Incidence of Depression and Anxiety in a Cohort of Adolescents With Nonalcoholic Fatty Liver Disease

Abstract

Objectives: To determine the incidence of clinically diagnosed depression and anxiety in adolescents with nonalcoholic fatty liver disease (NAFLD).

Methods: This was a prospective, longitudinal cohort study between January 1, 2012 and July 1, 2018 conducted in a Children's Hospital Pediatric Gastroenterology Clinic. Participants included adolescents 12 to 17 years old at baseline with biopsy-confirmed NAFLD. The primary outcomes were having depression and/or anxiety based upon a clinical diagnosis established by a physician or psychologist. The rates of depression and anxiety were measured at baseline and longitudinally throughout follow-up.

Results: A total of 160 adolescents with NAFLD were followed for a mean of 3.8 years. At baseline, 8.1% had a diagnosis of depression. During follow-up, an additional 9.5% (95% confidence interval, 4.7-14.3) developed depression. The incidence density of depression was 27 new cases per 1000 person-years at risk. In adolescents with NAFLD, 6.3% had anxiety at baseline and 6.7% (95% confidence interval, 2.6-10.7) developed anxiety during follow-up. The incidence density of anxiety was 18 new cases per 1000 person-years at risk. The change in alanine aminotransferase was significantly worse for adolescents with NAFLD who developed depression compared to those who did not develop depression (P < 0.01).

Conclusions: Adolescents with NAFLD had a high incidence of clinically diagnosed depression and anxiety. The rates were higher than expected relative to the available data in the general population. Addressing this mental health burden will require efforts at both the patient level and the systems level.

Figure 1.. Distribution of Age at Onset of Depression or Anxiety in Adolescents with NAFLD

The figure shows the distribution of age in years at the time of diagnosis of depression (in blue) or anxiety (in red) for all adolescents with NAFLD that have developed one or both of these conditions. For a given condition, 100% represents the total number with that condition at baseline and/or during follow-up (N = 27 for depression; N = 20 for anxiety).

Figure 2.. Survival Curves of Depression and Anxiety in Adolescents with NAFLD

The curves show the percent of adolescents with NAFLD diagnosed with depression (in blue) or anxiety (in red) at baseline and during follow-up. Percent with condition includes those adolescents who developed the conditions at each year following diagnosis with NAFLD. Percent with condition was not 0% at baseline (t=0) because some adolescents were diagnosed with depression or anxiety prior to diagnosis with NAFLD. Thereafter, percent with condition includes adolescents with NAFLD until the time they were diagnosed with depression or anxiety. Once a diagnosis of these conditions was made, adolescents were no longer included in the number at risk of developing depression or anxiety. Number at risk includes the number of adolescents with NAFLD at risk of developing depression or anxiety at each year following diagnosis of NAFLD who were not lost to follow-up.