• Rebecca M Saracino, Devika R Jutagir, Amy Cunningham, Kelly A Foran-Tuller, Mary A Driscoll, William H Sledge, Sukru H Emre, and Dwain C Fehon.
• Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, USA.
• J Pain Symptom Manage. 2018 Jul 1; 56 (1): 44-52.

ContextThe prevalence of psychiatric disorders and mental health service utilization among patients with end-stage liver disease awaiting transplant remains understudied.ObjectivesThis study assessed the prevalence of psychological disorders and symptoms with the use of a structured diagnostic interview and self-report measures, and examined patient-reported mental health service utilization and barriers to care.MethodsWaitlisted liver transplant candidates (N = 120) completed assessments during routine clinic appointments at a single time point.ResultsParticipants endorsed moderate-to-severe levels of depression (19.2%), anxiety (26.7%), and Post Traumatic Stress Disorder (PTSD) (23.3%). Forty-three percent had received some form of mental health treatment in the recent past, and a range of barriers to accessing mental health services were endorsed. In a subset of 39 participants who received a structure diagnostic assessment, there was a high prevalence of current (51.3%) and past (82.1%) psychiatric disorders. Elevated scores on depression, anxiety, and PTSD measures were associated with significant decrements in health-related quality of life, but were not differentially associated with mental health service utilization.ConclusionThere are a significant number of end-stage liver disease patients who could benefit from intervention who are not currently connected to treatment. Many patients do not see the need for accessing services, perhaps because of a lack of insight or knowledge about the benefits of mental health treatment. Future research should determine optimal treatment and service delivery methods for this vulnerable population.Copyright © 2018 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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