title: An insight into death wish among patients with amyotrophic lateral sclerosis in India using "Wish-to-Die Questionnaire".
abstract: OBJECTIVE
  In amyotrophic lateral sclerosis (ALS), death wish is expressed in a varying proportion of patients in different countries. In this first study from India, influence of belief system of religion/spirituality and attitude towards death, widely prevalent in the country, in decision making, was evaluated.
  
  
  METHODS
  Twenty ALS patients were assessed using 'Wish-to-Die Questionnaire' (WDQ) developed to reflect seven domains, namely religion/spirituality, belief in karma, meaning of life, hope, family support, financial support and death wish. Functional impairment, depression, hopelessness and suicidal ideation were assessed by ALS Functional Rating Scale, Beck's Depression Inventory, Beck Hopelessness Scale and The Scale of Suicidal Ideation, respectively.
  
  
  RESULTS
  On WDQ, all the 20 patients had belief in religion/spirituality, had hope and family support. Nineteen patients (95%) believed in karma, 16 (80%) still found life meaningful and 15 (75%) had financial support. Six patients (30%) had mild to moderate depression; hopelessness was present in 6 (30%) and suicidal ideation was present in one (5%). The 5 (25%) patients who expressed death wish did not significantly differ from others in 6 domains (religion/spirituality, belief in karma, meaning of life, hope, family support, financial support) of WDQ. The main reason in 3 patients who expressed death wish was lack of financial support. The fourth patient could not find meaning of life after the onset of illness, and the fifth wished to end his life since he had satisfactorily fulfilled all his responsibilities.
  
  
  CONCLUSIONS
  Smaller proportion of patients of ALS expressed death wish in India compared to the Western countries. This may be attributed to belief in religion/spirituality and karma, having meaning of life and family support. As this is the first report from India, useful information may be obtained if similar studies are done on a larger sample.
authors.affiliation: Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India.
authors.forename: Mandaville
authors.initials: M
authors.lastname: Gourie-Devi
authors.affiliation: Department of Clinical Psychology, Institute of Human Behaviour and Allied Sciences, New Delhi; Department of Psychology, University of Delhi, India.
authors.forename: Reema
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Department of Clinical Psychology, Institute of Human Behaviour and Allied Sciences, New Delhi, India.
authors.forename: Vibha
authors.initials: V
authors.lastname: Sharma
authors.affiliation: Department of Neurology, Bombay Hospital Institute of Medical Sciences, Mumbai, India.
authors.forename: Vibhor
authors.initials: V
authors.lastname: Pardasani
authors.affiliation: Department of Neurology, Institute of Human Behaviour and Allied Sciences, New Delhi, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Maheshwari
mesh_terms: D000328:Adult; D000368:Aged; D000690:Amyotrophic Lateral Sclerosis / Q000523:psychology*; D001293:Attitude to Death / Q000208:ethnology; D003866:Depressive Disorder / Q000523:psychology*; D000078022:Economic Status; D005190:Family; D005260:Female; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D012069:Religion and Psychology; D012944:Social Support; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires