Depression, anxiety and alexithymia symptoms are major determinants of health related quality of life (HRQoL) in cirrhotic patients

Abstract

HRQoL is impaired in cirrhosis. Establishing the relevance of depression, anxiety, alexithymia and cirrhosis stage on the patients' HRQoL. Sixty cirrhotics underwent a neuropsychological assessment, including ZUNG-SDS, STAI Y1-Y2 and TAS-20. Minimal hepatic encephalopathy (MHE) was detected by PHES, HRQoL by Short-Form-36 (SF-36). Depression was detected in 34 patients (57 %, 95%CI = 44-70 %), state-anxiety in 16 (27 %, 95%CI = 15-38 %), trait-anxiety in 17 (28 %, 95%CI = 17-40 %), alexithymia in 14 (31 % 95%CI = 16-46 %) and MHE in 22 (37 %, 95%CI = 24-49 %). Neuropsychological symptoms were unrelated to cirrhosis stage, hepatocellular carcinoma or MHE. A significant correlation was observed among psychological test scores and summary components of SF-36. At multiple linear regression analysis including Child-Pugh and MELD scores, previous-HE and the psychological test scores as possible covariates, alexithymia and depression as well as to the Child-Pugh score were significantly related to the SF-36 mental component; while trait-anxiety was the only variable significantly and independently related to the SF-36 physical component. Depression, state and trait-anxiety and alexithymia symptoms are frequent in cirrhotics and are among the major determinants of the altered HRQoL.

Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation

“…The conditions certainly have overlap in their pathological basis; for instance, single photon emission computed tomography (SPECT) demonstrated areas of hypoperfusion in the superior and middle frontal gyri 13 and in the anterior cingulated gyrus in cirrhotic patients with minimal hepatic encephalopathy, 14 which are areas also involved in other neuropsychological disorders. 15 However, recent research assessing for HRQOL and the prevalence of affective disorders in cirrhotic patients of mixed aetiologies shows no difference in psychological scores for depressive disease between the 22 patients with minimal hepatic encephalopathy (as diagnosed via PHES testing 16 ) compared to those without, 8 supporting the concept that hepatic encephalopathy and depression may have overlapping features but are distinct clinical entities. Several different explanations have been proposed to explain the high prevalence of depression in cirrhotic patients.…”

“…5 By BDI criteria, at least 30% of patients with cirrhosis have depressive symptoms. [6][7][8] Studies where cirrhotic patients have been assessed for health-related quality of life (HRQOL) as well as depression [the former typically also via questionnaires, such as the Short Form-36 (SF-36)] confirm that depressed cirrhotic patients experience a significantly reduced HRQOL in comparison to nondepressed subjects. 6,9 Furthermore, cirrhotic patients with depression experience worse clinical outcomes than those without.…”

Minimal Hepatic Encephalopathy Impairs Quality of Life

“…[44][45][46][47] MHE adversely affects HRQOL as shown by various studies. 11,41,43,[48][49][50] Complex activities which require attention or information processing and psychomotor skills are mainly affected, such as driving a car or planning a trip. Basic functions of day to day self-care like personal hygiene, dressing and shopping are preserved.…”

“…49 Depression, anxiety-trait and alexithymic symptoms occurs in cirrhotics and are major determinants of impaired HRQOL. 50 Treatment of MHE with lactulose, 11 rifaximin 27,51 or probiotics 29 reverses MHE in majority of patients. Significantly HRQOL also improves with treatment of MHE.…”

Female gender and gastrointestinal symptoms, not brain‐derived neurotrophic factor, are associated with depression and anxiety in cirrhosis

“…The majority of cirrhotic patients show mild to moderate, even severe, depression and anxiety and the health-related quality of life of patients is remarkably reduced by psychological distress rather than liver impairment. [2][3][4] However, limited studies have investigated the factors that influence the psychological status of cirrhotic patients. The severity of cirrhosis as assessed by the CP score does not seem to be related to depression or anxiety.…”