title: Mental Health and Behavioral Barriers in Access to Kidney Transplantation: A Canadian Cohort Study.
abstract: A history of mental health (MH) disorders or nonadherence (NA) may be barriers to completing the work-up (WU) and/or undergoing kidney transplantation (KT) but this has not been well documented. In this work, we analyzed the relationship between a history of MH disorders or NA and the likelihood of completing the WU or undergoing KT.
  
  
  
  Patients referred for KT to the Toronto General Hospital from January 1, 2003, to December 31, 2012, and who completed a social work assessment, were included (n = 1769). The association between the history of MH disorders or NA and the time from referral to WU completion or KT were examined using Cox proportional hazards models.
  
  
  
  A history of MH disorders or NA was present in 24% and 18%, respectively. Patients with MH disorders had a 17% lower adjusted hazard of completing the WU within 2 years of referral (HR 0.83; 95% confidence interval [95% CI], 0.71-0.97). Similarly, patients with a history of NA had a 21% lower hazard of completing the WU (hazard ratio [HR], 0.79; 95% CI, 0.66-0.94). The adjusted HR for KT was 0.88 (95% CI, 0.74-1.05) and 0.79 (95% CI, 0.64-0.97) for MH disorders and NA, respectively.
  
  
  
  These findings suggest that a history of MH disorders or NA is a potential barrier to KT. Whether targeted psychosocial support can improve access to KT for these patients requires further study.
authors.affiliation: 1 Division of Nephrology, Multi-Organ Transplant Program, University Health Network and University of Toronto, Toronto, Canada. 2 Centre for Mental Health, University Health Network and Department of Psychiatry, University of Toronto, Canada. 3 Institute of Behavioural Sciences, Semmelweis University Budapest, Hungary. 4 Institute of Health Policy, Management and Evaluation, University of Toronto.
authors.forename: Istvan
authors.initials: I
authors.lastname: Mucsi
authors.forename: Aarushi
authors.initials: A
authors.lastname: Bansal
authors.forename: Michael
authors.initials: M
authors.lastname: Jeannette
authors.forename: Olusegun
authors.initials: O
authors.lastname: Famure
authors.forename: Yanhong
authors.initials: Y
authors.lastname: Li
authors.forename: Marta
authors.initials: M
authors.lastname: Novak
authors.forename: S Joseph
authors.initials: SJ
authors.lastname: Kim
mesh_terms: D000328:Adult; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006769:Hospitals, General; D006801:Humans; D053208:Kaplan-Meier Estimate; D016030:Kidney Transplantation / Q000379:methods*; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000175:diagnosis / Q000523:psychology*; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D009864:Ontario; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D010361:Patients / Q000523:psychology*; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000175:diagnosis / Q000523:psychology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors