Exploring the Impact of Stigmatization on Mental Health in Patients with Liver Disease: A Scoping Review

Abstract Background: Stigmatization is a well-established social determinant of health that disproportionately affects individuals with chronic illnesses, including liver disease. Patients with liver conditions such as hepatitis B and C, cirrhosis, and non-alcoholic fatty liver disease (NAFLD) are often subject to public, self, and structural stigma, which may contribute to poor mental health outcomes and reduced engagement with care. Objective: This scoping review aims to explore how stigma influences the mental health of individuals with liver disease, with a focus on identifying key psychological outcomes. Methods: Following the Joanna Briggs Institute methodology and PRISMA-ScR guidelines, a systematic search was conducted in PubMed, Scopus, and Web of Science. Studies published between 2014 and 2024 were screened for inclusion based on relevance to liver disease, stigma, and mental health outcomes. A total of nine quantitative studies met the inclusion criteria. Data were charted according to study design, population characteristics, liver disease type, and outcomes. Results: Depression was the most frequently explored mental health outcome, with reporting a relationship between stigma and depressive symptoms. Anxiety was assessed less consistently but was commonly described in patients reporting shame, fear of disclosure, and social judgment. Stigma was also closely linked to reduced health-related quality of life (QOL) across emotional, physical, and social domains. Themes of concealment, social withdrawal, and internalized shame were prominent, particularly among patients with hepatitis B or alcohol-related cirrhosis. Stigma varied by liver disease etiology: moral judgment was more common in hepatitis C and alcohol-related liver disease, while lifestyle-related stigma predominated in NAFLD and MASLD. Hepatitis B stigma often intersected with racial discrimination and fear of transmission. Conclusion: Stigma in liver disease is a multifaceted psychosocial burden that contributes to poorer mental health, diminished quality of life, and care disengagement. Tailored, etiology-specific stigma-reduction interventions and the integration of psychosocial support into liver care are urgently needed.