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
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Context The risk of suicide is elevated in palliative care patients compared with the general population. Various psychological factors, including depression, demoralization, loss of control, and low self-worth, have been associated with a desire to hasten death.Objectives The aim of this study was to investigate whether depression, demoralization, loss of control, and low self-worth mediated the relationship between global quality of life and desire to hasten death.Methods A sample of 162 palliative care patients completed measures of global quality of life, depression, demoralization, perceived control, self-worth, and desire to hasten death. A multiple mediation model with bootstrapping sampling tested the total (combined) indirect effect and individual indirect effects of depression, the two subscales of demoralization (Meaning and Purpose, and Distress and Coping Ability), perceived control, and self-worth.Results Depressive symptoms, loss of meaning and purpose, loss of control, and low self-worth mediated the direct effect of global quality of life on desire to hasten death. The Distress and Coping Ability component of demoralization was not a significant mediator.Conclusion 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.
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Demoralization mediates suicidal thinking and leads to a desire to die.
“Its clinical importance relates to its mediation of suicidal thinking, leading to a desire to die (Robinson et al., 2016).”
From Why adults with psychiatric conditions request euthanasia: A qualitative interview study of life experiences, motives and preventive factors (2021) · cites this paper as Robinson et al., 2016
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- Authors
- Robinson, S., Kissane, D. W., Brooker, J., Hempton, C., & Burney, S.
- Affiliations
- Monash Health (AU)
- Cabrini Hospital (AU)
- Corresponding author
- Kissane, David W.
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2017-02
- Volume
- 53
- Issue
- 2
- Pages
- 243-249
- ISSN
- 0885-3924 (ISSN-L)
- OpenAlex
- W2530980885
- Cited by
- 112
- References
- 53
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 14 · 2023: 9 · 2022: 15 · 2021: 13 · 2020: 11 · 2019: 14 · 2018: 15 · 2017: 7
- FWCI
- 11.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed (publishedVersion)
- Own your potential (DEAKIN) (submittedVersion)
- Figshare (submittedVersion, cc-by)
- Funders
- Bethlehem Griffiths Research Foundation
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Social Sciences › Psychology › Clinical Psychology › Suicide and Self-Harm Studies
- Keywords
- quality of life, depression, demoralization, loss of control, self-worth, palliative care patients, suicide risk, meaning and purpose, multiple mediation, meaning-centered therapy
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Attitude to Death, Death, Depression, Female, Humans, Internal-External Control, Male, Middle Aged, Models, Psychological, Motivation, Palliative Care, Quality of Life, Self Concept, Stress, Psychological, Terminally Ill, Suicidal Ideation
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