This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Elwing, J. E. Articles by Clouse, R. E. Search for Related Content PubMed PubMed Citation Articles by Elwing, J. E. Articles by Clouse, R. E. Related Collections Anxiety Depression

Depression, Anxiety, and Nonalcoholic Steatohepatitis

From the Division of Gastroenterology (J.E.E., R.E.C.), Department of Psychiatry (P.J.L., R.E.C.), and Division of Anatomic Pathology (H.L.W.), Washington University School of Medicine, St. Louis, Missouri.

Address correspondence and reprint requests to Ray E. Clouse, MD, Division of Gastroenterology, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8124, St. Louis, MO 63110. E-mail: rclouse{at}im.wustl.edu

Objective: Nonalcoholic steatohepatitis (NASH) is a morbid liver disease with limited treatment. Depression and anxiety have been associated recently with insulin resistance and inflammatory states, factors that are relevant to the development of NASH. We hypothesized that depression and anxiety would be more prevalent in NASH patients and predict more severe histological findings on liver biopsy.

Methods: Histories of major depressive disorder (MDD) and generalized anxiety disorder (GAD) were determined using a structured interview and DSM-IV criteria in 36 NASH subjects and 36 matched controls without liver disease who had undergone cholecystectomy. Histological changes on liver biopsy in NASH subjects were age-adjusted and compared in subjects with and without psychiatric disorders. A multivariate model incorporating other potential risk factors for NASH (female sex, body mass index, waist-to-hip ratio, and presence of diabetes) was used to determine independent effects of MDD and GAD on severity of histological findings.

Results: NASH subjects had significantly increased lifetime rates of MDD (odds ratio [OR], 3.8; 95% confidence interval [CI], 1.4–10.2; p = .018) and GAD (OR 5.0, 95% CI, 1.7–14.9; p = .005). The onset of psychiatric illness preceded diagnosis of liver disease by 18 to 20 years. Each psychiatric disorder was associated with more severe histological features (p < .05 for each), the effect of GAD on fibrosis stage persisting in the multivariate model.

Conclusions: MDD and GAD are overrepresented in NASH subjects and are associated with more advanced liver histological abnormalities. Additional investigation will be required to determine if depression and anxiety affect the development or progression of NASH and serve as modifiable risk factors.

Key Words: nonalcoholic steatohepatitis • insulin resistance • major depressive disorder • generalized anxiety disorder

Abbreviations: BMI = body mass index; DIS = Diagnostic Interview Schedule; DSM-IV = Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition; GAD = generalized anxiety disorder; MDD = major depressive disorder; NASH = nonalcoholic steatohepatitis; PHQ = Patient Health Questionnaire; WHR = waist-to-hip ratio; OR = odds ratio; CI = confidence interval.

This article has been cited by other articles:

				D C Voaklander, B H Rowe, D M Dryden, J Pahal, P Saar, and K D Kelly Medical illness, medication use and suicide in seniors: a population-based case control study J. Epidemiol. Community Health, February 1, 2008; 62(2): 138 - 146. [Abstract] [Full Text] [PDF]