Desire for death near the end of life: the role of depression, anxiety and pain

Mystakidou, Kyriaki; Rosenfeld, Barry; Parpa, Efi; Katsouda, Emmanuela; Tsilika, Eleni; Galanos, Antonis; Vlahos, Lambros

doi:10.1016/j.genhosppsych.2005.02.004

« Previous Next »General Hospital Psychiatry
Volume 27, Issue 4 , Pages 258-262, July 2005

Desire for death near the end of life: the role of depression, anxiety and pain

Kyriaki Mystakidou, M.D., Ph.D.
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, University of Athens, 115 26 Athens, Greece
- Corresponding author. Tel.: +30210 7707669; fax: +30210 7488437.
Barry Rosenfeld, Ph.D., ABPP
- Department of Psychology, Fordham University, Bronx, NY 10458, USA
- Tel.: +1 718 817 3794; fax: +1 718 817 3699.
Efi Parpa, B.A., M.A.
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, University of Athens, 115 26 Athens, Greece
- Tel.: +30210 7707669; fax: +30210 7488437.
Emmanuela Katsouda, M.D.
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, University of Athens, 115 26 Athens, Greece
- Tel.: +30210 7707669; fax: +30210 7488437.
Eleni Tsilika, B.Sc., M.Sc.
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, University of Athens, 115 26 Athens, Greece
- Tel.: +30210 7707669; fax: +30210 7488437.
Antonis Galanos, B.Sc.
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, University of Athens, 115 26 Athens, Greece
Lambros Vlahos, M.D., Ph.D.
- Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, University of Athens, 115 26 Athens, Greece
- Tel.: +30210 7286137; fax: +30210 7488437.

Received 6 January 2005; accepted 22 February 2005.

Abstract

Objective

This study evaluated the desire of patients with advanced cancer for hastened death to determine its relationship to psychological distress, anxiety and pain.

Methods

One hundred twenty terminally ill cancer patients were surveyed from June to November 2003 at a palliative care unit in Athens, Greece. Greek versions of the Schedule of Attitudes Toward Hastened Death (G-SAHD), the Hospital Anxiety and Depression Scale (G-HADS) and the Brief Pain Inventory were administered.

Results

Significant correlations were seen between desire for hasten death and HADS-Depression (r=.605; P<.0005) and HADS-Anxiety (r=.636; P<.0005) scores. Results of multiple regression analyses showed that the HADS-Depression scale (B=.443; P<.0005) as well as the HADS-Anxiety scale (B=.326; P<.0005) and the interaction between HADS-Depression and opioids (B=−.159; P=.012), but not pain intensity, pain-related interference, age, sex, patient's performance status as defined by the Eastern Cooperative Oncology Group as well as the interactions between average pain and opioids and average pain and HADS-Depression, were significant predictors of G-SAHD scores.

Conclusions

In terminally ill cancer patients, depression and anxiety as well as the interaction between HADS-Depression and opioids appeared to have a significant impact on the desire for hastened death while pain does not. Effective management of psychological symptoms seems to be an important aspect of adequate palliative care in order to reduce the desire for hastened death.

Keywords: Desire for hastened death, Pain, Anxiety, Depression