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Association between psychological distress and liver disease mortality: a meta-analysis of individual study participants.

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Original languageEnglish
Pages (from-to)958-66
Early online date10 Feb 2015
Publication statusPublished - 10 Feb 2015


Background & Aims
Risk factors for cardiovascular disease, such as obesity and hypertension, have been associated with non-alcoholic 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 relation of psychological distress (measured by the 12-item General Health Questionnaire [GHQ]) with liver disease mortality.

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: zero (no distress), 1–3, 4–6, or 7–12.

We analyzed data from 166,631 individuals (55% women; age, 46.6±18.4 y; range,

16−102 y). During a mean follow-up period of 9.5 y, 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 (7–12), compared with the zero 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).

Based on a meta-analysis, psychological distress is associated with liver disease mortality, although this finding requires further analysis. Though one is not likely to cause the other, we provide further evidence for the deleterious effects of psychological problems on physical health.

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