Association Between Depression or Anxiety and the Risk of Hepatitis B Flares: A Nationwide Population-Based Cohort Study

Abstract

Meng-Ko Tsai,1– 3 Huey-Kang Sytwu,4,5 Tsai-Yuan Hsieh,6 Wu-Chien Chien,7,8 Chao-Hung Lai,9,* Hsiang-Cheng Chen2,10,* 1Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan; 2Division of Rheumatology, Immunology, and Allergy, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 3Institute of Medical Sciences, National Defense Medical Center, Taipei, 114, Taiwan; 4National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan; 5Department and Graduate Institute of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan; 6Division of Gastroenterology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 7School of Public Health, National Defense Medical Center, Taipei, Taiwan; 8Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; 9Division of Cardiology, Department of Internal Medicine, Taichung Armed Forces General Hospital, Taichung, Taiwan; 10Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan*These authors contributed equally to this workCorrespondence: Hsiang-Cheng Chen, Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Tel [phone], Fax [phone], Email [email protected]: Depression and anxiety have been reported to increase the risk of infectious diseases and reactivation of latent infection. We conducted a nationwide population-based retrospective cohort study to determine the relationship between hepatitis B flares and depression or anxiety, utilizing outpatient and inpatient data from the Taiwan National Health Insurance Research database collected from 2000 to 2015.Patients and Methods: A total of 12,992 patients with chronic hepatitis B and newly diagnosed anxiety/depression, without advanced liver disease, were propensity score-matched for age, sex, and comorbidities in a 1:4 ratio to 51,968 controls with chronic hepatitis B without depression/anxiety or advanced liver disease. Both groups were followed-up until December 31, 2015. Cox proportional hazards regression was used to determine the risk factors for hepatitis B flares. The Log rank test and Kaplan-Meier analysis were performed to assess differences in the cumulative incidence of hepatitis B flares according to anxiety/depression status.Results: The incidence of hepatitis B flares was higher in the depression/anxiety cohort than in the control cohort (log-rank; p < 0.001). Patients with depression/anxiety had a significantly higher incidence rate of hepatitis B flares than those without depression/anxiety (3017 per 105 person-years versus 2042 per 105 person-years, p = 0.003). After adjusting for age and comorbidities, anxiety/depression was independently associated with an increased risk of hepatitis B flares (hazard ratio, 1.173; 95% confidence interval, 1.033– 1.277; p = 0.003).Conclusion: This analysis suggests that in patients with chronic hepatitis B without advanced liver disease, those with concomitant depression or anxiety may be at higher risk of hepatitis B flares.Keywords: chronic hepatitis B, hepatitis B virus, hepatitis B virus reactivation, mental disorder, mood disorder

Keywords

• chronic hepatitis b
• hepatitis b virus
• hepatitis b virus reactivation
• mental disorder
• mood disorder