• Keith G Wilson, Tracy L Dalgleish, Harvey Max Chochinov, Srini Chary, Pierre R Gagnon, Karen Macmillan, Marina De Luca, Fiona O'Shea, David Kuhl, and Robin L Fainsinger.
• Department of Psychology, The Ottawa Hospital Rehabilitation Centre, Ottawa, Ontario, Canada.
• BMJ Support Palliat Care. 2016 Jun 1; 6 (2): 170-7.

ObjectivesThe desire for death in terminally ill patients is associated with depression and anxiety, but not all patients who report it meet criteria for mental disorders. We examined the characteristics of subgroups of palliative cancer patients who expressed a desire for death that occurred either with or without a concurrent depressive or anxiety disorder.DesignCross-sectional survey.SettingEight Canadian palliative care programs.Participants377 patients with cancer.Main Outcome MeasuresDesire for Death Rating Scale; Structured Interview of Symptoms and Concerns.ResultsMost participants (69.5%) had no desire for death. Of the remainder, 69 (18.3%) acknowledged occasional transient thoughts, and 46 (12.2%) reported an apparently genuine desire to die. In the latter group, 24 individuals (52.2%) were diagnosed with a mental disorder and 22 (44.8%) were not. Individuals with no serious desire for death and no mental disorder reported the least distress in physical, social, existential, and psychological symptoms and concerns; those with a mental disorder and a significant desire for death reported the most. The subgroup of patients with a serious desire for death but no concurrent mental disorders still reported increased distress due to physical symptoms and social concerns, as well as a higher prevalence of global suffering.ConclusionsThe expression of a desire for death by a terminally ill patient should raise a suspicion about mental health problems, but is not in itself clearly indicative of one. Nevertheless, it may serve as a catalyst to review the individual's physical symptom management and interpersonal concerns, and overall sense of suffering.Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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