Journal List > Korean J Adult Nurs > v.26(2) > 1094543

TOOLS
Kim and Lee: The Depression Predictors among Patients with Peg-interferon Treated Hepatitis C
Original Article

Korean J Adult Nurs 2014;26(2):214-222.

Published online: NaN April 2014

DOI: https://doi.org/10.7475/kjan.2014.26.2.214

The Depression Predictors among Patients with Peg-interferon Treated Hepatitis C

Ha-Na Kim, Eun-Nam Lee

Department of Nursing, Dong-A University, Busan, Korea

Corresponding author: Lee, Eun Nam Department of Nursing, Dong-A University, 3 ga-1, Tongdaesin-dong, Seo-gu, Busan 602-714, Korea. Tel: +82-51-240-2864, Fax: +82-51-240-2947, E-mail: enlee@dau.ac.kr

Received 30 October 20133 February 2014       Accepted 3 February 2014

© 2014 Korean Society of Adult Nursing

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was to identify factors predicting the occurrence of depression among patients with hepatitis C treated with Peg-interferon.

Methods

The subjects were 134 patients treated with Peg-interferon after the diagnosis with hepatitis C at the D University Hospital and 3 hospitals located in Busan, South Korea. The predictors of depression were identified by measuring the general characteristics of the subjects and their disease-related characteristics, social support, sleep disorders, and degree of side effects by interferon. The data were analyzed with a t-test, ANOVA, and logistic regression using the SPSS/WIN 18.0 program.

Results

Sixty-six point four percent of the subjects suffered from mild to more severe depression. Fatigue, hair loss, itching, and sleep disorders turned out to be significant predictors. In addition, the explanatory power of these variables for the occurrence of depression was 70%.

Conclusion

Sleep disorders and drug side effects were determined to have significant influence on the development of depression in hepatitis C patients treated with Peg-interferon. Therefore, the development of nursing intervention programs aimed to prevent depression by effectively managing sleep disorders and side effects is mandated in future to help the given population.

