Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients
We tested a model in which psychosocial and disease-related variables act as multiple protective and risk factors for psychological distress in patients with metastatic cancer. We hypothesized that depression and hopelessness constitute common pathways of distress, which mediate the effects of psych...
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| Veröffentlicht in: | Social science & medicine (1982) 2009-02, Vol.68 (3), p.562-569 |
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| container_title | Social science & medicine (1982) |
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| creator | Rodin, Gary Lo, Christopher Mikulincer, Mario Donner, Allan Gagliese, Lucia Zimmermann, Camilla |
| description | We tested a model in which psychosocial and disease-related variables act as multiple protective and risk factors for psychological distress in patients with metastatic cancer. We hypothesized that depression and hopelessness constitute common pathways of distress, which mediate the effects of psychosocial and disease-related factors on the desire for hastened death. This model was tested on a cross-sectional sample of 406 patients with metastatic gastrointestinal or lung cancer recruited at outpatient clinics of a Toronto cancer hospital, using structural equation modeling. The results supported the model. High disease burden, insecure attachment, low self-esteem, and younger age were risk factors for depression. Low spiritual well-being was a risk factor for hopelessness. Depression and hopelessness were found to be mutually reinforcing, but distinct constructs. Both depression and hopelessness independently predicted the desire for hastened death, and mediated the effects of psychosocial and disease-related variables on this outcome. The identified risk factors support a holistic approach to palliative care in patients with metastatic cancer, which attends to physical, psychological, and spiritual factors to prevent and treat distress in patients with advanced disease. |
| doi_str_mv | 10.1016/j.socscimed.2008.10.037 |
| format | Article |
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We hypothesized that depression and hopelessness constitute common pathways of distress, which mediate the effects of psychosocial and disease-related factors on the desire for hastened death. This model was tested on a cross-sectional sample of 406 patients with metastatic gastrointestinal or lung cancer recruited at outpatient clinics of a Toronto cancer hospital, using structural equation modeling. The results supported the model. High disease burden, insecure attachment, low self-esteem, and younger age were risk factors for depression. Low spiritual well-being was a risk factor for hopelessness. Depression and hopelessness were found to be mutually reinforcing, but distinct constructs. Both depression and hopelessness independently predicted the desire for hastened death, and mediated the effects of psychosocial and disease-related variables on this outcome. The identified risk factors support a holistic approach to palliative care in patients with metastatic cancer, which attends to physical, psychological, and spiritual factors to prevent and treat distress in patients with advanced disease.</description><identifier>ISSN: 0277-9536</identifier><identifier>EISSN: 1873-5347</identifier><identifier>DOI: 10.1016/j.socscimed.2008.10.037</identifier><identifier>PMID: 19059687</identifier><identifier>CODEN: SSMDEP</identifier><language>eng</language><publisher>Kidlington: Elsevier Ltd</publisher><subject>Adult and adolescent clinical studies ; Age Factors ; Aged ; Anxiety - etiology ; Attitude to Death ; Attitude to Health ; Biological and medical sciences ; Canada ; Canada Oncology Depression Hopelessness Psychosocial risk factors Palliative care Desire for hastened death ; Cancer ; Cancer Care Facilities ; Colorectal cancer ; Cost of Illness ; Depression ; Depressive Disorder - etiology ; Desire for hastened death ; Emotional disorders ; Ethics ; Female ; Gastrointestinal Neoplasms - pathology ; Gastrointestinal Neoplasms - psychology ; Homelessness ; Hopelessness ; Humans ; Lung cancer ; Lung Neoplasms - pathology ; Lung Neoplasms - psychology ; Male ; Medical sciences ; Mental depression ; Middle Aged ; Miscellaneous ; Models, Psychological ; Mood disorders ; Neoplasm Metastasis ; Neoplasm Staging ; Oncology ; Ontario ; Palliative care ; Patients ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Psychosocial risk factors ; Psychosociology ; Public health. Hygiene ; Public health. Hygiene-occupational medicine ; Risk Factors ; Self Concept ; Sickness Impact Profile ; Spirituality ; Well-being</subject><ispartof>Social science & medicine (1982), 2009-02, Vol.68 (3), p.562-569</ispartof><rights>2008 Elsevier Ltd</rights><rights>2009 INIST-CNRS</rights><rights>Copyright Pergamon Press Inc. 