• Adil Naseer Khan Ayub Medical College
  • Mohammad Arshad Abbassi AIMS AJK
  • Asad Gandapur Ayub Medical College
  • Aftab Alam Ayub Medical College
  • Muhammad Zeeshan Haroon Ayub Medical College
  • Jawad Hussain


Background: Psychiatric co-morbidity is a frequent finding in patients with chronic liver disease (CLD). Patients with CLD may have anxiety, depression, sleep disturbances and behavioural disorders as well as cognitive defects. Therefore, this study was designed to determine the frequency of major depression in patients diagnosed with chronic liver disease Methods: This descriptive cross-sectional study was conducted at the department of gastroenterology Ayub Teaching Hospital Abbottabad from January–July 2017. One hundred and eleven patients diagnosed with chronic liver disease were included in the study using consecutive non-probability sampling technique. A detailed medical history was taken and physical exam was conducted before the patients were asked to answer a questionnaire (HADS-D). The answers were marked to obtain a final score. Quantitative variables like age, HADS-D score, and duration of CLD were described in terms of mean and standard deviation. Categorical variables like gender and depression were described in terms of frequencies and percentages. Stratification was done on age, duration of CLD and gender to see the effect modifiers. Chi-Square test was used at 5% significance level for determining statistically significant differences. Results: Out of 111 patients, 38 (34.2%) were found to have depression on the basis of their HADS-D score. When depression was stratified according to age, gender and duration of chronic liver disease, a strong statistical association was seen with the duration of chronic liver disease and increased serum ALT levels (p<0.05). Conclusion: Depression is fairly common in patients with CLD and is significantly associated with the duration of CLD and the derangement of liver enzymes.

Author Biographies

Adil Naseer Khan, Ayub Medical College

Department of Gasteroenterology

Asad Gandapur, Ayub Medical College

Department of Gasteroenterology

Aftab Alam, Ayub Medical College

Department of Psychiatry

Muhammad Zeeshan Haroon, Ayub Medical College

Department of Community Medicine



Huang X, Liu X, Yu Y. Depression and Chronic Liver Diseases: Are There Shared Underlying Mechanisms? Front Mol Neurosci. 2017;10:134.

American Psychiatric Association. What Is Depression? [Internet]. American Psychiatric Association. 2017 [cited 2020 Jan 29]. Available from:

Health Quality Ontario. Screening and management of depression for adults with chronic diseases: an evidence-based analysis. Ont Health Technol Assess Ser. 2013;13(8):1–45.

Mansoor S, Haider A, Ramzan Z, Usman R. Frequency and Sociodemographic Determinants of Depression in Patients with Chronic Liver Disease. J Dow Univ Health Sci JDUHS. 2018;12(1):17–20.

Ingle VK, Pandey I, Singh AR, Pakhare A, Kumar S. Screening of Patients with Chronic Medical Disorders in the Outpatient Department for Depression Using Handheld Computers as Interface and Patient Health Questionnaire-9 as a Tool. Int J Appl Basic Med Res. 2017;7(2):129–33.

Bhana A, Rathod SD, Selohilwe O, Kathree T, Petersen I. The validity of the Patient Health Questionnaire for screening depression in chronic care patients in primary health care in South Africa. BMC Psychiatry. 2015;15(1):118.

Dworkin SF, Von Korff M, LeResche L. Multiple pains and psychiatric disturbance. An epidemiologic investigation. Arch Gen Psychiatry. 1990;47(3):239–44.

Prince M, Patel V, Saxena S, Maj M, Maselko J, Phillips MR, et al. No health without mental health. Lancet Lond Engl. 2007;370(9590):859–77.

National Collaborating Centre for Mental Health (UK). Depression in Adults with a Chronic Physical Health Problem: Treatment and Management [Internet]. Leicester (UK): British Psychological Society; 2010 [cited 2020 Jan 29]. (National Institute for Health and Clinical Excellence: Guidance). Available from:

Schäfer A, Wittchen H, Seufert J, Kraus MR. Methodological approaches in the assessment of interferon‐alfa‐induced depression in patients with chronic hepatitis C–a critical review. Int J Methods Psychiatr Res. 2007;16(4):186–201.

Coughlan B, Sheehan J, Hickey A, Crowe J. Psychological well‐being and quality of life in women with an iatrogenic hepatitis C virus infection. Br J Health Psychol. 2002;7(1):105–16.

Popovic D, Culafic D, Kisic-Tepavcevic D, Kovacevic N, Spuran M, Djuranovic S, et al. Assessment of depression and anxiety in patients with chronic liver disease. Vojnosanit Pregl. 2015;72(5):414–20.

Gilbody S, Richards D, Brealey S, Hewitt C. Screening for depression in medical settings with the Patient Health Questionnaire (PHQ): a diagnostic meta-analysis. J Gen Intern Med. 2007 Nov;22(11):1596–602.

Sanchez-Villegas A, Schlatter J, Ortuno F, Lahortiga F, Pla J, Benito S, et al. Validity of a self-reported diagnosis of depression among participants in a cohort study using the Structured Clinical Interview for DSM-IV (SCID-I). BMC Psychiatry. 2008;8(1):43.

Mitchell AJ, Meader N, Symonds P. Diagnostic validity of the Hospital Anxiety and Depression Scale (HADS) in cancer and palliative settings: a meta-analysis. J Affect Disord. 2010;126(3):335–48.

Hamilton M. The Hamilton rating scale for depression. In: Assessment of depression. Springer; 1986. p. 143–52.

