title: Cross-cultural variation in mental health at end of life in patients with ALS.
abstract: OBJECTIVE
  To examine mental health at the end of life among patients with ALS in three countries: Israel, Germany, and the United States.
  
  
  METHODS
  Patients met criteria for definite or probable ALS and had forced vital capacity (FVC) <60% of predicted. Patients completed nonsomatic items from the Beck Depression Inventory and visual analogue scale ratings.
  
  
  RESULTS
  The three sites contributed a total of 92 patients; 60 died during follow-up. Patients at the three sites did not differ significantly in sociodemographic features or ALS Functional Rating Scale-Revised summary disability score; sites differed in use of nasal ventilation but not percutaneous esophageal gastrostomy (PEG) tube placement. In analyses that adjusted for disability and use of nasal ventilation, patients at the three sites differed in reports of pessimism and suffering; American patients reported the least distress and Israeli patients the most. In analyses limited to people who died, similar patterns emerged, with wish to live greatest in Americans and least among Israelis. These models adjusted for disability and days until death.
  
  
  CONCLUSIONS
  Cultural factors may affect mental health at the end of life in patients with ALS.
authors: Gertrude H. Sergievsky Center, Columbia University, New York, NY, USA. smalbert@pitt.edu
authors: S M
authors: SM
authors: Albert
authors: M
authors: M
authors: Wasner
authors: T
authors: T
authors: Tider
authors: V E
authors: VE
authors: Drory
authors: G D
authors: GD
authors: Borasio
mesh_terms: D000223:Adaptation, Psychological; D000275:Adjustment Disorders / Q000453:epidemiology / Q000523:psychology; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000208:ethnology* / Q000523:psychology*; D001293:Attitude to Death / Q000208:ethnology*; D015897:Comorbidity; D003469:Culture; D004185:Disability Evaluation; D005260:Female; D005858:Germany; D006801:Humans; D007557:Israel; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D015995:Prevalence; D012133:Respiratory Paralysis / Q000523:psychology; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D014481:United States