Depression, distress and positive mood in late-stage cancer: a longitudinal study
Article first published online: 9 JUL 2008
Copyright © 2008 John Wiley & Sons, Ltd.
Volume 18, Issue 1, pages 79–86, January 2009
How to Cite
Rabkin, J. G., McElhiney, M., Moran, P., Acree, M. and Folkman, S. (2009), Depression, distress and positive mood in late-stage cancer: a longitudinal study. Psycho-Oncology, 18: 79–86. doi: 10.1002/pon.1386
- Issue published online: 18 DEC 2008
- Article first published online: 9 JUL 2008
- Manuscript Accepted: 27 MAR 2008
- Manuscript Revised: 14 MAR 2008
- Manuscript Received: 13 NOV 2007
- terminal illness;
- positive mood
Objectives: To determine whether new-onset clinical depression emerges over time, and whether positive and negative mood levels change among patients with terminal cancer.
Methods: In this two-site study, 58 cancer patients seen at least twice were interviewed monthly until death or study termination. Major measures included the Patient Health Questionnaire—9, Holland System of Beliefs Inventory, and Positive and Negative Affect Schedule.
Results: At study entry, 7% of patients had major depressive disorder; another 9% had depressive symptoms but no Axis I diagnosis. Twenty-two percent were taking antidepressants. During visits ranging from 2 to 21 per patient, 76% of patients never had a depression diagnosis, 3% were always depressed, and 14% became depressed for the first time, almost exclusively at their final visit before death. Scores on positive mood were equivalent to or higher than scores on negative mood and did not change over time. Cancer site, hospice, spiritual beliefs, income, and caregiver mood were unrelated to depression. Spiritual beliefs were, however, associated with positive mood, hope, and better quality of life.
Conclusions: In this exploratory study, terminally ill patients approaching death experienced positive as well as negative mood although a significant minority met criteria for major depression at the last visit before death. The findings suggest that major depression is not an inevitable part of the dying process in patients with terminal cancer. Further, the appropriateness of classifying sadness, loss of interest and thoughts that one would be better off dead in the last days of life as psychopathology should be reconsidered. Copyright © 2008 John Wiley & Sons, Ltd.