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We hypothesized that depression and hopelessness constitute common pathways of distress, which mediate the effects of psychosocial and disease-related factors on the desire for hastened death. This model was tested on a cross-sectional sample of 406 patients with metastatic gastrointestinal or lung cancer recruited at outpatient clinics of a Toronto cancer hospital, using structural equation modeling. The results supported the model. High disease burden, insecure attachment, low self-esteem, and younger age were risk factors for depression. Low spiritual well-being was a risk factor for hopelessness. Depression and hopelessness were found to be mutually reinforcing, but distinct constructs. Both depression and hopelessness independently predicted the desire for hastened death, and mediated the effects of psychosocial and disease-related variables on this outcome. The identified risk factors support a holistic approach to palliative care in patients with metastatic cancer, which attends to physical, psychological, and spiritual factors to prevent and treat distress in patients with advanced disease.</description><subject>Adult and adolescent clinical studies</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Anxiety - etiology</subject><subject>Attitude to Death</subject><subject>Attitude to Health</subject><subject>Biological and medical sciences</subject><subject>Canada</subject><subject>Canada Oncology Depression Hopelessness Psychosocial risk factors Palliative care Desire for hastened death</subject><subject>Cancer</subject><subject>Cancer Care Facilities</subject><subject>Colorectal cancer</subject><subject>Cost of Illness</subject><subject>Depression</subject><subject>Depressive Disorder - etiology</subject><subject>Desire for hastened death</subject><subject>Emotional disorders</subject><subject>Ethics</subject><subject>Female</subject><subject>Gastrointestinal Neoplasms - pathology</subject><subject>Gastrointestinal Neoplasms - psychology</subject><subject>Homelessness</subject><subject>Hopelessness</subject><subject>Humans</subject><subject>Lung cancer</subject><subject>Lung Neoplasms - pathology</subject><subject>Lung Neoplasms - psychology</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental depression</subject><subject>Middle Aged</subject><subject>Miscellaneous</subject><subject>Models, Psychological</subject><subject>Mood disorders</subject><subject>Neoplasm Metastasis</subject><subject>Neoplasm Staging</subject><subject>Oncology</subject><subject>Ontario</subject><subject>Palliative care</subject><subject>Patients</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Psychosocial risk factors</subject><subject>Psychosociology</subject><subject>Public health. Hygiene</subject><subject>Public health. Hygiene-occupational medicine</subject><subject>Risk Factors</subject><subject>Self Concept</subject><subject>Sickness Impact Profile</subject><subject>Spirituality</subject><subject>Well-being</subject><issn>0277-9536</issn><issn>1873-5347</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2009</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>X2L</sourceid><sourceid>BHHNA</sourceid><recordid>eNqFkc9u3CAQxq2qVbNJ-wotqtScslswBuzcoqh_Fak9pGeEYSyzso0LONW-Qx-6Y-1qD730MKAZft8w8BXFW0Z3jDL5Yb9LwSbrR3C7ktIaqzvK1bNiw2rFt4JX6nmxoaVS20ZweVFcprSnlDJa85fFBWuoaGStNsWfHyb3v80hkRyI8ylHSOmWPPZAxmXIfh6AOMgQRz-ZKScSOsznlfJhuiF9mGHAZMK4IWZyJPerIvkIpAuR9CZlmMBhDW8ifiIjZKyZ7C2xZrIQyYwJYPNXxYvODAlen_ar4uenj4_3X7YP3z9_vb972FohmrwVQslGVI4xI4G1zFQNp2XXWmOsEk45pVhVudq0gnKnytYx3lIpS8ZEazvLr4rrY985hl8LpKxHnywMg5kgLElzxUQtJUPw3T_gPixxwtl0yWlV87KpEFJHyMaQUoROz9GPJh40o3p1S-_12S29urUeoFuo_HZURpjBnmUAgPwKP2luZI3LAQOVDW4eg2PMGEKWWshG93nEZm9Osy7tqj0PcfIagfcnwCRrhi7i5_t05vB3Kkbl-p67IwdowZOHqHF0QKMcemqzdsH_92V_AdqJ0rA</recordid><startdate>20090201</startdate><enddate>20090201</enddate><creator>Rodin, Gary</creator><creator>Lo, Christopher</creator><creator>Mikulincer, Mario</creator><creator>Donner, Allan</creator><creator>Gagliese, Lucia</creator><creator>Zimmermann, Camilla</creator><general>Elsevier Ltd</general><general>Elsevier</general><general>Pergamon Press Inc</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>DKI</scope><scope>X2L</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U3</scope><scope>7U4</scope><scope>8BJ</scope><scope>BHHNA</scope><scope>DWI</scope><scope>FQK</scope><scope>JBE</scope><scope>K9.</scope><scope>WZK</scope></search><sort><creationdate>20090201</creationdate><title>Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients</title><author>Rodin, Gary ; Lo, Christopher ; Mikulincer, Mario ; Donner, Allan ; Gagliese, Lucia ; Zimmermann, Camilla</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c559t-5576954d11a6e1b1a49302fbcaac75d7d77144d8ab503d72bd13b0662115bcfc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2009</creationdate><topic>Adult and adolescent clinical studies</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Anxiety - etiology</topic><topic>Attitude to Death</topic><topic>Attitude to Health</topic><topic>Biological and medical sciences</topic><topic>Canada</topic><topic>Canada Oncology Depression Hopelessness Psychosocial risk factors Palliative care Desire for hastened death</topic><topic>Cancer</topic><topic>Cancer Care Facilities</topic><topic>Colorectal cancer</topic><topic>Cost of Illness</topic><topic>Depression</topic><topic>Depressive Disorder - etiology</topic><topic>Desire for hastened death</topic><topic>Emotional disorders</topic><topic>Ethics</topic><topic>Female</topic><topic>Gastrointestinal Neoplasms - pathology</topic><topic>Gastrointestinal Neoplasms - psychology</topic><topic>Homelessness</topic><topic>Hopelessness</topic><topic>Humans</topic><topic>Lung cancer</topic><topic>Lung Neoplasms - pathology</topic><topic>Lung Neoplasms - psychology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mental depression</topic><topic>Middle Aged</topic><topic>Miscellaneous</topic><topic>Models, Psychological</topic><topic>Mood disorders</topic><topic>Neoplasm Metastasis</topic><topic>Neoplasm Staging</topic><topic>Oncology</topic><topic>Ontario</topic><topic>Palliative care</topic><topic>Patients</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Psychosocial risk factors</topic><topic>Psychosociology</topic><topic>Public health. Hygiene</topic><topic>Public health. Hygiene-occupational medicine</topic><topic>Risk Factors</topic><topic>Self Concept</topic><topic>Sickness Impact Profile</topic><topic>Spirituality</topic><topic>Well-being</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rodin, Gary</creatorcontrib><creatorcontrib>Lo, Christopher</creatorcontrib><creatorcontrib>Mikulincer, Mario</creatorcontrib><creatorcontrib>Donner, Allan</creatorcontrib><creatorcontrib>Gagliese, Lucia</creatorcontrib><creatorcontrib>Zimmermann, Camilla</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>RePEc IDEAS</collection><collection>RePEc</collection><collection>CrossRef</collection><collection>Social Services Abstracts</collection><collection>Sociological Abstracts (pre-2017)</collection><collection>International Bibliography of the Social Sciences (IBSS)</collection><collection>Sociological Abstracts</collection><collection>Sociological Abstracts</collection><collection>International Bibliography of the Social Sciences</collection><collection>International Bibliography of the Social Sciences</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Sociological Abstracts (Ovid)</collection><jtitle>Social science & medicine (1982)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Rodin, Gary</au><au>Lo, Christopher</au><au>Mikulincer, Mario</au><au>Donner, Allan</au><au>Gagliese, Lucia</au><au>Zimmermann, Camilla</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients</atitle><jtitle>Social science & medicine (1982)</jtitle><addtitle>Soc Sci Med</addtitle><date>2009-02-01</date><risdate>2009</risdate><volume>68</volume><issue>3</issue><spage>562</spage><epage>569</epage><pages>562-569</pages><issn>0277-9536</issn><eissn>1873-5347</eissn><coden>SSMDEP</coden><abstract>We tested a model in which psychosocial and disease-related variables act as multiple protective and risk factors for psychological distress in patients with metastatic cancer. We hypothesized that depression and hopelessness constitute common pathways of distress, which mediate the effects of psychosocial and disease-related factors on the desire for hastened death. This model was tested on a cross-sectional sample of 406 patients with metastatic gastrointestinal or lung cancer recruited at outpatient clinics of a Toronto cancer hospital, using structural equation modeling. The results supported the model. High disease burden, insecure attachment, low self-esteem, and younger age were risk factors for depression. Low spiritual well-being was a risk factor for hopelessness. Depression and hopelessness were found to be mutually reinforcing, but distinct constructs. Both depression and hopelessness independently predicted the desire for hastened death, and mediated the effects of psychosocial and disease-related variables on this outcome. The identified risk factors support a holistic approach to palliative care in patients with metastatic cancer, which attends to physical, psychological, and spiritual factors to prevent and treat distress in patients with advanced disease.</abstract><cop>Kidlington</cop><pub>Elsevier Ltd</pub><pmid>19059687</pmid><doi>10.1016/j.socscimed.2008.10.037</doi><tpages>8</tpages></addata></record> |
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| ispartof | Social science & medicine (1982), 2009-02, Vol.68 (3), p.562-569 |
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| source | MEDLINE; RePEc; Elsevier ScienceDirect Journals; Sociological Abstracts |
| subjects | Adult and adolescent clinical studies Age Factors Aged Anxiety - etiology Attitude to Death Attitude to Health Biological and medical sciences Canada Canada Oncology Depression Hopelessness Psychosocial risk factors Palliative care Desire for hastened death Cancer Cancer Care Facilities Colorectal cancer Cost of Illness Depression Depressive Disorder - etiology Desire for hastened death Emotional disorders Ethics Female Gastrointestinal Neoplasms - pathology Gastrointestinal Neoplasms - psychology Homelessness Hopelessness Humans Lung cancer Lung Neoplasms - pathology Lung Neoplasms - psychology Male Medical sciences Mental depression Middle Aged Miscellaneous Models, Psychological Mood disorders Neoplasm Metastasis Neoplasm Staging Oncology Ontario Palliative care Patients Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Psychosocial risk factors Psychosociology Public health. Hygiene Public health. Hygiene-occupational medicine Risk Factors Self Concept Sickness Impact Profile Spirituality Well-being |
| title | Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients |
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