Pathways to Distress

Social Science & Medicine 68 (2009) 562–569

Contents lists available at ScienceDirect

Social Science & Medicine

journal homepage: www.elsevier.com/locate/socscimed

Pathways to distress: The multiple determinants of depression,

hopelessness, and the desire for hastened death in metastatic cancer patients

Gary Rodin a, b, c, *, Christopher Lo a, b, c, Mario Mikulincer d,

Allan Donner e, Lucia Gagliese f, Camilla Zimmermann a, b, c

a

Department of Psychosocial Oncology and Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada

Psychosocial Oncology and Palliative Care Research Division, Ontario Cancer Institute, Toronto, Ontario, Canada

University of Toronto, Toronto, Ontario, Canada

d

New School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel

e

Department of Epidemiology and Biostatistics, University of Western Ontario, London, Ontario, Canada

f

School of Kinesiology and Health Science, York University, Toronto, Ontario, Canada

b

c

article info

abstract

Article history:

Available online 7 December 2008

We tested a model in which psychosocial and disease-related variables act as multiple protective and risk

factors for psychological distress in patients with metastatic cancer. We hypothesized that depression

and hopelessness constitute common pathways of distress, which mediate the effects of psychosocial

and disease-related factors on the desire for hastened death. This model was tested on a cross-sectional

sample of 406 patients with metastatic gastrointestinal or lung cancer recruited at outpatient clinics of

a Toronto cancer hospital, using structural equation modeling. The results supported the model. High

disease burden, insecure attachment, low self-esteem, and younger age were risk factors for depression.

Low spiritual well-being was a risk factor for hopelessness. Depression and hopelessness were found to

be mutually reinforcing, but distinct...