# Distinct Patterns of Dyadic Mental Health in Patients with End-Stage Liver Disease and Their Care Partners

## TL;DR

The study found three distinct mental health patterns in patients with end-stage liver disease and their care partners over 12 months, highlighting the need for dyadic care and early palliative support.

## Contribution

The study identifies three unique mental health patterns in ESLD patient-care partner dyads and emphasizes the importance of addressing care partner mental health in clinical interventions.

## Key findings

- Three distinct dyadic mental health patterns were identified: 'disparate: patient better', 'shared mental health', and 'disparate: care partner better'.
- Care partners with worse mental health than patients should be prioritized in clinical care and intervention studies.
- Early referral to palliative care is recommended based on the observed mental health patterns.

## Abstract

What are the main findings?
Mental health is interdependent in end-stage liver disease and affects both members of the care dyad.Three distinct and different patterns of dyadic mental health were found over 12 months.

Mental health is interdependent in end-stage liver disease and affects both members of the care dyad.

Three distinct and different patterns of dyadic mental health were found over 12 months.

What are the implications of the main findings?
Care partners who experience worse mental health than patients with end-stage liver disease should be the focus in dyadic intervention studies and clinical care.Early referral to palliative care is necessary.

Care partners who experience worse mental health than patients with end-stage liver disease should be the focus in dyadic intervention studies and clinical care.

Early referral to palliative care is necessary.

Background/Objectives: Little research has examined changes over time in mental health within end-stage liver disease (ESLD) patient–care partner dyads. Therefore, the aim of this observational study was to identify patterns of dyadic mental health over time in a sample of ESLD dyads and associations with individual- and dyadic-level characteristics. Methods: Adult men and women with ESLD and their care partners were recruited at liver clinics at two healthcare centers in the U.S. Pacific Northwest. Survey data were collected at the time of study enrollment and at 3, 6, 9, and 12 months. Patients and care partners completed the Mishel Uncertainty in Illness Scale, the Multidimensional Perceived Social Support Scale, the Mutuality Scale, the Short-Form Health Survey, and one religiosity item. Standard summary statistics and multilevel and latent growth mixture modeling were used to analyze the data. Results: In total, 186 dyads were included in the analyses, which revealed three distinct patterns of dyadic mental health: “disparate: patient better” (n = 47 [25.3%]), “shared mental health” (n = 76 [40.86%]), and “disparate: care partner better” (n = 63 [33.87%]). Significant characteristics associated with the patterns included care-related strain, uncertainty, relationship quality, and social support. Conclusions: Clinical implications include greater attention to both members of the dyad, with particular attention to low levels of mental health in patients or care partners as identified by the different patterns. Future research should employ a dyadic approach to address the prevalence of characteristics and identify others to improve the mental health of both members of the dyad.