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Hepatitis C and Depressive Symptoms: Psychological and Social Factors Matter More Than Liver Injury

Objective: Given that the hepatitis C virus (HCV) crosses the blood-brain barrier, biological factors are commonly blamed for the high rates of mood disturbance in HCV-infected patients. However, no study assessing the potential contribution of psychosocial factors to depression in HCV has yet been conducted. Methods: A cross-sectional survey of 65 patients was undertaken to identify biological, psychological, and sociological contributions to depression. Biological, psychological, and sociological variables were tested for their association with depressive symptomatology as measured by the BDI-II. Separate analyses were conducted on health-related quality of life (HRQOL), as measured by the SF-36, in order to confirm findings in previous work. Results: Psychosocial variables assessed in the study, such as less social functioning, less religious faith, less ability to work, less salary, personal suicide attempt, worse reaction to diagnosis, and feeling “stressed out” were all associated with higher depression scores and lower HRQOL. Biological variables, including viral load, liver enzyme levels, INR, and stage of liver fibrosis on biopsy, were not associated with higher depression or lower HRQOL. Conclusions: The amount of disease as measured by laboratory abnormalities such as viral load, liver function tests, liver biopsy, and INR do not provide much useful information about a patient's depressive symptoms. Instead, these depressive symptoms are more influenced by psychological and social factors. Psychosocial support may therefore be beneficial to HCV patients.