Gastro hep advances · 2026
Comorbid Depression Among US Adults With Elastography-Defined Advanced Chronic Liver Disease and Clinically Significant Portal Hypertension: National Health and Nutrition Examination Survey 2017-2023.
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Boateng Sarpong, Nguefang Guy Loic, Mapouka Mexan, Nwatamole Bright, Gyabaah Solomon, Onyeaka Henry, Sierra Leandro, Al-Aljouni Yazan, Njei Basile
Аннотация
BACKGROUND AND AIMS: Depression is a critical yet underrecognized comorbidity in chronic liver disease, with important implications for treatment adherence, self-management, and clinical outcomes. However, nationally representative estimates of comorbid depression using contemporary elastography-defined advanced chronic liver disease (ACLD) and clinically significant portal hypertension (CSPH) are lacking.
METHODS: We analyzed adults from the National Health and Nutrition Examination Survey 2017-2020 and 2021-2023 cycles using valid vibration-controlled transient elastography, Patient Health Questionnaire-9 data, and complete covariates. Survey-weighted logistic regression identified factors associated with depression in ACLD patients, adjusting for the identified covariates. Sensitivity analyses were used to evaluate alternative Patient Health Questionnaire-9 scoring assumptions.
RESULTS: Among 13,291 participants representing the US adult population, the weighted prevalence of comorbid depression was 12.16% with 95% confidence interval (CI) 8.65, 15.66%. In multivariate analysis, female sex (adjusted odds ratio [aOR] 3.51; 95% CI 1.98, 6.23; P < .001) and greater sedentary time (aOR 1.012 per hour/day; 95% CI 1.006, 1.018; P = .021) were independently associated with higher odds of comorbid depression. Older age (aOR 0.97 per year; 95% CI 0.94, 0.99; P = .025) and non-Hispanic Black race compared with non-Hispanic White race (aOR 0.27; 95% CI 0.10, 0.71; P = .010) were associated with lower odds of depression in ACLD. The odds of depression were 78% higher in the postpandemic period than in the prepandemic (aOR 1.78; 95% CI 1.04, 3.02; P = .035). The findings were robust across sensitivity analyses.
CONCLUSION: Approximately 12% to 13% of US adults with ACLD or CSPH experience comorbid depression, with an increase in the post-COVID-19 era. Depression burden was the highest among women, younger adults, individuals with high sedentary time, and non-Hispanic Black adults with CSPH. Therefore, there is a need to integrate behavioral health pathways into hepatology care.
METHODS: We analyzed adults from the National Health and Nutrition Examination Survey 2017-2020 and 2021-2023 cycles using valid vibration-controlled transient elastography, Patient Health Questionnaire-9 data, and complete covariates. Survey-weighted logistic regression identified factors associated with depression in ACLD patients, adjusting for the identified covariates. Sensitivity analyses were used to evaluate alternative Patient Health Questionnaire-9 scoring assumptions.
RESULTS: Among 13,291 participants representing the US adult population, the weighted prevalence of comorbid depression was 12.16% with 95% confidence interval (CI) 8.65, 15.66%. In multivariate analysis, female sex (adjusted odds ratio [aOR] 3.51; 95% CI 1.98, 6.23; P < .001) and greater sedentary time (aOR 1.012 per hour/day; 95% CI 1.006, 1.018; P = .021) were independently associated with higher odds of comorbid depression. Older age (aOR 0.97 per year; 95% CI 0.94, 0.99; P = .025) and non-Hispanic Black race compared with non-Hispanic White race (aOR 0.27; 95% CI 0.10, 0.71; P = .010) were associated with lower odds of depression in ACLD. The odds of depression were 78% higher in the postpandemic period than in the prepandemic (aOR 1.78; 95% CI 1.04, 3.02; P = .035). The findings were robust across sensitivity analyses.
CONCLUSION: Approximately 12% to 13% of US adults with ACLD or CSPH experience comorbid depression, with an increase in the post-COVID-19 era. Depression burden was the highest among women, younger adults, individuals with high sedentary time, and non-Hispanic Black adults with CSPH. Therefore, there is a need to integrate behavioral health pathways into hepatology care.