Keywords: Depression, Hepatitis, Interferons

REFERENCES

Almeida A. G.., Guindalini C.., Batista-Neves S.., de Oliveira I. R.., Miranda-Scippa Â.., Qurantini L. C.2010. Can antidepressants prevent interferon-alpha-induced depression? A review of the literature. General Hospital Psychiatry. 32:401––405. http://dx.doi.org/10.1016/j.genhosppsych.2010.03.001.
crossref
Blasiole J. A.., Shinkunas L.., LaBrecque D. R.., Arnold R. M.., Zickmund S. L.2006. Mental and physical symptoms associated with lower social support for patients with hepatitis C. World Journal of Gastroenterology. 12:4665––4672.
crossref
Bonaccorso S.., Marino V.., Biondi M.., Grimaldi F.., Ippoliti F.., Maes M.2002. Depression induced by treatment with interferon-⍺ in patients affected by hepatitis C virus. Journal of Affective Disorders. 72:237––241. http://dx.doi.org/10.1016/S0165-0327(02)00264-1.
Capuron L.., Ravaud A.., Miller A. H.., Dantzer R.2004. Baseline mood and psychosocial characteristics of patients developing depressive symptoms during interleukin-2 and/or interferon-alpha cancer therapy. Brain, Behavior, and Immunity. 18:205––213. http://dx.doi.org/10.1016/j.bbi.2003.11.004.
crossref
Carroll V. K.., Rado J. T.2009. Is a medical illness causing your patient's depression? Current psychiatry. 8(8):43––54.
Cohen S.., Hoverman H.1983. Positive events and social support as buffers of life change stress. Journal of Applied Social Psychology. 13:99––125.
Evon D. M.., Ramcharran D.., Belle S. H.., Terrault N. A.., Fontana R. J.., Fried M. W., et al. 2009. Prospective analysis of depression during Peginterferon and Ribavirin therapy of chronic hepatitis C: Results of the Virahep-C study. The American Journal of Gastroenterology. 104:2949––2958. http://dx.doi.org/10.1038/ajg.2009.528.
Evon D. M.., Verma A.., Simpson K.., Galanko J. A.., Dougherty K. A.., Fried M. W.2008. Psychiatric symptoms during interferon treatment for hepatitis C: Experiences from a tertiary care hepatology centre. Alimentary Pharmacology & Therapeutics. 27:1071––1080. http://dx.doi.org/10.1111/j.1365-2036.2008.03640.x.
Franzen P. L.., Buysse D. J.., Rabinovitz M.., Pollock B. G.., Lo-trich F. E.2010. Poor sleep quality predicts onset of either major depression or subsyndromal depression with irritability during interferon-⍺ treatment. Psychiatry Research. 177(1-2):240––245. http://dx.doi.org/10.1016/j.psychres.2009.02.011.
Hoffman S.2003. Sleep in older adult: Implications for nurses. Geriatric Nursing. 24:210––216. http://dx.doi.org/10.1016/S0197-4572(03)00213-1.
Hwang S. Y.., Lee H. J.., Park K. T.., Kim K. Y.., Lee S. M.., Park C. W., et al. 2007. Effectiveness and complications of combination therapy with interferon ⍺ and ribavirin in patients with chronic hepatitis C. Korean Journal of Gastroenterology. 49:166––172.
Kim E. S.2009. Association between sleep disturbance and depression among patients with brain injury. Unpublished master's thesis. Keimyung University, Daegu.
Kim K. T.., Han S. Y.., Kim J. H.., Yoon H. A.., Bak Y. H.., Kim M. J., et al. 2008. Clinical outcome of pegylated interferon and ribavirin therapy. The Korean Journal of Hepatology. 14(1):36––45.
Korea Centers for Disease Control & Prevention. 2012, March. Viral hepatitis surveillance system and statue of C hepatitis sentinel surveillance in Korea Seoul Author.
Kwon J. H.., Bae S. H.2008. Current status and clinical course of hepatitis C virus in Korea. The Korean Journal of Gastroenterology. 51:360––367.
Lee H. M.2008. A study on the fatigue, depression, and sleep disorder of hemodialysis patients. Unpublished master's thesis, Chonnam National University, Gwangju.
Lee Y. H.., Song J. Y.1991. A study of the reliability and the validity of the BDI, SDS, and MMPI-D scales. Korean Journal of Clinical Psychology. 10(1):98––113.
Lotrich F. E.., Ferrell R. E.., Rabinovitz M.., Pollock B. G.2008. Risk for depression during interferon-⍺ treatment is affected by the serotonin transporter polymorphism. Biological Psychiatry. 65:344––348. http://dx.doi.org/10.1016/j.biopsych.2008.08.009.
Lotrich F. E.., Rabinovitz M.., Gironda P.., Pollock B. G.2007. Depression following pegylated interferon-alpha: Characteristics and vulnerability. Journal of Psychosomatic Research. 63:131––135. http://dx.doi.org/10.1016/j.jpsychores.2007.05.013.
crossref
Malik U. R.., Makower D. F.., Wadler S.2001. Interferon-mediated fatigue. Cancer. 92:1664––1668. http://dx.doi.org/10.1002/1097-0142(20010915)92:6+<1664::AID-CNCR1494>3.0.CO;2-9.
crossref
Oh J. J.., Song M. S.., Kim S. M.1998. Development and validation of Korean sleep scale A. Journal of Korean Academy of Nursing. 28:563––572.
Raison C. L.., Rye D. B.., Woolwine B. J.., Vogt G. J.., Bautista B. M.., Spivey J. R., et al. 2010. Chronic interferon-alpha administration disrupts sleep continuity and depth in patients with hepatitis C: Association with fatigue motor slowing, and increased evening cortisol. Biological Psychiatry. 68:942––949. http://dx.doi.org/10.1016/j.biopsych.2010.04.019.
crossref
Schäfer A.., Scheurlen M.., Seufert J.., Keicher C.., Weiβbrich B.., Rieger P., et al. 2010. Platelet serotonin (5-HT) levels in interferon-treated patients with hepatitis C and its possible association with interferon-induced depression. Journal of Hepatology. 52(1):10––15. http://dx.doi.org/10.1016/j.jhep.2009.10.007.
crossref
Shepard C. W.., Finelli L.., Alter M. J.2005. Global epidemiology of hepatitis C virus infection. The Lancet infectious Diseases. 5:558––567. http://dx.doi.org/10.1016/S1473-3099(05)70216-4.
crossref
Sohn S. K.2002. Relationship between fatigue and sleep quality in patients with cancer. Journal of Korean Academy of Adult Nursing. 14(3):378––389.
Suh M. J.1990. A study on factors influencing the state of adaptation of the hemiplegic patients. Journal of Korean Academy of Nursing. 20(1):88––117.
crossref

Table 1.
Subject Classification by the BDI Score (N=134)
Classification BDI score n (%)
Normal ≤9 45(33.6)
Mild depression 10~15 39(29.1)
Moderate depression 16~23 33(24.6)
Severe depression 24~63 17(12.7)

BDI=Beck depression inventory.

