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Mental disorders and the desire for death in patients receiving palliative care for cancer
  1. Keith G Wilson1,
  2. Tracy L Dalgleish2,
  3. Harvey Max Chochinov3,
  4. Srini Chary4,
  5. Pierre R Gagnon5,
  6. Karen Macmillan6,
  7. Marina De Luca7,
  8. Fiona O'Shea8,
  9. David Kuhl9 and
  10. Robin L Fainsinger10
  1. 1Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada
  2. 2Department Psychology, University of Ottawa, Ottawa, Ontario, Canada
  3. 3Department of Psychiatry, University of Manitoba, Winnipeg, Manitoba, Canada
  4. 4Department of Oncology, University of Calgary, Calgary, Alberta, Canada
  5. 5Faculty of Pharmacy, Université Laval, Québec, Québec, Canada
  6. 6Grey Nuns Community Hospital, Covenant Health, Edmonton, Alberta, Canada
  7. 7Department of Psychiatry, University of British Columbia—Okanagan, Kelowna, British Columbia, Canada
  8. 8Dr H. Bliss Murphy Cancer Centre, St. John's, Newfoundland and Labrador, Canada
  9. 9Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
  10. 10Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Alberta, Canada
  1. Correspondence to Dr Keith G Wilson, Department of Psychology, The Ottawa Hospital Rehabilitation Centre, 505 Smyth Road, Ottawa, ON, Canada, K1H 8M2; Kewilson{at}


Objectives The desire for death in terminally ill patients is associated with depression and anxiety, but not all patients who report it meet criteria for mental disorders. We examined the characteristics of subgroups of palliative cancer patients who expressed a desire for death that occurred either with or without a concurrent depressive or anxiety disorder.

Design Cross-sectional survey.

Setting Eight Canadian palliative care programs.

Participants 377 patients with cancer.

Main outcome measures Desire for Death Rating Scale; Structured Interview of Symptoms and Concerns.

Results Most participants (69.5%) had no desire for death. Of the remainder, 69 (18.3%) acknowledged occasional transient thoughts, and 46 (12.2%) reported an apparently genuine desire to die. In the latter group, 24 individuals (52.2%) were diagnosed with a mental disorder and 22 (44.8%) were not. Individuals with no serious desire for death and no mental disorder reported the least distress in physical, social, existential, and psychological symptoms and concerns; those with a mental disorder and a significant desire for death reported the most. The subgroup of patients with a serious desire for death but no concurrent mental disorders still reported increased distress due to physical symptoms and social concerns, as well as a higher prevalence of global suffering.

Conclusions The expression of a desire for death by a terminally ill patient should raise a suspicion about mental health problems, but is not in itself clearly indicative of one. Nevertheless, it may serve as a catalyst to review the individual's physical symptom management and interpersonal concerns, and overall sense of suffering.

  • Cancer
  • Clinical decisions
  • Psychological care

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