Correlates of desire for hastened death in chronic illness: A cross-sectional network analysis

Abstract

Objectives

Desire to hasten death (DHD) may reflect complex physical and psychosocial suffering. This study examined psychosocial and cognitive-affective correlates of DHD in patients with chronic physical illness using cross-sectional network analysis.

Methods

This cross-sectional analysis included 366 patients with renal, cardiovascular, or cerebrovascular disease were recruited from two hospitals in South Korea. Participants completed validated measures of DHD, physical quality of life (QOL), perceived burdensomeness (PB), thwarted belongingness (TB), fearlessness about death, hopelessness, helplessness, loss of autonomy, depression, and anxiety. Gaussian graphical models were estimated, and centrality, predictability, and relative importance were analyzed. Subgroup and covariate-adjusted analyses were also conducted.

Results

Overall, 11.0 % of participants reported high DHD, defined as a Schedule of Attitudes toward Hastened Death Abbreviated score of 3 or higher. The network explained 43.1 % of the variance in DHD. PB showed the strongest direct association with DHD, followed by hopelessness, anxiety, and helplessness. Although depression was not directly linked to DHD, it emerged as the most central node in the network. Relative importance analysis confirmed that PB and anxiety were most strongly associated with DHD. Subgroup analyses indicated that anxiety was more salient in the renal disease, while PB ranked highest in the cardio/cerebrovascular disease. These findings remained robust after adjusted analyses.

Conclusion

PB and anxiety were the most robust correlates of DHD, whereas depression played a central role in the network. Addressing perceived burden and emotional distress may be relevant for understanding and managing DHD among individuals with chronic illness.