title: Mental disorders and the desire for death in patients receiving palliative care for cancer.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional survey.
  
  
  METHODS
  Eight Canadian palliative care programs.
  
  
  METHODS
  377 patients with cancer.
  
  
  METHODS
  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.
authors.affiliation: Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada.
authors.forename: Keith G
authors.initials: KG
authors.lastname: Wilson
authors.affiliation: Department Psychology, University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Dalgleish
authors.affiliation: Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada.
authors.forename: Harvey Max
authors.initials: HM
authors.lastname: Chochinov
authors.affiliation: Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
authors.forename: Srini
authors.initials: S
authors.lastname: Chary
authors.affiliation: Faculty of Pharmacy, Université Laval, Québec, Québec, Canada.
authors.forename: Pierre R
authors.initials: PR
authors.lastname: Gagnon
authors.affiliation: Grey Nuns Community Hospital, Covenant Health, Edmonton, Alberta, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Macmillan
authors.affiliation: Department of Psychiatry, University of British Columbia-Okanagan, Kelowna, British Columbia, Canada.
authors.forename: Marina
authors.initials: M
authors.lastname: De Luca
authors.affiliation: Dr H. Bliss Murphy Cancer Centre, St. John's, Newfoundland and Labrador, Canada.
authors.forename: Fiona
authors.initials: F
authors.lastname: O'Shea
authors.affiliation: Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Kuhl
authors.affiliation: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Fainsinger
mesh_terms: D000368:Aged; D001008:Anxiety Disorders / Q000453:epidemiology*; D001293:Attitude to Death; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology*; D005065:Euthanasia; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000453:epidemiology* / Q000523:psychology; D010166:Palliative Care / Q000523:psychology*; D013315:Stress, Psychological / Q000453:epidemiology; D017236:Suicide, Assisted; D013727:Terminal Care / Q000523:psychology* / Q000706:statistics & numerical data; D019452:Terminally Ill / Q000523:psychology*
keywords: Cancer; Clinical decisions; Psychological care