Increasing clinical depression over the dying process is not inevitable but is associated
with mounting disease burden, tangible social support, and sense of burden to others
Siew Tzuh Tang, DNSc, Jen-Shi Chen, MD, Wen-Chi Chou, MD, Kuan-Chia Lin, PhD, Wen-Cheng Chang, MD, Chia-Hsun Hsieh, MD,Chiao-En Wu, MD,
Chang Gung University, School of Nursing, Tao-Yuan, Taiwan (Supported by NHRI-EX103-10208PI)
Introduction:
Terminally ill cancer patients experience progressive functional
decline, accelerating symptom severity, deteriorating social support, and perceived
sense of burden to others (SPB), predisposing them to suffer from depressive
symptoms. However, changes in the prevalence of clinical depression over the dying
process and the unique roles of these four variables have not often been studied
together.
Research aims:
The purposes of this study were to explore the longitudinal
changes in and the impact of symptom distress, functional dependence, social
support, and SPB on the prevalence of clinical depression over the dying process.
Methods: A convenience sample of 323 cancer patients was followed until death.
Prevalence of clinical depression was identified as scoring >11 on the depression
subscale of the Hospital Anxiety and Depression Scale. Longitudinal changes in and
determinants of clinical depression were examined by a multivariate logistic
regression model with the generalized estimating equation.
Results:
The prevalence of clinical depression increased as death approached.
However, clinical depression over the dying process was not determined by time
proximity to patient death after confounding factors were controlled. In contrast, the
likelihood of experiencing clinical depression was significantly higher in patients
who had a higher level of symptom distress and functional dependence, received
greater tangible support, and reported high SPB, but lower for patients reporting a
higher level of affectionate support and positive social interaction with their
supportive network.
Table 1. Multivariate analyses of determinants for clinical
depression among terminally ill Taiwanese cancer patients
Potential predictor
Time proximity to patient death (days)
1-30
31-90
91-180
>180
Disease burden
Symptom distress
Functional dependence
Parameter
95% CI
Z
p
1.09
0.58
2.05
0.26
0.79
0.94
0.60
1.49
-0.24
0.81
0.66
0.41
1.06
-1.71
0.09
1.17
1.13
1.20
10.98
<.0001
1.09
1.07
1.12
6.91
<.0001
1.03
1.01
1.04
2.62
0.009
0.98
0.96
1.00
-1.98
0.05
0.98
0.96
1.00
-1.68
0.09
1.00
0.98
1.02
-0.08
0.93
0.98
0.96
0.99
-2.82
0.005
1.61
1.12
2.29
2.60
0.009
Reference
Social support
Tangible support
Affectionate support
Emotional support
Informational support
Positive social interaction
Self-perceived burden to others
.
Conclusion: Increasing clinical depression as death approaches is not inevitable
but is associated with accelerating disease burden, greater tangible social support,
and increased SPB.
High
Low
Reference
Patient socio-demographics and characteristics of the stressor (cancer) were controlled for using a
multivariate logistic regression model with the generalized estimating equation