Depression in patients with primary biliary cirrhosis and primary sclerosing cholangitis q Erik van Os 1 , Walter W. van den Broek 1, * , Paul G.H. Mulder 2 , Pieter C.J. ter Borg 3 , Jan A. Bruijn 1 , Henk R. van Buuren 3 1 Department of Psychiatry, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands 2 Department of Epidemiology & Biostatistics, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands 3 Department of Gastroenterology, Erasmus Medical Centre, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands See Editorial, pages 992–994 Background/ Aims: Former studies reported a high prevalence of depression in patients with primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC). These studies hypothesized that the presence of depression could explain the fatigue experienced by these patients. Methods: Our aim was to study the prevalence of depression in a Dutch population with PBC and PSC. In addition, to inves- tigating the effects of using an additional diagnostic structured psychiatric interview, after screening with the Beck Depression Inventory (BDI), a self-report severity scale instrument used in former studies. Patients with PBC and PSC (n = 92) com- pleted the BDI. Patients with scores of 10 or higher (n = 39) were interviewed using a structured psychiatric interview. Patients with scores lower than 10 were at random (30/ 53, 57%) also interviewed using a structured psychiatric interview. Results: Of the 92 patients that were included 42% had depressive symptoms according to the BDI. However, of these patients only 3.7% had a depressive syndrome according to the DSM-IV criteria as assessed with the structured psychi- atric interview. Conclusions: The prevalence of a depressive disorder in patients with PBC and PSC is not higher than in the general population. Fatigue in patients with PBC and PSC cannot be explained by depression. Ó 2007 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. Keywords: Beck depression inventory (BDI); Depressive disorder; Cytokines; Interleukin; Sickness syndrome; Fatigue 1. Introduction Large community studies utilizing structured psy- chiatric interviews have reported an annual prevalence of major depression in the general population of 3– 5% [1,2]. Compared to the general population, the prevalence of depression in patients with a chronic ill- ness is increased [3,4]. One study reported that patients with one or more chronic sicknesses had a 41% increase in the relative risk of having any recent psychiatric illness [5]. Primary biliary cirrhosis (PBC) and primary sclerosing cholangitis (PSC) are chronic cholestatic liver diseases of which PBC has a relatively favourable prognosis for most patients [6–8]. Earlier studies in a population with PBC and PSC found a high prevalence of depression, ranging from 20% to 45% [9–12]. In those studies, depression was associ- ated with fatigue and it is suggested that depression may explain fatigue in PBC and other forms of liver cirrhosis. 0168-8278/$32.00 Ó 2007 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved. doi:10.1016/j.jhep.2007.01.036 Received 30 October 2006; received in revised form 31 December 2006; accepted 1 January 2007; available online 2 March 2007 q The authors who have taken part in this study declared that they have no relationship with the manufacturers of the drugs involved either in the past or present and did not receive funding from the manufacturers to carry out their research. They did not receive funding from any source to carry out this study. * Corresponding author. Tel.: +31 10 4639222; fax: +31 10 4633217. E-mail address: w.w.vandenbroek@erasmusmc.nl (W.W. van den Broek). www.elsevier.com/locate/jhep Journal of Hepatology 46 (2007) 1099–1103