Exploring the impact of stigmatization on mental health in persons with liver disease: a scoping review

Patients with liver conditions such as hepatitis B, C, and D, cirrhosis, metabolic dysfunction - associated steatotic liver disease (MASLD), and metabolic dysfunction - associated steatohepatitis (MASH) frequently experience public, self, and structural stigma, which contribute to psychological distress, reduced Quality of Life (QoL), and lower engagement with healthcare. Stigma is often fueled by misconceptions linking liver disease to personal behaviour, moral failure, or contagion, disproportionately affecting marginalised populations. In this context, this scoping review examines how stigma impacts mental health among individuals living with liver disease, mapping key psychological and psychosocial outcomes. Following Joanna Briggs Institute (JBI) methodology and PRISMA-ScR guidelines, we conducted a systematic search of PubMed, Scopus, and Web of Science to identify quantitative studies published between 2014 and 2024. Nine studies met the inclusion criteria. Across studies, stigma was consistently associated with adverse psychological and social outcomes. Depression was the most frequently assessed outcome and showed robust associations with stigma, particularly internalised shame and social judgement. Anxiety was linked to fear of disclosure and social rejection. Stigma was also associated with reduced health-related quality of life across emotional, physical, and social domains. Additional themes included concealment, social isolation, and identity-based shame. Stigma varied by disease aetiology - moralising stigma in hepatitis C and alcohol-related liver disease, lifestyle-related stigma in MASLD, and racialised stigma in hepatitis B - and by demographic characteristics, with higher levels reported by younger individuals, women, and transgender persons. Overall, stigma emerges as a pervasive and under-recognised determinant of mental health in liver disease. Addressing stigma requires patient-centred strategies, including non-stigmatising language, intersectional awareness, and integrated psychosocial care, with the active involvement of patient advocacy groups to ensure that interventions are inclusive, equitable, and effective.