Citation

Vehling S, Kissane DW, Lo C, Glaesmer H, Hartung TJ, Rodin G, Mehnert A. Cancer 2017; 123(17): 3394-3401.

Copyright

(Copyright © 2017, American Cancer Society, Publisher John Wiley and Sons)

DOI

10.1002/cncr.30749

PMID

28472548

Abstract

BACKGROUND: Demoralization refers to a state in which there is a perceived inability to cope, that is associated with a sense of disheartenment and a loss of hope and meaning. This study investigated the co-occurrence versus independence of demoralization with mental disorders and suicidal ideation to evaluate its features as a concept of distress in the context of severe illness.
METHODS: In a cross-sectional sample of 430 mixed cancer patients, we assessed demoralization with the Demoralization Scale (DS); the 4-week prevalence of mood, anxiety, and adjustment disorders and suicidal ideation with the standardized Composite International Diagnostic Interview-Oncology (CIDI-O); and depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). We compared the relative risk (RR) for mental disorders associated with demoralization to that associated with self-reported depression.
RESULTS: Clinically relevant levels of demoralization were present in 21% of the patients. Demoralization co-occurred with a mood/anxiety disorder in 7%; 14% were demoralized in absence of any mood/anxiety disorder. Demoralization and adjustment disorders co-occurred in 2%. The RR for any mood/anxiety disorder was 4.0 in patients with demoralization (95% confidence interval [CI], 2.5-6.2) and 3.0 in those with depression (95% CI, 1.9-4.6). Demoralization, but not depression, was associated with a significantly increased risk for suicidal ideation after controlling for mental disorders (RR, 2.0; 95% CI, 1.1-3.5).
CONCLUSIONS: Clinically relevant demoralization frequently occurs independently of a mental disorder in patients with cancer and has a unique contribution to suicidal ideation. Demoralization is a useful concept to identify profiles of psychological distress symptoms amenable to interventions improving psychological well-being in this population. Cancer 2017;123:3394-401. © 2017 American Cancer Society.

Language: en

Keywords

Humans; Cross-Sectional Studies; Adult; Aged; Female; Male; Middle Aged; Incidence; Severity of Illness Index; Risk Assessment; Neoplasms; Mood Disorders; Confidence Intervals; Survival Rate; Suicidal Ideation; Surveys and Questionnaires; suicidal ideation; depression; mental disorder; Follow-Up Studies; Anxiety Disorders; mood disorder; Stress, Psychological; demoralization; cancer; anxiety disorder; Mental Disorders; adjustment disorder; Behavior Rating Scale