title: Care complexity, mood, and quality of life in liver pre-transplant patients.
abstract: BACKGROUND
  This study was intended to document the frequency of care complexity in liver transplant candidates, and its association with mood disturbance and poor health-related quality of life (HRQoL).
  
  
  METHODS
  Consecutive patients fulfilling inclusion criteria, recruited in three European hospitals, were assessed with INTERMED, a reliable and valid method for the early assessment of bio-psychosocial health risks and needs. Blind to the results, they were also assessed with the Hospital Anxiety and Depression Scale (HADS). HRQoL was documented with the EuroQol and the SF36. Statistical analysis included multivariate and multilevel techniques.
  
  
  RESULTS
  Among patients fulfilling inclusion criteria, 60 patients (75.9%) completed the protocol and 38.3% of them were identified as "complex" by INTERMED, but significant between-center differences were found. In support of the working hypothesis, INTERMED scores were significantly associated with all measures of both the SF36 and the EuroQol, and also with the HADS. A one point increase in the INTERMED score results in a reduction in 0.93 points in EuroQol and a 20% increase in HADS score.
  
  
  CONCLUSIONS
  INTERMED-measured case complexity is frequent in liver transplant candidates but varies widely between centers. The use of this method captures in one instrument multiple domains of patient status, including mood disturbances and reduced HRQoL.
authors.affiliation: Zaragoza University, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Zaragoza, Spain. elobo@unizar.es
authors.forename: Elena
authors.initials: E
authors.lastname: Lobo
authors.forename: Frederic
authors.initials: F
authors.lastname: Stiefel
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Söllner
authors.forename: Javier
authors.initials: J
authors.lastname: Santabarbara
authors.forename: Antonio
authors.initials: A
authors.lastname: Lobo
authors.forename: Frits
authors.initials: F
authors.lastname: Huyse
authors.forename: Guillermo
authors.initials: G
authors.lastname: Marcos
authors.forename: Laurent
authors.initials: L
authors.lastname: Michaud
authors.forename: Werner
authors.initials: W
authors.lastname: Hohenberger
authors.forename: Gundula
authors.initials: G
authors.lastname: Ludwig
mesh_terms: D000341:Affective Disorders, Psychotic; D001007:Anxiety; D003863:Depression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016031:Liver Transplantation / Q000523:psychology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011379:Prognosis; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires