The Influence of Patients' Quality of Life at the End of Life on Bereaved Caregivers' Suicidal Ideation

Abstract

Context Recent studies have shown that patients’ quality of life at the end of life (QOL@EOL) affects the psychosocial adjustment of bereaved family caregivers. Objectives To examine the relationship between patients’ QOL@EOL and their surviving bereaved caregivers’ suicidal ideation. Methods Data were derived from the Coping with Cancer (CwC1) Study, a U.S. National Cancer Institute-funded multicenter prospective cohort investigation of patients with advanced cancer and their caregivers, enrolled September 2002 – February 2008. CwC1 data were used to examine changes in suicidal ideation in family caregivers before and after the patient’s death (N=127). Caregiver baseline suicidal ideation was assessed using the Yale Evaluation of Suicidality (YES) Scale a median of 4.1 months pre-loss; caregivers’ perception of patients’ QOL@EOL was assessed a median of 1.9 months post-loss; and caregiver suicidal ideation in bereavement was assessed using the YES a median of 6.5 months post-loss. Suicidal ideation was defined as a positive screen on the YES. Multiple logistic regression analysis examined the effect of caregivers’ perceptions of patients’ QOL@EOL on bereaved caregiver’s suicidal ideation, adjusting for the caregiver’s baseline suicidal ideation and confounding influences. Results Caregivers’ perception of patients’ QOL@EOL was significantly inversely related to caregivers’ suicidal ideation post-loss (AOR=0.79, P=0.023), adjusting for caregivers’ baseline suicidal ideation, relationship to patient, and years of education. Conclusion The more caregivers perceive their loved ones’ QOL@EOL to be poor, the greater their risk for suicidal ideation in bereavement over and above prior levels of suicidal ideation. Caregivers of patients who have poor QOL@EOL appear to be a group of caregivers to target for reduction of suicidal risk.

Suicidal Ideation in Bereavement: A Systematic Review

“…This literature search produced seven studies investigating suicidal ideation among family members of individuals deceased by cancer, all of whom reported to be informal caregivers for the deceased. Abbott, Prigerson, and Maciejewski found prevalence rates of suicidal ideation in family caregivers of cancer patients to be 12% (n = 15) pre-loss and 16.5% (n = 21) post-loss in a multi-site study [11]. The authors also reported that the poorer family members rated the quality of life at the end-of-life of the deceased, the greater risk these individuals were at for suicidal ideation, even when adjusting for pre-loss suicidal ideation (AOR = 0.79, p = 0.023).…”

“…Eight studies included in our review included informal caregiving populations [11,27,28,29,30,31,32,33]. These articles found rates of SI from 16.5% to 31.4% in informal caregivers bereaved by cancer [11,28] and 13.7% in informal caregivers bereaved by dementia [33]. Informal caregiving is well-established as an independent risk factor for poor mental health [48] and SI [11,33] and the limited results of this literature search show that these risks may continue into bereavement.…”

“…For example, place of death of a family member was associated with post-traumatic stress disorder (PTSD) and PGD in a bereaved sample (specifically among patients with cancer who die in a hospital or ICU) [9]. Additionally, PGD and quality of life/quality of death of the patient may affect bereaved informal caregivers’ mental health [10] and even their degree of suicidal ideation [11]. What remains less well-known and studied is the relationship between the deceased’s cause of death and the bereaved family caregiver’s risk of suicidal ideation.…”

Impact of Radiation Therapy on Aggressive Care and Quality of Life Near Death

“…Consistent with prior validation studies, we combined these three questions to assess patients’ QoD, 18,19, 20 after reverse-coding the psychological and physical distress items. Composite scores were dichotomized, based on a median split, to reflect higher (158/312, 50.6%) and lower (154/312, 49.4%) patient QoD in the present analysis.…”

Identities in Transition: Women Caregivers in Bereavement

“…Many studies have examined factors that influence caregiver bereavement in an attempt to understand and predict possible bereavement reactions (Abbott, Prigerson, & Maciejewski, 2014;Digiacomo, Lewis, Nolan, Phillips, & Davidson, 2013a, 2013bGarrido & Prigerson, 2014;McGhan, Loeb, Baney, & Penrod, 2013;Romero, Ott, & Kelber, 2014). Studies that demonstrated caregivers' prolonged and complex bereavement reactions were indicative of high levels of caregiving demand in long-term caregiving .…”