title: Hepatitis C virus infection is independently associated with depression among methadone maintenance treatment heroin users in China.
abstract: BACKGROUND
  Depression and hepatitis C virus (HCV) infection are two common conditions among heroin users in methadone maintenance treatment (MMT). However, the comorbid relationship between depression and HCV infection among MMT patients is not well understood.
  
  
  METHODS
  One hundred and fifteen MMT patients were recruited from the Yangpu MMT Clinic in Shanghai. Demographic characteristics, drug use and HCV-related information were collected using a structured interview. The Beck Depression Inventory (BDI-II) and the Perceived Stress Scale (PSS) were administered to evaluate participants' symptoms of depression and stress severity. HCV antibody (anti-HCV) test results were collected from patients' MMT clinical medical records.
  
  
  RESULTS
  58.2% of participants were anti-HCV positive, and 41.3% scored moderate-to-severe for symptoms of depression (BDI-II scores >19). The prevalence of depressive symptoms (BDI-II score >19) was greater in HCV positive than HCV negative participants (51.6% versus 27.7%, respectively; P = 0.02). There was no significant difference in the perceived stress level by anti-HCV status; overall, the perceived stress level score was 15.9 ± 5.7. In logistic regression analysis, positive anti-HCV status (OR = 3.75, 95% CI = 1.42-9.90), and greater perceived stress (OR = 1.23, 95% CI = 1.11-1.36) were independently associated with depression, after controlling for gender, age, duration of drug use and the awareness of HCV infection.
  
  
  CONCLUSIONS
  Depression and HCV infection are common and co-occurring among MMT patients in Shanghai. HCV infection itself appears to be associated with depressive symptoms regardless of whether the individual is aware of his HCV infection status. This finding indicates that it is important to consider the impact of depressive symptoms on injection risk behaviors and HCV transmission when planning intervention programs in MMT clinics.
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.forename: Jiang
authors.initials: J
authors.lastname: Du
authors.forename: Min
authors.initials: M
authors.lastname: Zhao
authors.forename: Kimberly
authors.initials: K
authors.lastname: Page
authors.forename: Zeping
authors.initials: Z
authors.lastname: Xiao
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Mandel
mesh_terms: D000328:Adult; D002681:China / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005260:Female; D006526:Hepatitis C / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D008691:Methadone / Q000627:therapeutic use*; D008875:Middle Aged; D058850:Opiate Substitution Treatment / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000188:drug therapy* / Q000453:epidemiology / Q000523:psychology; D011569:Psychiatric Status Rating Scales; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000453:epidemiology
chemical_list: D008691:Methadone
keywords: depression; hepatitis C; methadone maintenance treatment; perceived stress