Table 4

Studies on depression and the WTHD in amyotrophic lateral sclerosis (ALS)

AuthorsN *Depression assessment scaleAssessment scale for the wish to hasten death (WTHD)Findings
Ganzini L, Goy ER, Dobscha SK 200858 (ALS 7)Hospital Anxiety and Depression Scale
Participants reported the influence of depression as a reason for the desire to die on a scale: 1=“depression not at all important in the decision to request a lethal prescription” and 5=“depression very important in the decision to request a lethal prescription.”
The participants estimated their desire to die in the last 2 weeks on a 11-point scale: 0=“I desire to live as long as possible” and 10=“I have a strong desire to die soon.”Three-quarters of the people who received a lethal drug were not depressed.
Six out of 18 who received a lethal drug felt influenced in their decision by depression.
Gourie-Devi M, Gupta R, Sharma V, et al 201720Beck’s Depression InventoryThe Scale of Suicidal Ideation and Wish-to-Die QuestionnaireOf five patients who expressed a wish to die, only two had mild-to-moderate depression that did not require treatment.
LeBon B, Fisher S 20111Not specifiedNot specifiedIn this individual case study, the patient who was non-clinically depressed wanted his ventilator to be switched off.
Lulé D, Nonnenmacher S, Sorg S, et al 201493Allgemeine Depressionsskala (German version of the Center for Epidemiologic Studies Depression Scale) range 0–60Schedule of attitudes towards hastened death range 0–20, with 10 indicating a clinically significant desire for hastened death.
A 120-item questionnaire on the status of decision, treatment and determinants of decisions regarding NIV, IV and PEG; including the questions “Did you seek information how to shorten life?” and “Should euthanasia be allowed?” (options: “yes” or “no”).
About one-third of the patients (n=35) sought information on how to shorten life and more than two-thirds (n=63) were of the opinion that euthanasia should be allowed. Nonetheless, the desire for hastened death was low and decreased over the 6-month study period, despite declining physical functions.
Depression was not a significant predictor of WTHD.
Maessen M, Veldink JH, van den Berg LH, et al 201051Nurses’ Observation Scale for Geriatric PatientsData from the Support and Consultation in Euthanasia in The Netherlands evaluation study plus additional questions answered by the treating physicians on the patients, including depressive symptoms at the time of consultation.None of the patients who wanted to die were depressed.
Maessen M, Veldink JH, Onwuteaka-Philipsen BD, et al 2014102Hospital Anxiety and Depression ScalePhysicians were asked about their end-of-life practices, using descriptive terms from medical practice and avoiding terms like “euthanasia”, “physician-assisted suicide” and “sedation”. Whereas “intensified alleviation of pain or symptoms while taking into account the possible hastening of death” was subsumed under end-of-life practices, continuous deep sedation was not, because the intention was palliation of otherwise untreatable symptoms and not to hasten death.No difference in depressive symptoms in the group of patients who explicitly demanded euthanasia and assisted suicide and those who did not.
Rabkin JG, Goetz R, Factor-Litvak P, et al 2015329Patient Health QuestionnaireThe item on the wish to die was modified into: “thoughts that you’d be better off dead/thoughts about ending your life” and the frequency in the last 4 weeks was measured with four possible answers: “not at all; several days, more than half the days; and nearly every day.”Patients who did not express the wish to die had significantly lower depression values.
Smith TJ, Vota S, Patel S, et al 20122Not specifiedTwo ALS patients who requested the withdrawal of life-support measures and organ donation after cardiac death.Requests for withdrawal and organ donation were not associated with clinical depression.
Stutzki R, Schneider U, Reiter-Theil S, et al 201233Hospital Anxiety and Depression ScaleNumeric rating scale (0–10) regarding the actual WTHD: “How strong is your current desire to ask others for help to end your life prematurely?”; “How distressing or how helpful was it for you to speak about such issues?”
Questions regarding life-prolonging measures:
“What is your attitude toward the following life-prolonging measures? (a) Tracheotomy; (b) NIV; (c) PEG.” Respondents were given four possible answers: “(a) I am not sure; (b) I am absolutely in favour of it; (c) I am in favour of it under certain circumstances; (d) I am against it”.
Questions regarding hastening death:
Two possible answers (yes/no) were given for the questions: “Have you ever thought about committing suicide after receiving your diagnosis?”, “Can you imagine a future scenario in which a physician prescribes a fatal drug which you administer yourself?”, “Can you imagine a future scenario in which a physician prescribes and administers to you a fatal drug?”, “Have you ever discussed suicide with others?”, “Would you like to discuss suicide with a physician?”.
The Hospital Anxiety and Depression Scale score is a predictor of the desire to discuss suicide with a physician.
Stutzki R, Weber M, Reiter-Theil S, et al 201466Hospital Anxiety and Depression ScaleNumeric rating scale (0–10) regarding the actual WTHD:
“How strong is your current wish to ask others for assistance to end your life prematurely?”
Questions regarding life-prolonging measures:
Participants’ attitudes on tracheostomy, NIV and PEG were assessed using four possible answers (“disfavour, favour under certain circumstances, favour generally, uncertain”).
Questions regarding hastening death:
Two possible answers (yes/no) were given for the questions: “Have you ever thought about committing suicide?”, “Can you imagine asking a physician for a prescription to commit suicide?”, “Can you imagine asking a physician to administer a lethal medication?”, “Have you been under treatment for depression since your ALS diagnosis?”, “With whom did you talk about the option to hasten death?”, “Have you ever talked about (sic!) someone about the option to hasten death?”, “Would you like to talk with a physician about the option to hasten death?”.
The WTHD can be predicted based on the degree of depression
Veldink J, Maessen M, Onwuteaka-Philipsen B, et al 2012/Not specifiedNot specifiedNo significant difference between ALS patients who requested euthanasia or assisted suicide and patients who did not.
Verschueren A, Kianimehr G et al 201971Beck’s Depression InventoryColumbia Suicide Severity Rating Scale and Reasons for Living inventoryPatients with suicidal ideation were more likely to be depressed and have greater physical disability. Physical disability and depression were correlated.
  • ALS, amyotrophic lateral sclerosis; IV, invasive ventilation; NIV, non-invasive ventilation; PEG, percutaneous endoscopic gastrostomy; WTHD, wish to hasten death.