Depression and Anxiety Are Common Among Patients With Cirrhosis

Ruben Hernaez, Jennifer R. Kramer, Aisha Khan, Jessica Phillips, Katharine McCallister, Kassie Chaffin, Adriana Portela Hernandez, Hannah Fullington, Cynthia Ortiz, James Michael Blackwell, Adam Loewen, Yan Liu, Jasmin A. Tiro, Simon C. Lee, Amit G. Singal

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background & Aims: Depression and anxiety can have negative effects on patients and are important to treat. There have been few studies of their prevalence among patients with cirrhosis. We aimed to characterize the prevalence and risk factors for depression and anxiety in a large multi-center cohort of patients with cirrhosis. Methods: We conducted a telephone-based survey of patients with cirrhosis at 3 health systems in the United States (a tertiary-care referral center, a safety net system, and a Veterans hospital) from April through December 2018. Of 2871 patients approached, 1021 (35.6%) completed the survey. Depression and anxiety were assessed using the PHQ-9 (range 0–25) and STAI (range 20–80) instruments, with clinically significant values defined as PHQ-9 ≥15 and STAI ≥40. We performed multivariate logistic regression analysis to identify factors associated with significant depression and anxiety. Results: The median PHQ-9 score was 7 (25th percentile–75th percentile, 3–12) and the median STAI score was 33 (25th percentile–75th percentile, 23–47); 15.6% of patients had moderately severe to severe depression and 42.6% of patients had high anxiety. In multivariable analyses, self-reported poor health (odds ratio [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, 0.30; 95% CI, 0.10–0.95), and Hispanic ethnicity (OR, 0.57; 95% CI, 0.33–0.97) were associated with moderately severe to severe depression. 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. Conclusions: Nearly 1 in 6 patients with cirrhosis have moderately severe to severe depression and nearly half have moderate–severe anxiety. Patients with cirrhosis should be evaluated for both of these disorders.

Original languageEnglish (US)
Pages (from-to)194-203.e1
JournalClinical Gastroenterology and Hepatology
Issue number1
StatePublished - Jan 2022


  • Anxiety
  • Cirrhosis
  • Comorbidity
  • Depression
  • Liver Disease
  • Psychiatric Illness

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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