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Depression and Suicidal Ideation in Patients Who Discontinue the Life-Support Treatment of Dialysis

From the Department of Psychiatry, Baystate Medical Center (L.M.C.), Springfield, Massachusetts; Department of Psychiatry, Portland VA Medical Center (S.K.D.), Portland, Oregon; Department of Psychiatry, Albert Einstein Medical Center (K.C.H.), Philadelphia, Pennsylvania; School of Public Health and Health Sciences, University of Massachusetts (P.S.P.), Amherst, Massachusetts; and Department of Psychiatry and Family Medicine, University of Manitoba, and CancerCare Manitoba (H.M.C.), Winnipeg, Manitoba, Canada.

Address reprint requests to: Lewis M. Cohen, MD, Baystate Medical Center, S2669, Springfield, MA 01199. Email: lewis.cohen{at}bhs.org

OBJECTIVE: The objective of this study was to determine the prevalence of major depression and suicidal ideation in patients who stop the life-support treatment of dialysis.

METHODS: The authors prospectively studied 79 subjects who discontinued maintenance dialysis at eight facilities in North America. Structured interviews were conducted with 23 patients and 76 families.

RESULTS: The prevalence of major depression in the sample was between 5% and 25%, and only 1 of 22 patients considered himself to have the illness of depression. Approximately 12% of the respondents were unsure or believed that discontinuing dialysis was the equivalent of suicide. This belief did not correlate with measures of depression. In comparison with the general population there seemed to be an increased prevalence of past suicide attempts.

CONCLUSIONS: Most patients who decide to stop dialysis do not seem to be influenced by major depression or ordinary suicidal ideation. Although the sample size was small, these results highlight the need to further examine the theoretical framework and terminology of depression and suicide in the context of terminal illness.

Key Words: dialysis, • depression, • suicide, • life support.

Abbreviations: ESRD = end-stage renal disease.

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