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

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.

Latent class analysis differentiation of adjustment disorder and demoralization, more severe depressive and anxiety disorders, and somatic symptoms in patients with cancer

“…This is consistent with recent studies of demoralization that revealed higher odds of suicidal ideation compared to anhedonic depression . Loss of meaning, hopelessness, worthlessness, and loss of control were also stronger mediators of a desire for hastened death than depressed mood . Clinicians recognize suicidal risk in patients with AD as well as MDD, with these mediators of suicidality arising from disordered coping rather than anhedonia per se .…”

“…In 3 systematic reviews, factors associated with demoralization included poor health, inadequately controlled physical or mental symptoms, reduced quality of life, unemployment and financial strain, reduced social functioning, single status, and social isolation or alienation . Furthermore, demoralization has a stronger association than depression with desire for hastened death and suicidal ideation .…”

The association of demoralization with mental disorders and suicidal ideation in patients with cancer

“…14 Demoralization is associated instead with a feeling of being unable to accomplish things that personally matter in the future, which may generate a sense of meaninglessness and futility. Robinson et al 16 and Fang et al 17 have found significant associations between demoralization and the wish to hasten death. Robinson et al 16 and Fang et al 17 have found significant associations between demoralization and the wish to hasten death.…”

“…15 Demoralization may be an important risk factor for suicidal ideation in patients with cancer. Robinson et al 16 and Fang et al 17 have found significant associations between demoralization and the wish to hasten death. Further evidence on this relationship is yet needed, especially on the extent to which demoralization may predict suicidal ideation independently of mental disorders.…”

Beyond the bucket list: Unfinished and business among advanced cancer patients

“…In the context of advanced disease, this realization can catalyze existential distress. Several researchers have explored existential distress among patients with advanced disease, examining related constructs, such as sense of meaning, demoralization, desire for hastened death, hopelessness, and despair . However, the concept of unfinished business (UB) has received less attention.…”