The Influence of Patients' Quality of Life at the End of Life on Bereaved Caregivers' Suicidal Ideation

Context. Recent studies have shown that patients' quality of life at the end of life (QOL@EOL) affects the psychosocial adjustment of bereaved family caregivers. Objectives. To examine the relationship between patients' QOL@EOL and the suicidal ideation of their surviving bereaved caregivers. Methods. Data were derived from the Coping with Cancer (CwC1) Study, a U.S. National Cancer Institute-funded multicenter prospective cohort investigation of patients with advanced cancer and their caregivers, in which patients were enrolled September 2002 to February 2008. CwC1 data were used to examine changes in suicidal ideation in family caregivers before and after the patient's death (N = 127). Caregiver baseline suicidal ideation was assessed using the Yale Evaluation of Suicidality (YES) Scale a median of 4.1 months pre-loss; caregivers' perception of patients' QOL@EOL was assessed a median of 1.9 months postloss; and caregiver suicidal ideation in bereavement was assessed using the YES a median of 6.5 months postloss. Suicidal ideation was defined as a positive screen on the YES. We used multiple logistic regression analysis to examine the effect of caregivers' perceptions of patients' QOL@EOL on the suicidal ideation of bereaved caregiver's, adjusting for the caregiver's baseline suicidal ideation and confounding influences. Results. Caregivers' perception of patients' QOL@EOL was significantly inversely related to caregivers' suicidal ideation postloss (adjusted odds ratio 0.79, P = 0.023), after we adjusted for caregivers' baseline suicidal ideation, relationship to patient, and years of education. Conclusion. The more caregivers perceive their loved ones' QOL@EOL to be poor, the greater their risk for suicidal ideation in bereavement over and above prior levels of suicidal ideation. Caregivers of patients who have poor QOL@EOL appear to be a group of caregivers to target for reduction of suicidal risk. (C) 2014 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.