Watchful Waiting: Role of Disease Progression on Uncertainty and Depressive Symptoms in Patients With Chronic Hepatitis C

J. P. Colagreco; D. E. Bailey; J. J. Fitzpatrick; C. M. Musil; N. H. Afdhal; M. Lai

Disclosures

J Viral Hepat. 2014;21(10):727-733. 

In This Article

Results

Sample Characteristics

The ninety-two subjects enrolled in this study were mostly male (64%), White (83%), non-Hispanic (99%), with at least a high school diploma as their highest level of education (94%) (See Table 2). The mean age for patients was 56.10 years (SD = 7.40) with a range of 24–74 years. Sixty-four of the subjects failed treatment previously (69.6%), while 19 subjects (20.7%) were treatment naïve, and nine subjects (9.8%) were interferon intolerant or ineligible (See Table 3). The mean time between the two biopsies was 4.45 years (range 1.08–8.59 years).

Illness Uncertainty

This cohort of participants with CHC on watchful waiting had a moderate level of illness uncertainty. The mean MUIS-A score was 86.45 (SD 13.84; range: 37–117), which indicates a moderate level of illness uncertainty (See Table 3). Fifty participants (54%) had uncertainty scores of 80 or greater, indicating moderate levels of uncertainty.

Depressive Symptoms

The mean CES-D was 18.87 (SD 8.4; range: 0–47), indicating a mild to moderate level of depressive symptoms (See Table 3). There were 37 subjects (40.2%) who had a CES-D score of 16 or greater, indicating an increased risk for clinical depression. Of these 37 subjects, 20 subjects (21.7%) had scores of 16–23, indicating mild to moderate risk for clinical depression, and 17 subjects (18.5%) had scores greater than 23, indicating high risk.

Treatment naïve subjects had lower mean scores on both the CES-D and the MUIS-A total score, MUIS-A Ambiguity subscale and MUIS-A Inconsistency subscale than subjects who failed treatment or were interferon intolerant or ineligible (See Table 3). These were not evaluated with tests of statistical significance.

Correlations

The total MUIS-A and the Ambiguity and Inconsistency subscale scores were significantly correlated with the CES-D score (r = 0.49, 0.51, 0.36; P < 0.01, <0.01, <0.01, respectively) (See Table 4). CES-D and MUIS-A (total and all the subscales) were not significantly correlated with time from the diagnosis of HCV or fibrosis progression, measured as a dichotomous variable (See Table 4), nor was the ranked change in stage of fibrosis significantly correlated with depressive symptoms. Ranked change in stage of fibrosis was significantly correlated with the MUIS-A unpredictability subscale (See Table 4). Stage of fibrosis was significantly correlated with the MUIS-A Complexity subscale, but not with CES-D, the total MUIS-A score or any of the other subscales.

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