depress Res Treat 2012;2012:604684. doi: 10.1155/2012/604684.  Back to cited text no. 11
    
12.
Kahraman H, Orhan FO, Sucakli MH, Ozer A, Koksal N, Sen B. Temperament and character profiles of male COPD patients. J Thorac Dis 2013;5:406-13.  Back to cited text no. 12
    
13.
Kose S, Sayar K, Kalelioglu U, Aydin N, Celikel FC, Gulec H, et al. Normative data and factorial structure of the Turkish version of the Temperament and Character Inventory. Compr Psychiatry 2009;50:361-8.  Back to cited text no. 13
    
14.
Arkar H, Sorias O, Tunca Z, Safak C, Alkin T, Binnur Akdede B, et al. Factorial structure, validity, and reliability of the Turkish temperament and character inventory. Turk Psikiyatri Derg 2005;16:190-204.  Back to cited text no. 14
    
15.
Köse S, Sayar K, Ak İ, Aydin N, Kalelioglu U, Kirpinar İ, et al. Turkish version of TCI: Reliability, validity and factor structure. Bull Clin Psychopharmacol 2004;14:107-31.  Back to cited text no. 15
    
16.
Aydemir O, Guvenir T, Kuey L, Kultur S. Validity and reliability of turkish version of hospital anxiety and depression scale. Turk Psikiyatri Derg 1997;8:280-7.  Back to cited text no. 16
    
17.
Jaber AA, Khan AH, Syed Sulaiman SA, Ahmad N, Anaam MS. Evaluation of health-related quality of life among tuberculosis patients in two cities in Yemen. PLoS One 2016;11:e0156258.  Back to cited text no. 17
    
18.
Aggarwal AN. Quality of life with tuberculosis. J Clin Tuberc Other Mycobact Dis 2019;17:100121.  Back to cited text no. 18
    
19.
Ren J, Li Q, Zhang T, Li X, Zhang S, Wright J, et al. Perceptions of engagement in health care among patients with tuberculosis: A qualitative study. Patient Prefer Adherence 2019;13:107-17.  Back to cited text no. 19
    
20.
Lerner BH. Can stress cause disease? Revisiting the tuberculosis research of Thomas Holmes, 1949-1961. Ann Intern Med 1996;124:673-80.  Back to cited text no. 20
    
21.
Young C, Walzl G, Du Plessis N. Therapeutic host-directed strategies to improve outcome in tuberculosis. Mucosal Immunol 2019;13:190-204. [doi: 10.1038/s41385-019-0226-5].  Back to cited text no. 21
    
22.
Fali T, Vallet H, Sauce D. Impact of stress on aged immune system compartments: Overview from fundamental to clinical data. Exp Gerontol 2018;105:19-26.  Back to cited text no. 22
    
23.
Molla A, Mekuriaw B, Kerebih H. Depression and associated factors among patients with tuberculosis in Ethiopia: A cross-sectional study. Neuropsychiatr Dis Treat 2019;15:1887-93.  Back to cited text no. 23
    
24.
Chaudhri S, Bansal A, Singh A, Sampath A, Verma AK, Tripathi A, et al. Impact of psychiatric profile and personality trait on directly observed tuberculosis treatment outcome. Int J Med Public Health 2013;3:303-8.  Back to cited text no. 24
  [Full text]  
25.
Min J, Chung C, Jung SS, Park HK, Lee SS, Lee KM. Understanding illness perception in pulmonary tuberculosis patients: One step towards patient-centered care. PLoS One 2019;14:e0218106.  Back to cited text no. 25
    
26.
Gencay-Can A, Can SS. Temperament and character profile of patients with fibromyalgia. Rheumatol Int 2012;32:3957-61.  Back to cited text no. 26
    
27.
Mohseni N, Togha M, Arzaghi SM, Nekooie S, Tafti MF, Fatehi F. Personality traits and anxiety and depressive disorders in patients with medication-overuse headache versus episodic migraine. Prim Care Companion CNS Disord 2017;19:17m02188.  Back to cited text no. 27
    
28.
Sasayama D, Hori H, Teraishi T, Hattori K, Ota M, Matsuo J, et al. Difference in Temperament and Character Inventory scores between depressed patients with bipolar II and unipolar major depressive disorders. J Affect Disord 2011;132:319-24.  Back to cited text no. 28
    
29.
Rubeen R, Zareen N, Zameer S, Rasool GA, Naqri NS, Iqbal J. et al. Anxiety and depression in tuberculosis can create impact on quality of life of patient. Acta Med Int 2014;1:93-8.  Back to cited text no. 29
    
30.
Deribew A, Tesfaye M, Hailmichael Y, Apers L, Abebe G, Duchateau L, et al. Common mental disorders in TB/HIV co-infected patients in Ethiopia. BMC Infect Dis 2010;10:201.  Back to cited text no. 30
    
31.
Araújo GS, Pereira SM, Santos DN, Marinho JM, Rodrigues LC, Barreto ML. Common mental disorders associated with tuberculosis: A matched case-control study. PLoS One 2014;9:e99551.  Back to cited text no. 31
    
32.
Dhingra VK, Khan S. A sociological study on stigma among TB patients in Delhi. Indian J Tuberc 2010;57:12-8.  Back to cited text no. 32
    
33.
Christodoulou M. The stigma of tuberculosis. Lancet Infect Dis 2011;11:663-4.  Back to cited text no. 33
    
34.
Roba AA, Dasa TT, Weldegebreal F, Asfaw A, Mitiku H, Teklemariam Z, et al. Tuberculosis patients are physically challenged and socially isolated: A mixed methods case-control study of Health Related Quality of Life in Eastern Ethiopia. PLoS One 2018;13:e0204697.  Back to cited text no. 34
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Tables

 Article Access Statistics
    Viewed477    
    Printed26    
    Emailed0    
    PDF Downloaded63    
    Comments [Add]    

Recommend this journal