Abstract
The prevalence of depression is high among injection drug users (IDUs) and among those infected with the hepatitis C virus (HCV). Moreover, one of the drugs used in the standard treatment for HCV infection (interferon) has been known to exacerbate, underlying psychiatric disorders such as depression and has been associated with the development of major, depressive disorder among HCV-infected patients. For these reasons, the most recent National Institutes of Health consensus statement on the management of HCV infection recommends the identification and treatment of depression prior to the start of HCV treatment. This study aimed to examine the extent of current moderate/severe depressive symptoms in a cohort of HCV-infected IDUs as measured by two screening tools, the Center for Epidemiologic Studies Depression Scale (CES-D) and the Beck Depression Inventory (BDI). Subjects were participants in a multisite behavioral intervention trial among HCV-seropositive, human immunodeficiency virus-negative IDUs aged 18–35 years; the trial was designed to prevent secondary transmission of HCV and to enhance uptake of HCV treatment. Baseline data on demographics, risk behaviors, depression, alcohol use, and health care utilization were measured via audio computer-assisted self-interview. A factor analysis was conducted on each scale to examine the clustering of items used in each to measure depressive symptoms. Baseline depressive symptoms, as measured via the CES-D and the BDI, were also compared using Pearson’s correlation coefficient. Of 193 HCV-infected individuals enrolled to date, 75,6% were male, and 65.3% were white. Median age was 25.8 years. Factor analyses revealed that these scales measured depression differently; a distinct somatic component was present in the BDI, but not the CES-D. Using cutoff scores of 23 for the CES-D and 19 for the BDI, 44.0% and 41.5% of the participants were identified as having moderate/severe depressive symptoms, respectively. Over half (56.0%) were identified as having depressive symptoms
Article PDF
Similar content being viewed by others
References
Centers for Disease Control and Prevention. Viral Hepatitis, and Injection Drug Users. 2002. Available at: www.cdc.gov/idu.
Thomas DL, Astemborski J, Rai RM, et al. The natural history of hepatitis C virus infection: host, viral, and environmental factors. JAMA. 2000;284:450–456.
Management of Hepatitis C: 2002. NIH Consens State Sci Statements. 2002 Jun 10–12; 19(3):1–41.
Edlin BR, Seal KH, Lorvick J, et al. Is it justifiable to withhold treatment for hepatitis C from illicit-drug users? N Engl J Med. 2001;345:211–215.
Management of Hepatitis C. NIH Consensus Statement 1997 Mar 24–26; 15(3):1–41.
Hauser P, Khosla J, Aurora H, et al. A prospective study of the incidence and open-label treatment of interferon-induced major depressive disorder in patients with hepatitis C. Mol Psychiatry. 2002;7:942–947.
Bonaccorso S, Marino V, Biondi M, Grimaldi F, Ippoliti F, Maes M. Depression induced by treatment with interferon-alpha in patients affected by hepatitis C virus. J Affect Disord. 2002;72:237–241.
Khantizian EJ, Treece C. DSM-III psychiatric diagnoses of narcotic addicts. Arch Gen Psychiatry. 1985;42:1067–1071.
Ross HE, Glaser FB, Germanson F. The prevalence of psychiatric disorders in patients with alcohol and other drug problems. Arch Gen Psychiatry. 1988;45:1023–1031.
Rounsaville BJ, Weissman MM, Kleber HD, et al. Heterogeneity of psychiatric diagnosis in treated opiate addicts. Arch Gen Psychiatry. 1982;39:161–166.
Johnson ME, Fisher DG, Fenaughty, A, Theno SA. Hepatitis C virus and depression in drug users. Am J Gastroenterol. 1998;93:785–789.
Knowlton AR, Latkin CA, Schroeder JR, Hoover DR, Ensminger M, Celentano DD. Longitudinal predictors of depressive symptoms among low income injection drug users. AIDS Care. 2001;13:549–559.
Dinwiddie SH, Reich T, Cloninger CR. Psychiatric comorbidity and suicidality among intravenous drug users. J Clin Psychiatry. 1992;53:364–369.
American Psychiatric, Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association; 1994.
Brienza RS, Stein MD, Chen M, et al. Depression among needle exchange program and methadone maintenance clients. J Subst Abuse Treat. 2000;18:331–337.
Stein MD, Solomon DA, Herman DS, Anderson BJ, Miller I. Depression severity and drug injection HIV risk behaviors. Am J Psychiatry. 2003;160:1659–1662.
