title: Association Between Psychological Distress and Liver Disease Mortality: A Meta-analysis of Individual Study Participants.
abstract: OBJECTIVE
  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.
authors: Division of Psychiatry, University of Edinburgh, UK; Alzheimer Scotland Dementia Research Centre, University of Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK; Scottish Dementia Clinical Research Network, NHS Scotland, UK. Electronic address: tc.russ@ed.ac.uk.
authors: Tom C
authors: TC
authors: Russ
authors: Department of Epidemiology and Public Health, University College, London, UK.
authors: Mika
authors: M
authors: Kivimäki
authors: Centre for Population Health Sciences, University of Edinburgh, UK.
authors: Joanne R
authors: JR
authors: Morling
authors: Alzheimer Scotland Dementia Research Centre, University of Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK; Scottish Dementia Clinical Research Network, NHS Scotland, UK.
authors: John M
authors: JM
authors: Starr
authors: Charles Perkins Centre, University of Sydney, Sydney, Australia; Exercise and Sport Sciences, Faculty of Health Sciences, University of Sydney, Sydney, Australia.
authors: Emmanuel
authors: E
authors: Stamatakis
authors: Alzheimer Scotland Dementia Research Centre, University of Edinburgh, UK; Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, UK; Department of Epidemiology and Public Health, University College, London, UK.
authors: G David
authors: GD
authors: Batty
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D005260:Female; D006304:Health Status; D006801:Humans; D008107:Liver Diseases / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013315:Stress, Psychological / Q000175:diagnosis / Q000401:mortality* / Q000523:psychology; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Cirrhosis; GHQ-12; Mental Health; Steatosis