The Use of Life-Sustaining Procedures in the Last Month of Life Is Associated With More Depressive Symptoms in Surviving Spouses  Katherine A. Ornstein, PhD, MPH, Melissa D. Aldridge, PhD, MPH, MBA, Melissa M. Garrido, PhD, Rebecca Gorges, MS, Evan Bollens- Lund, MA, Albert L. Siu, MD, MSPH, Kenneth M. Langa, MD, PhD, Amy S. Kelley, MD, MS  Journal of Pain and Symptom Management  Volume 53, Issue 2, Pages 178-187.e1 (February 2017) DOI: 10.1016/j.jpainsymman.2016.08.023 Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 1 Mean spouse depressive symptom scores with 95% CI by intensive life-sustaining procedure use by time before and after death (n = 1258). Scores are grouped base on timing (in six-month intervals) of post-death interviews relative to respondent death with the exception of interviews conducted zero to one month before death which were excluded. CES-D = Center for Epidemiologic Studies Depression Scale which is scored 0 (no symptoms) to 8 (severe symptoms); CI = confidence interval. Journal of Pain and Symptom Management 2017 53, 178-187.e1DOI: (10.1016/j.jpainsymman.2016.08.023) Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions

Fig. 2 Increase in spouse depressive symptom scores pre- to post-death with 95% CI after death by intensive life-sustaining procedure use (matched sample*) (n = 1255). Scores are grouped base on timing (in 6-month intervals) of post-death interviews relative to respondent death; CES-D = Center for Epidemiologic Studies Depression Scale which is scored 0 (no symptoms) to 8 (severe symptoms); CI = confidence interval. *Sample matched based on patient net worth, nursing home residence, self-rated health, advance directive, death expected, ADL impairment, patient illnesses and comorbidity count and spousal pre-death clinically significant depression, age at patient death, gender, race, education, self-rated health, religion important, comorbidities, psychiatric treatment or diagnosis, caregiver status, and timing of interview after death. Journal of Pain and Symptom Management 2017 53, 178-187.e1DOI: (10.1016/j.jpainsymman.2016.08.023) Copyright © 2016 American Academy of Hospice and Palliative Medicine Terms and Conditions