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Distress increases liver disease mortality

Psychological distress is associated with increased liver disease mortality, according to new study data published in Gastroenterology.

Researchers, including Tom Russ, division of psychiatry, Royal Edinburgh Hospital, United Kingdom, performed a meta-analysis of data from patients enrolled in 16 prospective studies of the general population in the United Kingdom between 1994 and 2008, to determine any relationship between psychological distress and liver disease mortality.

Tom Russ

The 12-item General Health Questionnaire (GHQ) was used to measure psychological distress and includes items that measure symptoms of anxiety, depression, social dysfunction and loss of confidence, according to the research. 166,631 individuals were divided into groups based on their GHQ score. The groups were: 0 (no distress), 1-3, 4-6, or 7-12, according to the research.

"This was the first study to examine the association between psychological distress and liver disease mortality, though there could be a plausible link since both have been linked with cardiovascular disease," Russ told Healio.com/Hepatology. "Ours was a large, general population based prospective longitudinal study based on multiple health surveys which allowed us to account for various other important factors, including socioeconomic status, physical health (including diabetes) and alcohol intake. While this association is unlikely to be causal, it does highlight the close relationship between psychological and physical health and should lead to further work to elucidate the underlying mechanism."

Over the course of follow-up (mean, 9.5 years), 17,368 participants died, of which 457 had liver disease.

Results showed an increase in liver disease mortality as GHQ score increased (P < .001). Psychological distress was associated with increased liver disease mortality rates in age- and sex-adjusted models (HR=1.40; 95% CI, 1.31-1.5). The age- and sex-adjusted hazard ratio for the highest GHQ score category compared with the no distress category was 3.48 (95% CI, 2.68-4.52). The HR decreased to 2.59 (95% CI, 1.82-3.68) after adjusting for diabetes, body mass index, health behaviors and socioeconomic status.

Participants with high GHQ scores were at an increased risk of liver disease mortality (multivariable-adjusted HR = 2.59; 95% CI, 1.82-3.68) compared with participants scoring) on the GHQ-12. Those with high GHQ scores tended to be female, smoke, obese, have diabetes mellitus and have a basic education.

“We add to the growing evidence of a detrimental impact of psychological distress on physical conditions by showing a new relationship with liver disease mortality,” the researchers wrote. “The raised risk evident at lower levels of distress that are not typically treated by specialists in mental health has particular relevance for general health professionals.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.