Neuroticism in four non-cancer populations at the end-of-life
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Date
2019-06-25
Authors
Kredentser, Maia Simone
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Abstract
Statement of the Problem:
Neuroticism is a significant predictor of adverse psychological outcomes in cancer. However, less is known about how this relationship manifests in those with non-cancer illness at the end-of-life. In assessing such patients, reliance on proxy-reports of patient symptoms and experiences are common. The purpose of this thesis was to examine two separate, yet related aspects of neuroticism at the end-of-life – neuroticism as moderator of physical symptoms and depression, and caregiver-patient congruence (i.e., the extent to which patients and caregivers rated patient neuroticism similarly) on ratings of patient neuroticism.
Methods:
Secondary analysis of data was assessed using data collected in the Dignity and Distress across End-of-Life Populations study (Chochinov et al, 2016). The data included N = 404 patients with amyotrophic lateral sclerosis (ALS) (N = 101), chronic obstructive pulmonary disease (COPD) (N = 100), end-stage renal disease (ESRD) (N = 101), and frailty (N = 102) in the estimated last six months of life. N = 216 of these participants had an identified caregiver as a co-participant. Using ordinary least squares (OLS) regression, Study 1 explored neuroticism as a moderator between illness-related symptoms at Time 1 (~six-months prior to death) and depression at Time 2 (~three-months prior to death). Study 2 explored degree and predictors of incongruence between patient-participants and their caregivers on patients’ neuroticism (NEO-FFI) using hierarchical linear modelling.
Results:
Neuroticism significantly moderated the relationship between the following symptoms and depression three months 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). Degree of congruence between patients and caregivers on patient neuroticism varied significantly across dyads. Caregivers rated patients’ average neuroticism significantly higher than patients. Patient depression, anxiety, illness group, and caregiver burden were positively associated with the dyad’s mean level of patient neuroticism. Congruence increased when patients perceived themselves as more dependent, and when relatives other than adult children or spouses provided proxy ratings.
Conclusion:
Neuroticism represents a vulnerability factor that either attenuates or amplifies the relationship of specific illness and depressive symptoms in these non-cancer illness groups at the EOL. As patients and caregivers may perceive neuroticism differently, care must be taken when using proxy assessment of this trait that has such important public health consequences.
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Keywords
Neuroticism, Personality, Palliative care, ALS, End-stage renal disease, Chronic obstructive pulmonary disease, Frailty, End of life, Caregiving