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Pathways to distress: The multiple determinants of depression, hopelessness, and the desire for hastened death in metastatic cancer patients
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.
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“Attachment security, which refers to internalized expectations of emotional support from significant others and the flexible capacity to make use of it, 18 has been shown to be an important mediator of distress 3 and spiritual wellbeing 19 in patients with advanced cancer and is a potential target of psychotherapeutic interventions. 20”
From Managing cancer and living meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer (2019) · cites this paper as [3]
In the citing paper
“Attachment security may be particularly amenable to therapeutic intervention because the threat posed by illness and death and the anticipation of increasing dependency needs heightens the salience of attachment security. 3,4”
From Managing cancer and living meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer (2019) · cites this paper as [3]
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Spiritual care provided by nursing home physicians: a nationwide survey
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Self-citationMeaning in life and quality of life: palliative care patients versus the general population
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Metadata
- Authors
- Rodin, G., Lo, C., Mikulincer, M., Donner, A., Gagliese, L., & Zimmermann, C.
- Affiliations
- University Health Network (CA)
- Reichman University (IL)
- Western University (CA)
- York University (CA)
- Corresponding author
- Rodin, Gary
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2009-02
- Volume
- 68
- Issue
- 3
- Pages
- 562-569
- ISSN
- 0277-9536 (ISSN-L)
- OpenAlex
- W2145839824
- Cited by
- 323
- References
- 92
- Citations by year
- 2026: 15 · 2025: 18 · 2024: 23 · 2023: 12 · 2022: 22 · 2021: 30 · 2020: 22 · 2019: 18 · 2018: 12 · 2017: 24 · 2016: 14 · 2015: 22 · 2014: 20 · 2013: 20 · 2012: 11
- FWCI
- 13.19
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline - JCU (James Cook University) (submittedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Topics
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- metastatic cancer, psychological distress, depression, hopelessness, suicidal ideation, psychosocial risk factors, disease burden, insecure attachment, self-esteem, spiritual well-being, palliative care, gastrointestinal cancer, lung cancer, mediation
- MeSH terms
- Age Factors, Aged, Anxiety, Attitude to Death, Attitude to Health, Cancer Care Facilities, Depressive Disorder, Female, Gastrointestinal Neoplasms, Humans, Lung Neoplasms, Male, Middle Aged, Models, Psychological, Neoplasm Metastasis, Neoplasm Staging, Ontario, Risk Factors, Self Concept, Cost of Illness, Sickness Impact Profile, Spirituality
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