Background: Drug-resistant Tuberculosis (DR-TB) presents substantial psychological, social, and health-related quality of life (HRQoL) challenges for patients. Evidence remains limited on how these experiences vary across treatment phases, care models, and social contexts, particularly in low-resource settings.
Aim: This study examined psychosocial outcomes (depressive symptoms, social support) and HRQoL among patients receiving DR-TB treatment in Northern Nigeria, and explored how structural, relational, and cultural factors may influence these outcomes.
Methods: A mixed-methods design was used. First, a systematic review synthesised evidence on psychosocial outcomes and HRQoL among DR-TB patients in low-resource settings. Second, a cross-sectional survey of 95 patients across three states utilised the PHQ-9, OSSS-3, and WHOQOL-BREF. Third, semi-structured interviews were conducted with 64 stakeholders (patients, relatives, healthcare providers, clerics, and policymakers).
Findings: Depressive symptoms appeared widespread (mean PHQ-9 = 9.2; 95% CI: 8.0–10.4), with 40% screening positive for at least moderate symptoms. Scores were higher in the intensive phase than in the continuation phase, although confidence intervals indicated uncertainty about the true size of this difference. Younger, single, unskilled, and rural participants tended to report higher depressive symptoms and lower HRQoL. Social support was generally adequate (mean OSSS-3 = 9.3; 95% CI: 8.8–9.8) but unevenly distributed, with younger and unskilled patients reporting lower levels. HRQoL was moderately high (mean WHOQOL-BREF = 79; 95% CI: 76–82) and tended to improve during the continuation phase, although estimates again reflected uncertainty. Qualitative findings highlighted that patients in the early phases of treatment experienced shock and hopelessness, fear of death and withdrawal, while those in later phases of treatment face cumulative exhaustion, financial depletion, and social disconnection. Moreover, patients reported differential coping and social support from relatives and caregivers, shaped largely by relationships, religious beliefs and cultural norms.
Conclusions: This study provides a contextually grounded understanding of changes in psychosocial outcomes across treatment stages among DR-TB patients in Northern Nigeria. The findings highlight the importance of strengthening psychosocial support, enhancing patient-centred care, and incorporating relational and broader structural factors into DR-TB services. The study also has the potential to inform policy development and realisation of Sustainable Development Goal 3 (aimed at ensuring healthy lives and promoting well-being for people of all ages by 2030).
Keywords: Drug-resistant tuberculosis; depressive symptoms; social support; Health-related quality of life; mixed-methods approach; Nigeria.
