How persons with chronic hepatitis C in residential substance abuse treatment programs think about depression and interferon therapy

OBJECTIVE: This secondary analysis of existing qualitative descriptive data is the first to specifically report on how persons undergoing residential treatment for substance abuse think about depression and the risks of neuropsychiatric side effects associated with interferon (IFN) treatment for hepatitis C virus (HCV) infection. METHOD: Krippendorff's method for qualitative content analysis was used to describe patient perspectives about psychiatric symptoms and potential side effects of IFN treatment. Transcripts from face-to-face, semistructured interviews with 20 patients in 3 residential substance abuse treatment programs were analyzed. RESULTS: Themes included patients' powerlessness and their evaluation of risk and confidence. Participants commented that residential substance abuse treatment programs offered a unique opportunity to undergo antiviral treatment because they capitalized on a patient's heightened readiness for change. Barriers to treatment included perceived obstacles, such as compulsory waiting periods before treatment initiation, fear that neuropsychiatric treatment side effects would sabotage addiction recovery, and concern that psychiatric providers lacked sufficient HCV knowledge. However, when patients perceived clinicians as knowledgeable and genuinely caring, they were amenable to considering antiviral treatment. CONCLUSION: Increasing HCV-specific psychiatric education and staff training, exploring combined psychiatric and antiviral treatment combinations, and therapeutically supporting patient decision making are needed to better use substance abuse residential treatment programs as sites for treating HCV infection. Novel antidepressant treatment approaches are required in this population. Advanced practice psychiatric nurses are well-positioned to develop new integrative models of care addressing the medical, psychiatric, and substance abuse comorbidities in this highly vulnerable group.