Utility of the Beck Depression Inventory to screen for and track depression in injection drug users seeking hepatitis C treatment

Holtzheimer, Paul E.; Veitengruber, Jason; Wang, Chia C.; Krows, Meighan; Thiede, Hanne; Wald, Anna; Roy-Byrne, Peter

doi:10.1016/j.genhosppsych.2010.02.001

« Previous Next »General Hospital Psychiatry
Volume 32, Issue 4 , Pages 426-432, July 2010

Utility of the Beck Depression Inventory to screen for and track depression in injection drug users seeking hepatitis C treatment☆

Paul E. Holtzheimer, M.D., M.Sc.
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA 30322, USA
- Corresponding author. Tel.: +1 404 727 9004; fax: +1 404 727 3233.
Jason Veitengruber, M.D.
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA 98104, USA
Chia C. Wang, M.D., M.S.
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
Meighan Krows, B.A.
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
Hanne Thiede, D.V.M.
- Public Health Seattle & King County, Seattle, WA 98104, USA
Anna Wald, M.D.
- Department of Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
- Department of Medicine, Epidemiology and Laboratory Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA
- Vaccine and Infectious Disease Institute, Fred Hutchinson Cancer Research Center, Seattle, WA 98199, USA
Peter Roy-Byrne, M.D.
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Medical Center, Seattle, WA 98104, USA

Received 7 November 2009; accepted 2 February 2010. published online 05 April 2010.

Abstract

Objective

Treating acute hepatitis C (HCV) in injection drug users (IDUs) is complicated by a high prevalence of psychiatric comorbidities that may lead to increased risk for depressive complications of interferon treatment. Effective screening strategies are needed to help non-psychiatric clinicians identify depressive disorders.

Methods

Thirty IDUs with acute HCV completed the Beck Depression Inventory (BDI), underwent a psychiatric examination, and were randomized to 24 weeks of pegylated interferon treatment (IFA) or observation (OBS). Sensitivity, specificity, positive (PPV) and negative predictive values (NPV) of the BDI for diagnosing depression (with a cutoff >10) were calculated. The psychiatrist's diagnosis was used as the gold standard. Depression severity was assessed over time with the BDI.

Results

Forty-seven percent of individuals met criteria for a depressive disorder. Sensitivity (91%) and NPV (92%) were high for the BDI; specificity (58%) and PPV (56%) were low. BDI worsened in 2 patients completing the study (one IFA, one OBS); two IFA patients were discontinued for possible depression-related complications. At baseline, subject-rated fatigue was associated with alanine aminotransferase level.

Conclusion

The BDI is an adequate tool for ruling out depressive disorders in active IDUs with acute HCV, but specificity is low. Psychiatric consultation is recommended for all active IDUs being considered for acute HCV treatment.

Keywords: Depression, Screening, Injection drug use, Acute hepatitis C, Interferon-alpha