The association of household food insecurity and HIV infection with common mental disorders among newly diagnosed tuberculosis patients in Botswana

Objective To determine the association between food insecurity and HIV-infection with depression and anxiety among new tuberculosis patients. Design Our cross-sectional study assessed depression, anxiety, and food insecurity with Patient Health Questionnaire (PHQ9), Zung Anxiety Self-Assessment Scale (ZUNG), and Household Food Insecurity Access Scale, respectively. Poisson regression models with robust variance were used to examine correlates of depression (PHQ9 ≥ 10) and anxiety (ZUNG ≥ 36) Setting Gaborone, Botswana. Participants Patients who were newly diagnosed with tuberculosis. Results Between January and December 2019, we enrolled 180 TB patients from primary health clinics in Botswana. Overall, 99 (55.0%) were HIV-positive, 47 (26.1%),85 (47.2%), and 69 (38.5%) indicated depression, anxiety, and moderate to severe food insecurity, respectively. After adjusting for potential confounders, food insecurity was associated with a higher prevalence of depression (adjusted prevalence ratio [aPR] =2.30; 95% confidence interval [CI] = 1.40, 3.78) and anxiety (aPR = 1.41; 95% CI = 1.05, 1.91). Prevalence of depression and anxiety were similar between HIV-infected and -uninfected participants. Estimates remained comparable when restricted to HIV-infected participants. Conclusions Mental disorders may be affected by food insecurity among new tuberculosis patients, regardless of HIV status.