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Depression, Hopelessness, and the Desire for Life-Saving Treatments Among Elderly Medically Ill Veterans

Received June 14, 1999; revised March 1, 2000; accepted March 22, 2000. From the Mental Health Clinical Center, Department of Veterans Affairs Maryland Health Care System, Baltimore, MD and the Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, Baltimore, MD. Address correspondence to Dr. Menon, Ward 25B, Perry Point VAMC, Perry Point, MD 21902.

During a serious medical illness, several factors, including perceived quality of life, social support, functional disability, severity of illness, and presence of depressive symptoms, influence desire for life-saving treatments such as cardiopulmonary resuscitation (CPR), mechanical ventilation, tube feeding, and intravenous fluids. The authors examined the influence of depression and hopelessness on preferences for life- saving treatment in older, medically ill male patients in the medical service of a Veterans Administration Medical Center. Subjects with high levels of hopelessness desired less life-saving treatment during their current illness; they were at least five times more likely to refuse CPR if required during the current hospitalization. This effect remained statistically significant after removing confounds of race, education, and religiosity. The diagnosis of major depression did not significantly influence the desire for life-saving treatment. Our findings suggest that psychiatrists should assess patients for severity of hopelessness when evaluating decision-making capacity in the context of intervention refusal.

Key Words: Depression • Primary Care • Medical Illness

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