Table 2.
Comparison of General Characteristics between the Depressed Group and Non-depressed Group (N=134)
Characteristics Categories Total Non-depressed group (n=45) Depressed group (n=89) x2 or t p
n (%) or M±SD n (%) or M±SD n (%) or M±SD
Age (year)   48.22±8.84 48.78±8.95 47.94±8.82 0.52 .608
Gender Male 76 (56.7) 23 (51.1) 53 (59.6) 0.87 .363
Female 58 (43.3) 22 (48.9) 36 (40.4)
Spouse Yes 118 (88.1) 40 (88.9) 78 (87.6) 1.11 .775
No 16 (11.9) 5 (11.1) 11 (12.4)
Educational level ≤High school 72 (53.7) 23 (51.1) 49 (55.1) 0.19 .665
≥College graduate 62 (46.3) 22 (48.9) 40 (44.9)
Occupation Yes 76 (56.7) 22 (48.9) 54 (60.7) 1.69 .193
No 58 (43.3) 23 (51.1) 35 (39.3)
Monthly income (10,000 won) ＜300 82 (61.2) 27 (60.0) 55 (61.8) 004 .840
≥300 52 (38.8) 18 (40.0) 34 (38.2)
Monthly medical cost (10,000 won) ＜70 39 (29.1) 19 (42.2) 20 (22.5) 5.65 .017
≥70 95 (70.9) 26 (57.8) 69 (77.5)
Alcohol† Yes 11 (8.2) 1 (0.02) 10 (11.2) 3.22 .098
No 123 (91.8) 44 (97.8) 79 (88.8)
Smoking Yes 46 (34.3) 11 (24.4) 35 (39.3) 2.94 .087
No 88 (65.7) 34 (75.6) 54 (60.7)
Family history of hepatitis Yes 41 (30.6) 15 (33.3) 26 (29.2) 0.24 .625
No 93 (69.4) 30 (66.7) 63 (70.8)

† Fisher's exact test.

Table 3.
Comparison of Disease related Characteristics between the Depressed Group and Non-depressed Group (N=134)
Characteristics Categories Total Non-depressed group (n=45) Depressed group (n=89) x2 or t p
n (%) or M±SD n (%) or M±SD n (%) or M±SD
Duration since diagnosis (year) ＜1 27 (20.1) 18 (40.0) 9 (10.1) 16.59 ＜.001
≥1 107 (79.9) 27 (40.0) 80 (89.9)
Duration since treatment (week) 1~4 34 (25.4) 25 (55.6) 9 (10.1) 32.63 ＜.001
5~12 43 (32.1) 9 (20.0) 34 (38.2)
≥13 57 (42.5) 11 (24.4) 46 (51.7)
Perceived health status compared to before treatment Improved 90 (67.2) 40 (88.9) 50 (56.2) 14.50 ＜.001
Not improved 44 (32.8) 5 (11.1) 39 (43.8)
Level of depression   13.63±7.91 5.36±2.66 17.81±6.20 -16.24 ＜.001
Level of sleep disturbance   37.37±4.14 33.13±3.82 39.45±4.65 -7.86 ＜.001
Level of social support   38.32±4.79 40.07±5.24 37.39±4.28 3.16 .002
Table 4.
Comparison of Severity of Interferon-related Side Effects between the Depressed Group and Non-depressed Group (N=134)
Variables Total Non-depressed group (n=45) Depressed group (n=89) t p
M±SD M±SD M±SD
Helplessness 4.73±3.88 3.82±3.97 5.19±3.77 -1.95 .053
Fatigue 7.18±2.57 6.40±3.06 7.57±2.21 -2.29 .025
Flu-like symptom 5.93±3.64 6.91±3.07 5.44±3.82 2.41 .018
Anorexia 2.39±3.30 0.31±1.46 3.44±3.47 -7.32 ＜.001
Weight loss 2.25±3.20 0.00±0.00 3.38±3.40 -9.38 ＜.001
Dizziness 3.37±4.07 3.18±4.18 3.47±4.03 -0.39 .698
Alopecia 3.63±4.15 1.04±2.72 4.93±4.15 -6.50 ＜.001
Itching sense 2.96±3.88 0.71±2.30 4.09±4.02 -6.17 ＜.001
Headache 2.27±3.67 1.71±3.29 2.55±3.84 -1.32 .190
Total 39.10±12.46 30.64±9.70 43.38±11.51 -6.37 ＜.001
Table 5.
Predictors of Depression by Logistic Regression (N=134)
Variables B SE Wald p OR 95% CI for OR
Lower Upper
(Constant) -19.05 3.67 26.98 ＜.001 0.00    
Fatigue 0.54 0.15 12.29 ＜.001 1.72 1.27 2.32
Alopecia 0.25 0.10 6.84 .009 1.28 1.06 1.54
Itching sense 0.37 0.11 11.44 .001 1.45 1.17 1.79
Sleep disturbance 0.40 0.08 23.72 ＜.001 1.50 1.27 1.76
Nagelkerke R2=.70; x2=94.16, df=4, p＜.001; Hit ratio=87.3%

SE=standardized error; OR=odds ratio; CI=confidence interval.

TOOLS
Similar articles