We are living through some pretty stressful times. The COVID-19 pandemic has brought with it unprecedented levels of social, economic and mental stress, and no-one has been spared. Even if someone hasn’t been directly affected by the virus itself, there has been some level of disruption to their employment, living arrangements, family dynamics or income. After nearly 2 years of living with these disruptions, change and uncertainty, day in and day out, the stress that is associated with them has become ‘normal’. The truth is; this type of ‘new normal’ is anything but. Even though you may not feel the same heart-pounding, sweat- inducing worry that you once did, chronic, unabated stress can start to take a toll on your health – both physically and emotionally.

Even for those who are healthy, the pandemic has highlighted the idea of a disease being front and centre in all you do in your life. However, for someone who might have living with a chronic disease long before COVID-19 came along, this has already been their reality, and the pandemic has simply made things worse.

Economic, social and psychological distress is common amongst those living with chronic diseases, such as tuberculosis. This type of distress is similar to COVID-related change. Someone affected by TB may not be able to work. Particularly those who aren’t able to work from home may find themselves unemployed. They may have to isolate at home, they may be shunned by their community, and may be unable to access the treatment necessary to manage their condition. Unsurprisingly, besides tuberculosis being one of the leading causes of death in South Africa, it is also one of the biggest drivers of mental distress.

Several studies have found a strong link between tuberculosis and psychological distress, showing that up to 80% of patients with TB experience mental health problems. But something less often reported is that this relationship can be bi-directional. In other words, general mental distress, emotional turmoil, and social isolation, may be considered an important risk factor for the development of TB.

Poor mental health and chronic stress deliver a devastating blow to the immune system. These conditions, via changes in the release and regulation of hormones, impair the healthy functioning of the immune system, thus resulting in an increased risk of infections, chronic metabolic disease (e.g. diabetes), and sometimes even cancer. In the case of TB, a lowered immune status could also mean an increased risk of activation of a latent TB infection to an active one.

There has been much progress in the fight against TB, specifically with recent advances in the development of new vaccines and medications. While these developments are encouraging, it’s important to take a holistic look at TB prevention and consider the important role that stress and mental health have in both the development of the disease, and the management of it.

Here are 8 ways that you can contribute to lowering the TB burden in your community, and improve your own resilience to infection:

1. Become aware of your current stress levels and take a proactive approach to managing these. Regular exercise, meditation, engaging with others and spending time in nature can all be effective in easing stress levels.
2. Speak out when feeling overwhelmed, and if you experience mental health concerns, ensure that you seek treatment.
3. Maintain strong social ties to help buffer the negative effects of stress.
4. Live a healthy lifestyle – by eating well, exercising regularly and prioritising sleep, you give your immune system the best chance of keeping you healthy.
5. Act early – the sooner you can be diagnosed and treated; the more successful treatment will be.
6. Manage existing conditions – keep chronic conditions, like HIV and diabetes, under control and take medication for these conditions as prescribed.
7. Ensure your children are vaccinated against TB.
8. If you have active TB, ensure you continue to take your medication for the full duration – not only for your own sake, but for everyone else around you too.

References

• Mental health disorders, social stressors, and health-related quality of life in patients with multidrug-resistant tuberculosis: A systematic review and meta-analysis. Journal of Infection. Volume 77, Issue 5, November 2018, Pages 357-367
• Prevalence of psychological distress and associated factors in tuberculosis patients in public primary care clinics in South Africa. BMC Psychiatry. 12, Article number: 89 (2012)
• Influence of Stress and Depression on the Immune System in Patients Evaluated in an Anti-aging Unit. Front. Psychol., 04 August 2020
• The relationship between mental health and risk of active tuberculosis: a systematic review. BMJ Open 2022;12:e048945
• WHO. Fact sheets on tuberculosis