Annie B. Fox, PhD

Wei Zhang, MD, PhD

Rates of chronic liver disease, especially alcohol-associated liver disease (ALD), have risen substantially over the last two decades. People with ALD may be unfairly judged or feel that healthcare providers will make assumptions about them, but the extent to which these and other forms of stigma pose a barrier to their care hasn’t been quantified.

A recent study from researchers at Mass General Brigham, led by first author Wei Zhang, MD, PhD, and senior author Annie B. Fox, PhD, unveils a potential new tool for measuring liver-disease specific stigma.

The team surveyed 211 adults with chronic liver disease who received care at Massachusetts General Hospital to develop and evaluate their Liver Disease Stigma Scale (LDSS).

They found that the LDSS reliably measured five stigma domains:

• Internalized stigma

• Anticipated stigma from family

•Experienced stigma from family

• Anticipated stigma from healthcare workers

• Experienced stigma from healthcare workers

The scale showed excellent reliability and validity. Patients with ALD reported higher stigma, especially internalized stigma and stigma experienced from family. Higher stigma was linked to worse mental health symptoms and more negative attitudes toward treatment and was cited more frequently by patients with cirrhosis.

The authors hope that the LDSS may help clinicians, researchers and health systems better understand how stigma shapes patient experiences and develop more patient-centered approaches to care.

Published in JHEP Reports on May 6, 2026 | Read the paper: “Development and Psychometric Evaluation of the Liver Disease Stigma Scale (LDSS)”

Summary reviewed by: Wei Zhang, MD, PhD