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NEUROLOGY 2007;68:1058-1061
© 2007 American Academy of Neurology

Cross-cultural variation in mental health at end of life in patients with ALS

S. M. Albert, PhD, M. Wasner, MA, T. Tider, MSW, V. E. Drory, MD and G. D. Borasio, MD

From the Gertrude H. Sergievsky Center (S.M.A., T.T.), Columbia University, New York, NY; Interdisciplinary Center for Palliative Medicine (M.W., G.D.B.), University of Munich, Munich, Germany; and Department of Neurology (V.E.D.), Tel-Aviv Sourasky Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel.

Address correspondence and reprint requests to Dr. Steven M. Albert, Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, A211 Crabtree, 130 DeSoto Street, Pittsburgh, PA 15261; e-mail: smalbert{at}pitt.edu

Objective: To examine mental health at the end of life among patients with ALS in three countries: Israel, Germany, and the United States.

Methods: Patients met criteria for definite or probable ALS and had forced vital capacity (FVC) <60% of predicted. Patients completed nonsomatic items from the Beck Depression Inventory and visual analogue scale ratings.

Results: The three sites contributed a total of 92 patients; 60 died during follow-up. Patients at the three sites did not differ significantly in sociodemographic features or ALS Functional Rating Scale–Revised summary disability score; sites differed in use of nasal ventilation but not percutaneous esophageal gastrostomy (PEG) tube placement. In analyses that adjusted for disability and use of nasal ventilation, patients at the three sites differed in reports of pessimism and suffering; American patients reported the least distress and Israeli patients the most. In analyses limited to people who died, similar patterns emerged, with wish to live greatest in Americans and least among Israelis. These models adjusted for disability and days until death.

Conclusions: Cultural factors may affect mental health at the end of life in patients with ALS.

Supported by MH62200 (NIMH) and Fetzer Institute.

Disclosure: The authors report no conflicts of interest.

Received July 18, 2006. Accepted in final form November 27, 2006.


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