Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: Systematic review and meta-analysis
Darren Jun Hao Tan, Sabrina Xin Zi Quek, Jie Ning Yong, Adithya Suresh, Kaiser Xuan Ming Koh, Wen Hui Lim, Jingxuan Quek, Ansel Shao Pin Tang, Caitlyn Tan, Benjamin Nah, Eunice Xiang‐Xuan Tan, Taisei Keitoku, Mark Muthiah, Nicholas Syn, Cheng Han Ng, Beom Kyung Kim, Nobuharu Tamaki, Cyrus S. H. Ho, Rohit Loomba, Daniel Q. Huang
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. CONCLUSION: 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.