Impact of depressive symptoms and hepatic encephalopathy on health-related quality of life in cirrhotic hepatitis C patients

Abstract

Depression, common in chronic medical conditions, and hepatic encephalopathy (HE), a reversible neuropsychiatric syndrome due to liver dysfunction, are associated with impaired health-related quality of life (HRQOL) in cirrhosis and hepatitis C (HCV). This study investigated the impact of depression and HE on HRQOL in cirrhotic patients with HCV. A convenience sample of 43 ambulatory patients, with varying degrees of cirrhosis secondary to HCV, was prospectively enrolled in this study. Participants were assessed for any current depressive, fatigue, and daytime sleepiness symptoms and underwent a psychometric evaluation to determine the presence of HE symptoms. Participants reported current HRQOL on general health and liver disease-specific questionnaires. Diagnosis and current health status were confirmed via medical records. The associations between disease severity, depressive symptoms, HE, fatigue, and daytime sleepiness were measured. Predictors of HRQOL in this sample were determined. Depressive symptoms (70 %) and HE (77 %) were highly prevalent in this sample, with 58 % actively experiencing both conditions at the time of study participation. A significant positive association was found between depressive symptoms and HE severity (P = .05). Depressive symptoms were significantly associated with fatigue (P < .001), daytime sleepiness (P < .001), general HRQOL (P < .001), and disease-specific HRQOL (P < .001). HE was significantly associated with fatigue (P = .02), general HRQOL (P < .001), and disease-specific HRQOL (P < .001). Depressive symptoms and HE were significant predictors of reduced HRQOL (P < .001), with depressive symptoms alone accounting for 58.8 % of the variance. Depressive symptoms and HE accounted for 68.0 % of the variance. Findings suggest a possible pathophysiological link between depression and HE in cirrhosis, and potentially a wider-reaching benefit of treating minimal and overt HE than previously appreciated.

A Survey on the Prevalence of Depression in Blood Donors with Hepatitis C in Shiraz

“…Participants were asked about the demographic characteristics, the risk factors probably related to hepatitis infection, the risk factors probably related to depression, history of any psychiatric or medical problems, and use of any medication. The psychiatrist interviewed subjects using the NIMH Diagnostic interview schedule (DIS) (3). The Beck depression inventory (BDI) (Persian one) as a reliable, validated, standardized questionnaire, which assesses presence and severity of depressive symptoms, is a self-report measure that rates severity of depressive symptoms (3).…”

“…The psychiatrist interviewed subjects using the NIMH Diagnostic interview schedule (DIS) (3). The Beck depression inventory (BDI) (Persian one) as a reliable, validated, standardized questionnaire, which assesses presence and severity of depressive symptoms, is a self-report measure that rates severity of depressive symptoms (3). This instrument has a good reliability (r = 0.72) and high internal consistency (Cronbach’s α = 0.94).…”

“…It is estimated that depression is affecting 350 million individuals around the world every year (3). Similar to other chronic diseases, mood disorders and psychiatric problems are more prevalent in hepatitis C patients.…”

“…Furthermore, treatment of HCV by Peginterferon or Ribavirin was also accompanied by physical, behavioral, and psychiatric side effects, including flu-like symptoms, fatigue, insomnia, depression, and irritability (6). All these could decline psychosocial functioning, worsen physical symptoms , decrease patients’ quality of life, cause poor treatment adherence and efficacy, and increase the burden of disease in terms of medical costs, morbidity, and mortality (3, 7). Thus, depression could be a main barrier to start the treatment in the HCV patients (6).…”

Pre-Transplant Depression Is Associated with Length of Hospitalization, Discharge Disposition, and Survival after Liver Transplantation

“…heart failure, acute myocardial infarction and stroke)[2–4]. Depression detracts from quality of life [5] and is associated with disability among patients with chronic liver disease [6], but remains undertreated both in the pre- and post- transplant settings [7, 8]. Therefore, it is critical to understand the associations between depression and outcomes after liver transplantation.…”