Analysis of the association between chronic liver disease and depressive disorder and the mediating effect of nocturnal sleep duration

Panshili HAN; Yue FENG; Yanhang GAO

doi:10.12449/JCH260418

Volume 42 Issue 4

Apr. 2026

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Article Navigation > Journal of Clinical Hepatology > 2026 > 42(4): 890-899

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Analysis of the association between chronic liver disease and depressive disorder and the mediating effect of nocturnal sleep duration

DOI: 10.12449/JCH260418

Panshili HAN^{1, 2, 3},
Yue FENG^{1, 2, 3},
Yanhang GAO^{1, 2, 3
,
,
,}

1.
Department of Hepatology，Center of Infectious Diseases and Pathogen Biology，The First Hospital of Jilin University，Changchun 130021，China
2.
Jilin Provincial Key Laboratory of Metabolic Liver Diseases，Jilin University，Changchun 130021，China
3.
China-Singapore Belt and Road Joint Laboratory on Liver Disease Research，Changchun 130021，China

Research funding:

National Natural Science Foundation of China (U24A20654);

National Natural Science Foundation of China (82170602);

Natural Science Foundation for Self-Exploration Research of Jilin Province (YDZJ202401427ZYTS);

Jilin Provincial Key Laboratory of Metabolic Liver Diseases (YDZJ202502CXJD002);

National Key Research and Development Program of China (2024YFE0213800)

More Information

Corresponding author: GAO Yanhang， yanhang@mail.jlu.edu.cn （ORCID： 0000-0001-8590-6706）
Received Date: 2025-09-28
Accepted Date: 2026-01-26
Published Date: 2026-04-25

Abstract

Abstract

Objective To investigate the association between chronic liver disease （CLD） and depression and the mediating role of nocturnal sleep duration， as well as the consistency of this association between Chinese and American populations. Methods The data from two databases were integrated， i.e.， China Health and Retirement Longitudinal Study （CHARLS）（n=14 225） in China and National Health and Nutrition Examination Survey （NHANES）（n=11 353） in the United States， and the subjects were divided into CLD group and non-CLD group. A stepwise Logistic regression model was used to assess the independent association between CLD and depression. Bootstrap resampling （1 000 times） was used to quantify the proportion of the mediating effect of nocturnal sleep duration， and interaction effects were evaluated through stratified analyses based on the factors including registered residence/race and income. The independent-samples t test was used for comparison of continuous data between two groups； the chi-square test or the Fisher’s exact test was used for comparison of categorical data； a multivariate Logistic regression model analysis was used to investigate the association of different types of CLD with depression. Results After multivariate adjustment， CLD was significantly associated with the increased risk of depression （CHARLS： odds ratio ［OR］=1.76， 95% confidence interval ［CI］： 1.46 — 2.12， P<0.001； NHANES： OR=1.87， 95%CI： 1.50 — 2.35， P<0.001）. Nocturnal sleep duration played a partial mediating role in the association between CLD and depression， with a mediating effect accounted for 12.41% in CHARLS and 2.16% in NHANES （P<0.05）. The interaction analysis showed that in CHARLS， the association between CLD and depression was more significant in the residents with agricultural registered permanent residence （OR=2.07， 95%CI： 1.67 — 2.57， P<0.001）， and in NHANES， this association was more significant in the population with moderate poverty income ratio （OR=2.66， 95% CI： 1.92 — 3.69， P<0.001）. The subtype analysis showed that autoimmune hepatitis （OR=3.63， 95%CI： 1.49 — 8.88， P=0.005）， liver cirrhosis （OR=2.46， 95%CI： 1.32 — 4.60， P=0.005）， and fatty liver disease （OR=1.75， 95%CI： 1.27 — 2.39， P=0.001） significantly increased the risk of depression， while no statistical significance was observed for viral hepatitis or other liver diseases （P>0.05）. Conclusion This study reveals the significant association between CLD and depression at the population level and suggests that nocturnal sleep duration may play a partial mediating role， which is consistent between the Chinese and American populations. These research findings provide quantitative evidence-based support for understanding the underlying mechanism of CLD-related depression and points out the potential significance of sleep issues in CLD management.
- Chronic Liver Disease,
- Sleep,
- Depression,
- Mediation Analysis

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References

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Analysis of the association between chronic liver disease and depressive disorder and the mediating effect of nocturnal sleep duration

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