Background: The increasing health problem of hepatitis C virus (HCV) infection has only recently attracted the attention of psychosocial research, especially among subjects at higher risk (e.g. intravenous drug users; IDUs). The aim of the present study was to compare emotional stress symptoms, psychosocial variables (i.e. social support, external locus of control and emotional repression) and coping strategies in HCV-seropositive, human immunodeficiency virus (HIV)-seropositive and HCV/HIV-noninfected IDUs. Methods: IDUs followed by the Infectious Diseases Outpatient clinic were enrolled in the study over a period of 1 year. HCV-positive (n = 62) and HIV-positive (n = 76) IDUs and HCV/HIV-seronegative IDUs (n = 152) completed the Brief Symptom Inventory, the Social Provision Scale, the Locus of Control scale and the affective inhibition scale of the Illness Behavior Questionnaire. Coping with illness among HCV-positive and HIV-positive subjects was assessed through a modified version of the Mental Adjustment to Cancer Scale. Results: No significant differences were found between the samples with respect to individual and interpersonal variables. HCV-positive subjects showed higher scores on several psychological stress dimensions (i.e. obsessive-compulsive, phobic anxiety, paranoid ideation, psychoticism) and lower scores on fighting spirit, hopelessness and anxious preoccupation towards illness than HIV-positive patients. HCV-positive and HCV/HIV-seronegative IDUs reported comparable scores on most of the psychological measures. Conclusions: The findings indicate that routine assessment of psychosocial variables and coping mechanisms should be integrated into all HCV and HIV services, especially those dedicated to treatment of patients with substance abuse, as a vulnerable segment of the population at risk for life-threatening physical illness such as HCV and HIV infections.

Keywords:
Hepatitis C infection, HIV infection, Psychosocialvariables, Coping
1.
World Health Organization: Hepatitis C Infection; Fact Sheet No. 164, revised October 2000. Geneva, WHO, 2001.
2.
Gombas W, Fischer G, Jagsch R, Eder H, Okamoto I, Schindler S, Muller C, Ferenci P, Kasper S: Prevalence and distribution of hepatitis C subtypes in patients with opioid dependence. Eur Addict Res 2000;6:198–204.
3.
Harsch HH, Pankiewicz J, Bloom AS, Rainey C, Cho JK, Sperry L, Stein EA: Hepatitis C virus infection in cocaine users – a silent epidemic. Community Ment Health J 2000;36:225–233.
4.
Sladden TJ, Hickey AR, Dunn TM, Beard JR: Hepatitis C virus infection: Impacts on behaviour and lifestyle. Aust NZ J Public Health 1998;22:509–511.
5.
Rodger AJ, Jolley D, Thompson SC, Lanigan A, Crofts N: The impact of diagnosis of hepatitis C virus on quality of life. Hepatology 1999;30:1299–1301.
6.
Singh N, Gayowski T, Wagener MM, Marino IR: Quality of life, functional status, and depression in male liver transplant recipients with recurrent viral hepatitis C. Transplantation 1999;67:69–72.
7.
Singh N, Squier C, Sivek C, Wagener MM, Yu VL: Psychological stress and depression in older patients with intravenous drug use and human immunodeficiency virus infection: Implications for intervention. Int J STD AIDS 1997;8:251–255.
8.
Johnson ME, Fisher DG, Fenaughty A, Theno SA: Hepatitis C virus and depression in drug users. Am J Gastroenterol 1998;93:785–789.
9.
Dwight MM, Kowdley KV, Russo JE, Ciechanowski PS, Larson AM, Katon WJ: Depression, fatigue, and functional disability in patients with chronic hepatitis C. J Psychosom Res 2000;49:311–317.
10.
Kraus MR, Schäfer A, Csef H, Scheurlen M, Faller H: Emotional state, coping styles, and somatic variables in patients with chronic hepatitis C. Psychosomatics 2000;41:377–384.
11.
Yovtcheva SP, Rifai MA, Moles JK, Van der Linden BJ: Psychiatric comorbidity among hepatitis C-positive patients. Psychosomatics 2001;42:411–415.
