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BMJ Support Palliat Care. 2016 Jun;6(2):170-7. doi: 10.1136/bmjspcare-2013-000604. Epub 2014 Mar 4.

Mental disorders and the desire for death in patients receiving palliative care for cancer.

Author information

1
Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada.
2
Department Psychology, University of Ottawa, Ottawa, Ontario, Canada.
3
Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
4
Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
5
Faculty of Pharmacy, Université Laval, Québec, Québec, Canada.
6
Grey Nuns Community Hospital, Covenant Health, Edmonton, Alberta, Canada.
7
Department of Psychiatry, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada.
8
Dr H. Bliss Murphy Cancer Centre, St. John's, Newfoundland and Labrador, Canada.
9
Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
10
Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.

Abstract

OBJECTIVES:

The desire for death in terminally ill patients is associated with depression and anxiety, but not all patients who report it meet criteria for mental disorders. We examined the characteristics of subgroups of palliative cancer patients who expressed a desire for death that occurred either with or without a concurrent depressive or anxiety disorder.

DESIGN:

Cross-sectional survey.

SETTING:

Eight Canadian palliative care programs.

PARTICIPANTS:

377 patients with cancer.

MAIN OUTCOME MEASURES:

Desire for Death Rating Scale; Structured Interview of Symptoms and Concerns.

RESULTS:

Most participants (69.5%) had no desire for death. Of the remainder, 69 (18.3%) acknowledged occasional transient thoughts, and 46 (12.2%) reported an apparently genuine desire to die. In the latter group, 24 individuals (52.2%) were diagnosed with a mental disorder and 22 (44.8%) were not. Individuals with no serious desire for death and no mental disorder reported the least distress in physical, social, existential, and psychological symptoms and concerns; those with a mental disorder and a significant desire for death reported the most. The subgroup of patients with a serious desire for death but no concurrent mental disorders still reported increased distress due to physical symptoms and social concerns, as well as a higher prevalence of global suffering.

CONCLUSIONS:

The expression of a desire for death by a terminally ill patient should raise a suspicion about mental health problems, but is not in itself clearly indicative of one. Nevertheless, it may serve as a catalyst to review the individual's physical symptom management and interpersonal concerns, and overall sense of suffering.

KEYWORDS:

Cancer; Clinical decisions; Psychological care

PMID:
24644212
DOI:
10.1136/bmjspcare-2013-000604
[Indexed for MEDLINE]
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