Psychological impact of chronic hepatitis C: comparison with other stressful life events and chronic diseases

Abstract

Aim: To examine the psychological impact of chronic hepatitis C (CHC) diagnosis in a large cohort of CHC patients as compared with other stressful life events and chronic diseases carrying a risk of life-threatening complications.

Methods: One hundred and eighty-five outpatients with compensated CHC were asked to self-grade, using a 100-mm visual analogue scale (VAS), the degree of stress caused by the learning of CHC diagnosis and the perceived severity of their disease. Diagnosis-related stress was compared to four other stressful life events and perceived CHC severity was compared to four other common chronic diseases.

Results: Learning of CHC diagnosis was considered a major stressful event (mean+/-SD scores: 72+/-25), significantly less than death of a loved-one (89+/-13, P<0.0001) and divorce (78+/-23, P<0.007), but more than job dismissal (68+/-30, P<0.04) and home removal (26+/-24, P<0.0001). CHC was considered a severe disease (74+/-19), after AIDS (94+/-08, P<0.001) and cancer (91+/-11, P<0.001), but before diabetes (66+/-23, P<0.001) and hypertension (62+/-20, P<0.001). Perceived CHC severity was not related to the actual severity of liver disease, assessed according to Metavir fibrosis score. In multivariate analysis, diagnosis-related stress was related to perceived disease severity (P<0.001), trait anxiety (P<0.001) and infection through blood transfusion (P<0.001).

Conclusion: Our results show the considerable psychological and emotional burden that a diagnosis of CHC represents, even in the absence of significant liver disease. They should be taken into account when announcing a diagnosis of CHC in order to reduce its negative effects.

Figure 1

(A) Comparison between mean visual analogue scale (VAS) scores for chronic hepatitis C (CHC) diagnosis-related stress and four other stressful life events (i.e., home removal, job dismissal, divorce, and death of a loved-one) selected from the Paykel life-event scale[23] in the 185 patients. P values are for post-hoc comparisons made after significant one-way ANOVA (F = 249.32, P < 0.0001). (B) Comparison between mean visual analogue scale (VAS) scores for perceived chronic hepatitis (CHC) severity and four other common chronic diseases carrying a risk of life-threatening complications (i.e., hypertension, diabetes, cancer and AIDS) in the subgroup of 185 patients. P values are for post-hoc comparisons made after significant one-way ANOVA (F = 173.81, P < 0.001). (C) Mean visual analogue scale (VAS) scores for perceived chronic hepatitis (CHC) severity according to actual severity of liver disease assessed using METAVIR fibrosis score (F0: no fibrosis; F1: portal fibrosis without septa; F2: portal fibrosis and few septa; F3: numerous septa without cirrhosis; F4: cirrhosis) in the 169 patients with available liver specimen. In Figures A, B and C, the upper and lower limits of the boxes and the middle square indicate the standard error and the mean, respectively. The upper and lower horizontal bars indicate the standard deviation.