title: Euthanasia and depression: a prospective cohort study among terminally ill cancer patients.
abstract: OBJECTIVE
  To study the association between depression and the incidence of explicit requests for euthanasia in terminally ill cancer patients.
  
  
  METHODS
  A prospective cohort study was conducted on 138 consecutive cancer patients with an estimated life expectancy of 3 months or less, in the period between September 1999 and August 2003. At inclusion, participants completed the Hospital Anxiety and Depression Scale. To identify "depressed mood" we used a cutoff score of 20. Kaplan-Meier curves and Cox regression analyses were used to assess the association between depressed mood and the risk of a request for euthanasia.
  
  
  RESULTS
  Of 138 patients, 32 patients had depressed mood at inclusion. Thirty patients (22%) made an explicit request for euthanasia. The risk to request euthanasia for patients with depressed mood was 4.1 times higher than that of patients without depressed mood at inclusion (95% CI, 2.0 to 8.5).
  
  
  CONCLUSIONS
  Depression in cancer patients with an estimated life expectancy of less than 3 months is associated with a higher likelihood to request for euthanasia. The question of whether depressed mood can adequately be treated in this terminally ill population, and if so, whether it would lower the incidence of requests for euthanasia needs further investigation.
authors.affiliation: Department of Clinical Psychology, Faculty Social Sciences, Utrecht University, Utrecht, the Netherlands. m.l.vanderlee@erasmusmc.nl
authors.forename: Marije L
authors.initials: ML
authors.lastname: van der Lee
authors.forename: Johanna G
authors.initials: JG
authors.lastname: van der Bom
authors.forename: Nikkie B
authors.initials: NB
authors.lastname: Swarte
authors.forename: A Peter M
authors.initials: AP
authors.lastname: Heintz
authors.forename: Alexander
authors.initials: A
authors.lastname: de Graeff
authors.forename: Jan
authors.initials: J
authors.lastname: van den Bout
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D001293:Attitude to Death; D015331:Cohort Studies; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D033101:Euthanasia, Active, Voluntary / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011446:Prospective Studies; D012297:Right to Die; D017678:Sex Distribution; D018434:Sickness Impact Profile; D013727:Terminal Care / Q000523:psychology; D019452:Terminally Ill / Q000523:psychology*