Factors associated with depression among tuberculosis patients with HIV co-infection in rural community Thailand

Depression is a significant comorbidity among patients with tuberculosis (TB) and HIV co-infection. Factors associated with depression in this vulnerable population remain inadequately characterised. This study had two primary objectives: (1) to identify demographic, clinical, and psychological factors including rumination associated with clinically significant depressive symptoms among TB patients in rural Thailand; and (2) to estimate the effect of HIV co-infection on depression risk using propensity score methods to address confounding. This retrospective propensity score-matched study was conducted among 9,289 TB patients (2014–2023) in Sakon Nakhon Province, Thailand. Data were retrieved from the National TB Information System (NTIP), including 1,952 (21.0%) with HIV co-infection. Depressive symptoms were assessed using the validated Thai 9-Question (9Q) Depression Screening Tool, with a score ≥ 30 indicating clinically significant depressive symptoms. Multiple logistic regression and propensity score matching were employed to examine associations between demographic characteristics, clinical variables, rumination, and depression outcomes. The prevalence of high depression was 28.8% (n = 2,671). Mean age was 52.6 ± 16.7 years, with 63.6% male. HIV-positive patients were younger (47.2 ± 16.8 vs. 54.0 ± 16.4 years, p < 0.001) and showed higher depression rates (32.5% vs. 27.6%, p = 0.001). In multivariable analysis, HIV-positive status (adjusted OR 1.28, 95% CI: 1.14–1.44, p < 0.001), female sex (aOR 1.18, 95% CI: 1.07–1.30, p = 0.001), older age (aOR 1.04 per 10 years, 95% CI: 1.01–1.07, p = 0.012), and higher rumination scores (aOR 1.08 per 5-point increase, 95% CI: 1.05–1.11, p < 0.001) were independently associated with high depression. Clinically significant depressive symptoms (9Q score ≥ 30) are highly prevalent among TB patients in rural Thailand. HIV co-infection, female sex, older age, and higher rumination scores are independently associated with elevated depressive symptom burden. These findings support integrated mental health screening targeting high-risk subgroups within TB care programmes, with referral for formal psychiatric evaluation when indicated.