12.
Ibanez A, Gimenez-Barcons M, Tajahuerce A, Tural C, Sirera G, Clotet B, Sanchez-Tapias JM, Rodes J, Martinez MA, Saiz JC: Prevalence and genotypes of GB virus C/hepatitis G virus (GBV-C/HGV) and hepatitis C virus among patients infected with human immunodeficiency virus: Evidence of GBV-C/HGV sexual transmission. J Med Virol 1998;55:293–299 .
13.
Pallas JR, Farinas-Alvarez C, Prieto D, Delgado-Rodriguez M: Coinfections by HIV, hepatitis B and hepatitis C in imprisoned injecting drug users. Eur J Epidemiol 1999;15:699–704.
14.
Emmelkamp PM: Psychosocial factors in HIV-AIDS. Psychother Psychosom 1996;65:225–228.
15.
Khouzam HR, Donnelly NJ, Ibrahim NF: Psychiatric morbidity in HIV patients. Can J Psychiatry 1998;43:51–56.
16.
Grassi L, Righi R, Sighinolfi L, Makoui S, Ghinelli F: Coping styles and psychosocial related variables in HIV-infected patients. Psychosomatics 1998;39:350–359.
17.
Grassi L, Righi R, Makoui S, Sighinolfi L, Ferri S, Ghinelli F: Illness behavior, emotional stress and psychosocial factors among asymptomatic HIV-infected patients. Psychother Psychosom 1999;68:31–38.
18.
Theorell T, Blomquist V, Jonsson H, Shulman S, Berntorp E, Stigendal L: Social support and the development of immune function in HIV infection. Psychosom Med 1995:57:32–36.
19.
Leserman J, Jackson ED, Petitto JM, Golden RN, Silva SG, Perkins DO, Cai J, Folds JD, Evans DL: Progression to AIDS: The effects of stress, depressive symptoms, and social support. Psychosom Med 1999;61:397–406.
20.
Grassi L, Mondardini D, Pavanati M, Sighinolfi L, Serra A, Ghinelli F: Suicide probability and psychological morbidity secondary to HIV infection: A control study of HIV-seropositive, hepatitis C virus (HCV)-seropositive and HIV/HCV-seronegative injecting drug users. J Affect Disord 2001;64:195–202.
21.
Lipsitz JD, Williams JBW, Rabkin JG, Remien RH, Bradbury M, el Sandr W, Goetz R, Sorrell S, Gorman JM: Psychopathology in male and female intravenous drug users with and without HIV infection. Am J Psychiatry 1994;151:1662–1668.
22.
Rabkin JG, Johnson J, Lin SH, Lipsitz JD, Remien RH, Williams JB, Gorman JM: Psychopathology in male and female HIV-positive and negative injecting drug users: Longitudinal course over 3 years. AIDS 1997;11:507–515.
23.
Davis R, Metzger DS, Meyers K, McLellan AT, Mulvaney FD, Navaline HA, Woody GE: Long-term changes in psychological symptomatology associated with HIV serostatus among male injecting drug users. AIDS 1995;9:73–79.
24.
Mezzelani P, Quaglio GL, Venturini L, Lugoboni F, Friedman SR, Des Jaralmais DC: A multicentre study on the causes of death among Italian injecting drug users. AIDS has overtaken overdose as the principal cause of death. AIDS Care 1998;10:61–67.
25.
Ademmer K, Beutel M, Bretzel R, Clemens J, Reimer C: Suicidal ideation with IFN-α and ribavirin in a patient with hepatitis C. Psychosomatics 2001;42:365–367.
26.
Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 1973;60:646–654.
27.
Yates WR, Gleason O: Hepatitis C and depression. Depress Anxiety 1998;7:188–193.
28.
Dieperink E, Willenbring M, Ho SB: Neuropsychiatric symptoms associated with hepatitis C and interferon alpha: A review. Am J Psychiatry 2000;157:867–876.
29.
Lerner DM, Stoudemire A, Rosenstein DL: Neuropsychiatric toxicity associated with cytokine therapies. Psychosomatics 1999;40:510–512.
