title: Associations of depression, anxiety and antidepressants with histological severity of nonalcoholic fatty liver disease.
abstract: BACKGROUND
  Depression and anxiety are common in patients with nonalcoholic fatty liver disease (NAFLD). However, their associations with histological severity of NAFLD are unknown.
  
  
  OBJECTIVE
  This study examined the association(s) of depression, anxiety and antidepressant pharmacotherapy with severity of histological features in patients with NAFLD.
  
  
  METHODS
  We analysed 567 patients with biopsy-proven NAFLD enrolled in the Duke NAFLD Clinical Database. Depressive and anxiety symptoms were assessed using the Hospital Anxiety & Depression Scale (HADS). The associations of depression and anxiety with severity of histological features of NAFLD were analysed using multiple logistic (or ordinal logistic) regression models with and without adjusting for confounding factors.
  
  
  RESULTS
  Subclinical and clinical depression was noted in 53% and 14% of patients respectively. Subclinical and clinical anxiety was noted in 45% and 25% of patients respectively. After adjusting for confounders, depression was significantly associated with more severe hepatocyte ballooning in a dose-dependent manner (likelihood ratio test, P = 0.0201); adjusted cumulative odds ratio (COR) of subclinical and clinical depression for having a higher grade of hepatocyte ballooning were 2.1 [95% CI, 1.0, 4.4] and 3.6 [95% CI, 1.4, 8.8].
  
  
  CONCLUSIONS
  In patients with NAFLD, depression was associated with more severe hepatocyte ballooning. Further investigation exploring pathobiological mechanisms underlying the observed associations and potential effects of antidepressant pharmacotherapy on NAFLD liver histology is warranted.
authors.affiliation: Department of Psychiatry, Duke University, Durham, NC, USA.
authors.forename: Nagy A
authors.initials: NA
authors.lastname: Youssef
authors.forename: Manal F
authors.initials: MF
authors.lastname: Abdelmalek
authors.forename: Martin
authors.initials: M
authors.lastname: Binks
authors.forename: Cynthia D
authors.initials: CD
authors.lastname: Guy
authors.forename: Alessia
authors.initials: A
authors.lastname: Omenetti
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Smith
authors.forename: Anna Mae E
authors.initials: AM
authors.lastname: Diehl
authors.forename: Ayako
authors.initials: A
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D000928:Antidepressive Agents / Q000627:therapeutic use*; D001007:Anxiety / Q000209:etiology*; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy* / Q000209:etiology*; D005234:Fatty Liver / Q000150:complications*; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D065626:Non-alcoholic Fatty Liver Disease; D009657:North Carolina; D016017:Odds Ratio; D011795:Surveys and Questionnaires
chemical_list: D000928:Antidepressive Agents
keywords: hepatic fibrosis; hepatocyte ballooning; liver injury; mood disorder; nonalcoholic steatohepatitis