The association between hepatic encephalopathy/minimal hepatic encephalopathy and depressive and anxiety disorders: a systematic review

Australas Psychiatry. 2020 Feb;28(1):61-65. doi: 10.1177/1039856219875054. Epub 2019 Dec 23.


Objectives: This review examined the currently available evidence of the association between liver encephalopathy and mood/anxiety disorders.

Method: English-language studies using the keywords "hepatic encephalopathy," "depression," and "anxiety" were searched through PubMed, Medline, Cochrane Library, and PsycINFO databases. A total of 135 articles were considered for this review, of which 9 were qualitative and quantitative research papers regarding depression and anxiety in hepatic encephalopathy (HE).

Results: There is a significant discrepancy between the research method of the studies and their outcomes. The number of studies suggesting a relationship between HE and mood/anxiety disorders is slightly higher than that of studies with opposite results; however, based on the current evidence, it is difficult to conclude a significant association between these two conditions.

Conclusion: More longitudinal studies that include face-to-face psychiatric assessments are required to highlight any possible association between depressive/anxiety disorders and HE.

Keywords: anxiety; depression; hepatic encephalopathy.

Publication types

  • Systematic Review

MeSH terms

  • Anxiety Disorders / epidemiology*
  • Comorbidity
  • Depressive Disorder / epidemiology*
  • Hepatic Encephalopathy / epidemiology*
  • Humans