Depression and anxiety in nonalcoholic steatohepatitis: is there any association?

Several authors consider that depression and anxiety may induce inflammatory states, and thus can influence the progression of nonalcoholic fatty liver disease (NAFLD). The purpose of this paper was to evaluate if there was an association between anxiety, depression and NAFLD, in patients with normal and elevated serum transaminases.

We selected a group of patients with NAFLD and a group of female patients with chronic viral hepatitis (B or C). Clinical and biological parameters were collected. All patients filled in several questionnaires assessing total distress, and the presence of symptoms of depression and anxiety. We compared all these scores in female versus males, in patients with normal and elevated liver serum transaminases (LST), and in female patients with NAFLD versus female patients with chronic hepatitis.

The NAFLD group included 63 patients (38 females). The viral hepatitis group included 18 female patients. Female patients had significantly higher scores in all questionnaires when compared with male patients. There was a strong association between feminine gender and depression, with a relative risk of 3.2 (95% CI = 1.6-6.7). Depression, anxiety and distress scores were not statistically different in patients with NAFLD and normal LST as compared with patients with NAFLD and elevated LST. No differences were noticed when comparing the scores of depression, anxiety, or distress in females with NAFLD and females with viral hepatitis. There were no correlations between the scores for personality traits and serological tests in either of groups.

Symptoms of depression and anxiety are common in our region, and are more often seen in female patients. We cannot support any relationship between NAFLD and depression or anxiety. Prospective studies should be done in order to assess the real influence of depression and anxiety on the outcome of patients with NAFLD or chronic viral hepatitis.