High prevalence of anxiety and depression among patients with acute and chronic pancreatitis: A systematic review and meta-analysis

BACKGROUND: Depression and anxiety are increasingly recognized as important comorbidities in gastrointestinal (GI) disorders, influencing disease burden and patient outcomes. However, their prevalence in pancreatitis, both in its acute (AP) and chronic (CP) forms, remains underexplored. This systematic review and meta-analysis aimed to quantify the burden of depressive and anxiety symptoms among patients with pancreatitis. METHODS: We conducted a systematic search (PROSPERO: CRD42023481739) across three databases: MEDLINE, Embase, and CENTRAL, to identify studies reporting on the prevalence of depression and anxiety symptoms in patients with AP or CP, as of November 10, 2023. The random-effects model was used to calculate the pooled proportion rate and pooled means of different anxiety/depression scores, along with 95 % confidence intervals (CI). RESULTS: In total, 44 studies were included. Anxiety was observed in 23 % (CI: 7 %-54 %) of the AP cases, and it was observed in 31 % (CI: 23 %-39 %) of the CP cases. Depressive symptoms were observed in 29 % (CI: 14 %-51 %) of the AP patients, while in CP cases, the prevalence was 39 % (CI: 30 %-48 %). The pooled single-mean analysis of psychological questionnaire data confirms clinically significant levels of both depressive and anxiety symptoms. Mean scores exceeded established cut-off points across all measures: CESD-10 (14.30 [CI: 6.69-21.92]), HADS-depression (8.23 [CI: 4.53-11.94]), SES (49.29 [CI: 44.01-54.57]), HADS-anxiety (8.67 [CI: 6.89-10.46]), and SAS (47.75 [CI: 35.05-60.45]). These findings indicate that many participants experienced symptom levels beyond the normative range. Overall, a low risk of bias was observed; however, several studies were identified as high risk due to reporting limitations. CONCLUSIONS: Our findings reveal a notably high prevalence of depression and anxiety in pancreatitis, exceeding global averages and rates seen in other GI disorders. These findings warrant routine psychological screening, ongoing follow-up, and the integration of mental health professionals into multidisciplinary care teams are therefore warranted.