Table 3.
List of recommendations based on the statements that reached a consensus.
| Recommendations | Strength of consensus | |
|---|---|---|
| #1 | A systematic screening for mental health issues and substance abuse disorders should be included in routine assessment and care for all TB patients. | Strong |
| #2 | The screening should be conducted with short validated specific scales and, if scoring abnormally, they should be referred for further psychological and/or psychiatric assessment, follow-up, and specific interventions. | Strong |
| #3 | Mental health screening for TB patients should be conducted at diagnosis, at month 2 (M2), at month 6 (M6), and at the end of treatment (if not coinciding with M6), in accordance with WHO guidelines for monitoring changes in symptoms over time. | Moderate |
| #4 | There is consensus that short, validated screening tools should be used for TB patients. We propose employing the WHO-recommended tools (WHO Operational Handbook on Tuberculosis, Module 6: Tuberculosis and Comorbidities – Mental Health Conditions, Geneva: WHO; 2023): the Patient Health Questionnaire-9 (PHQ-9) for depression, the Generalised Anxiety Disorder Assessment-7 (GAD-7) for anxiety, assessments for psychosis symptoms, and the Alcohol Use Disorders Identification Test (AUDIT) and/or the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) for substance use disorders. | Strong |
| #5 | People with mental health disorders and/or substance abuse should be recognised as high-risk groups for TB in countries where they are not currently included. | Moderate |
| #6 | Individuals with multidrug-resistant TB and extensively drug-resistant TB represent populations with a high prevalence of mental illness. Psychological and psychiatric support should therefore be prioritised and made readily available for these patients. | Strong |
| #7 | The psychiatric effects of anti-TB drugs should not be overlooked. When managing patients with both TB and mental health conditions, the use of antidepressants, anxiolytics, antipsychotics, and anti-TB medications must consider potential side effects and drug interactions. | Moderate |
| #8 | Efforts to reduce the stigma associated with TB and mental illness should include sensitive education for patients, health care workers, and the general public. | Moderate |
| #9 | Individuals diagnosed with TB should receive counselling on the common occurrence of mental health issues following diagnosis to enable early symptom recognition and timely help-seeking. Additionally, psychoeducation should be provided to those who do not require specialised care, equipping them with self-help strategies for managing their symptoms. | Strong |
| #10 | Mental health support should be integrated into TB services via established referral pathways and coordinated care. Where direct integration is not feasible due to logistical challenges, limited resources, or cost-effectiveness (as may occur in very low-TB-incidence countries with decentralised care), robust referral pathways to mental health providers must be established, monitored, and improved. In addition, peer-to-peer advice can serve as an effective interim measure to facilitate psychological support for TB patients. Local-level barriers to accessing psychosocial support should be adequately addressed. | Moderate |
| #11 | Technology and telemedicine should be leveraged to enhance access to mental health services, management, and treatment for TB patients, especially in resource-limited or isolated settings. | Moderate |
| #12 | Access barriers for psychosocial support must be adequately addressed at the local, national, and supranational levels. | Strong |
| #13 | Given that mental health issues are often compounded by social, economic, or legal challenges, these factors should be assessed and addressed for each TB patient. Tailored social support should be provided by engaging the social sector, public health agencies, and local communities. | Strong |
| #14 | All health care workers involved in TB care should receive training to recognise and manage mental health issues. This training should include the proper use of screening tools, knowledge of available interventions (e.g., brief interventions, substance withdrawal management, and supportive structures), and strategies to avoid stigmatising language and practices related to both TB and mental health conditions. | Moderate |
| #15 | A systematic TB data collection form should be developed for routine use in TB units across the EU. This form must include information on substance abuse and concomitant mental health disorders, whether pre-existing or developed during TB disease or treatment. | Moderate |
| #16 | Aggregated data on TB cases, including the incidence of concomitant mental health disorders, should be systematically reported at local, national, and supranational levels. Such data should be disaggregated by biological sex and gender. | Moderate |
| #17 | Recommendations should first be adopted by professional physicians’ associations, supported by patient associations, and then proposed for adoption, approval, and endorsement by health policy makers (e.g., the Ministry of Health). | Moderate |
| #18 | Robust financing for psychosocial support structures and information campaigns is essential to improve people-centred care, particularly for underserved populations with concomitant mental health issues. | Strong |
Strength of consensus is defined as follows: strong = ≥90% agreement; moderate = 70%–89% agreement.