Anxiety and depression are associated with long-term outcomes of hepatocellular carcinoma: A nationwide study of a cohort from Taiwan

Abstract

Objectives: A natural experimental design was coupled with propensity score matching to assess the risks of anxiety and depression and to assess the longitudinal effects of anxiety and depression on healthcare utilisation and mortality in hepatocellular carcinoma (HCC) patients.

Methods: This nationwide population-based cohort study retrospectively analysed 7304 patients treated for HCC during 1996–2010. Generalised estimating equations were used to estimate differences-in-differences models for examining the effects of anxiety and depression disorders.

Results: Independent risk factors for anxiety and depression in the HCC patients were female gender (hazard ratio (HR) 1.45; P < 0.001), Charlson co-morbidity index score (HR 1.12; P = 0.005), and liver cirrhosis (HR 1.35; P = 0.004). Anxiety and depression (differences-in-differences value) had a significant (P < 0.001) positive net effect on number of physician visits. Furthermore, the mean overall survival time was 83.4 months (SD 5.4 months) in the anxiety/depression group and 65.4 months (SD 4.8 months) in the non-disorder group. Additionally, the overall survival rate was significantly higher in the anxiety/depression group compared to the non-disorder group during the study period (P = 0.003).

Conclusions: Anxiety disorders and depression disorders are associated with a significantly increased overall survival rate in HCC patients. However, further studies are needed to investigate this association.

Keywords:

• Anxiety and depression
• outcomes
• hepatocellular carcinoma
• propensity score matching
• generalised estimating equations

Statement of interest

The authors have no conflicts of interest to declare. All authors had full access to all data (including statistical reports and tables) used in the study and assume responsibility for the integrity of the data and the accuracy of the data analysis. The specific contributions of each author were as follows: conceptualisation and design of study, KTL, JJL and HYS. Acquisition of data, HYS. Analysis and interpretation of data, KTL, JJL and HYS. Initial drafting of manuscript, KTL, JJL and HYS. Critical revision of the manuscript for important intellectual content, KTL, JJL and HYS. Statistical analysis of data, KTL, JJL and HYS. Application for funding of study, KTL, JJL and HYS. Administrative, technical and material support of study, KTL, JJL and HYS. Supervision of study, KTL, JJL and HYS.