A Rutgers-led study finds that many terminally ill people – particularly women, young adults, minorities and low-income individuals – experience symptoms of depression in the last few months of their lives, and that quality end-of-life psychological care is needed to address this growing trend.
The study, published in the Journal of the American Geriatrics Society, is the first nationwide evaluation of depression in the final 12 months before death. Among the 3,274 participants, the researchers found that these groups of people were more likely to experience depression in their final months of life.
“Psychological symptoms are important to address throughout the lifespan of people, but especially in the context of serious or chronic illness, it is critical to reduce suffering and distress to help individuals experience a ‘good death,’ said lead author Elissa Kozlov, an instructor at the Rutgers School of Public Health and a faculty member at the Institute for Health, Health Care Policy and Aging Research.
Additional research and policy work is needed to address the lack of skilled geriatric personnel and end-of-life mental health providers, limited reimbursement for psychological care and a gap in evidence-based, non-pharmacological care for terminally ill adults, Kozlov said.
Researchers found varying rates of symptoms of depression among different groups of people. For instance, women reported higher rates of depression symptoms than men, while younger adults diagnosed with severe illnesses reported high depression, perhaps because they saw their illnesses or death as untimely and had difficulty accepting it. People with financial problems in their last year of life also have high chronic stress, which might contribute to higher rates of symptoms of depression.
Patients with cancer reported an increase in symptoms of depression during the final year with the severity increasing in the final months while individuals with lung disease and activities of daily living (ADL) impairments showed persistently high depression throughout the entire year before death. These different trajectories in symptom severity imply that different treatments may be more beneficial for different populations.
Researchers also found differences in symptoms of depression at end of life for different racial groups. Non-white people reported more depressive symptoms in the last month of life, received less hospice care, had more aggressive medical treatments and reported poor communication among health providers as compared to their white counterparts.
While 300 million people worldwide experience depression according to the World Health Organization, depressive symptoms at the end of life are common and are treatable. Kozlov said health care providers should screen and address these symptoms to reduce suffering and ensure that everyone has an equal opportunity to experience a “good death.”
