title: The Relationship Between Poor Quality of Life and Desire to Hasten Death: A Multiple Mediation Model Examining the Contributions of Depression, Demoralization, Loss of Control, and Low Self-worth.
abstract: The risk of suicide is elevated in palliative care patients compared with the general population. Various psychological factors, including depression, demoralization, loss of control, and low self-worth, have been associated with a desire to hasten death.
  
  
  
  The aim of this study was to investigate whether depression, demoralization, loss of control, and low self-worth mediated the relationship between global quality of life and desire to hasten death.
  
  
  
  A sample of 162 palliative care patients completed measures of global quality of life, depression, demoralization, perceived control, self-worth, and desire to hasten death. A multiple mediation model with bootstrapping sampling tested the total (combined) indirect effect and individual indirect effects of depression, the two subscales of demoralization (Meaning and Purpose, and Distress and Coping Ability), perceived control, and self-worth.
  
  
  
  Depressive symptoms, loss of meaning and purpose, loss of control, and low self-worth mediated the direct effect of global quality of life on desire to hasten death. The Distress and Coping Ability component of demoralization was not a significant mediator.
  
  
  
  Depression, loss of meaning and purpose, loss of control, and low self-worth are strong clinical markers for desire to hasten death. Targeting these symptoms through existentially oriented therapies, such as meaning-centered therapy, may ameliorate suicidal thinking.
authors.affiliation: Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; School of Psychological Sciences, Monash University, Melbourne, Australia.
authors.forename: Sophie
authors.initials: S
authors.lastname: Robinson
authors.affiliation: Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; School of Psychological Sciences, Monash University, Melbourne, Australia; Szalmuk Family Psycho-oncology Unit, Cabrini Health, Melbourne, Australia. Electronic address: david.kissane@monash.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Kissane
authors.affiliation: Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia; Szalmuk Family Psycho-oncology Unit, Cabrini Health, Melbourne, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Brooker
authors.affiliation: Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Australia.
authors.forename: Courtney
authors.initials: C
authors.lastname: Hempton
authors.affiliation: School of Psychological Sciences, Monash University, Melbourne, Australia; Szalmuk Family Psycho-oncology Unit, Cabrini Health, Melbourne, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Burney
mesh_terms: D000223:Adaptation, Psychological / Q000502:physiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D003643:Death; D003863:Depression / Q000523:psychology*; D005260:Female; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D009042:Motivation; D010166:Palliative Care / Q000523:psychology; D011788:Quality of Life / Q000523:psychology*; D012649:Self Concept; D013315:Stress, Psychological / Q000523:psychology; D059020:Suicidal Ideation; D019452:Terminally Ill / Q000523:psychology*
keywords: Desire to hasten death; demoralization; depression; loss of control; loss of meaning; palliative care; self-worth; suicide