The impact of chronic hepatitis C and comorbid psychiatric illnesses on health-related quality of life

Impact of severe mental illnesses on health-related quality of life among patients attending the Institute of Psychiatry, Rawalpindi from 2019 to 2021: A cross-sectional study

BACKGROUND

Severe mental illnesses have huge impact on health-related quality of life. They contribute to significant morbidity in terms of number of number of years of life lost in form DALYS (disability adjusted life years) and shorter life expectancy and early mortality. There is limited evidence on their burden in low- and middle-income countries like Pakistan.

OBJECTIVE

To determine the health-related quality of life in patients suffering from severe mental illness (schizophrenia, depression, and bipolar affective disorder) and demographic factors associated with poor health related quality of life in these patients.

METHODOLOGY

This was descriptive cross sectional, using retrospective record view of data. Study was done under IMPACT (Improving Mental And Physical health Together) Program, which conducted a multi-morbidity survey conducted at institute of psychiatry, Benazir Bhutto hospital, Rawalpindi, using EQ 5d 5l (EURO QOL 5D5L) questionnaire having both subjective (EQVAS) and objective domains.

RESULTS

The study included 922 SMI patients, of whom 555 participants (60.2%) were males and 367(39.69%) were females. The participants suffered from major depressive disorder (422;45.8%), followed by bipolar affective disorder (392; 42.51%) and schizophrenia (108;11.7%). Most participants were in a younger age group with (80%) of population being below 50 years old and had education level below secondary education (57.4%). In the analysis of association between EQ-VAS (subjective quality of life scale) and demographic factors, a significant association was found for marital status(p<0.001), gender (p< 0.001) and education (p< 0.001). Women had lower EQ-VAS scores (M = 49.43±SD = 27.72) as compared to males (M = 58.81±SD = 27.1) and individuals with lower educational status also had lower mean scores. Additionally, participants who were single, divorced or widowed also had lower mean EQVAS scores. When health related quality of life was analyzed across SMI, it was lower in all SMI, but was significantly lower for depression in both subjective and objective domains of health related of quality-of-life instrument.

CONCLUSION

Health related quality of life is an important outcome measure and regular assessment of both subjective and objective aspects should be incorporated in management plans of patients suffering from severe mental illnesses.

Interaction of anxiety and hypertension on quality of life among patients with gynecological cancer: a cross-sectional study

BACKGROUND

Patients with gynecological cancer are prone to anxiety, and many of them are accompanied by hypertension, which seriously affects the quality of life (QOL). The study was to explore the interaction of anxiety and hypertension on QOL, and the moderating effect of perceived social support (PSS) in the impact of anxiety and hypertension on QOL of patients with gynecological cancer.

METHODS

A cross-sectional study was conducted in 2020, and 566 patients have been collected from the Affiliated Hospital of China Medical University. The Self-Rating Anxiety Scale (SAS), the Functional Assessment of Cancer Therapy Genera tool (FACT-G), and the Multidimensional Scale of Perceived Social Support Scale (MSPSS) were used. The interaction was analyzed by additive model, and the moderating effect was conducted by regression analysis and the simple slope analysis.

RESULTS

We found that 68.8% of patients had poor QOL due to the interaction between anxiety and hypertension. The relative excess risk ratio (RERI) was 22.238 (95%CI:44.119-88.596); the attribution ratio (AP) was 0.688 (95%CI:0.234-1.142); The interaction index (S) was 3.466 (95%CI: 0.823-14.435). The interaction items of PSS and anxiety were negatively correlated with QOL (β = -0.219, P < 0.01) and explained an additional 4.0% variance (F = 68.649, Adjusted R² = 0.399, ΔR² = 0.040, P < 0.01); PSS and blood pressure interaction item was not associated with QOL (β = 0.013, F = 55.138, Adjusted R² = 0.365, ΔR² = 0.001, P = 0.730).

CONCLUSIONS

When anxiety and hypertension coexist, the QOL was affected. PSS played a moderating role in the impact of anxiety on QOL. Healthcare providers should take intervention measures to improve patients' social support to reduce the impact of anxiety on QOL.

