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

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 elevated rates of liver disease. We investigated the relation of psychological distress (measured by the 12-item General Health Questionnaire; GHQ) with liver disease mortality. Methods: We performed a meta-analysis of data from individual participants in 16 prospective studies of the general population of the UK, initiated from 1994 through 2008. We categorized GHQ score into four groups: zero (no distress), 1-3, 4-6, and 7-12. Results: We used data from 166,631 individuals (55% women; 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 risk for liver disease mortality as GHQ score increased across categories (ptrend