Individuals in last year of life experience high rates of depressive symptoms

Individuals in their last year of life had high rates of depressive symptoms, with nearly 60% experiencing depression in the last month before death, according to results of an observational cross-sectional cohort study published in Journal of the American Geriatrics Society.

“Psychological symptoms are important to address throughout the lifespan, but especially in the context of serious or chronic illness in order to reduce suffering and distress and help individuals experience a ‘good death,’” Elissa Kozlov, PhD, of the Rutgers Institute for Health in New Jersey, said in a press release.

According to Kozlov and colleagues, previous studies on end-of-life depressive symptoms were limited by a focus on the very end of life or the last days of life, as well as specific populations such as those enrolled in hospice or with cancer. In the present study, the researchers gained a more long-term perspective by focusing on the epidemiology of depressive symptoms in the year prior to death. They included 3,274 individuals who died within 12 months of assessment, with the primary outcome being scores on the eight-item Center for Epidemiologic Studies Depression Scale (CESD-8).

The researchers reported that the average CESD-8 score increased over the last year of life, with 59.3% of respondents having screened positive for depression in the last month before death. From 12 months to 4 months before death, depression symptoms increased gradually for an increase of 0.05 points per month (95% CI, 0.01-0.08). Scores escalated from 4 months to 1 month before death for an increase of 0.29 points per month (95% CI, 0.16-0.39). Nonwhite adults, younger adults and women all had higher rates of depressive symptoms. Individuals with lung disease and activity of daily living impairment had persistently high rates throughout the year before death, whereas individuals with cancer reported escalating rates of depressive symptoms at the end of life.

“More research and policy work are needed to address the lack of skilled geriatric and end-of-life mental health providers, limited reimbursement structure for psychological care and gaps in adapting and disseminating evidence-based nonpharmacological interventions for adults with limited life expectancies,” Kozlov said. – by Joe Gramigna

Disclosures: Kozlov reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.