The combined polymorphisms of interleukin-6-174GG genotype and interleukin-10 ATA haplotype are associated with a poor quality of life in patients with chronic hepatitis C

PURPOSE

Chronic hepatitis C (CHC) is associated with a decreased health-related quality of life (HRQOL). More recent studies have pointed toward a genetic basis of patient-reported quality of life outcomes. Taking into account that the influence of single-nucleotide polymorphisms (SNPs) on the HRQOL of CHC patients has not been studied, we investigated the combined IL10-1082G/A, - 819C/T, and - 592C/A SNPs, and IL6-174G/C SNP. We also evaluated the association between demographic, clinical, psychiatric, virological, and genetic variables with domains and summaries of HRQOL in CHC patients.

METHODS

132 consecutive CHC patients and 98 controls underwent psychiatric evaluation by using the Mini International Neuropsychiatric Interview. HRQOL was assessed by a generic questionnaire, the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36), and by the specific Liver Disease Quality of Life Questionnaire (LDQOL). IL6 and IL10 polymorphisms were evaluated by Taqman SNP genotyping assay. Multivariate analysis was used to evaluate the associations.

RESULTS

Major depressive disorder was associated with lower SF-36 and LDQOL scores in seven and ten domains, respectively. Diabetes and hypertension were also associated with reduced HRQOL. CHC patients carrying the combination of IL10 ATA haplotype/IL6-GG genotype had lower scores in the SF-36-physical functioning domain, and reduced scores in the LDQOL effects of liver disease on activities of daily living, quality of social interaction, and sexual function domains than the non-carriers of the combined haplotype/genotype.

CONCLUSION

This is the first study to demonstrate that combined IL6 high-producer GG genotype and IL10 low-producer ATA haplotype is associated with poorer HRQOL in CHC patients.

A comprehensive assessment of patient reported symptom burden, medical comorbidities, and functional well being in patients initiating direct acting antiviral therapy for chronic hepatitis C: Results from a large US multi-center observational study

BACKGROUND

Symptom burden, medical comorbidities, and functional well-being of patients with chronic hepatitis C virus (HCV) initiating direct acting antiviral (DAA) therapy in real-world clinical settings are not known. We characterized these patient-reported outcomes (PROs) among HCV-infected patients and explored associations with sociodemographic, liver disease, and psychiatric/substance abuse variables.

METHODS AND FINDINGS

PROP UP is a large US multicenter observational study that enrolled 1,600 patients with chronic HCV in 2016-2017. Data collected prior to initiating DAA therapy assessed the following PROs: number of medical comorbidities; neuropsychiatric, somatic, gastrointestinal symptoms (PROMIS surveys); overall symptom burden (Memorial Symptom Assessment Scale); and functional well-being (HCV-PRO). Candidate predictors included liver disease markers and patient-reported sociodemographic, psychiatric, and alcohol/drug use features. Predictive models were explored using a random selection of 700 participants; models were then validated with data from the remaining 900 participants. The cohort was 55% male, 39% non-white, 48% had cirrhosis (12% with advanced cirrhosis); 52% were disabled or unemployed; 63% were on public health insurance or uninsured; and over 40% had markers of psychiatric illness. The median number of medical comorbidities was 4 (range: 0-15), with sleep disorders, chronic pain, diabetes, joint pain and muscle aches being present in 20-50%. Fatigue, sleep disturbance, pain and neuropsychiatric symptoms were present in over 60% and gastrointestinal symptoms in 40-50%. In multivariable validation models, the strongest and most frequent predictors of worse PROs were disability, unemployment, and use of psychiatric medications, while liver markers generally were not.

CONCLUSIONS

This large multi-center cohort study provides a comprehensive and contemporary assessment of the symptom burden and comorbid medical conditions in patients with HCV treated in real world settings. Pain, fatigue, and sleep disturbance were common and often severe. Sociodemographic and psychiatric markers were the most robust predictors of PROs. Future research that includes a rapidly changing population of HCV-infected individuals needs to evaluate how DAA therapy affects PROs and elucidate which symptoms resolve with viral eradication.

TRIAL REGISTRATION

(Clinicaltrial.gov: NCT02601820).

A Randomized Trial of Off-Site Collaborative Care for Depression in Chronic Hepatitis C Virus

OBJECTIVE

To test the effectiveness of a collaborative depression care model in improving depression and hepatitis C virus (HCV) care.

