Meta-analysis of factors associated with the incidence of comorbid depression and anxiety in patients with chronic hepatitis B

Abstract

BACKGROUND

Chronic hepatitis B (CHB) affects millions worldwide, and many patients develop depression and anxiety. The disease’s long-term nature, potential complications, and social stigma contribute to these mental-health issues. However, previous studies on this link differed in their methods and results, making it hard to draw clear conclusions. This study aimed to analyze factors associated with CHB through meta-analysis of previous studies to help improve patients’ mental health.

AIM

To systematically search, screen, and comprehensively analyze existing relevant research through meta-analysis of previous studies to assess the correlation of the previously identified factors found to be associated with comorbid depression and anxiety in patients with CHB, with the goal of improving the patients' mental-health status.

METHODS

This study strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Relevant literature from the inception of the PubMed, EMBASE, Cochrane Library, and Web of Science databases up to January 2025 was comprehensively searched. The search used medical subject headings combined with free-text terms, supplemented by literature tracing. The search terms covered vocabulary related to CHB, such as depression, anxiety, and risk factors. The literature was selected according to strict inclusion and exclusion criteria. Two researchers independently and blindly screened the literature and extracted key information. STATA12.0 and RevMan 5.3 software were used to perform meta-analysis of the extracted data, and an appropriate model based on the heterogeneity of the studies was selected.

RESULTS

The study included 14 articles from five countries (China, United States, Turkey, Australia, and Vietnam), involving 4494 patients with CHB. The analysis revealed that the incidence of comorbid depression in patients with CHB was 30.1% [95% confidence interval (95%CI): 0.182-0.420], the incidence of comorbid anxiety was 40.2% (95%CI: 0.126-0.678), and the overall incidence of negative emotions was 33.7% (95%CI: 0.182-0.420). Further research identified eight factors significantly associated with depression and anxiety. Among them, high educational level was a protective factor against comorbid anxiety and depression in patients with CHB [odds ratio (OR) = 0.43, 95%CI: 0.20-0.93, P < 0.05]. The risk of comorbid depression and anxiety was higher for older patients (OR = 3.05, 95%CI: 1.90-4.90, P < 0.05), longer treatment duration (OR = 3.11, 95%CI: 1.72-5.62, P > 0.05), presence of comorbidities (OR = 2.65, 95%CI: 1.21-5.77, P < 0.05), poor sleep quality (Fisher’s Z = 0.48, 95%CI: 0.41-0.55, Summary r = 0.447, P < 0.05), emotional instability (Fisher’s Z = 0.42, 95%CI: 0.29-0.55, summary r = 0.393, P < 0.05), a high number of hepatitis relapses (OR = 4.07, 95%CI: 2.81-5.89, P < 0.05), and a high degree of hepatitis (OR = 4.28, 95%CI: 1.76-10.41, P < 0.05).

CONCLUSION

Multiple factors were significantly associated with comorbid depression and anxiety in patients with CHB. Clinically, it is essential to identify high-risk patients at the earliest opportunity and implement effective intervention to enhance patients’ mental health and optimize CHB disease management and treatment.

Keywords: Chronic hepatitis B; Depression; Anxiety; Correlative factors; Meta-analysis

Core Tip: Patients with chronic hepatitis B may experience a significant burden of mental-health issues, with 30.1% experiencing depression, 40.2% anxiety, and 33.7% overall negative emotions. Higher educational level was a protective factor (odds ratio = 0.43) by enhancing self-management and disease understanding, whereas older age, longer treatment duration, comorbidities, poor sleep quality, emotional instability, frequent hepatitis relapses, and severe hepatitis status all elevated the risk of comorbid depression and anxiety. Clinically, early identification of high-risk groups and targeted interventions, such as education-based counseling and sleep management, are crucial for improving mental-health outcomes, although current research heterogeneity from diverse assessment tools and regional sampling indicates the need for standardized broader population studies in the future.