A Comparison of Depression Screening Instruments in Hepatitis C and the Impact of Depression on Somatic Symptoms

Abstract

Treatment of hepatitis C (HCV) with pegylated interferon-alpha (IFNα) can cause depression in approximately 30% of patients and underscores the need for effective detection of depression prior to and during IFNα treatment. Elevated rates of depression in untreated HCV can be a barrier to initiating HCV therapy and can impact fatigue and physical symptoms. In this preliminary study, we examined the accuracy of the seven-item Hamilton Depression Rating Scale (HAM-7) and Patient Health Questionnairre-9 (PHQ-9) in detecting depression in HCV-infected patients and determined the effect of major depression on somatic symptoms. We conducted a preliminary comparison of operating characteristics of the PHQ-9 and HAM-7 to the MINI International Neuropsychiatric Interview for major depression in 116 individuals with chronic HCV assessed in an ambulatory office setting. We also examined the differences in fatigue and somatic symptoms in depressed HCV-infected patients. Currently depressed chronic hepatitis C patients had significantly higher scores on all the scales compared with nondepressed patients. HAM-7 and PHQ-9 scores were significantly correlated with somatic and physical symptoms scales. Both the PHQ-9 and HAM-7 demonstrated comparable accuracy in detecting depression in comparison to the MINI. Our results suggest that the HAM-7 and PHQ-9 both have good operating characteristics compared with a criterion standard measure. Given that depression was associated with fatigue and increased somatic complaints, improved detection and treatment of depression could reduce disability and facilitate treatment for depressed HCV-infected patients.