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Liver disease prevalence and severity in people with serious mental illness: a cross-sectional analysis using non-invasive diagnostic tools


Background/purpose of the study

Little is known about all-cause liver disease in people with serious mental illness (SMI), despite heightened risk factors. We, therefore, prospectively assessed liver disease by etiology and severity in a cross-sectional cohort of people with SMI at a tertiary health service.


We recruited 255 people with SMI between August 2019 and March 2020. Liver disease data were derived from structured interview, medical records, biochemical and BBV serological analyses, and vibration-controlled transient elastography (VCTE). Steatosis was determined using a threshold of ≥ 248 db/m via the controlled attenuation parameter (CAP) on VCTE. Liver disease prevalence was assessed descriptively, and predictors of metabolic-dysfunction associated fatty liver disease (MAFLD) analyzed using linear regression and multivariable analysis. Best fit modeling of non-invasive screening tests for MAFLD was also assessed.


Valid VCTE was obtained for 252 (98.9%) participants. Median age was 40 years (IQR 31–49) with male predominance (65.9%). Hepatitis C Virus (HCV) seroprevalence was 14.7% (37/252), with four new viremic cases identified. Hepatic steatosis was diagnosed in 61.5% (155/252) of participants, with MAFLD criteria met in 59.9% (151/252) of cases. Clozapine and paliperidone were associated with hepatic steatosis (CAP + 23.3 db/m, p 0.013 and CAP + 25.5, p 0.037, respectively). Advanced liver disease, defined by LSM ≥ 8.2 kPa, was identified in 26 individuals (10.3%). MAFLD compared to no MAFLD was associated with more advanced liver disease (5.3 kPa, 4.3–6.5 versus 4.9 kPa, 3.9–5.6, p < 0.001).


Liver disease is common in people with SMI and should be screened for as part of standard physical health assessment.

Graphic abstract

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Data availability

Deidentified data will be provided to authorized academic partners upon written request.


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Authors and Affiliations



Conceptualisation: MRB and AD; Methodology: MRB; Recruitment: MRB, AB, SSand T-HN; Formal analysis and investigation: MRB and DC; Writing—original draft preparation: MRB; Writing—review and editing: MRB, JL and WS; Funding acquisition: N/A; Resources: N/A; Supervision: JL, AD and WS; Project oversight: DC, AD and WS.

Corresponding author

Correspondence to Michael Rudi Braude.

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Conflict of interest

Michael Rudi Braude, Danny Con, John Lubel, Abhijit Bidwai, Hoang-Thy Nguyen, Shipra Sharmamiglani, David Clarke, Anouk Dev and William Sievert declares that they have nil financial or institution disclosures or conflicts of interest.

Ethical approval

The study was approved by the Monash Health Human Research and Ethics Committee (RES-19-0000208A, HREC 52541) and was conducted in accordance with the Australian National Statement on Ethical Conduct in Human Research.

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Written consent was obtained from all recruited participants in accordance with the ethics-approved study protocol.

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Braude, M.R., Con, D., Lubel, J. et al. Liver disease prevalence and severity in people with serious mental illness: a cross-sectional analysis using non-invasive diagnostic tools. Hepatol Int 15, 812–820 (2021).

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