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Global prevalence of depression and anxiety in patients with hepatocellular carcinoma: Systematic review and meta-analysis
Authors:Darren Jun Hao Tan  Sabrina Xin Zi Quek  Jie Ning Yong  Adithya Suresh  Kaiser Xuan Ming Koh  Wen Hui Lim  Jingxuan Quek  Ansel Tang  Caitlyn Tan  Benjamin Nah  Eunice Tan  Taisei Keitoku  Mark D. Muthiah  Nicholas Syn  Cheng Han Ng  Beom Kyung Kim  Nobuharu Tamaki  Cyrus Su Hui Ho  Rohit Loomba  Daniel Q. Huang
Abstract:
Background/AimsDepression 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.MethodsMEDLINE 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.ResultsSeventeen 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.ConclusionsOne 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.
Keywords:Depression   Anxiety   Hepatocellular carcinoma   Meta-analysis   Systematic review
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