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

Sophie Robinson, David W. Kissane, Joanne Brooker, Courtney Hempton, Susan Burney

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Context
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.

Objectives
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.

Methods
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.

Results
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.

Conclusion
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.
Original languageEnglish
Pages (from-to)243-249
Number of pages7
JournalJournal of Pain and Symptom Management
Volume53
Issue number2
DOIs
Publication statusPublished - Feb 2017

Keywords

  • Desire to hasten death; suicide; palliative care; depression; demoralization; loss of meaning; loss of control; self-worth

Cite this

@article{ae5df494a92f400cb2b4af8947a9fbaf,
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 = "ContextThe 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.ObjectivesThe 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.MethodsA 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.ResultsDepressive 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.ConclusionDepression, 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.",
keywords = "Desire to hasten death; suicide; palliative care; depression; demoralization; loss of meaning; loss of control; self-worth",
author = "Sophie Robinson and Kissane, {David W.} and Joanne Brooker and Courtney Hempton and Susan Burney",
year = "2017",
month = "2",
doi = "10.1016/j.jpainsymman.2016.08.013",
language = "English",
volume = "53",
pages = "243--249",
journal = "Journal of Pain and Symptom Management",
issn = "0885-3924",
publisher = "Elsevier",
number = "2",

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TY - JOUR

T1 - The Relationship Between Poor Quality of Life and Desire to Hasten Death

T2 - A Multiple Mediation Model Examining the Contributions of Depression, Demoralization, Loss of Control, and Low Self-worth

AU - Robinson, Sophie

AU - Kissane, David W.

AU - Brooker, Joanne

AU - Hempton, Courtney

AU - Burney, Susan

PY - 2017/2

Y1 - 2017/2

N2 - ContextThe 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.ObjectivesThe 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.MethodsA 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.ResultsDepressive 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.ConclusionDepression, 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.

AB - ContextThe 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.ObjectivesThe 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.MethodsA 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.ResultsDepressive 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.ConclusionDepression, 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.

KW - Desire to hasten death; suicide; palliative care; depression; demoralization; loss of meaning; loss of control; self-worth

U2 - 10.1016/j.jpainsymman.2016.08.013

DO - 10.1016/j.jpainsymman.2016.08.013

M3 - Article

VL - 53

SP - 243

EP - 249

JO - Journal of Pain and Symptom Management

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SN - 0885-3924

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