DATA SOURCES/STUDY SETTING

Hepatitis C virus clinic patients who screened positive for depression at four Veterans Affairs Hospitals.

STUDY DESIGN

We compared off-site depression collaborative care (delivered by depression care manager, pharmacist, and psychiatrist) with usual care in a randomized trial. Primary depression outcomes were treatment response (≥50 percent decrease in 20-item Hopkins Symptoms Checklist [SCL-20] score), remission (mean SCL-20 score, <0.5), and depression-free days (DFDs). Primary HCV outcome was receipt of HCV treatment.

DATA COLLECTION

Patient data were collected by self-report telephone surveys at baseline and 12 months, and from electronic medical records.

PRINCIPAL FINDINGS

Baseline screening identified 292 HCV-infected patients with depression, and 242 patients completed 12-month follow-up (82.9 percent). Intervention participants were more likely to report depression treatment response, remission, and more DFDs than usual care participants. Intervention participants were more likely to receive antiviral treatment; however, the difference was not statistically significant.

CONCLUSION

Off-site depression collaborative care improved depression outcomes in HCV patients and may serve as a model for collaboration between mental health and specialty physical health providers in other high co-occurring conditions.

Spontaneous and post-treatment HCV clearance: relationships with health-related quality of life in HIV infection (ANRS-VESPA2 study)

BACKGROUND

Post-treatment clearance of HCV is associated with improved health-related quality of life (HRQL) in HIV-HCV co-infection. However, the potential differences in HRQL between post-treatment and spontaneous clearers remain poorly documented.

METHODS

Linear regression models were used to assess the relationships between HCV status and HRQL (PROQOL-HIV scale) in 411 co-infected adults followed-up in French hospitals in 2011 (ANRS-VESPA2 survey).

RESULTS

After adjustment for socio-economic and clinical factors, patients previously exposed to HCV treatment showed better physical HRQL and better experience of HIV treatment than treatment-naive HCV-chronic patients. Post-treatment clearers showed better mental HRQL. Spontaneous clearers showed better experience of HIV treatment.

CONCLUSION

Spontaneous and post-treatment HCV clearance may influence different dimensions of HRQL of HIV-HCV co-infected patients. Further studies in real-life settings are needed to document patient-reported outcomes in the era of direct-acting antiviral agents for HCV treatment.

Maternal hepatitis B and hepatitis C infection and neonatal neurological outcomes

To examine the associations between maternal hepatitis B (HBV) and hepatitis C (HCV) infection status and selected infant neurological outcomes diagnosed at birth, we conducted a population-based, retrospective cohort study on singleton live births in Florida from 1998 to 2009. Primary exposures included maternal HBV and HCV monoinfection. The neurological outcomes included brachial plexus injury, cephalhematoma, foetal distress, feeding difficulties, intraventricular h aemorrhage and neonatal seizures. Multivariable logistic regression models were used to generate odds ratios (OR) and 95% confidence intervals (CI) that were adjusted for socio-demographic characteristics, risky behaviours, pregnancy complications and pre-existing medical conditions, and timing of delivery. The risk of an adverse neurological outcome was higher in infants born to mothers with hepatitis viral infection (7.2% for HCV, 5.0% for HBV), compared with infants of hepatitis virus-free mothers (4.2%). After adjusting for potential confounders, women with HBV were twice as likely to have infants who suffered from brachial plexus injury (OR = 2.04, 95% CI = 1.15-3.60), while those with HCV had an elevated odds of having an infant with feeding difficulties (OR: 1.32, 95% CI = 1.06-1.64) and a borderline increased likelihood for neonatal seizures (OR = 1.74, 95% CI = 0.98-3.10). Additionally, HCV+ mothers had a 22% increased odds of having an infant with some type of adverse neurological outcome (OR: 1.22, 95% CI = 1.03-1.44). Our findings add to current understanding of the association between maternal HBV/HCV infections and infant neurological outcomes. Further research evaluating the role of maternal HBV and HCV infections (including viraemia, treatment) on pregnancy outcomes is warranted.

