Clin Mol Hepatol.
2022 Oct;28(4):864-875. 10.3350/cmh.2022.0136.
Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: Systematic review and meta-analysis
- Tan DJH
1 - Quek SXZ1,2
- Yong JN1
- Suresh A1
- Koh KXM1
- Lim WH1
- Quek J1
- Tang A1
- Tan C1
- Nah B2
- Tan E1,2
- Keitoku T3
- Muthiah MD1,2
- Syn N1
- Ng CH1
- Kim BK4,5
- Tamaki N3
- Ho CSH1,6
- Loomba R7
- Huang DQ1,2,7
- Affiliations
-
- 1Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- 2Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
- 3Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan
- 4Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- 5Yonsei Liver Center, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- 6Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- 7NAFLD Research Center, Division of Medicine, University of California San Diego, La Jolla, California, USA
- KMID: 2534351
- DOI: http://doi.org/10.3350/cmh.2022.0136
Abstract
- Background/Aims
Depression and anxiety are associated with poorer outcomes in patients with hepatocellular carcinoma (HCC). However, the prevalence of depression and anxiety in HCC are unclear. We aimed to establish the prevalence of depression and anxiety in patients with HCC.
Methods
MEDLINE and Embase were searched and original articles reporting prevalence of anxiety or depression in patients with HCC were included. A generalized linear mixed model with Clopper-Pearson intervals was used to obtain the pooled prevalence of depression and anxiety in patients with HCC. Risk factors were analyzed via a fractional-logistic regression model.
Results
Seventeen articles involving 64,247 patients with HCC were included. The pooled prevalence of depression and anxiety in patients with HCC was 24.04% (95% confidence interval [CI], 13.99–38.11%) and 22.20% (95% CI, 10.07–42.09%) respectively. Subgroup analysis determined that the prevalence of depression was lowest in studies where depression was diagnosed via clinician-administered scales (16.07%;95% CI, 4.42–44.20%) and highest in self-reported scales (30.03%; 95% CI, 17.19–47.01%). Depression in patients with HCC was lowest in the Americas (16.44%; 95% CI, 6.37–36.27%) and highest in South-East Asia (66.67%; 95% CI, 56.68–75.35%). Alcohol consumption, cirrhosis, and college education significantly increased risk of depression in patients with HCC.
Conclusions
One in four patients with HCC have depression, while one in five have anxiety. Further studies are required to validate these findings, as seen from the wide CIs in certain subgroup analyses. Screening strategies for depression and anxiety should also be developed for patients with HCC.
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