Swartz MS, Swanson JW, Hannon MJ, et al. Blood-borne infections and persons with mental illness: regular sources of medical care among persons with severe, mental illness at risk of hepatitis C infection. Psychiatr Serv. 2003;54:854–859.
Scalori A, Apale P, Panizzuti F, et al. Depression during interferon therapy for chronic viral hepatitis: early identification of patients at risk by means of a computerized test. Eur J Gastroenterol Hepatol. 2000;12:505–509.
Macalino GE, Celentano DD, Latkin C, Strathdee SA, Vlahov D. Risk behaviors by audio computer-assisted self-interviews among HIV-seropositive and HIV-seronegative injection drug users. AIDS Educ Prev. 2002;14:367–378.
Newman JC, Des J, Turner CF, Gribble J, Cooley P, Paone, D. The differential effects of face-to-face and computer interview modes. Am J Public Health. 2002;92:294–297.
Metzger DS, Koblin B, Turner C, et al. Randomized controlled trial of audio computer-assisted self-interviewing: utility and acceptability in longitudinal studies. HIVNET Vaccine Preparedness Study Protocol Team. Am J Epidemiol. 2000;152:99–106.
Centers for Disease Control and Prevention. HIV counseling, testing and referral standards and guidelines. Atlanta, GA. US Department of Health and Human Services, Public Health Service, CDC, 1994.
Radloff LS. The CES-D scale: a self report depression scale for research in the general population. Appl Psychol Measure. 1977;1:385–401.
Clark CH, Mahoney JS, Clark DJ, Eriksen LR. Screening for depression in a hepatitis C population: the reliability and validity of the Center for Epidemiologic Studies Depression Scale (CES-D). J Adv Nurs. 2002;40:361–369.
Roberts RE. Reliability of the CES-D scale in different ethnic contexts. Psychiatry Res. 1980;2:125–134.
Weissman MW, Sholomskas D, Pottenger M, Prusoff BA, Locke BZ. Assessing depressive symptoms in five psychiatric populations, a validation study. Am J Epidemiol. 1977;106:203–214.
Perdue T, Hagan H, Thiede H, Valleroy L. Depression and HIV risk behavior among Seattle-area injection drug users and young men who have sex with men. AIDS Educ Prev. 2003;15:81–92.
Beck AT, Ward CH, Mendelson M, Mock J, Erbaugh J. An inventory for measuring depression. Arch Gen Psychiatry. 1961;4:561–571.
Joe GW, Knezek L, Watson D, Simpson DD. Depression and decision-making among intravenous drug users. Psychol Rep. 1991;68:339–347.
Beck AT, Steer RA, Garbin MG. Psychometric properties of the Beck Depression Inventory: 25 years of evaluation. Clin Psychol Rev. 1988;8:77–100.
Shaw BF, Steer RA, Beck AT, Schut J. The structure of depression in heroin addicts. Br J Addict Alcohol Other Drugs. 1979;74:295–303.
Reynolds WM, Gould JW. A psychometric investigation of the standard and short form Beck Depression Inventory. J Consult Clin Psychol. 1981;49306–307.
Mulder RT, Ang M, Chapman B, Ross A, Stevens IF, Edgar C. Interferon treatment is not associated with a worsening of psychiatric symptoms in patients with hepatitis C. J Gastroenterol Hepatol. 2000;15:300–303.
Musselman DL, Lawson DH, Gumnick JF, et al. Paroxetine for the prevention of depression induced by high-dose interferon alfa. N Engl J Med. 2001;344:961–966.
Gleason OC, Yates WR, Isbell MD, Philipsen MA. An open-label trial of citalopram for major depression in patients with hepatitis C. J Clin Psychiatry. 2002;63:194–198.
Bernstein D, Kleinman L, Barker CM, Revicki DA, Green J. Relationship of health-related quality of life to treatment a dherence and sustained response in chronic hepatitis C patients. Hepatology 2002;35:704–8.
Schaefer M, Schmidt F, Folwaczny C, et al. Adherence and mental side effects during hepatitis C treatment with interferon alfa and ribavirin in psychiatric risk groups. Hepatology. 2003;37:443–451.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Golub, E.T., Latka, M., Hagan, H. et al. Screening for depressive symptoms among HCV-infected injection drug users: Examination of the utility of the CES-D and the beck depression inventory. J Urban Health 81, 278–290 (2004). https://doi.org/10.1093/jurban/jth114
Issue Date:
DOI: https://doi.org/10.1093/jurban/jth114