Addressing Tri‐Morbidity (Hepatitis C, Psychiatric Disorders, and Substance Use): The Importance of Routine Mental Health Screening as a Component of a Comanagement Model of Care

Abstract

Psychiatric and substance use disorders are highly prevalent among veterans with chronic hepatitis C. Thirty-five percent have significant symptoms of depression before the initiation of treatment with interferon (IFN). Routine screening for underlying psychiatric and substance use disorders and early treatment intervention before initiating antiviral therapy is essential to prevent worsening of depression and to optimize the outcome of treatment with IFN. Comanagement treatment models involving mental health care may expand the pool of patients eligible to receive treatment with IFN, as well as enhance treatment outcomes.

Systemic abnormalities in liver disease

“…The therapeutic response to antiviral treatment for neuropathies is generally unsatisfactor y [172] . Furthermore, fatigue or depression is found in many patients with chronic HCV infection, with incidences of about 50% and 35%, respectively [173][174][175] . These neurocognitive dysfunctions have been characterized epidemiologically or pathophysiologically in chronic HCV infection [166,167,176] , and may be explained by the neuroinvasion of HCV, because HCV has been reported to be found in monocytes/microglia of the central nervous system [176,177] .…”

Depressive symptoms in patients with chronic hepatitis C are correlated with elevated plasma levels of interleukin-1β and tumor necrosis factor-α

“…Depressive symptoms often accompany diseases affecting the immune system including, but not limited to, HIV/AIDS [26], diabetes [3], multiple sclerosis [10] and cardiovascular disease [21]. Depressive symptoms are also common in patients with chronic hepatitis C viral infection (HCV) [1,9,12]. In a study of 293 patients with HCV, 35% had depression rating scale scores in the moderate-to-severe range prior to starting antiviral [interferon (IFN)-based] therapy [9].…”

Antiviral Completion Rates and Sustained Viral Response in Hepatitis C Patients With and Without Preexisting Major Depressive Disorder

“…In a more recent prospective study, conducted by the Hepatitis C Resource Center (HCRC) at the Portland VA Medical Center (PVAMC), in which HCV patients were screened for psychiatric illness when they attended their initial hepatology appointment, 81% screened positive for depression, and between 35% and 40% had a Beck Depression Inventory score over 20, suggesting moderate-to-severe depression. 5 Because of the high risk of IFNinduced depression, patients with HCV and comorbid depression have been excluded historically from antiviral therapy.…”