Barriers to accessing care in patients with chronic hepatitis C: the impact of depression

[Guest guest]

http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2036.2010.04460.x/abstract

Barriers to accessing care in patients with chronic hepatitis C: the impact of

depression

D. M. Evon1, K. M. Simpson1, D. Esserman2,3, A. Verma1, S. 4, M. W.

Fried1Article first published online: 17 SEP 2010

DOI: 10.1111/j.1365-2036.2010.04460.x

© 2010 Blackwell Publishing Ltd

Issue

Alimentary Pharmacology & Therapeutics

Volume 32, Issue 9, pages 1163–1173, November 2010

Aliment Pharmacol Ther 2010; 32: 1163–1173

Summary

Background  Patients with hepatitis C viral (HCV) may perceive barriers to

accessing speciality care for HCV, and these barriers may be related to

depressive symptoms.

Aim  To evaluate the relationship between barriers to care, demographics, and

depressive symptoms.

Methods  A cross-sectional analysis of 126 patients referred for HCV at two

speciality HCV clinics. Barriers to care, depressive symptoms and

sociodemographics were measured using standardized instruments. A retrospective

chart review was conducted to collect clinical outcome data.

Results  Depressive symptoms were reported in 26%. Common barriers included

lack of personal financial resources; lack of HCV knowledge in the community;

lack of professionals competent in HCV care; stigmatization of HCV; and long

distances to clinics offering care. After we controlled for sociodemographics,

depression accounted for an additional 7–18% of variability in all barriers

(all p values <0.01). Lower depression, marital and employment status were

associated with subsequent receipt of HCV treatment in 38% (45/120) of patients;

perceived barriers were not.

Conclusions  Depression is independently associated with perceived barriers to

care. Higher depressive scores, but not perceived barriers, were associated with

nontreatment. Healthcare providers who diagnose HCV need to be cognizant of

numerous perceived barriers to accessing HCV care, and the impact that

depression may have on these perceptions and receipt of treatment.