S2709 Global Prevalence of Anxiety and Depression in Patients With Liver Cirrhosis: A Systematic Review and Meta-Analysis

Introduction: Patient with liver cirrhosis have a heightened prevalence of anxiety and depression linked to decreased health-related quality of life and poor treatment outcomes. This study aims to examine the current evidence of anxiety and/or depression prevalence in cirrhotic patients. Methods: PubMed/MEDLINE, Embase, and Cochrane databases were searched for original articles from inception till December 2024. Included articles investigated the prevalence of depression or anxiety in liver cirrhosis of all etiologies. All analyses were conducted on R using the “meta” package. This review was conducted per the preferred reporting Items for systematic reviews and meta-analyses guidelines. Results: Twenty-three worldwide articles describing 979,113 patients were included: 11 cohort studies and 12 cross-sectional studies. The majority were hospital-based studies (82.6%) and 4 studies were population-based. The mean age was 57.1 ± 13.4 years, and men comprised 57% of the total number of patients. Subgroup analysis illustrated an overall proportion of depression of 0.37 [95% CI: 0.29-0.46, P = 0.1] in cirrhotic patients. In hospital-based studies, the proportion was 0.4 [95% CI: 0.3-0.51] versus 0.28 [95% CI: 0.19-0.39] in population-based studies. High heterogeneity was observed, (I2 = 99.9%), and sensitivity analysis failed to identify a particular source of heterogeneity. Therefore, it was deemed as natural data heterogeneity. Meta-regression was performed to assess the ability of demographic or etiological factors to predict depression in cirrhotic patients. Age, viral and alcohol related etiologies significantly predicted depression incidence. Anxiety proportions were assessed using meta-analysis of proportions. Among studies reporting anxiety incidences, the overall proportion was 0.53 [95% C.I. 0.33-0. 73], with significant subgroup differences (P < 0.01). The high proportion was mainly due to hospital-based cohorts' anxiety incidence that was 0.57 [95% C.I. 0.35-0.77]. Meta-regression of suspected predictors of anxiety was conducted with no significant results. Conclusion: Our analysis revealed that nearly 1 in 3 cirrhotic patients experience depression, while close to half suffer from anxiety. Additional prospective studies are warranted to validate these results. Standardized screening for mental health in cirrhosis is crucial for early identification or intervention and should be adopted globally.