Session number: 1035
Abstract title: Psychiatric Disorders Among Veterans with Hepatitis C Infection : A Case-Control Study
Author(s):
HB El-Serag - The Sections of Health Services Research and Gastroenetrology at The Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston TX
M Kunik - The Section of Health Services Research and Department of Psychiatry at The Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston TX
P Richardson - The Sections of Health Services Research at The Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston TX
L Rabeneck - The Sections of Health Services Research and Gastroenetrology at The Houston Veterans Affairs Medical Center and Baylor College of Medicine, Houston TX
Objectives: The presence of psychiatric, drug and alcohol use disorders in HCV infected patients may influence the management and prognosis of these patients. The frequency and the risk of these disorders among HCV-infected patients are unknown. Our objective was to examine the magnitude of psychiatric disorders among HCV-infected veterans.
Methods: A population based case-control study using the computerized databases of the Department of Veterans Affairs (VA). Cases were HCV-infected patients who were hospitalized during 1992-1999. For each case, four control subjects without HCV were randomly chosen from hospitalized patients and were matched with cases on the year of admission. The inpatient and outpatient files were searched for predefined psychiatric, drug and/or alcohol use disorders. The frequency of these disorders was compared between cases and control and the strength of these associations was assessed in multivariable logistic regression analyses.
Results: We identified 33,824 HCV-infected patients (cases) and 134,322 controls without HCV. Patients in the case group were younger (45.2±9.3 years vs. 57.0±13.4, p<0.0001), were more frequently nonwhite (39.6% vs. 26.3%, p<0.0001), more frequently men (98.1% vs. 97.0%, p<0.0001), and were more likely to have served in Vietnam [86.1% vs. 33.0%, p<0.0001]. At least one psychiatric, drug use, or alcohol use disorder was recorded in 86.4% of HCV infected patients; 7.2 % of those had psychiatric disorder(s) only, 37.9% had drug or alcohol use disorder only, and the rest had both psychiatric and drugs/alcohol use disorders. Cases were more likely to have depressive disorders (45.6% vs. 28.3%, p<0.0001), posttraumatic stress disorder (PTSD) (26.4% vs. 12.1%, p<0.0001), psychosis (22.3% vs. 16.2%, p<0.0001), bipolar disorder (15.5% vs. 8.6%, p<0.0001), and anxiety disorders (44.6% vs. 30.1%, p<0.0001). Alcohol dependence was reported in 72.9% of cases and 30.9% of controls (p<0.0001), and drug use disorders (including cocaine, heroin, barbiturates, amphetamine) in 64.1% vs. 17.7% (p<0.0001), respectively. In the multivariable analyses, drug use [adjusted OR=2.8, (2.8-3.00), p<0.0001] and alcohol use disorders [adjusted OR=2.1, (2.0-2.2), p<0.0001] remained strongly associated with HCV. However, after adjusting for the higher frequency of drug/alcohol use disorders in HCV infected cases, the positive associations seen in the univariate analyses between HCV and psychiatric disorders (depressive, PTSD, psychotic bipolar, anxiety) were no longer significant.
Conclusions: Several psychiatric, drug and alcohol use disorders are more commonly found among HCV-infected veterans compared with those who are not infected. The apparent increase in psychiatric illness among HCV-infected patients compared with other veterans is mostly explained by their higher frequency of drug and alcohol use.
Impact statement: This highlights the potential use of exisiting VA databases to guide policy makers. It also emphasizes the need for a multidisciplinary approach to HCV-infected patients.