Trends in Concurrent Psychiatric Comorbidities in Alcohol-Associated Liver Disease: A Nationwide Study from 2015-2023

Psychiatric comorbidities with alcohol use disorder increase the risk of alcohol abuse and relapse. However, updated epidemiologic trends of comorbid psychiatric disorders in patients with alcohol-associated liver disease (ALD) remain limited. We aim to investigate the trends of prevalence of psychiatric comorbidities among those with ALD.

This population-level cohort study used TriNetX data from over 113 million U.S. patients to assess trends in nine psychiatric disorders from 2015 to 2023 among individuals with ALD, stratified by cirrhosis status and age. In addition, we also compared the trends between patients with ALD and non-ALD chronic liver disease (CLD). Joinpoint regression analyses evaluated temporal trends using annual percentage changes (APC) and average annual percentage changes (AAPC) to identify significant inflection points over the study period.

We observed significant increases in the prevalence of major depressive disorder (MDD), anxiety, and post-traumatic stress disorder, while schizophrenia and psychotic disorders declined in both ALD with and without cirrhosis groups. In individuals with ALD cirrhosis, schizophrenia and psychotic disorders declined at a greater rate than those without cirrhosis. Stratifying by age, we found older individuals with ALD have a rising trend in seven out of nine psychiatric comorbidities and had a greater increase compared to younger individuals, particularly in MDD, anxiety, and bipolar disorder.

Patients with ALD without cirrhosis have the highest psychiatric comorbidity rates. However, trends of prevalence are rising significantly among those with ALD cirrhosis and older adults, highlighting the urgent need for targeted mental health interventions in this vulnerable population.