Suicidal Thoughts in Patients with Chronic Hepatitis C

Abstract

Hepatitis C virus (HCV) infection is one of the main causes of chronic liver disease worldwide, affecting about 170 million people [1, 2].Depression is common in patients with chronic viral hepatitis. Considering the fact that patients with chronic hepatitis C (CHC) have an increased prevalence of psychiatric comorbidities compared with the general population [7] and that psychiatric disorders are a contraindication to antiviral therapy. The most common psychiatric side effect is depression, the prevalence of which ranges from 30% to 70% [2]; therefore, depending on the severity of the depressive disorder, psychosis, suicidal thoughts and suicide attempts may occur [3,5].The progressive nature of hepatitis C results in a high rate of hospitalizations, heavy drug use, increased financial burden, frequent need for invasive procedures, changes in body image, and increased morbidity and mortality. All these factors contribute to physical and psychological stress, which mediates the development of depression and the formation of suicidal behavior. Several studies have shown that psychological stress in patients with hepatitis C has clinical significance. Nearly one in six patients with hepatitis C has moderate or more severe depression than controls, and nearly 66% of these patients have moderate or higher anxiety symptoms, according to the researchers. The severity of distress and depression correlates with the severity of liver disease[6, 8]. Moreover, psychiatric disorders have been found to worsen the clinical prognosis in patients with chronic liver disease, cirrhosis, and after liver transplantation.[10].

Current evidence suggests that the risk of suicide in people with chronic diseases such as cancer, kidney or heart failure is significantly higher than in the general population.[1,2, 4] .Patients with chronic liver disease also have higher rates of suicide attempts as a result of psychological stress and depression.[5].It is becoming clear that psychological intervention is needed to prevent suicide in hepatitis C.

In a study of patients with hepatitis C chronic liver disease, an integrated model developed by mental health providers and clinicians was recommended instead of the conventional model of care. In particular, it is shown that the active help of experts and psychological intervention are necessary to reduce the risk of suicide in patients due to their social maladaptation and self-stigmatization. Through the integrated care model, specific risk factors were identified during screening, treatments were proposed, and clinical and mental health improvements were made through regular follow-up. However, there are relatively few studies on the assessment of suicidal risk in patients with hepatitis C, and the relationship between liver hepatitis and suicidal behavior remains poorly understood.