Hepatitis C in people with mental illness: how big is the problem and how do we respond?

Scoping review of research in Australia on the co-occurrence of physical and serious mental illness and integrated care

The physical health of people with serious mental illness (SMI) has become a focal area of research. The aim of the present study was to ascertain the attention and distribution of research from within Australia on physical illness and SMI co-occurrence, and to identify gaps. A scoping review of peer-reviewed research literature from Australia, published between January 2000 and March 2014, was undertaken through an electronic literature search and coding of papers to chart trends. Four trends are highlighted: (i) an almost threefold increase in publications per year from 2000-2006 to 2007-2013; (ii) a steady release of literature reviews, especially from 2010; (iii) health-related behaviours, smoking, integrated-care programmes, and antipsychotic side-effects as the most common topics presented; and (iv) paucity of randomized, controlled trials on integrated-care models. Despite a marked increase in research attention to poorer physical health, there remains a large gap between research and the scale of the problem previously identified. More papers were descriptive or reviews, rather than evaluations of interventions. To foster more research, 12 research gaps are outlined. Addressing these gaps will facilitate the reduction of inequalities in physical health for people with SMI. Mental health nurses are well placed to lead multidisciplinary, consumer-informed research in this area.

Anxiety and depression in Australian chronic hepatitis C outpatients: prevalence and predictors

OBJECTIVE

The present study aimed to assess the prevalence and predictors of anxiety and depression in Australian chronic hepatitis C (CHC) outpatients.

METHOD

Hospital Anxiety and Depression Scale scores at referral and other patient data was analysed for 395 CHC outpatients attending the Royal Adelaide Hospital liver clinic from 2006 to 2010.

RESULTS

Results revealed probable prevalence rates of 41% for anxiety and 27% for depression. CHC patients had rates of anxiety and depression 1.2 and 2.4 times higher than community norms, respectively. Younger patients were found to experience increased anxiety, while married patients or those in a de facto relationship experienced decreased anxiety and depression.

CONCLUSION

Regular psychiatric screening, and subsequent referral for mental health treatment, where necessary, is recommended for Australian CHC patients. Younger patients or those lacking social supports may be at increased risk. Research is needed to develop and evaluate psychological interventions.

Prevalence of hepatitis C in two inpatient psychiatry populations

OBJECTIVE

Psychiatric populations may be particularly at risk of hepatitis C (HCV), less likely to receive appropriate interventions and at greater risk of liver damage due to comorbid substance abuse. This study sought to determine the prevalence of HCV in two inpatient psychiatric populations of seriously mentally ill patients and the relationship to risk factor screening.

METHOD

Two inpatient units were chosen in similar socio-economic areas. Persons admitted to these wards over the course of the study were invited to participate and provided with pre-test counselling. Where informed consent was obtained, individuals were included in the study. It was planned to screen all consenting patients. However, funding was reduced for one site meaning that only patients with identified risk factors could be screened there.

RESULTS

Around 18% of psychiatric inpatients admitted to risk factors for HCV. The prevalence of HCV with screening of all consenting patients in unit A was 3.2%. With selective screening in unit B, 41.7% of those with identified risk factors tested positive. These results compare to the Australian community rate of approximately 1.1%.

CONCLUSION

Results are consistent with elevated rates of HCV in mentally ill populations elsewhere in the world, and provide support for selective screening.

Australians living with and managing hepatitis C

This paper discusses the psychosocial impact of being diagnosed with hepatitis C virus (HCV). The paper clarifies some of the key misconceptions about the virus, especially the impact HCV has on people who have been recently diagnosed. An individual's reaction to the HCV diagnosis and the subsequent lifestyle challenges to maintain health, well-being, family, and social networks are discussed, particularly the issues surrounding mental health in respect to a recent chronic illness diagnosis and how to manage the trajectory of the illness in the community and individually. HCV disclosure and its effect on intimacy are also detailed. For people living with both a diagnosed mental illness and HCV, managing the illness can be complicated. Not only are these individuals concerned about their mental illness, its treatment, and the social stigma and discrimination associated with it, they also may be alarmed over their future physical health. The paper is preliminary to research using the psychotherapeutic approach of Cognitive Behavioural Therapy (CBT) in groups of persons with a dual diagnosis of mental illness and HCV.

Hepatitis C in psychiatry inpatients: testing rates, prevalence and risk behaviours

OBJECTIVE

Estimates for the prevalence of hepatitis C among people with a serious mental illness are high compared with the general population. High-risk behaviours commonly associated with mental illness may contribute to the estimated increased prevalence. This study aims to assess the contribution of risk behaviours to blood-borne virus infection in psychiatric populations in Australia, and to determine whether a pre- and post-test education and counselling program increases the number of patients willing to be tested for hepatitis C.

METHOD

The proportion of psychiatric inpatients being screened for hepatitis C at the Alfred Hospital over a 6-month period was obtained by retrospective review of the number of admissions and hepatitis C serology tests. The change in screening rate was prospectively recorded following the introduction of an education and voluntary screening program. In the study period, 346 people were approached and 84 (24%) agreed to participate. Pre- and post-test counselling, including a thorough risk assessment, were offered to all participants. Venous blood was tested for hepatitis C. A modified version of the Risk Behaviour Questionnaire was used to measure sexual and drug-related risk behaviour.

RESULTS

The proportion of inpatients being tested for hepatitis C increased from 9% in the 6 months prior to the study, to 18% during the study (p <0.01). The rate of hepatitis C in those consenting to testing was 19.4%. Participants reported high rates of risk-taking behaviours, including intravenous drug use and unprotected sex.

CONCLUSIONS

An education and counselling program can increase rates of screening among psychiatric inpatients. There are high rates of risk-taking behaviour among this group of psychiatric inpatients, which may contribute to the higher prevalence of hepatitis C compared to the general population.