title: Anxiety and depression are associated with long-term outcomes of hepatocellular carcinoma: A nationwide study of a cohort from Taiwan.
abstract: 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.
  
  
  
  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.
  
  
  
  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).
  
  
  
  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.
authors.affiliation: a Department of Healthcare Administration and Medical Informatics , Kaohsiung Medical University , Kaohsiung , Taiwan.|b Division of Hepatobiliary Surgery, Department of Surgery , Kaohsiung Medical University Hospital , Kaohsiung , Taiwan.
authors.forename: King-Teh
authors.initials: KT
authors.lastname: Lee
authors.affiliation: c Department of Psychiatry , Chi-Mei Medical Center , Tainan , Taiwan.|d Department of Psychiatry , Chi-Mei Hospital , Liouying , Tainan , Taiwan.|e Department of Psychiatry, School of Medicine, College of Medicine , Taipei Medical University , Taipei , Taiwan.
authors.forename: Jin-Jia
authors.initials: JJ
authors.lastname: Lin
authors.affiliation: a Department of Healthcare Administration and Medical Informatics , Kaohsiung Medical University , Kaohsiung , Taiwan.
authors.forename: Hon-Yi
authors.initials: HY
authors.lastname: Shi
mesh_terms: D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology*; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology* / Q000401:mortality; D015897:Comorbidity; D003866:Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000453:epidemiology*; D008113:Liver Neoplasms / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013624:Taiwan / Q000453:epidemiology
keywords: Anxiety and depression; generalised estimating equations; hepatocellular carcinoma; outcomes; propensity score matching