Silent barriers: psycho-social factors and the hidden risk of medication non-adherence among tuberculosis patients in Mongolia

Background: Medication non-adherence, potentially influenced by psychological and social factors, is a major barrier to effective treatment of tuberculosis. This study aimed to examine the associations between anxiety, depression, and social support with medication adherence. Method: A cross-sectional study was conducted among 215 inpatients at the National Center for Communicable Diseases. Data were collected using Hospital Anxiety and Depression Scale (HADS), Medication Adherence Rating Scale (MARS), Oslo Social Support Scale (OSSS-3). Associations with medication adherence were examined using chi-squared tests and multivariable logistic regression. Results: Among the participants, 53.0% (n = 114) exhibited clinical signs of depression, and 44.2% (n = 95) had borderline or abnormal anxiety. Medication non-adherence was reported in 56.7% of patients. Abnormal anxiety was linked to a threefold higher risk of non-adherence (OR = 3.829, 95% CI = 1.495-9.807, P = 0.005). Poor (OR = 2.769, P = 0.024) and moderate (OR = 2.409, P = 0.043) social support also significantly increased risk. Depression was common but not significantly associated with adherence. Conclusion: Anxiety and social support influence TB patients' adherence with their treatment repertoire. Screening for anxiety and implementing interventions to enhance social and family support may improve adherence and optimize treatment outcomes in this patient population.