Hepatitis C virus infection as a traumatic experience

OBJECTIVE

The purpose of this study was to evaluate whether individuals consider their HCV infection to be a potentially traumatic experience. Additionally, we investigated its association with Post-Traumatic Stress Disorder (PTSD) and the impact of PTSD diagnosis on health-related quality of life (HRQoL) in HCV infected subjects.

METHODS

We conducted a cross-sectional survey of 127 HCV-infected outpatients recruited at a University Hospital in Salvador, Brazil. All subjects answered an orally-administered questionnaire to gather clinical and socio-demographic data. We investigated traumatic experiences and the subject's perception of the disease using the Trauma History Questionnaire. PTSD and other psychiatric diagnoses were assessed through the Mini International Neuropsychiatric Interview-Brazilian Version 5.0.0 (M.I.N.I. PLUS). HRQoL was assessed using Short-Form 36 (SF-36).

RESULTS

Approximately 38.6% of the patients considered hepatitis C to be a traumatic experience. Of these, 60.7% had a PTSD diagnosis. PTSD was associated with significant impairment in quality of life for individuals in seven SF-36 domains as shown bymultivariate analysis: Role-Physical (β: -24.85; 95% CI: -42.08; -7.61), Bodily Pain (β: -19.36; 95% CI: -31.28; -7.45), General Health (β: -20.79; 95% CI: -29.65; -11.92), Vitality (β: -11.92; 95% CI: -20.74; -3.1), Social Functioning (β: -34.73; 95% CI: -46.79; -22.68), Role-Emotional (β: -26.07; 95% CI: -44.61; -7.53), Mental Health (β: -17.46; 95% CI: -24.38; -10.54).

CONCLUSION

HCV is frequently a traumatic experience and it is strongly associated with PTSD diagnosis. PTSD significantly impaired HRQoL.

Quality of life, depression, and anxiety among hepatitis B patients

This descriptive cross-sectional study was designed to determine the depression and anxiety levels, and their effects, on quality of life of patients with chronic Hepatitis B. Chronic infection with Hepatitis B virus has a profound effect on health-related quality of life. Medications, including interferon, that are commonly used to treat chronic viral Hepatitis B may cause depression as an adverse effect. However, little is known about the impact of depression and anxiety on quality of life in patients with Hepatitis B. A total of 96 patients aged between 15 and 61 years were included in the study. Slightly more than half of them (52%) were female. Three scales-the Beck Depression Inventory, Beck Anxiety Scale, and Short Form of the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF)-were used in the study. The scores obtained from the BDS in 91.7% of the patients were above the cutoff value of 17. Moreover, 80 patients received interferon. There was a negative correlation between the physical, environmental, and cultural areas on the Beck Anxiety Scale and WHOQOL-BREF (Turkish) (p< .05). A high level of depressive symptoms was established in this study, and the physical, environmental, and cultural aspects of quality of life were determined to increase as the anxiety level increased.

The health-related quality of life burden of co-morbid cardiovascular disease and major depressive disorder in Australia: findings from a population-based, cross-sectional study

PURPOSE

Health-related quality of life (HRQOL) can be significantly impaired by the presence of chronic conditions such as cardiovascular disease (CVD) and major depressive disorder (MDD). The aim of this paper was to (1) identify differences in HRQOL between individuals with CVD, MDD, or both, compared to a healthy reference group, (2) establish whether the influence of co-morbid MDD and CVD on HRQOL is additive or synergistic and (3) determine the way in which depression severity interacts with CVD to influence overall HRQOL.

METHODS

Population-based data from the 2007 Australian National Survey of Mental Health and Well-being (NSMHWB) (n = 8841) were used to compare HRQOL of individuals with MDD and CVD, MDD but not CVD, CVD but not MDD, with a healthy reference group. HRQOL was measured using the Assessment of Quality of Life (AQOL). MDD was identified using the Composite International Diagnostic Interview (CIDI 3.0).

RESULTS

Of all four groups, individuals with co-morbid CVD and depression reported the greatest deficits in AQOL utility scores (Coef: -0.32, 95% CI: -0.40, -0.23), after adjusting for covariates. Those with MDD only (Coef: -0.27, 95% CI: -0.30, -0.24) and CVD only (Coef: -0.08, 95% CI: -0.11, -0.05) also reported reduced AQOL utility scores. Second, the influence of MDD and CVD on HRQOL was shown to be additive, rather than synergistic. Third, a significant dose-response relationship was observed between depression severity and HRQOL. However, CVD and depression severity appeared to act independently of each other in impacting HRQOL.

