A 2007 study published in the journal Neurology compared reports of mental health at the end of life among Israeli, German, and US patients with amyotrophic lateral sclerosis (ALS).1 The sample included 92 patients who were considered to be near the end of life on clinical grounds; 60 died during follow-up. Patients completed nonsomatic items from the Beck Depression Inventory and several visual analogue rating scales. Neither sociodemographic features nor ALS Functional Rating Scale scores differed significantly among the full set of patients. However, reports on issues relevant to mental health did vary considerably. American patients reported the least distress/pessimism, whereas German patients had the strongest wish to live. Although spirituality and religiousness were significantly more important for patients in Germany and the United States as compared to Israel, suicidal thoughts were rare in all 3 settings. Patients reported that differences in disability were not responsible for the variation in distress experienced at the end of life, although the perceived burden of family caregivers was very high in all 3 countries.

Despite similarities in disease severity and proximity to death, differences in indicators of distress and in the wish to live persisted, even with adjustment for disability and the use of noninvasive ventilation. The study indicated that cultural factors may significantly affect mental health at the end of life in patients with ALS. A more detailed summary of the article is available as an article of the month for January 2008 at the International Association for Hospice and Palliative Care Web site (http://www.hospicecare.com/news/08/01/aom.html).

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