Sunday, October 14, 2012

Severity of depression in hepatitis B and hepatitis C patients.

J Coll Physicians Surg Pak. 2012 Oct;22(10):632-4. doi: 10.2012/JCPSP.632634.

Severity of depression in hepatitis B and hepatitis C patients.

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Discussion provided below

Department of Gastroenterology, Shifa International Hospital, Islamabad.

Objective: To assess and compare the severity of depression in chronic hepatitis B (CHB), chronic hepatitis C (CHC) and healthy subjects.

Study Design: Comparative study. Place and Duration of Study: Shifa International Hospital, Islamabad from July 2011 to February 2012.

Methodology: A total of 206 subjects were divided in three groups. Group-I (chronic hepatitis C, n = 95), group-II (chronic hepatitis B, n = 29) and group-III (healthy subjects, n = 82). They were matched for age, gender and socioeconomic status and were compared for frequency and severity of depression as measured by Hospital Anxiety and Depression Scale (HADS).

Results: Some degree of depression was noted in all groups. Frequency of depression was 72.6% in group-I, 58.6% in group-II and 37.8% in group-III (p value < 0.001). Conclusion: Both CHC and CHB had high frequency of some degree of depression. Hepatitis C patients had more depressive features than CHB. It is worthwhile to do more close mental health observation in them. A multidisciplinary team including a psychiatric specialist can help in this approach.


Most of the patients with liver diseases experience anxiety and depression symptoms.10,18 The number of people with co-morbid HCV and depressive disorder (including minor depression) increased significantly between 1995 and 2005 from 18% to over 35% of all people with diagnosed HCV.

The results of this study reveal that patients with hepatitis C had more depression compared with those suffering from hepatitis B and controls (72.6% in HCV group, 58.6% in HBV group and 37.8% in the control group).

These results are in accordance with a previous study that demonstrated that hepatitis C positive patients had more psychiatric disorders than hepatitis B positive patients.

In another study, hepatitis C patients exhibited more anxiety,depression and mood disorders in comparison with other liver diseases. 21 It has also been demonstrated that the quality of life is lower in CHC patients as compared to CHB patients.

It is hypothesized that multiple factors are responsible for depression in hepatitis patients. Complexity, ambiguity, inconsistency and unpredictability of the course of illness, alterations in brain metabolites as evident by magnetic resonance imaging spectroscopy, and emotional factors and perception of stigma are thought to be the causes of depression in this population.23,24

Diagnosis of the psychiatric disorders at the commencement of interferon therapy seems to be very important as some severe psychiatric disorders like depression have been a contraindication for prescribing these agents necessitating a close monitoring of these patients.

Incidence of depression and mortality following interferon therapy has been reported to be as high as 17% and 0.02% to 3.4%, respectively. 26 Taking into consideration that psychiatric disorders usually occur in the first month following commencement of interferon therapy, early assessment of patient's mental health seems to be desirable in most cases. Early treatment of depression does affect response and adherence to treatment. 27 The frequency of depression in hepatitis patients in this study was even higher, especially in CHC. A multi-disciplinary team should be consulted to develop complex physical and psychological treatments for patients with CHC.

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