30.
Maunder RG, Hunter JJ, Feinman SV: Interferon treatment of hepatitis C associated with symptoms of PTSD. Psychosomatics 1998;39:461–464.
31.
Jacobs JW, Bernhard MR, Delgado A: Screening for organic mental syndromes in the medically ill. Ann Intern Med 1977;86:40–46.
32.
Karnofsky DA, Burchenal JH: The clinical evaluation of chemotherapeutic agents in cancer; in MacLeod CM (ed): Evaluation of Chemotherapeutic Agents. New York, Columbia University Press, 1949, pp 191–205.
33.
Derogatis LR, Spencer PM: The Brief Symptom Inventory (BSI). Administration, Scoring and Procedures Manual-I. Towson, Clinical Psychometric Research, 1982.
34.
Russel D, Cutrona C: The provisions of social relationships and adaptation to stress. Adv Pers Relat 1987;1:37–67.
35.
Husaini BQ, Neff JA: Social class and depressive symptomatology. The role of life change events and locus of control. J Nerv Ment Dis 1981;169:638–647.
36.
Pilowsky I, Murrell TGC, Gordon A: The development of a screening method for abnormal illness behaviour. J Psychosom Res 1978;23:203–207.
37.
Watson M, Greer S, Young J, Inayat Q, Burgess C, Robertson B: Development of a questionnaire measure of adjustment to cancer: The MAC scale. Psychol Med 1988;18:203–209.
38.
Ross MW, Hunter CE, Condon J, Collins P, Begley K: The Mental Adjustment to HIV scale: Measurement and dimensions of response to AIDS/HIV disease. AIDS Care 1994;6:407–411.
39.
SPSS: SPSS 10. Applications Guide. Chicago, SPSS, 1999.
40.
Moore J, Schuman P, Schoenbaum E, Boland B, Solomon L, Smith D: Severe adverse life events and depressive symptoms among women with, or at risk for, HIV infection in four cities in the United States of America. AIDS 1999;13:2459–2468.
41.
Malbergier A, de Andrade AG: Depressive disorders and suicide attempts in injecting drug users with and without HIV infection. AIDS Care 2001;13:141–150.
42.
Dew MA, Becker JT, Sanchez J, Caldararo R, Lopez OL, Wess J, Dorst SK, Banks G: Prevalence and predictors of depressive, anxiety and substance use disorders in HIV-infected and uninfected men: A longitudinal evaluation. Psychol Med 1997;27:395–409.
43.
Blomqvist V, Jonsson L, Theorell T: Life events and coping patterns reported in HIV-infected hemophiliacs a year after diagnosis. Scand J Soc Med 1991;19:94–98.
44.
Fukunishi I, Hosaka T, Negishi M, Moriya H, Hayashi M, Matsumoto T: Avoidance coping behaviors and low social support are related to depressive symptoms in HIV-positive patients in Japan. Psychosomatics 1997;38:113–118.
45.
Avants SK, Warburton LA, Margolin A: How injection drug users coped with testing HIV-seropositive: Implications for subsequent health-related behaviors. AIDS Educ Prev 2001;13:207–218.
46.
Singh N, Berman SM, Swindells S, Justis JC, Mohr JA, Squier C, Wagener MM: Adherence of human immunodeficiency virus-infected patients to antiretroviral therapy. Clin Infect Dis 1999;29:824–830.
47.
Swindells S, Mohr J, Justis JC, Berman S, Squier C, Wagener MM, Singh N: Quality of life in patients with human immunodeficiency virus infection: Impact of social support, coping style and hopelessness. Int J STD AIDS 1999;10:383–391.
48.
Mulder CL, de Vroome EM, van Griensven GJ, Antoni MH, Sandfort TG: Avoidance as a predictor of the biological course of HIV infection over a 7-year period in gay men. Health Psychol 1999;18:107–113.
49.
Novara C, Casari S, Compostella S, Dorz S, Sanavio E, Sica C: Coping and cognitive processing style in HIV-positive subjects. Psychother Psychosom 2000;69:316–321.
50.
