Burden beyond biology: Understanding stigma, social anxiety, social exclusion, and self-esteem in TB patients to identify priority groups for psychosocial intervention.

Context: Tuberculosis (TB) continues to pose a significant public health challenge globally, with India accounting for approximately 26% of the global TB burden. Beyond its biomedical implications, TB is also associated with profound psychosocial consequences that can impede treatment adherence, affect patient well-being, and delay recovery. Aim: This study examines the psychosocial, clinical, and sociodemographic factors influencing TB patients to identify priority groups for targeted psychosocial interventions. Design and Method: A cross-sectional study was conducted on 90 patients registered at the DOTS Centre of Indira Gandhi Government Medical College, Nagpur. Standardized instruments, including the Social Anxiety Questionnaire for Adults, the Van Rie TB Stigma Scale, the Arcencio TB Stigma Scale, Rosenberg Self-esteem scale, and Visual Analogue Scales, were administered. Statistical Analysis: Data analysis was performed using SPSS version 21. Data were analyzed using frequency, percentage, and the independent samples Results: Findings indicate that over 50% of participants reported high levels of social anxiety and perceived stigma, both self-directed and from family members. More than 60% reported a significant disease burden and fear of social exclusion and 70% of the patients displayed low self-esteem. Social anxiety, in domains such as public speaking and interpersonal interactions, was more prevalent among married individuals, those aged between 30 and 45 years and those in the early stages of the disease. Older adults reported greater social anxiety in situations involving interactions with the opposite sex, assertive communication, and fear of criticism or embarrassment. Self-stigma was more pronounced during the early stages of illness, whereas stigma perceived by family members was higher in later stages. Conclusion: The findings highlight the need for psychosocial interventions and family-centered approaches tailored to specific patient profiles and to mitigate stigma within the household and society.