Depression, demoralization, and suicidality

David Kissane, Matthew Doolittle

Research output: Chapter in Book/Report/Conference proceedingChapter (Book)Otherpeer-review


The development of clinical depression is common during palliative care, adversely affects quality of life and adherence to medical treatments, yet regrettably can pass unrecognized. Screening for distress as the sixth vital sign is therefore highly recommended. Demoralization is another form of distress where the apparent pointlessness of continued life may lead to suicidal thinking. As the mental condition deteriorates, co-morbid states of anxiety, depression, and demoralization become more likely. Rates of suicide are increased with advanced cancer and poor symptom control. Fortunately, combined treatment with medication and counselling is effective in ameliorating depression, demoralization, and suicidality. Meta-analyses of psychotherapy trials confirm clear benefits, with behavioural activation, supportive, interpersonal, and cognitive behavioural therapies all making contributions. Group, couple, and family therapies optimize support for all involved. All members of the multidisciplinary team contribute to the active treatment of depression, demoralization, and the prevention of suicide.
Original languageEnglish
Title of host publicationOxford Textbook of Palliative Medicine
EditorsN I Cherny, M T Fallon, S Kaasa, R K Portenoy, D C Currow
Place of PublicationNew York NY USA
PublisherOxford University Press
Number of pages11
ISBN (Print)9780199656097
Publication statusPublished - 2015

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