Brook JS, Brook DW, Win PT, Whiteman M, Masci JR, de Catalogne J, Roberto J, Amundsen F: Coping with AIDS: A longitudinal study. Am J Addict 1997;6:11–20.
51.
Ricci Bitti PE, Gremigni P, Bertolotti G, Zotti AM: Dimensions of anger and hostility in cardiac patients, hypertensive patients, and controls. Psychother Psychosom 1995;64:162–172.
52.
Jorgensen RS, Abdul-Karim K, Kahan TA, Frankowski JJ: Defensiveness, cynical hostility and cardiovascular reactivity: A moderator analysis. Psychother Psychosom 1995;64:156–161.
53.
Grassi L, Rosti G, Lasalvia A, Marangolo M: Psychosocial variables associated with mental adjustment to cancer. Psychooncology 1993;2:11–20.
54.
Leiberich P, Engeter M, Olbrich E, Rubbert A, Schumacher K, Brieger M, Kalden JR, Joraschky P: Longitudinal development of distress, coping and quality of life in HIV-positive persons. Psychother Psychosom 1997;66:237–247.
55.
Latkin CA, Mandell W: Depression as an antecedent of frequency of intravenous drug use in an urban nontreatment sample. Int J Addict 1993;28:1601–1612.
56.
Camacho LM, Brown BS, Simpson DD: Psychological dysfunction and HIV/AIDS risk behavior. J Acquir Immune Defic Syndr Hum Retrovirol 1996;11:198–202.
57.
Dinwiddie SH, Cottler L, Compton W, Abdallah AB: Psychopathology and HIV risk behaviors among injection drug users in and out of treatment. Drug Alcohol Depend 1996;43:1–11.
58.
King VL, Kidorf MS, Stoller KB, Brooner RK: Influence of psychiatric comorbidity on HIV risk behaviors: Changes during drug abuse treatment. J Addict Dis 2000;19:65–83.
59.
Mandell W, Kim J, Latkin C, Suh T: Depressive symptoms, drug network, and their synergistic effect on needle-sharing behavior among street injection drug users. Am J Drug Alcohol Abuse 1999;25:117–127.
60.
Avants SK, Warburton LA, Hawkins KA, Margolin A: Continuation of high-risk behavior by HIV-positive drug users. Treatment implications. J Subst Abuse Treat 2000;19:15–22.
61.
Stein MD, Hanna L, Natarajan R, Clarke J, Marisi M, Sobota M, Rich J: Alcohol use patterns predict high-risk HIV behaviors among active injection drug users. J Subst Abuse Treat 2000;18:359–363.
62.
Kiecolt-Glaser JK, McGuire L, Robles TF, Glaser R: Psychoneuroimmunology and psychosomatic medicine: Back to the future. Psychosom Med 2002;64:15–28.
63.
Lesens O, Deschenes M, Steben M, Belanger G, Tsoukas CM: Hepatitis C virus is related to progressive liver disease in human immunodeficiency virus-positive hemophiliacs and should be treated as an opportunistic infection. J Infect Dis 1999;179:1254–1258.
64.
Haydon GH, Flegg PJ, Blair CS, Brettle RP, Burns SM, Hayes PC: The impact of chronic hepatitis C virus infection on HIV disease and progression in intravenous drug users. Eur J Gastroenterol Hepatol 1998;10:485–489.
65.
Monga HK, Rodriguez-Barradas MC, Breaux K, Khattak K, Troisi CL, Velez M, Yoffe B: Hepatitis C virus infection-related morbidity and mortality among patients with human immunodeficiency virus infection. Clin Infect Dis 2001;33:240–247.
66.
Bing EG, Burnam MA, Longshore D, Fleishman JA, Sherbourne CD, London AS, Turner BJ, Eggan F, Beckman R, Vitiello B, Morton SC, Orlando M, Bozzette SA, Ortiz-Barron L, Shapiro M: Psychiatric disorders and drug use among human immunodeficiency virus-infected adults in the United States. Arch Gen Psychiatry 2001;58:721–728.
© 2002 S. Karger AG, Basel
2002
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.