Perceived Stigma, Psychological Distress, and Symptom Burden in Decompensated Cirrhosis.

Abstract

Despite perceived stigma's impact in HIV, mental illness, and obesity, its association with adverse outcomes in decompensated cirrhosis (DC) remains under-investigated. We aimed to quantify liver-related perceived stigma and examine its associations with patient-reported psychological distress and symptom burden among patients with DC. We conducted a cross-sectional study of outpatients with DC from August 2018 to September 2022. Participants completed validated instruments: the four-item perceived stigma domain from the Short-Form Liver Disease Quality of Life questionnaire (range 0-100; reverse-scored where higher scores = greater stigma), the Hospital Anxiety and Depression Scale (0-21; scores ≥8: clinically significant anxiety and depression symptoms), and the Revised Edmonton Symptom Assessment System (0-100; scores ≥40: moderate-to-severe burden). We used multivariable linear regression adjusted for age, gender, etiology, and DC severity. Among 218/312 (70%) eligible patients (median age 60 [interquartile range 51-65]; 54% male; 58% alcohol-related; median MELD-Na 16), mean stigma score was 34.3 (standard deviation 26.3). Greater stigma was reported by those with advanced disease (Child-Pugh A vs. B vs. C: 19.4 vs. 32.2 vs. 42.2; P = 0.001) and younger patients (18-44 vs. 45-64 vs. ≥65: 38.6 vs. 37.1 vs. 26.2; P = 0.019). In adjusted analyses, greater stigma was independently associated with higher depression symptoms (β = 0.08, P < 0.001), anxiety symptoms (β = 0.07, P < 0.001), and symptom burden (β = 0.33, P < 0.001). Among patients with DC, younger adults and those with advanced disease reported greater perceived stigma, independently associated with higher psychological distress and symptom burden. These findings highlight perceived stigma as a modifiable target for palliative care-focused interventions to improve patient-reported outcomes in DC.