Abstract
BACKGROUND: The co-occurrence of smoking and depression presents a significant public health concern, particularly among individuals with tuberculosis (TB). Smoking delays the recovery from tuberculosis (TB) and it has also been associated with depression in those who have been diagnosed with the disease. The review aimed to find out the association between smoking and depression among TB patients. METHODS: A systematic review and meta-analysis were conducted following PRISMA guidelines, in PubMed, Scopus, and ScienceDirect databases. Literature searches were employed using terms related to "tuberculosis", "smoking," and "depression" across all articles either by title, abstract, or keywords. To evaluate the risk of bias, the Joanna Briggs Institute Critical Appraisal Checklist (JBI) was used. For clinical heterogeneity, a meta-analysis was conducted to pool estimates using RevMan 5.3 and Stata 13.0 software was used for publication bias assessment. RESULTS: From the 1393 studies identified, eleven studies were eligible for inclusion in this study. There were nine cross-sectional, and two cohort studies. Only 5 studies reported effect size calculation suitable for multivariate analysis. The pooled analysis indicates that smoking TB patients were associated with a higher odds of depression (OR = 2.56, 95% CI: 1.11-5.92), though the wide confidence interval and substantial heterogeneity (I² = 71%, p = 0.003) indicates uncertainty regarding the effect size. Subgroup analysis based on depression assessment tools revealed a stronger association between smoking TB patients with depression (OR = 3.36; 95% CI: 1.19-9.50) with high heterogeneity (I² = 75%). Publication bias, as indicated by Egger's test (bias coefficient = 0.59, p = 0.874). CONCLUSIONS: Existing evidence suggests a potential association between depression and smoking among tuberculosis patients, which encourages more studies to explore whether smoking cessation would contribute to the improvement of mental health outcomes in this population. TRIAL REGISTRATION: This review was developed and registered in the International Prospective Register of Systematic Reviews (PROSPERO). CRD42024528399 Registered on 06 April 2024.