The impact of depression (assessed by the Beck Depression Inventory) on quality of life and outcome was prospectively assessed in adult patients with cirrhosis. Patients with depression had significantly poorer perceived quality of life (P = 0.006), poorer adaptive coping (P = 0.001), and lower functional status, i.e., Karnofsky performance score (P = 0.06), as compared to the nondepressed patients. Survival after transplantation was not different between depressed and nondepressed patients. However, the patients with depression were significantly more likely to die while awaiting transplantation than the nondepressed patients (P = 0.02). The difference in mortality between the depressed and the nondepressed patients with end-stage liver disease could not be explained by the severity of illness variables; Child-Pugh score, complications of liver disease, renal function, serum albumin, prothrombin time, frequency and duration of hospitalizations were not significantly different for depressed and nondepressed patients. Symptoms of depression should be sought in patients with cirrhosis since depression is a modifiable illness that is amenable to treatment.