Mental health and nontuberculous mycobacteria infections: a single center retrospective study in Milan

The prolonged nature of non-tuberculous mycobacterial pulmonary disease (NTM-PD), its complex treatment, and limited public awareness contribute to negative emotional experiences, including anxiety and depression. Approximately 30% of NTM-PD patients face mental health problems. The aim of this observational, retrospective study is to describe and compare epidemiological and clinical characteristics of patients with NTM-PD, with and without anxiety and/or depression(A/D). We considered all patients enrolled in the IRENE registry by the Regional TB Reference Centre Villa Marelli Institute (Milan) until 31st December 2022. Among 226 enrolled patients, 20% reported A/D symptoms. The median age is 66 years in Healthy group (H) and 69 years in A/D group (p<0.05). Thirty-six percent of A/D had ≥5 comorbidities, compared to 19% of H(p<0.05). The Body Mass Index median was 19.8 in A/D and 20.9 in H (p<0.05). Overall, patients reported a median of 2 symptoms, with a higher distribution in A/D (p<0.05). A/D showed a higher incidence of cavitary disease(45%, p<0.05), and large cavities (25%, p<0.05). Thirty-two percent of A/D and 24% of H were not on NTM treatment (n.s.). The reason included minimal radiological findings, clinical stability, minimal/absent symptoms, unfavorable risk/benefit ratio. Two patients opted against treatment for personal reason, both in A/D(p<0.05). Adverse drug reactions were reported by 64% of A/D and 42% of H (p<0.05). The interplay between NTM-PD and mental health is complex and requires further investigation. Recognizing and addressing NTM-PD psychological aspects might improve the well-being and quality of life of those affected, and their adherence to treatment.