The association of demoralization with mental disorders and suicidal ideation in patients with cancer
Open accessAbstract
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.
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After adjustment for psychiatric disorders, studies found that patients with demoralization had twice the risk of suicidal thinking.
“After controlling for psychiatric disorders, studies have shown a two-fold risk of suicidal thinking in patients with demoralization (Vehling et al., 2017;Fang et al., 2014).”
From Why adults with psychiatric conditions request euthanasia: A qualitative interview study of life experiences, motives and preventive factors (2021) · cites this paper as Vehling et al., 2017
Compared to major depressive disorder, demoralization is more strongly associated with suicidal ideation.
“and compared to MDD, demoralization is more strongly associated with suicidal ideation [6].”
From Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study. (2020) · cites this paper as [6]
Demoralization is associated with high physical symptom burden and poor quality of life.
“and is associated with high physical symptom burden and poor quality of life [5,6].”
From Psilocybin-assisted group therapy for demoralized older long-term AIDS survivor men: an open-label safety and feasibility pilot study. (2020) · cites this paper as [6]
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- Vehling, S., Kissane, D. W., Lo, C., Glaesmer, H., Hartung, T. J., Rodin, G. & Mehnert, A. (2017). The Association of Demoralization With Mental Disorders and Suicidal Ideation in Patients With Cancer. CANCER, 123 (17), pp.3394-3401. https://doi.org/10.1002/cncr.30749. Persistent Link: http://hdl.handle.net/11343/292868
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- Authors
- Vehling, S., Kissane, D. W., Lo, C., Glaesmer, H., Hartung, T. J., Rodin, G., & Mehnert, A.
- Affiliations
- University Health Network (CA)
- Monash University (AU)
- University Hospital Leipzig (DE)
- Corresponding author
- Vehling, Sigrun
- ORCID
- Venue
- Cancer
- Publisher
- Wiley
- Published
- 2017-05-04
- Volume
- 123
- Issue
- 17
- Pages
- 3394-3401
- ISSN
- 0008-543X (ISSN-L)
- 1097-0142
- OpenAlex
- W2610614969
- Cited by
- 182
- References
- 47
- Citations by year
- 2026: 12 · 2025: 25 · 2024: 25 · 2023: 14 · 2022: 17 · 2021: 28 · 2020: 17 · 2019: 22 · 2018: 17 · 2017: 4
- FWCI
- 7.23
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cancer (publishedVersion)
- PubMed (publishedVersion)
- ResearchOnline at James Cook University (James Cook University) (submittedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Funders
- Deutsche Krebshilfe (107465)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- demoralization, cancer patients, suicidal ideation, mood disorders, anxiety disorders, adjustment disorder, depression, psychological distress, hopelessness, meaning in life, Demoralization Scale
- MeSH terms
- Behavior Rating Scale, Adult, Aged, Anxiety Disorders, Mental Disorders, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasms, Surveys and Questionnaires, Severity of Illness Index, Stress, Psychological, Incidence, Survival Rate, Confidence Intervals, Risk Assessment, Mood Disorders, Suicidal Ideation
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