Brief Article
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World J Gastroenterol. Dec 21, 2013; 19(47): 9069-9076
Published online Dec 21, 2013. doi: 10.3748/wjg.v19.i47.9069
Anxiety and depression propensities in patients with acute toxic liver injury
Jeong Ill Suh, Jeong Kyu Sakong, Kwan Lee, Yong Kook Lee, Jeong Bae Park, Dong Joon Kim, Yeon Seok Seo, Jae Dong Lee, Soon Young Ko, Byung Seok Lee, Seok Hyun Kim, Byung Seok Kim, Young Seok Kim, Heon Ju Lee, In Hee Kim, Joo Hyun Sohn, Tae Yeob Kim, Byung Min Ahn
Jeong Ill Suh, Yong Kook Lee, Jeong Bae Park, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju 780-350, South Korea
Jeong Kyu Sakong, Department of Psychiatry, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, Gyeongju 780-350, South Korea
Kwan Lee, Department of Preventive Medicine, Dongguk University College of Medicine, Gyeongju 780-350, South Korea
Dong Joon Kim, Department of Internal Medicine, Hallym University Medical Center, Hallym University College of Medicine, Chuncheon 200-704, South Korea
Yeon Seok Seo, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul 136-705, South Korea
Jae Dong Lee, Soon Young Ko, Department of Internal Medicine, Konkuk University Chungju Hospital, Konkuk University College of Medicine, Chungju 380-704, South Korea
Byung Seok Lee, Seok Hyun Kim, Department of Internal Medicine, Chungnam National University Hospital, Chungnam University College of Medicine, Daejeon 301-721, South Korea
Byung Seok Kim, Department of Internal Medicine, Daegu Catholic University Medical Center, Daegu Catholic University College of Medicine, Daegu 705-718, South Korea
Young Seok Kim, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon 420-767, South Korea
Heon Ju Lee, Department of Internal Medicine, Yeungnam University Medical Center, Yeungnam University College of Medicine, Daegu 705-703, South Korea
In Hee Kim, Department of Internal Medicine, Chonbuk National University Hospital, Chonbuk National University College of Medicine, Jeonju 561-712, South Korea
Joo Hyun Sohn, Tae Yeob Kim, Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri 471-701, South Korea
Byung Min Ahn, Department of Internal Medicine, Hwain Metro Hospital, Chunan 331-959, South Korea
Author contributions: Suh JI, Lee YK and Park JB contributed to the study protocol design, collection and assembly of data, analysis and interpretation of the data, drafting of the article, and administrative and technical support; Sakong JK contributed psychiatric expertise; Lee K contributed methodological and statistical analysis; Kim DJ, Seo YS, Lee JD, Ko SY, Lee BS, Kim SH, Kim BS, Kim YS, Lee HJ, Kim IH, Sohn JH, Kim TY, Ahn BM contributed to collection and assembly of data and provision of study materials or patients; All authors contributed to manuscript writing and approved the final version of the manuscript.
Supported by Foundation of the Korean Association for the Study of the Liver Research Grant
Correspondence to: Jeong Ill Suh, MD, PhD, Professor, Department of Internal Medicine, Dongguk University Gyeongju Hospital, Dongguk University College of Medicine, 87 Dongdae-ro, Gyeongju 780-350, South Korea. sujungil@dongguk.ac.kr
Telephone: +82-54-7708207 Fax: +82-54-7708378
Received: August 31, 2013
Revised: October 12, 2013
Accepted: October 17, 2013
Published online: December 21, 2013
Abstract

AIM: To investigate anxiety and depression propensities in patients with toxic liver injury.

METHODS: The subjects were divided into three groups: a healthy control group (Group 1, n = 125), an acute non-toxic liver injury group (Group 2, n = 124), and a group with acute toxic liver injury group caused by non-commercial herbal preparations (Group 3, n = 126). These three groups were compared and evaluated through questionnaire surveys and using the Hospital Anxiety-Depression Scale (HADS), Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI), and the hypochondriasis scale.

RESULTS: The HADS anxiety subscale was 4.9 ± 2.7, 5.0 ± 3.0 and 5.6 ± 3.4, in Groups 1, 2, and 3, respectively. The HADS depression subscale in Group 3 showed the most significant score (5.2 ± 3.2, 6.4 ± 3.4 and 7.2 ± 3.4 in Groups 1, 2, and 3, respectively) (P < 0.01 vs Group 1, P < 0.05 vs Group 2). The BAI and BDI in Group 3 showed the most significant score (7.0 ± 6.3 and 6.9 ± 6.9, 9.5 ± 8.6 and 8.8 ± 7.3, 10.7 ± 7.2 and 11.6 ± 8.5 in Groups 1, 2, and 3, respectively) (BAI: P < 0.01 vs Group 1, P < 0.05 vs Group 2) (BDI: P < 0.01 vs Group 1 and 2). Group 3 showed a significantly higher hypochondriasis score (8.2 ± 6.0, 11.6 ± 7.5 and 13.1 ± 6.5 in Groups 1, 2, and 3, respectively) (P < 0.01 vs Group 1, P < 0.05 vs Group 2).

CONCLUSION: Psychological factors that present vulnerability to the temptation to use alternative medicines, such as herbs and plant preparations, are important for understanding toxic liver injury.

Keywords: Liver injury, Herb, Toxic, Anxiety, Depression

Core tip: In South Korea, the number of toxic liver injuries caused by herbal and folk remedies is increasing. Although positive views on folk remedies are widespread and patients who have been hospitalized with toxic liver injury are often re-hospitalized, no studies have been conducted on the correlation between toxic liver injury and anxiety or depression. This multi-center nation-wide prospective study showed the anxiety and depression propensities in patients with toxic liver injury. Psychological factors that lead to vulnerability to the temptation to use alternative medicines, such as herbs and plant preparations, are important to better understand toxic liver injury.