title: Female gender and gastrointestinal symptoms, not brain-derived neurotrophic factor, are associated with depression and anxiety in cirrhosis.
abstract: OBJECTIVE
  Cirrhosis places a substantial burden on the psychological status of affected individuals. The aim of our study was to identify the associated factors of psychological distress in cirrhosis.
  
  
  METHODS
  A total of 208 patients with cirrhosis were recruited. Each patient received validated questionnaires to assess gastrointestinal (GI) symptoms, depression, and anxiety. Serum brain-derived neurotrophic factor (BDNF) levels were measured by enzyme-linked immunosorbent assay.
  
  
  RESULTS
  A total of 16.35% of patients (n = 34) were diagnosed with depression and 10.58% (n = 22) with anxiety. The percentages of female patients among those diagnosed with depression and anxiety were 58.8% and 77.3%, respectively, which were significantly higher than that in non-depressed (35.1%) and non-anxious patients (34.4%). The patients who showed more GI symptoms had higher depression and anxiety scores. The GI symptom scores of patients with depression and anxiety were 4 (2.75, 7) and 4 (2.75, 7.25), respectively, which were significantly higher than that of patients without depression (2 [0, 4]) and anxiety (2 [1, 4]). Significantly higher depression and anxiety scores were detected in patients who suffered from abdominal bloating, belching, anorexia, abdominal pain, nausea/vomiting, and constipation. Cirrhotic patients had higher serum levels of BDNF than healthy controls (159.33 [96.64, 243.30] pg/mL vs. 70.74 [56.58, 93.52] pg/mL). In the cirrhosis group, there was no significant difference in BDNF levels between depressed and non-depressed patients. Multiple linear regression analysis revealed that depression and anxiety were each independently associated with female gender and GI symptom scores.
  
  
  CONCLUSIONS
  Female gender and GI symptoms are closely associated with depression and anxiety in cirrhosis. There is no significant correlation between BDNF level and psychological distress in cirrhosis.
authors.affiliation: Liver Cirrhosis Section, Department of Hepatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.|Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai, China.|Department of Gastroenterology and Hepatology, Hangzhou Red Cross Hospital, Hangzhou, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Xu
authors.affiliation: Liver Cirrhosis Section, Department of Hepatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.|Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Zhou
authors.affiliation: Liver Cirrhosis Section, Department of Hepatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.|Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Fangyuan
authors.initials: F
authors.lastname: Ko
authors.affiliation: Liver Cirrhosis Section, Department of Hepatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.|Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai, China.|Key Laboratory of Liver and Kidney Diseases (Shanghai University of Traditional Chinese Medicine), Ministry of Education, Shanghai, China.
authors.forename: Jian
authors.initials: J
authors.lastname: Ping
authors.affiliation: Liver Cirrhosis Section, Department of Hepatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.|Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Liver Cirrhosis Section, Department of Hepatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.|Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
authors.forename: Changqing
authors.initials: C
authors.lastname: Zhao
authors.affiliation: Liver Cirrhosis Section, Department of Hepatology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China.|Institute of Liver Diseases, Shanghai University of Traditional Chinese Medicine, Shanghai, China.|Key Laboratory of Liver and Kidney Diseases (Shanghai University of Traditional Chinese Medicine), Ministry of Education, Shanghai, China.
authors.forename: Lieming
authors.initials: L
authors.lastname: Xu
keywords: anxiety; brain-derived neurotrophic factor; depression; gastrointestinal symptom; liver cirrhosis