Neuroticism as a moderator of symptom-related distress and depression in 4 noncancer end-of-life populations.

Abstract

Neuroticism is a significant predictor of adverse psychological outcomes in patients with cancer. Less is known about how this relationship manifests in those with noncancer illness at the end-of-life (EOL). The objective of this study was to examine the impact of neuroticism as a moderator of physical symptoms and development of depression in patients with amyotrophic lateral sclerosis (ALS), chronic obstructive pulmonary disease (COPD), end-stage renal disease (ESRD), and frailty in the last 6 months of life. We met this objective using secondary data collected in the Dignity and Distress across End-of-Life Populations study. The data included N=404 patients with ALS (N=101), COPD (N=100), ESRD (N=101), and frailty (N=102) in the estimated last 6 months of life, with a range of illness-related symptoms, assessed longitudinally at 2 time points. We examined neuroticism as a moderator of illness-related symptoms at Time 1 (∼6months before death) and depression at Time 2 (∼3months before death) using ordinary least squares regression. Results revealed that neuroticism significantly moderated the relationship between the following symptoms and depression measured 3months later: drowsiness, fatigue, shortness of breath, wellbeing (ALS); drowsiness, trouble sleeping, will to live, activity (COPD); constipation (ESRD); and weakness and will to live (frailty). These findings suggest that neuroticism represents a vulnerability factor that either attenuates or amplifies the relationship of specific illness and depressive symptoms in these noncancer illness groups at the EOL. Identifying those high in neuroticism may provide insight into patient populations that require special care at the EOL.