CONCLUSIONS

HRQOL is greatly impaired in individuals with co-morbid MDD and CVD; these conditions appear to influence HRQOL in an additive fashion. HRQOL alters with depression severity, therefore treating depression and improving HRQOL is of clinical importance.

Hepatitis C infection, antiviral treatment and mental health: a European expert consensus statement

Mental health problems frequently occur in chronic infection with the hepatitis C virus (HCV) and during antiviral treatment with pegylated interferon-alpha (PegIFNα) and ribavirin. Depression is one of the most important complications during antiviral treatment of chronic hepatitis C infection. However, an increased prevalence of depression, fatigue, and cognitive disturbances has also been reported in untreated HCV-positive patients. Patients with psychiatric disorders or drug addiction also have an increased risk of HCV infection. Furthermore, because of possible drug-drug interactions, new antivirals administered together with PegIFNα and ribavirin may complicate psychiatric side effect management, even if no specific psychiatric adverse events are known so far for these new drugs. The European liver patient's organization (ELPA) organised a European expert conference to review the literature and develop expert recommendations for the management of mental health problems in HCV infected patients. This paper results from the output of the 2011 EASL meeting and subsequent dialogue with patient groups and relevant experts in Europe. It summarises the current knowledge of HCV infection and the brain; prevalence, course, and neurobiology of IFN-α associated psychiatric side effects; possible risk factors for IFN-α associated depression and suicide attempts; psychiatric management of HCV infected patients before and during antiviral treatment; prevention of IFN- α associated psychiatric side effects; and psychiatric aspects of the new antivirals. The summarised current knowledge about mental health changes before and during antiviral treatment should improve interdisciplinary management of HCV infected patients.

Somatic symptoms and the association between hepatitis C infection and depression in HIV-infected patients

Studies of depression and hepatitis C virus (HCV) infection in HIV-infected patients have been contradictory and often not addressed key differences between HCV-infected and uninfected individuals including substance use. This cross-sectional observational study from the University of Washington HIV cohort examined associations between HCV, symptoms, and depression in HIV-infected patients in routine clinical care. Patients completed instruments measuring depression, symptoms, and substance use. We generated depression severity scores and used linear regression to examine the relationship with HCV accounting for demographic and clinical characteristics. We conducted sensitivity analyses in which we removed depression somatic symptom items (e.g., fatigue) from depression scores, and sensitivity analyses in which we also adjusted for nondepression somatic symptom items to examine the role of somatic and nonsomatic symptoms in the association between depression and HCV. Of 764 HIV-infected patients, 160 (21%) were HCV-infected. In adjusted analysis, HCV-infected patients had worse depression severity (p =0.01) even after adjusting for differences in substance use. HCV remained associated with depression severity in secondary analyses that omitted the depression somatic patient health questionnaire-9 (PHQ-9) items (p=0.01). However, when nondepression somatic symptoms were included as covariates in multivariate analyses, HCV was no longer associated with depression (p=0.09).

The impact of hepatitis C on labor force participation, absenteeism, presenteeism and non-work activities

OBJECTIVE

Between 2.7 and 3.9 million people are currently infected with the hepatitis C virus (HCV) in the United States. Although many studies have investigated the impact of HCV on direct healthcare costs, few studies have estimated the indirect costs associated with the virus using a nationally-representative dataset.

METHODS

Using data from the 2009 United States (US) National Health and Wellness Survey, patients who reported a hepatitis C diagnosis (n = 695) were compared to controls on labor force participation, productivity loss, and activity impairment after adjusting for demographics, health risk behaviors, and comorbidities. All analyses applied sampling weights to project to the population.

RESULTS

Patients with HCV were significantly less likely to be in the labor force than controls and reported significantly higher levels of absenteeism (4.88 vs. 3.03%), presenteeism (16.69 vs. 13.50%), overall work impairment (19.40 vs.15.35%), and activity impairment (25.01 vs. 21.78%). A propensity score matching methodology replicated many of these findings.

