Association between experiences of advanced cancer patients at the end of life and depression in their bereaved caregivers

Yutaka Hatano, Tatsuya Morita, Masanori Mori, Maho Aoyama, Saran Yoshida, Koji Amano, Toru Terabayashi, Kiyofumi Oya, Hiroaki Tsukuura, Yusuke Hiratsuka, Isseki Maeda, Yoshiyuki Kizawa, Satoru Tsuneto, Yasuo Shima, Kento Masukawa, Mitsunori Miyashita

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Objective: Research on the association between circumstances of death in advanced cancer patients and depression in their bereaved caregivers is limited. Methods: A longitudinal study was performed on patients admitted to 21 inpatient hospices/palliative care units (PCUs) in Japan. Patient symptoms were assessed at admission and in the last 3 days of life. Data on distressing events (unexpected death, bleeding) and received treatments (morphine prescriptions, continuous deep sedation, cardiopulmonary resuscitation) were also obtained. Bereaved caregiver depression was assessed 6 months or more after patient death via mail survey using the Patient Health Questionnaire-9 (PHQ-9). A multivariable logistic regression analysis was used to explore variables predicting bereaved caregiver depression. Results: Of 1324 deceased patient–bereaved caregiver dyads, data were finally analyzed for 711 dyads. The proportion of probable depression (PHQ-9 scores ≥10) in bereaved caregivers was 13.6% (91/671; 95% confidence interval: 11.0–16.2). The multivariable logistic regression analysis showed that patient hyperactive delirium at PCU admission was significantly associated with the development of bereaved caregiver depression (odds ratio: 2.2, 95% CI: 1.2–3.8). Bereaved caregiver perceived low social support (OR: 4.7, 95% CI: 2.2–10.0) and low preparedness for death (OR: 4.5, 95% CI: 2.6–7.8) were also significantly associated with the development of depression. Other patient and bereaved caregiver variables had no association with depression. Conclusions: Hyperactive delirium in terminally ill cancer patients was associated with bereaved caregiver depression. The development of effective strategies to reduce delirium-related agitation and to provide educational interventions for caregivers may be needed.

Original languageEnglish
Pages (from-to)1243-1252
Number of pages10
Issue number7
Publication statusPublished - 2022 Jul


  • bereavement
  • caregiver depression
  • circumstances of death
  • delirium in advanced cancer patients
  • hyperactive delirium

ASJC Scopus subject areas

  • Experimental and Cognitive Psychology
  • Oncology
  • Psychiatry and Mental health


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