Barriers to accessing care in patients with chronic hepatitis C: the impact of depression

D. M. Evon 1, K. M. Simpson 1, D. Esserman 2,3, A. Verma 1, S. Smith 4, M. W. Fried 1

Article first published online: 17 SEP 2010
DOI: 10.1111/j.1365-2036.2010.04460.x
Aliment Pharmacol Ther 2010; 32: 1163–1173

Summary

Background Patients with hepatitis C viral (HCV) may perceive barriers to accessing speciality care for HCV, and these barriers may be related to depressive symptoms.

Aim To evaluate the relationship between barriers to care, demographics, and depressive symptoms.

Methods A cross-sectional analysis of 126 patients referred for HCV at two speciality HCV clinics. Barriers to care, depressive symptoms and sociodemographics were measured using standardized instruments. A retrospective chart review was conducted to collect clinical outcome data.

Results Depressive symptoms were reported in 26%. Common barriers included lack of personal financial resources; lack of HCV knowledge in the community; lack of professionals competent in HCV care; stigmatization of HCV; and long distances to clinics offering care. After we controlled for sociodemographics, depression accounted for an additional 7–18% of variability in all barriers (all p values <0.01). Lower depression, marital and employment status were associated with subsequent receipt of HCV treatment in 38% (45/120) of patients; perceived barriers were not.

Conclusions Depression is independently associated with perceived barriers to care. Higher depressive scores, but not perceived barriers, were associated with nontreatment. Healthcare providers who diagnose HCV need to be cognizant of numerous perceived barriers to accessing HCV care, and the impact that depression may have on these perceptions and receipt of treatment.

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