In the current study we aimed to examine the effect of gender differences on personality problems and psychiatric symptoms among chronic HCV patients receiving DAAs with repeated follow up to 3 months after treatment. Our study included 170 participants, who were divided into two gender-based groups and evaluated at the beginning of the study, at the first, second, and third months of treatment, and three months after the end of therapy. We used the Hamilton depression and anxiety scales to evaluate the subject.
Marital status was significantly different among the studied groups in this study. A higher proportion of married states was observed in both male and female groups. Also, there was a significant difference in occupation among the studied groups, where the higher proportion was non-workers. Consistent with research by Gallach and colleagues, most females were non-workers (91.8%) while all males were workers [12].
Furthermore, BMI showed significant differences among studied groups, where the female group had higher BMIs. This can be explained as differences BMI among male and female due to pertaining to body weight perception, eating attitudes and weight-loss strategies [32].
In this study, there was a significant difference among studied groups regarding hypertension. The higher percentage of hypertension and diabetes mellitus were in the male group compared to the female groups. Previously, Fabrazzo and colleagues studied the effect of DAAs on CHC patients with and without psychiatric symptoms. Consistent with our findings, the researchers found a similar percentage of diabetes mellitus in the total population. However, the percentage of hypertension in study participants was higher than in our study [3]. Women are more aware of high blood pressure than men, while men have a larger prevalence of high blood pressure until after menopause as a result of decrease female hormon protection [33].
In this study, no statistically significant difference between the mean values of SIFFM subscales and total across the groups under study. On the scales of, a greater proportion of individuals were neuroticism, extraversion, and agreeableness with moderate class than those from the low class. Consistent with our findings, previous investigation [22] found no significant of personality disorders on in tolerability, clinical efficacy, or treatment discontinuation; however, this study included only 19 patients with PD and interferon treatment [21]. Similarly, another study reported no different between individuals with PD who had interferon therapy in Spanish prisoners in discontinuation rate [34]. In this study, there was no apparent explanation for this finding; however, it may be connected to the fact that a much greater proportion of people with PD were already getting psychiatric care prior to beginning HCV treatment. This could have a protective effect by reducing the likelihood of adverse mental events, as well as lead to more frequent contact with health services and a decreased risk of treatment cessation [34].
In the repetitive ANOVA measures of the HADS-A and HADS-D scores, no gender difference regarding psychiatric problems when patients were treated with DAAs. We observed a progressive decline in the mean HADS-A and HADS-D scores between baseline (before treatment) and consequence follow-up (during and after treatment) measurements.
Similar to our study, Sundberg and colleagues measured symptoms of depression in HCV patients (cirrhotic and non-cirrhotic) treated with DAAs using the self-rating version of the Montgomery Åsberg Depression Rating Scale (MADRS-S). Psychiatric assessment, and patient self-report measures were administered at baseline, after 1 month, 2 months of treatment, at the end of treatment, and three months after treatment. Three months after treatment, the MADRS-S score was significantly lower than at the beginning [4].
According to previous research that published the results of the Hamilton Depression Rating Scale (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A) before and three months after therapy with DAAs, most CHC patients were diagnosed with mixed anxiety-depressive disorder. However, with treatment, both HAM-D and HAM-A scores decreased significantly [3, 35].
Moreover, a study conducted by Kesen and colleagues administered the Hospital Anxiety and Depression (HAD) questionnaire to measure the severity of the anxiety and depression symptoms at the beginning and at the end of the treatment by DAAs [36]. Both HAM-D and HAM-A scores decreased significantly with treatment. In addition, Nardelli and colleagues who examined the prevalence of neuropsychiatric disorders, found that their incidence decreased after HCV eradication but without reaching statistical significance [37].
On the one hand, in a study done by Gallach and colleagues that measured the anxiety and depression status of patients who completed the validated Spanish version of the Hospital Anxiety and Depression Scale (HADS-D and HADS-A). HADS was administered at the beginning of treatment, after one month of treatment, 2 months of treatment, after treatment, and 3 months after the conclusion of treatment. Even in high-risk patients with major psychiatric disorders, DAA treatment had no effect on anxiety or depression during or after treatment for chronic hepatitis C infection [12].
Depression has been identified as a consequence for HCV infection. This correlation was associated with extrahepatic HCV manifestations in the central nervous system [38]. Additionally, the elimination of HCV with antiviral medication may reduce inflammation levels, resulting in fewer psychiatric symptoms, which may account for the observed reduction in depression ratings after treatment. In addition to the psychological effect of being healthy after virus eradication, there is also a significant physical effect [4, 6].
In this study, there were no significant gender-based differences in HADS scores when variables were analyzed by gender. Similar to our study, Gallach and colleagues and Bertine and colleagues reported that there was no statistically significant difference between the mean HADS-D and HADS-A scores for gender. In contrast, they found that depression, anxiety, and related disorders were more prevalent in female patients [36, 39].
The current study's regression model showed that individuals who had a high level of extraversion were more likely to have an increase in depression. Chronic HCV patients received INF in a previous trial had a statistically significant connection between HADS-D, HADS-A, and neuroticism. However, unlike our study, the researchers did not divide patients by gender [40].
Our study had notable limitations, including its narrow focus on depression and anxiety symptoms rather than cognitive disorders or sleep problems. The second limitation is the exclusion of cirrhotic patients and those with previous psychiatric disorders from our sample. In addition, all patients were administered DAAs according to a single regimen (Sofosbuvir/daclatasvir). Consequently, the observed effects cannot be formally extrapolated to other treatment protocols.