CONCLUSIONS

While much of the work on HCV has focused on direct costs, our results suggest indirect costs should not be ignored when quantifying the societal burden of HCV. To our knowledge, this is the first study which has utilized a large, nationally-representative data source for identifying the impact of HCV on labor force participation and work and activity impairment using both a propensity-score matching and a regression modeling framework.

LIMITATIONS

All data were patient-reported (including HCV diagnosis and work productivity), which could have introduced some subjective biases.

Effects of recognizing depression with a standardized questionnaire (CES-D) versus patient reporting of depression after a single-standardized question on the outcomes of treatment for hepatitis C with pegylated interferon-α-2b and ribavirin

BACKGROUND

Depression may worsen during antiviral treatment for hepatitis C virus, resulting in noncompliance treatment.

AIM

The aim was to compare the response and compliance rates between the groups of veteran patients using two different methods of identifying depression, either the Centers for Epidemiology Studies for Depression Scale (group A) questionnaire or the report of symptoms of depression after a single-standardized question by the health care provider (group B).

METHODS

One hundred and twenty-nine patients were randomly assigned to the two groups before the treatment.

RESULTS

No statistical differences were noted in baseline characteristics between the groups. Depression was common in both the groups. No difference between initial Centers for Epidemiologic Studies Depression Scale scores and diagnosis of depression between the two groups was noted. Furthermore, the number of patients diagnosed with depression during the treatment was similar in each group. There were no significant differences between the groups in rates of sustained viral response (30% group A, 35% group B) or in rates of overall compliance with patients receiving more than 90% of prescribed PegIntronA therapy (44% group A, 39% group B), and ribavirin (32% group A and 37% group B).

CONCLUSION

The use of the Centers for Epidemiology Studies for Depression Scale questionnaire to recognize depression had no significant advantage over patient reporting of depression symptoms after a single-standardized question on the hepatitis C virus clearance and the treatment compliance rates in veteran populations.

Hepatitis C and depressive symptoms: psychological and social factors matter more than liver injury

OBJECTIVE

Given that the hepatitis C virus (HCV) crosses the blood-brain barrier, biological factors are commonly blamed for the high rates of mood disturbance in HCV-infected patients. However, no study assessing the potential contribution of psychosocial factors to depression in HCV has yet been conducted.

METHODS

A cross-sectional survey of 65 patients was undertaken to identify biological, psychological, and sociological contributions to depression. Biological, psychological, and sociological variables were tested for their association with depressive symptomatology as measured by the BDI-II. Separate analyses were conducted on health-related quality of life (HRQOL), as measured by the SF-36, in order to confirm findings in previous work.

RESULTS

Psychosocial variables assessed in the study, such as less social functioning, less religious faith, less ability to work, less salary, personal suicide attempt, worse reaction to diagnosis, and feeling "stressed out" were all associated with higher depression scores and lower HRQOL. Biological variables, including viral load, liver enzyme levels, INR, and stage of liver fibrosis on biopsy, were not associated with higher depression or lower HRQOL.

CONCLUSIONS

The amount of disease as measured by laboratory abnormalities such as viral load, liver function tests, liver biopsy, and INR do not provide much useful information about a patient's depressive symptoms. Instead, these depressive symptoms are more influenced by psychological and social factors. Psychosocial support may therefore be beneficial to HCV patients.

Humanistic and economic impacts of hepatitis C infection in the United States

OBJECTIVE

Prior research examining the effect of hepatitis C virus (HCV) on health-related quality of life (HRQoL) and healthcare costs is flawed because non-patient controls were not adequately comparable to HCV patients. The current study uses a propensity score matching methodology to address the following research question: is the presence of diagnosed hepatitis C (HCV) associated with poorer health-related quality of life (HRQoL) and greater healthcare resource use?

METHODS

Using data from the 2009 US National Health and Wellness Survey, patients who reported a HCV diagnosis (n = 695) were compared to propensity-matched controls (n = 695) on measures of HRQoL and healthcare resource use. All analyses applied sampling weights to project to the US population.

RESULTS

HCV patients reported significantly lower levels of HRQoL relative to the matched-control group, including the physical component score (39.6 vs. 42.7, p < 0.0001) and health utilities (0.63 vs. 0.66, p < 0.0001). The number of emergency room visits (0.59 vs. 0.44, p < 0.05) and physician visits (7.7 vs. 5.9, p < 0.05) in the past 6 months were significantly higher for the HCV group relative to matched controls.

