Engagement in Group Psychotherapy Among Marginalized Individuals With Hepatitis C

This article examines an innovative psychoeducational group model at a community-based hepatitis C treatment program in Toronto, Canada. Group support is increasingly used as part of community-based, interdisciplinary approaches to addressing the complex psychosocial needs and barriers to care of individuals living with and/or undergoing treatment for hepatitis C. This article articulates the theoretical framework and details of one such group model. It also examines group engagement and outcomes using data collected over three group cycles. Psychotherapeutic engagement was higher than might be anticipated for a highly marginalized population. Specifically, group cohesion measures were equivalent or higher compared to norms for other support/psychotherapy groups. This study suggests that individuals with complex psychosocial issues have the ability to engage meaningfully in group therapy.

Influence of psychiatric diagnosis on treatment uptake and interferon side effects in patients with hepatitis C

BACKGROUND AND AIM

Pegylated-interferon-α/ribavirin (PEG-IFN/RBV) treatment can cure hepatitis C virus (HCV) infection but has frequent neuropsychiatric side-effects. Patients with pre-existing psychiatric illness may not be offered therapy. We established prevalence of self-reported psychiatric comorbidity among HCV-infected patients in a hospital-liver clinic, and determined the impact of such diagnoses on uptake and tolerance to PEG-IFN/RBV.

METHODS

All HCV cases referred for assessment in Australian Capital Territory/surrounding regions April 2004-March 2012 were entered into a clinical database. We conducted univariate and multivariate analyses of variables correlating with uptake of antiviral therapy and frequency of treatment-related side-effects.

RESULTS

Of 773 referred patients, 235 (30%) described pre-existing psychiatric illness. Among these, 26% received antiviral therapy, compared with 30% of 538 without psychiatric comorbidity. History of depression (usually validated by liaison psychiatry) was associated with higher incidence of treatment-related neuropsychiatric side-effects (odds ratio 2.79 [1.35-5.70], P < 0.05) but did not affect treatment outcome. Twenty-seven patients reported schizophrenia: three (11%) received antiviral therapy, compared with 30% admitting depression and 20% with bipolar affective disorder (all assessed by psychiatrist). In most schizophrenia cases, the reason for not offering antiviral treatment was psychological illness, yet none of five treated (these three plus two others in a psychiatric rehabilitation facility) experienced worsening psychiatric symptoms.

CONCLUSIONS

A history of depression is common with hepatitis C but does not affect initiation of antiviral treatment, despite substantially increased risk of psychiatric side-effects. In contrast, pre-existing schizophrenia appears to influence treatment decisions, despite little evidence that PEG-IFN/RBV exacerbates the psychiatric condition, and well-supervised antiviral therapy can have good outcomes.

"It gives me a sense of belonging": providing integrated health care and treatment to people with HCV engaged in a psycho-educational support group

BACKGROUND

Injection drug use (IDU) increases the risk of contracting hepatitis C virus (HCV) yet very few people living with HCV access effective, and potentially curative, treatments. The East Toronto Hepatitis C Program (ETHCP) was developed in 2006 and provides health care, treatment and support to people living with HCV who have complex mental health, physical health and psychosocial needs. The program is anchored in a 16-18 week psychosocial support group located within one of the 3 participating community-based health clinics. The objective of this study was to explore the experiences of individuals engaged in the ETHCP psycho-educational group.

METHODS

This phenomenological qualitative study consisted of semi-structured in-depth interviews with twenty randomly selected program participants.

RESULTS

The three dominant themes that emerged from the analysis were program structure, group cohesion and group as agent for change. The ETHCP "one-stop shopping" model provided a stable foundation allowing for the development of group cohesion. Group cohesion was marked by the formation of intense relationships creating a safe and non-judgmental environment where participants could self-reflect, make social connections and feel cared for and accepted. Three types of relationships characterized group cohesion: relationship to self, relationships with individual group members and relationship to group as a whole. Within the nurturing group environment, participants could challenge themselves and others, ultimately enabling change.

CONCLUSION

The results of our qualitative study suggest that it is the formation of strong group cohesion that facilitated participants' behavioural change, regardless of their level of substance use. The structure of the group provided stability and was characterized by consistent weekly meetings, knowledge exchange and the provision of multiple services in one location. The support from peers and staff allowed participants to develop personal goals. Participants began to see themselves in a new and changed way; expressing this change in a variety of positive behaviours.

Treatment of chronic hepatitis C infection among current and former injection drug users within a multidisciplinary treatment model at a community health centre

The aim of the present prospective observational study was to assess uptake and success of hepatitis C virus (HCV) treatment among a group of former and current injection drug users with chronic HCV infection at the Street Health Centre in Kingston, Ontario. The Street Health Centre offers hepatitis C education, assessment and treatment within a multidisciplinary, integrated and collaborative treatment model of care delivered by primary care professionals. The study enrolled a convenience sample of 34 patients. Seventy per cent of study patients had no postsecondary education, 85% were unemployed and one-third were unstably housed. A majority of study patients self-reported mental health problems. Of the 14 patients who initiated antiviral treatment in the study period, eight (57%) achieved sustained virological response. Regardless of virological outcome, patients who initiated treatment showed positive trends toward increased social and psychiatric stability, and decreases in high-risk behaviours. These results suggest that not only is successful treatment of chronic HCV infection in current and former injection drug users with concurrent psychiatric disorders possible, but the benefits of such treatment delivered in a community-based, multidisciplinary, primary care model may extend beyond narrowly defined virological outcomes.

Neuropsychiatric and psychosocial issues of patients with hepatitis C infection: a selective literature review

CONTEXT

We briefly reviewed the evidence on the association of hepatitis C (HCV) infection with several aspects of mental and psychosocial health.

EVIDENCE ACQUISITION

Medline was searched with appropriate keywords. The primary sources were the systematic reviews. If systematic reviews were not available for a subject, then the most relevant and methodologically sound original studies were selected.

RESULTS

HCV infection is associated with poorer health-related quality of life, and physical, mental, and social health. A part of impaired health of these patients is related to cirrhosis, intravenous drug use, co morbid psychiatric disorders, stigmatization, poor social support, alcohol abuse, and interferon treatment. However, HCV itself is also associated with poorer health status particularly in the physical and cognitive domains, which might be related to brain alterations induced by the virus. Interferon treatment is an important cause of depression in HCV patients and sometimes is associated with irritability, manic episode, or acute confusional state. Social health of HCV patients is significantly impaired by stigmatization, poor social support, psychiatric comorbidties, and impaired coping. Psychosocial impairment of HCV patients significantly impairs their treatment adherence. A supportive and nonjudgmental multidisciplinary team is required for optimal management of these patients.

CONCLUSIONS

Patients with HCV infection had complex neuropsychiatric and psychosocial problems. These problems are challenges for management of HCV infection, affect the patient's care significantly, and might alter the course of the disease. A multidisciplinary approach, a supportive environment, and a nonjudgmental healthcare team are required for optimal medical and psychosocial management of patients with HCV.