Desire for death near the end of life: the role of depression, anxiety and pain.
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.
Department of Radiology, Pain Relief and Palliative Care Unit, Areteion Hospital, School of Medicine, University of Athens, 115 26 Athens, Greece. mistakidou@yahoo.com
Kyriaki
K
Mystakidou
Barry
B
Rosenfeld
Efi
E
Parpa
Emmanuela
E
Katsouda
Eleni
E
Tsilika
Antonis
A
Galanos
Lambros
L
Vlahos
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001007:Anxiety / Q000150:complications / Q000523:psychology*; D001293:Attitude to Death; D003625:Data Collection; D003863:Depression / Q000150:complications / Q000523:psychology*; D005260:Female; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D010146:Pain / Q000150:complications / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications; D019452:Terminally Ill / Q000523:psychology*