CONCLUSION

The results of this study suggest that HCV represents a substantial burden on patients by having a significant and clinically-relevant impact on key dimensions of HRQoL as well as on utilization of healthcare resources, the latter of which would result in increased direct medical costs.

LIMITATIONS

Due to limitations of the internet survey approach (e.g., inability to confirm HCV diagnosis), future research is needed to confirm these findings.

Specialty care and education associated with greater disease-specific knowledge but not satisfaction with care for chronic hepatitis C

BACKGROUND

Little is known about differences among hepatitis C virus (HCV) patients managed by generalists vs. specialists with respect to patient-centred outcomes, such as disease-specific knowledge, health-related quality of life (HRQoL) and satisfaction with care.

AIM

To examine selected patient-centred outcomes of HCV-related care provided in primary care, specialty care or both.

METHODS

A total of 629 chronic HCV patients completed a survey including an HCV knowledge assessment and validated instruments for satisfaction and HRQoL. Multivariable linear regression was used to compare outcomes between groups.

RESULTS

Adjusted total HCV knowledge score was lower among patients who did not attend specialty care (P < 0.01). Primary care and specialty patients did not differ in adjusted general HRQoL or satisfaction. Sixty percent of specialty patients underwent formal HCV education, which was associated with 5% higher knowledge score (P = 0.01). General HRQoL and patient satisfaction did not differ between primary care and specialty groups. Disease-specific knowledge and care satisfaction were independent of mental illness, substance abuse, socio-economic variables, history of antiviral treatment, formal HCV education and duration of time between last visit and survey completion.

CONCLUSIONS

Primary care patients with chronic HCV have lower adjusted disease-specific knowledge than specialty patients, but no difference in general HRQoL or patient satisfaction.

Health-related quality of life in methadone maintenance patients with untreated hepatitis C virus infection

OBJECTIVE

To assess health-related quality of life (HRQOL) in methadone maintenance treatment (MMT) patients with untreated chronic HCV infection and to determine the clinical factors that predict HRQOL.

METHOD

HRQOL was measured in 100 MMT patients entering an HCV treatment trial. Subjects were mostly male (61%) and white (81%) with a mean age of 43 (+/-10). 57% had a current non-substance use psychiatric disorder. 55% had a current (past 12 months) substance use disorder, including 44% with current opioid or cocaine abuse/dependence. HRQOL in our sample was compared to published reports for the general population as well as for non-MMT HCV patients. To assess predictors of SF-36 HRQOL, hierarchical multiple regression techniques were used to assess model improvement with four blocks of baseline predictors: Demographics, Medical Severity, Addiction Severity, and Depression Severity.

RESULTS

HRQOL scores were significantly lower than scores for the general population and were also lower than scores reported for untreated HCV patients not in MMT. Regression analysis demonstrated a consistent pattern whereby Depression Severity increased predictive accuracy for HRQOL measures over simpler models. Beck Depression Inventory scores significantly predicted quality of life across both the mental and physical composite scores and all eight sub-scales of the SF-36.

CONCLUSIONS

Untreated HCV patients in MMT had lower HRQOL than HCV patients not in MMT. Depression Severity was associated with significantly lower quality of life measures, suggesting that psychiatric evaluation and intervention prior to the start of HCV treatment may improve overall quality of life and could influence HCV treatment outcomes in MMT patients.

Impact of hepatitis C virus infection on children and their caregivers: quality of life, cognitive, and emotional outcomes

OBJECTIVE

Hepatitis C virus (HCV) infection is associated with decreased quality of life (QOL) and neurocognitive dysfunction in adults, but little is known about its impact on children and their caregivers.

PATIENTS AND METHODS

We studied the QOL, behavioral, emotional, and cognitive functioning of 114 treatment-naïve children with HCV enrolled in a placebo-controlled, randomized, multisite clinical trial evaluating peginterferon alpha-2a alone or with ribavirin. Baseline assessment included measures of children's QOL, cognitive functioning, behavioral adaptation, and depression. Caregivers' QOL also was assessed.

