Psychiatr Serv 54:842-847, June 2003
© 2003 American Psychiatric Association
Blood-Borne Infections and Persons With Mental Illness: Substance Abuse and the Transmission of Hepatitis C Among Persons With Severe Mental Illness
Fred C. Osher, M.D.,
Richard W. Goldberg, Ph.D.,
Scot W. McNary, Ph.D.,
Marvin S. Swartz, M.D.,
Susan M. Essock, Ph.D.,
Marian I. Butterfield, M.D., M.P.H.,
Stanley D. Rosenberg, Ph.D. and
the Five-Site Health and Risk Study Research Committee
OBJECTIVES: The authors sought to better understand the relationship of substance abuse to higher rates of transmission of hepatitis C among persons with severe mental illness. METHODS: The authors assessed 668 persons with severe mental illness for HIV, hepatitis B, and hepatitis C infection through venipuncture. Demographic characteristics, substance abuse, and risk behaviors for blood-borne infections were assessed through interviews and collection of clinical data. RESULTS: Eighty-two percent of the assessed persons were not infected, and 18 percent had hepatitis C. Among those with hepatitis C infection, 546 (82 percent) tested negative for all viruses. Of the 122 (18 percent) who had hepatitis C, 53 (8 percent) had only hepatitis C, 56 (8 percent) had both hepatitis C and hepatitis B, three (1 percent) had hepatitis C and HIV, and ten (2 percent) had all three infections. More than 20 percent of the sample reported lifetime intravenous drug use, and 14 percent reported lifetime needle sharing. Fifty-seven percent had sniffed of snorted cocaine, and 39 percent had smoked crack. A stepwise regression model was used to identify interaction effects of these behaviors and risk of hepatitis C infection among persons with severe mental illness. Use of needles and of crack cocaine were associated with a large increase in the likelihood of hepatitis C infection. CONCLUSIONS: The high rates of co-occurring substance use disorders among persons with severe mental illness, coupled with the role of substance abuse as the primary vector for hepatitis C transmission, warrants special consideration.
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