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Sadeghi A, Raissi-Dehkordi N, Eliaei S, Rastegar R, Cheraghpour M, Hatami H et al . Prevalence of Anxiety and Depression Among Patients With Symptomatic Choledocholithiasis: A Cross-sectional Study in Iran. CPR 2024; 3 (1) :25-32
URL: http://cpr.mazums.ac.ir/article-1-153-en.html

Background and Objective: Diseases of the gallbladder pose significant health challenges. Among these, symptomatic choledocholithiasis which is characterized by obstructive gallstones in the common bile duct (CBD) requires timely intervention to prevent severe complications. Recent evidence suggests potential links between mental health, specifically anxiety and depression, with gastrointestinal conditions. The objective of this study was to examine the presence of anxiety and depression in patients undergoing treatment for CBD stones and evaluate associations with demographic/clinical variables.
Materials & Methods: This cross-sectional study was conducted at Taleghani Teaching Hospital in Tehran, Iran, from June to August 2023. We used a consecutive sampling strategy, enrolling all eligible adult patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) for symptomatic CBD stones; the presence of CBD stones was confirmed endoscopically, and 215 of 265 eligible patients were included in the final analysis, and 215 of 265 eligible patients were analyzed. Anxiety and depression were assessed using the validated Persian version of the hospital anxiety and depression scale (HADS). Demographic and clinical data included age, sex, BMI, serum amylase, and stone size. To explore the relationship between HADS-A/HADS-D scores and continuous demographic or clinical variables, simple linear regression analyses were performed. Data were analyzed using IBM SPSS statistics software, version 24 with chi-square, student’s t-test, and Mann–Whitney U tests, with significance set at P<0.05. 
Results: Among 215 patients with symptomatic CBD stones (mean age 65.9±11.9 years; 50.2% male), anxiety and depression were identified in 39.5% and 24.2% of cases, respectively. There were no significant associations between anxiety or depression and age (P=0.54 and P=0.47), BMI (P=0.09 and P=0.11), serum amylase (P=0.38 and P=0.40), stone size (P=0.55 and P=0.58), or sex (P=0.21 and P=0.33).
Conclusion: Anxiety and depression were common among patients with symptomatic CBD stones, affecting 39.5% and 24.2% of the study population, respectively. However, these psychological symptoms were not significantly associated with age, sex, BMI, serum amylase, or stone size. These findings suggest that anxiety and depression should not be overlooked during patient care. Incorporating routine psychological screening, such as the HADS scale, into the management of patients with choledocholithiasis may help identify and address comorbid mental health issues early, improving overall treatment outcomes. When clinically indicated, early integration of psychological care into routine patient management may help improve patient care and recovery.