Physical and psychosocial contributors to quality of life in veterans with hepatitis C not on antiviral therapy.
OBJECTIVE
Treatment-naive hepatitis C virus (HCV)-infected patients report impaired health-related quality of life (HRQOL), although causes are unclear. Psychosocial factors may be major determinants of HRQOL.


METHODS
We administered a general (Short Form-36; SF-36) and a liver-specific (Chronic Liver Disease Questionnaire; CLDQ) HRQOL measure to 62 HCV-infected veterans being considered for antiviral therapy. Psychosocial assessment included the Structured Clinical Interview for DSM-IV Axis I Disorders/Non-Patient (SCID-I/NP), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Abbreviated Cook-Medley (ACM) anger measure, and Medical Outcomes Study Social Support Measure (SSM). We examined the potential determinants of HRQOL, including psychosocial measures, demographic measures (age, sex, race/ethnicity), clinical measures (presence of cirrhosis, comorbid medical conditions), and viral data (quantitative PCR).


RESULTS
SF-36 scores were significantly lower in HCV-infected patients than published U.S. population norms but similar to those reported by previous studies of HCV-infected samples. CLDQ scores were very similar to those reported by previous studies. Demographic, clinical, and viral indicators were not statistically associated with HRQOL, and neither was the presence of a substance abuse or psychotic disorder. Lower BDI-II and BAI scores were associated with better general and disease-specific HRQOL. Lower SSM scores were associated with lower scores on SF-36 but not CLDQ; however, this effect did not persist in multiple linear regression analyses. In these, BDI-II was the strongest independent predictor of both SF-36 and CLDQ.


CONCLUSIONS
Psychosocial factors, especially depression, are strong indicators of impaired HRQOL for HCV-infected veterans not receiving antiviral therapy. Screening and treatment of psychosocial factors is recommended.
Rowan
Paul J
PJ
Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA.
Al-Jurdi
Rayan
R
Tavakoli-Tabasi
Shahriar
S
Kunik
Mark E
ME
Satrom
Sarah L
SL
El-Serag
Hashem B
HB
D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D018450:Disease Progression; D005260:Female; D006304:Health Status; D019698:Hepatitis C, Chronic / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011581:Psychological Tests; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
D000998:Antiviral Agents