title: Depression and wish to die in a multicenter cohort of ALS patients.
abstract: Our objective was to determine prevalence of depressive disorders and wish to die at the baseline visit of a longitudinal multisite study of patients with ALS. Structured telephone interviews were conducted with patients diagnosed in past 18 months at 16 U.S. ALS centers. Demographic, medical, psychiatric and other psychological measures were administered. Of 329 patients assessed, mean ALSFRS-R score was 36.6; 88% (289/329) had no depressive disorder, 7% (24/329) had minor depression, and 5% (16/329) had current major depressive disorder (DSM-IV criteria). Demographic, financial and employment factors were unrelated to depression, as were duration of ALS symptoms and respiratory status, although depressed patients had lower scores on the total ALSFRS-R (p = 0.004) and gross motor function (p < 0.001). Depressed patients reported less pleasure, greater suffering, weariness and anxiety, more stress, were less hopeful, felt less control over illness management, reported lower quality of life, more often had thoughts about ending their lives and hastening death (all p < 0.001). Of the 62 patients (19% of the sample) who expressed a wish to die, only 37% (23/62) were clinically depressed. In conclusion, depressive disorders are not necessarily to be expected of ALS patients. Wish to die is not always expressed in the context of depression and does not necessarily represent psychopathology as such.
authors.affiliation: New York State Psychiatric Institute and Department of Psychiatry, Columbia University College of Physicians and Surgeons , New York.
authors.forename: Judith G
authors.initials: JG
authors.lastname: Rabkin
authors.forename: Raymond
authors.initials: R
authors.lastname: Goetz
authors.forename: Pam
authors.initials: P
authors.lastname: Factor-Litvak
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hupf
authors.forename: Martin
authors.initials: M
authors.lastname: McElhiney
authors.forename: Jessica
authors.initials: J
authors.lastname: Singleton
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Mitsumoto
mesh_terms: D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000150:complications* / Q000453:epidemiology / Q000523:psychology*; D000704:Analysis of Variance; D015331:Cohort Studies; D015897:Comorbidity; D003863:Depression / Q000209:etiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life; D059020:Suicidal Ideation; D014481:United States
keywords: ALS; depressive disorder; wish to die