Anxiety, depression common among patients with cirrhosis

Approximately one in six patients with cirrhosis had depression while more than half had moderate-severe anxiety, according to the results of a phone interview survey.

Ruben Hernaez, MD, MPH, PhD, of the section of gastroenterology at Michael E. DeBakey Veterans Affairs Medical Center in Houston, and colleagues wrote that anxiety and depression decrease quality of life and can impact care of chronic diseases dues to missed medical appointments and poor drug adherence.

“Estimates for the prevalence of depression and anxiety are best known in patients with decompensated cirrhosis and liver transplant candidates,” they wrote. “However, the burden of these mental health disorders in a broad cirrhosis patient population, particularly across different health care settings, is lacking.”

Researchers reached out to 2,871 patients with cirrhosis to evaluate the prevalence and risk factors for anxiety and depression. Of the patients they approached for the phone survey, 1,021 patients (35.6%) completed it.

Investigators defined clinically significant depression as a Patient Health Questionairre-9 (PHG9) score of at least 15 and anxiety as a State-Trait Anxiety Inventory (STAI) score of at least 40.

In their study group, Hernaez and colleagues found that the median PHQ9 score was 7, and 15.6% of patients had moderately severe to severe depression. Additionally, they found that the median STAI score was 33, and 42.6% of patients had high anxiety.

Investigators determined that self-reported poor health (OR = 4.08; 95% CI, 1.79-9.28), being widowed (OR = 2.08; 95% CI, 1.07-4.05), fear of hepatocellular carcinoma (OR = 1.89; 95% CI, 1.04-3.42), higher household income (OR = 0.3; 95% CI, 0.1-0.95) and Hispanic ethnicity (OR = 0.57, 95% CI, 0.33-0.97) were all associated with moderately severe to severe depression.

In their analysis they also found that male sex (OR = 0.71; 95% CI, 0.51-0.98), self-reported poor health (OR = 2.73; 95% CI, 1.73-4.32), and fear of hepatocellular carcinoma (OR = 2.24; 95% CI, 1.33-3.78) were associated with high anxiety.

“Even though depression and anxiety are common, with significant implications for patient adherence and satisfaction, these comorbidities unfortunately often go unnoticed in clinical practice,” Hernaez and colleagues wrote. “Screening for depression and anxiety should be encouraged in all patients with cirrhosis to identify those in need of mental health counseling.”