By Dr. Brian McDonough, Medical Editor

PHILADELPHIA (CBS) - It is not something that we like to think about but with the exception of those of us who die suddenly, most people experience fear and grief as we approach the end of life.

There are many factors including health, wealth, self-image and perhaps the biggest issue, the loss of a sense of self control.

These issues happen over time and can impact relationships, privacy and dignity. In some cases major depression can occur. This is estimated to occur in 5 to 30% of people.

This is a very important issue because depression can impact health and a person’s immune system. The important point to think about is that all of this potentially happens at the end of life and health care providers need to be aware – and family members can provide support as well.