Depression, anxiety, substance misuse and self-harm in children and young people with rare chronic liver disease

The burden of mental illness in young people with chronic liver disease is not known. In this population cohort study in England, we identified 358 individuals (aged ≤25 years) diagnosed with autoimmune hepatitis or liver disease related to cystic fibrosis and 1541 propensity-score-matched controls. By the first year of follow-up, the cumulative burden of psychiatric events in participants with liver disease was high compared with controls: anxiety disorder (6.87 per 100 individuals [95% CI 4.00–9.73] v. 2.22 [95% CI 1.37–3.07]), depression (5.10 [95% CI 2.83–7.37] v. 0.86 [95% CI 0.53–1.19]), substance misuse (10.61 [95% CI 9.50–11.73] v. 1.23 [95% CI 0.71–1.75]) and self-harm (3.09 [95% CI 1.12–5.05] v. 0.20 [95% CI 0.07–0.33]). Participants with liver disease had a 2-fold increase (OR = 1.94, 95% CI 1.45–2.58), a 2.5-fold increase (OR = 2.59, 95% CI 1.91–3.50) and 4.4-fold increase (OR = 4.44; 95% CI 3.46–5.71) in the risk of anxiety, depression and substance misuse, respectively. These findings highlight the need for effective intervention in psychiatric disorders in young people with rare liver disease.