RESULTS

Relative to published normative data, caregivers were more likely to believe that their children's health was poor and would likely worsen (t = 3.93; P < 0.0001), and reported higher concern about their children's health status (t = 6.63; P < 0.0001) and that this concern limited family activities (t = 2.45; P < 0.01); they also viewed their children as having more internalizing behavioral problems (t = 1.98; P < 0.05). Only 2 (2%) children had a score in the clinically depressed range. Children with HCV had worse cognitive functioning than the normative sample but significantly better functioning than children with attention-deficit/hyperactivity disorder. Caregivers' QOL scores did not differ significantly from the normative sample, but infected mothers had lower QOL than noninfected caregivers. Caregivers were highly distressed about their children's medical circumstances.

CONCLUSIONS

Although HCV infection, in its early stages, does not lead to global impairment in QOL, cognitive, behavioral, or emotional functioning in children, it is associated with higher caregiver stress and strain on the family system, and it may be associated with some cognitive changes in children.

Guideline-concordant hepatitis C virus testing and notification among patients with and without mental disorders

OBJECTIVE

We compared screening for hepatitis C virus (HCV), positive HCV test rates and test result notification among Veterans Affairs (VA) patients diagnosed with psychosis (e.g., schizophrenia, bipolar disorder) or depression or those with no psychiatric diagnosis.

METHOD

We identified all patients in the VA's External Peer Review Program national random sample of chart reviews regarding HCV care in fiscal year 2004. We then identified individuals diagnosed with psychosis or depression using data from the VA's National Psychosis and Depression registries. Using multivariable logistic regression and generalized estimating equation analyses, we evaluated associations between mental disorder diagnosis and receipt of HCV screening and notification of results.

RESULTS

Out of 19,397 patients, 94% received HCV tests. Of those tested, 6.9% were HCV positive, and of those who were positive, 48.2% were notified of their result within 60 days. After adjusting for demographic and clinical factors (including illicit drug use and comorbidities), individuals with psychosis or depression were no less likely to have a positive test or be notified of their result < or =60 days compared to nonpsychiatric groups. Those with drug use disorder diagnoses (OR=4.64; P<.001) and Blacks (OR=1.96; P<.001) were more likely to have a positive test.

CONCLUSIONS

Study limitations included inability to fully control for sociodemographic confounders (e.g., homelessness, incarceration). Nevertheless, we found that although the vast majority of patients were tested, only half were notified of test results. VA HCV prevention and follow-up strategies focus on enhanced notification overall and tailoring HCV risk reduction programs to minorities and those with drug use disorders.

The impact of chronic hepatitis C and co-morbid illnesses on health-related quality of life

OBJECTIVES

Determine the relative impact of chronic hepatitis C (CHC) and co-morbid illnesses on health-related quality of life (HRQoL) in 3023 randomly selected veterans with known hepatitis C virus antibody (anti-HCV) status who previously completed a veteran-specific HRQoL questionnaire (SF-36V).

METHODS

Multiple regression analyses were performed to measure the relative contribution of anti-HCV status, four demographic variables, and ten common medical and six psychiatric co-morbidities to HRQoL between 303 anti-HCV(+) and 2720 anti-HCV(-) patients.

RESULTS

Anti-HCV(+) veterans were younger, reported a lower HRQoL on seven of eight 36-Item Short Form Health Survey for Veterans (SF-36V) subscales (P < or = 0.001) and the mental component summary (MCS) scale (P < 0.001). The ten medical and six psychiatric co-morbidities had variable impact on predicting lower HRQoL in both groups. After adjusting for demographic variables and co-morbid illnesses, we found that anti-HCV(+) patients reported a significantly lower MCS score (P < 0.001) and a trend toward a lower physical component summary (PCS) score (P < 0.07) compared to anti-HCV(-) veterans. Among the anti-HCV(+) veterans, co-morbid medical illnesses contributed to impaired PCS but not to MCS.

CONCLUSIONS

Veterans with CHC were younger than HCV(-) veterans and hence less likely to have other co-morbid medical illnesses. Medical co-morbidities seen in those veterans with CHC contribute to impaired PCS but not MCS. Anti-HCV(+) status negatively affects HRQoL, particularly MCS, independently of medical and psychiatric co-morbidities.