Association between psychological distress and liver disease mortality: A meta-analysis of individual study participants
Open accessAbstract
Background & aims Risk factors for cardiovascular disease, such as obesity and hypertension, have been associated with nonalcoholic fatty liver disease. Psychological distress (symptoms of anxiety and depression) is a risk factor for cardiovascular disease, so it might also be associated, directly or indirectly, with liver disease. We investigated the relationship between psychological distress (measured by the 12-item General Health Questionnaire [GHQ]) and liver disease mortality.Methods We performed a meta-analysis of data from individual participants in 16 prospective studies of the general population in the United Kingdom, initiated from 1994 through 2008. Subjects were assigned to groups based on GHQ score: 0 (no distress), 1-3, 4-6, or 7-12.Results We analyzed data from 166,631 individuals (55% women; mean ± SD age, 46.6 ± 18.4 years; range, 16-102 years). During a mean follow-up period of 9.5 years, 17,368 participants died (457 with liver disease). We found a significant increase in liver disease mortality with increase in GHQ score (Ptrend < .001). The age- and sex-adjusted hazard ratio for the highest GHQ score category (ie, 7-12), compared with the 0 score category, was 3.48 (95% confidence interval: 2.68-4.52). After adjustment for health behaviors, socioeconomic status, body mass index, and diabetes, this hazard ratio decreased to 2.59 (95% confidence interval: 1.82-3.68).Conclusions Based on a meta-analysis, psychological distress is associated with liver disease mortality, although this finding requires additional analysis. Although one is not likely to cause the other, we provide additional evidence for the deleterious effects of psychological problems on physical health.
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Depression and anxiety are major contributors to increased morbidity and mortality, reduced health-related quality of life, and decreased functional status.
“Depression and anxiety are major contributors to increased morbidity and mortality, reduced health-related quality of life, and decreased functional status.7”
From Management of depression/anxiety in patients with chronic liver disease (2024) · cites this paper as [7]
The Results reported in the paper's Abstract associate psychological distress with higher liver-disease mortality, supporting the mortality portion in this specific setting. The Strengths and Limitations section says the distress measure does not provide a clinical diagnosis of depression or anxiety. The paper does not establish that those conditions are major contributors to morbidity, reduced health-related quality of life, or decreased functional status. (LLM, conf=0.88)
Experimental — accuracy not yet measuredAlcohol use disorder, substance abuse, and depression deteriorate the quality of life of patients with chronic liver disease.
“Alcohol use disorder, substance abuse, and depression are illnesses that deteriorate the quality of life (QOL) of patients with chronic liver disease (CLD).”
From A Behavioral Health Program for Alcohol Use Disorder, Substance Abuse, and Depression in Chronic Liver Disease (2019) · cites this paper as [10]
The Results section reports an association between psychological distress and liver disease mortality, not quality of life in patients with chronic liver disease. Searches for quality of life, alcohol use disorder, and substance abuse found no passage addressing the claimed effect on QOL. (LLM, conf=0.75)
Experimental — accuracy not yet measuredDepression remains underdiagnosed and untreated in chronic liver disease.
“Depression remains under diagnosed and untreated in CLD10 and is associated with worse clinical outcomes and higher mortality.11”
From A Behavioral Health Program for Alcohol Use Disorder, Substance Abuse, and Depression in Chronic Liver Disease (2019) · cites this paper as [10]
The quoted underdiagnosis and undertreatment claim is followed by citation 10; this source is citation 11, attached to the subsequent outcomes and mortality claim. The paper’s Results report an association between psychological distress and liver disease mortality, but the passages found when searching for underdiagnosed and untreated depression do not address depression diagnosis or treatment in people with chronic liver disease. (LLM, conf=0.78)
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- Authors
- Russ, T. C., Kivimäki, M., Morling, J. R., Starr, J. M., Stamatakis, E., & Batty, G. D.
- Affiliations
- National Health Service Scotland (GB)
- University of Edinburgh (GB)
- The University of Sydney (AU)
- Alzheimer Scotland (GB)
- Corresponding author
- Russ, Tom C.
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2015-05
- Volume
- 148
- Issue
- 5
- Pages
- 958-966.e4
- ISSN
- 0016-5085 (ISSN-L)
- OpenAlex
- W2011563017
- Cited by
- 110
- References
- 49
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 11 · 2023: 13 · 2022: 13 · 2021: 17 · 2020: 16 · 2019: 5 · 2018: 9 · 2017: 4 · 2016: 8 · 2015: 2
- FWCI
- 1.00
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Repository@Nottingham (University of Nottingham) (acceptedVersion, other-oa)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by-nc-nd)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Nottingham ePrints (University of Nottingham) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- Diabetes UK
- Academy of Medical Sciences (AMS-SGCL12-Russ)
- University College London
- University of Edinburgh (G0700704/84698)
- Centre for Cognitive Ageing and Cognitive Epidemiology
- National Institutes of Health
- Directorate for Biological Sciences
- Medical Research Council (MR/K013351/1, G0700704, MR/K026992/1, R01AG034454)
- Engineering and Physical Sciences Research Council
- Biotechnology and Biological Sciences Research Council
- Economic and Social Research Council (R01AG034454, ES/J023299/1, R01HL036310)
- National Institute on Aging (R01AG034454)
- National Heart, Lung, and Blood Institute (R01HL036310)
- Topics
- Health Sciences › Medicine › Epidemiology › Liver Disease Diagnosis and Treatment
- Health Sciences › Medicine › Pathology and Forensic Medicine › Alcohol Consumption and Health Effects
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Keywords
- psychological distress, liver disease mortality, anxiety, depression, non-alcoholic fatty liver disease, General Health Questionnaire, cardiovascular risk factors, prospective cohort
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Cause of Death, Female, Health Status, Humans, Liver Diseases, Male, Mental Health, Middle Aged, Predictive Value of Tests, Prognosis, Surveys and Questionnaires, Risk Factors, Stress, Psychological, Risk Assessment, Young Adult
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