Patients with end-stage liver disease (ESLD) awaiting transplant often face long wait times during which they experience not only deterioration in health, but also ongoing psychosocial stressors associated with chronic illness management. Currently, in the U.S., over 14,000 people are awaiting liver transplantation; every year, 6000 are transplanted and upward of 2000 of these individuals die or become too ill for transplant. Patients with liver disease often have a history of psychiatric illness such as substance use disorder and depression. These individuals are inherently at risk for increasing psychological distress as they cope with the stresses of chronic illness and awaiting transplant. Thus, the importance of accurately identifying and intervening with these high-risk patients is vital to optimize quality of life and transplant outcomes over time.

Similarly, as in other illnesses, the fatigue associated with advanced disease can prevent individuals from engaging in regular activities, contributing to a lack of positive reinforcement in one's environment and leading to social withdrawal and disengagement. The impact of anxiety and trauma symptoms on physical health has been demonstrated in other seriously medically ill populations such as patients with cancer, heart failure, and end-stage renal disease (ESRD); these symptoms may first predispose, and second, worsen, health outcomes over time (e.g., adherence, inflammation, mortality). Moreover, a review of the literature does not reveal any formal assessment of patient-reported mental health service utilization or perceived barriers regarding access to psychological services. These gaps in the literature are salient among other transplant populations such as those with ESRD as well, but the present study focuses on those with ESLD as a starting point for future research.