Aghanwa HS, Ndububa D. Specific psychiatric morbidity in liver cirrhosis in a Nigerian general hospital setting. Gen Hosp Psychiatry. 2002;24(6):436–41.

Mullish BH, Kabir MS, Thursz MR, Dhar A. Review article: depression and the use of antidepressants in patients with chronic liver disease or liver transplantation. Aliment Pharmacol Ther. 2014;40(8):880–92.

Corruble E, Barry C, Varescon I, Falissard B, Castaing D, Samuel D. Depressive symptoms predict long-term mortality after liver transplantation. J Psychosom Res. 2011;71(1):32–7.

Gutteling JJ, De Man RA, Van Der Plas SM, Schalm SW, Busschbach JJV, Darlington A-SE. Determinants of quality of life in chronic liver patients. Aliment Pharmacol Ther. 2006;23(11):1629–35.

Patten SB, Williams JVA, Lavorato DH, Modgill G, Jetté N, Eliasziw M. Major depression as a risk factor for chronic disease incidence: longitudinal analyses in a general population cohort. Gen Hosp Psychiatry. 2008;30(5):407–13.

Weinstein AA, Price JK, Stepanova M, Poms LW, Fang Y, Moon J, et al. Depression in patients with nonalcoholic fatty liver disease and chronic viral hepatitis B and C. Psychosomatics. 2011;52(2):127–32.

Lin EH, Katon W, Von Korff M, Rutter C, Simon GE, Oliver M, et al. Relationship of depression and diabetes self-care, medication adherence, and preventive care. Diabetes Care. 2004;27(9):2154–60.

DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med. 2000;160(14):2101–7.

Bautista LE, Vera-Cala LM, Colombo C, Smith P. Symptoms of depression and anxiety and adherence to antihypertensive medication. Am J Hypertens. 2012 Apr 1;25(4):505–11.

Katon WJ, Russo JE, Heckbert SR, Lin EHB, Ciechanowski P, Ludman E, et al. The relationship between changes in depression symptoms and changes in health risk behaviors in patients with diabetes. Int J Geriatr Psychiatry. 2010;25(5):466–75.

De Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depression and diabetes complications: a meta-analysis. Psychosom Med. 2001;63(4):619–30.

Jain G, Roy A, Harikrishnan V, Yu S, Dabbous O, Lawrence C. Patient-reported Depression Severity Measured by the PHQ-9 and Impact on Work Productivity: Results From a Survey of Full-time Employees in the United States. J Occup Environ Med. 2013;55(3):252–8.

Egede LE. Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. Gen Hosp Psychiatry. 2007;29(5):409–16.

Bukhari MH, Tariq A, Khalid MS, Sufyan A. The Frequency of Anxiety and Depression in Patients with Hepatitis C at a Public Sector Liver Centre in Pakistan. J Rawalpindi Med Coll. 2019;23(S-2).

World Health Organization. Depression and other common mental health disorders global health estimates 2017 [Internet]. 2017 [cited 2020 Jan 27]. Available from:;jsessionid=A172235F032E441B2F0631057537BF68?sequence=1

Dogar I, Siddiqui N, Bajwa A, Bhatti A, Haider N, Hashmi ZY. Relationship between liver diseases and levels of anxiety and depression. J Pak Psych Soc. 2009;6(2):61–4.


Lee K, Otgonsuren M, Younoszai Z, Mir HM, Younossi ZM. Association of Chronic Liver Disease with Depression: A Population-Based Study. Psychosomatics. 2013;54(1):52–9.

Dwight MM, Kowdley KV, Russo JE, Ciechanowski PS, Larson AM, Katon WJ. Depression, fatigue, and functional disability in patients with chronic hepatitis C. J Psychosom Res. 2000;49(5):311–7.

Fontana RJ, Schwartz SM, Gebremariam A, Lok ASF, Moyer CA. Emotional Distress During Interferon-α-2B and Ribavirin Treatment of Chronic Hepatitis C. Psychosomatics. 2002;43(5):378–85.

Bonaccorso S, Marino V, Biondi M, Grimaldi F, Ippoliti F, Maes M. Depression induced by treatment with interferon-alpha in patients affected by hepatitis C virus. J Affect Disord. 2002;72(3):237–41.

Silva LD, da Cunha CC, da Cunha LR, Araújo RF, Barcelos VM, Menta PL, et al. Depression rather than liver impairment reduces quality of life in patients with hepatitis C. Rev Bras Psiquiatr. 2015;37(1):21–30.

Mohamed HI, Fath-Elbab HK, Rabie SM, Abel-Hamid WM. Assessment of cognitive functions in patients with chronic liver diseases using neuropsychological test battery. J Med Medical Sci. 2013;4(4):167–73.

Mohamed HI, Fath-Elbab HK, Rabie SM, Abel-Hamid WM. Assessment of cognitive functions in patients with chronic liver diseases using neuropsychological test battery. J Med Medical Sci. 2013;4(4):167–73.

Shaikh MW, Ahmad F, Shaikh G, Danish SH, Makheja KD, Qidwai MA. Frequency of depressive and anxiety symptoms among patients on inter-feron and pegylated interferon. Pak J Med Dentist. 2016;5(1):3–10.

Kazmi SF, Rehman AU, Khan AM, Taj R. Psychiatric Co Morbidity in Patients of Hepatitis B Virus. Ann Pak Inst Med Sci. 2014;10(2):97–101.




Most read articles by the same author(s)

1 2 3 > >>