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HSR&D 2004 National Meeting Abstracts


2003. Justification for Routine Mental Health Screening in HCV+ Veterans
Marian Fireman, MD, Portland VAMC, Behavioral Health and Clinical Neurosciences Division, Northwest Hepatitis C Resource Center, AJ Whitehead, Portland VAMC, Behavioral Health and Clinical Neurosciences Division, Northwest Hepatitis C Resource Center, A Blackwell, Portland VAMC, Behavioral Health and Clinical Neurosciences Division, Northwest Hepatitis C Resource Center, DW Indest, Portland VAMC, Behavioral Health and Clinical Neurosciences Division, Northwest Hepatitis C Resource Center, P Hauser, Portland VAMC, Behavioral Health and Clinical Neurosciences Division, Northwest Hepatitis C Resource Center

Objectives: Although veterans with Hepatitis C commonly have co-morbid psychiatric and substance use disorders, few hepatology or GI clinics routinely screen patients for these co-morbidities. The purpose of our study was to assess the frequency of psychiatric and substance use disorders in a sample of patients presenting for initial assessment of a positive hepatitis C antibody test.

Methods: 293 HCV-AB+ veterans signed informed consent for this IRB-approved study. This represented the majority of veterans scheduled for their initial hepatology clinic visit at the Portland VA Medical Center during 2002-2003. These veterans were administered the following screening questionnaires Patient Screening Questionnaire (PSQ) (which includes the AUDIT-C) and the Beck Depression Inventory (BDI-II). The PSQ detects a history of psychiatric illness and substance use disorders and the BDI-II assesses severity of depression.

Results: 93% of patients reported a current or past history of at least one psychiatric disorder; 73% reported two or more disorders. The most common disorders included: depression (81%), PTSD (62%), substance use disorder (58%), bipolar disorder (20%), and other psychotic disorders (16%). 102 patients (35%) had baseline BDI-II scores in the moderate-severe depression range (BDI > 19). 61 patients (20%) endorsed current heavy alcohol use (AUDIT-C > 4).

Conclusions: Psychiatric and substance use disorders are highly prevalent in veterans with Hepatitis C and 35% have significant depressive symptoms prior to the initiation of interferon treatment. In order prevent worsening of depression in these patients and optimize the outcome of interferon treatment, identification and treatment of depression and other underlying psychiatric and substance use disorders appears essential.

Impact: Optimal treatment of HCV+ veterans should include concurrent diagnosis and treatment of psychiatric and substance use disorders. Co-management treatment models involving mental health care may expand the pool of patients eligible to receive interferon treatment as well as enhance treatment outcomes.