Low Health Literacy in Patients with Steatotic Liver Disease and Depressive Symptoms
4 affiliations
- 1Department of Dermatology, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- 2Department of Medicine II, Saarland University Medical Center, Saarland University, 66421 Homburg, Germany
- 3First Department of Medicine, University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
- 4Cirrhosis Center Mainz (CCM), University Medical Center of the Johannes Gutenberg University Mainz, 55131 Mainz, Germany
Abstract
Background and Objectives: Health literacy (HL) affects the course of chronic diseases, yet little is known about HL in steatotic liver disease (SLD), and the role of mental comorbidities has not been examined. This study assessed HL in patients with SLD and sought to identify factors linked to lower HL. Materials and Methods: This bicentric cross-sectional study comprised 234 patients with SLD: 209 recruited prospectively in Homburg, Germany (2024–2025), and 25 patients with metabolic dysfunction-associated steatohepatitis (MASH)-related cirrhosis from an existing cohort in Mainz. HL was measured with the German version of the nine-scale Health Literacy Questionnaire (HLQ). SLD was defined by a controlled attenuation parameter ≥ 275 dB/m, and advanced chronic liver disease (ACLD) by liver stiffness ≥ 15 kPa (Baveno VII/VIII) or known cirrhosis. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9 ≥ 10; Homburg) or the Hamilton Depression Rating Scale (HDRS-17 ≥ 8; Mainz). Results: Sixty-eight patients (29%) had depressive symptoms (Homburg 25.8%, Mainz 56.0%). The groups were comparable with respect to age, sex, schooling, liver stiffness and BMI. In univariable analyses, patients with depressive symptoms had lower scores on scales 2, 3, 6 and 7. After adjustment for sex, age, BMI, schooling, and ACLD, associations remained significant for scale 2 (“Having sufficient information to manage my health”; β = −0.14, p = 0.04), scale 3 (“Actively managing my health”; β = −0.15, p = 0.02), scale 6 (“Ability to actively engage with healthcare providers”; β = −0.21, p = 0.003) and scale 7 (“Navigating the healthcare system”; β = −0.16, p = 0.02). The association with scale 6 was consistent across all sensitivity analyses, including an analysis restricted to the Homburg cohort. ACLD was not independently associated with any HLQ scale, whereas higher BMI was associated with lower scores in five of nine domains. Conclusions: More than one in four patients with SLD has depressive symptoms, which are associated with lower self-reported HL, especially regarding engagement with healthcare providers and navigation of the healthcare system. Screening for depression could help to identify patients who require additional support.
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BibTeX
@article{kaps2026health,
title = {{Low Health Literacy in Patients with Steatotic Liver Disease and Depressive Symptoms}},
author = {Leonard Kaps and Christian Labenz and Alexander Barton and Jörn M. Schattenberg and Maurice Michel},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15218474},
url = {https://www.mdpi.com/2077-0383/15/21/8474},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Low Health Literacy in Patients with Steatotic Liver Disease and Depressive Symptoms
AU - Leonard Kaps
AU - Christian Labenz
AU - Alexander Barton
AU - Jörn M. Schattenberg
AU - Maurice Michel
PY - 2026
DA - 2026/10/30
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15218474
UR - https://www.mdpi.com/2077-0383/15/21/8474
AB - Background and Objectives: Health literacy (HL) affects the course of chronic diseases, yet little is known about HL in steatotic liver disease (SLD), and the role of mental comorbidities has not been examined. This study assessed HL in patients with SLD and sought to identify factors linked to lower HL. Materials and Methods: This bicentric cross-sectional study comprised 234 patients with SLD: 209 recruited prospectively in Homburg, Germany (2024–2025), and 25 patients with metabolic dysfunction-associated steatohepatitis (MASH)-related cirrhosis from an existing cohort in Mainz. HL was measured with the German version of the nine-scale Health Literacy Questionnaire (HLQ). SLD was defined by a controlled attenuation parameter ≥ 275 dB/m, and advanced chronic liver disease (ACLD) by liver stiffness ≥ 15 kPa (Baveno VII/VIII) or known cirrhosis. Depressive symptoms were assessed with the Patient Health Questionnaire-9 (PHQ-9 ≥ 10; Homburg) or the Hamilton Depression Rating Scale (HDRS-17 ≥ 8; Mainz). Results: Sixty-eight patients (29%) had depressive symptoms (Homburg 25.8%, Mainz 56.0%). The groups were comparable with respect to age, sex, schooling, liver stiffness and BMI. In univariable analyses, patients with depressive symptoms had lower scores on scales 2, 3, 6 and 7. After adjustment for sex, age, BMI, schooling, and ACLD, associations remained significant for scale 2 (“Having sufficient information to manage my health”; β = −0.14, p = 0.04), scale 3 (“Actively managing my health”; β = −0.15, p = 0.02), scale 6 (“Ability to actively engage with healthcare providers”; β = −0.21, p = 0.003) and scale 7 (“Navigating the healthcare system”; β = −0.16, p = 0.02). The association with scale 6 was consistent across all sensitivity analyses, including an analysis restricted to the Homburg cohort. ACLD was not independently associated with any HLQ scale, whereas higher BMI was associated with lower scores in five of nine domains. Conclusions: More than one in four patients with SLD has depressive symptoms, which are associated with lower self-reported HL, especially regarding engagement with healthcare providers and navigation of the healthcare system. Screening for depression could help to identify patients who require additional support.
SN - 2077-0383
ER -