Relationship of demoralization with anxiety, depression, and quality of life: A S outhern E uropean study of I talian and P ortuguese cancer patients
Open accessAbstract
Background: Demoralization syndrome is a significant condition that has not been greatly studied in Southern European countries. Aims: To extend the knowledge of demoralization in Southern Europe by examining its prevalence according to different methods of assessment, its relationship with anxiety and depression, and its impact on quality of life (QoL) among cancer patients. Methods: A convenience sample of 195 cancer outpatients from two oncology centers (102 from Lisbon, Portugal, and 93 from Ferrara, Italy) participated in an observational, cross‐sectional study using the Diagnostic Criteria of Psychosomatic Research‐Demoralization interview (DCPR/D) and psychometric tools (Demoralization scale‐DS; Patient Health Questionnaire–9/PHQ‐9; Hospital Anxiety Depression Scale‐HADS; and European Quality of Life‐5‐EQ‐5D). Results: A 25.1% prevalence (CI 95%, 0.19‐0.31) of clinically relevant demoralization was reported on the DCPR/D interview. A total demoralization score cutoff score ≥ 25 maximized sensitivity (81.6%), and specificity (72.6%) in identifying DCPR/D demoralized patients. The DCPR/D and DS were associated with poorer levels of QoL. About half of the patients who were demoralized were not clinically depressed (PHQ‐9). Self‐reported suicidal ideation (PHQ‐9 item 9) was found in a minority of patients (8.2%), most of whom (77%) were cases of depression (PHQ‐9), but one‐quarter (23%) were not depressed, yet moderately/severely demoralized (DCPR/D and DS). Conclusions: This Southern European study confirms the importance of demoralization in cancer patients as a different condition with respect to depression and its relationship with poor QoL and suicidal ideation.
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Demoralization is highly prevalent (13-53%) among patients with serious medical illness.
“Demoralization is highly prevalent (13–53%) among patients with serious medical illness (e.g., advanced cancer and acquired immunodeficiency syndrome [AIDS], etc.) [2], [3], [4]”
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 [4]
Highly demoralized patients can screen negative for major depressive disorder.
“Highly demoralized patients can screen negative for major depressive disorder (MDD); [3,4]”
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 [4]
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- Authors
- Nanni, M. G., Caruso, R., Travado, L., Ventura, C., Palma, A., Berardi, A. M., Meggiolaro, E., Ruffilli, F., Martins, C., Kissane, D., & Grassi, L.
- Affiliations
- University of Ferrara (IT)
- Champalimaud Foundation (PT)
- Unidade de Psicologia Clínica, Centro Hospitalar de Lisboa Central Lisbon Portugal
- Fondazione Sabir Palermo Italy
- Psycho‐Oncology Unit Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS Meldola Italy
- Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IT)
- Unidade Local de Saúde de São José (PT)
- Cabrini Hospital (AU)
- Corresponding author
- Grassi, Luigi
- ORCID
- Venue
- Psycho-Oncology
- Publisher
- Wiley
- Published
- 2018-08-06
- Volume
- 27
- Issue
- 11
- Pages
- 2616-2622
- ISSN
- 1057-9249 (ISSN-L)
- 1099-1611
- OpenAlex
- W2810219060
- Cited by
- 78
- References
- 38
- Citations by year
- 2026: 10 · 2025: 11 · 2024: 13 · 2023: 8 · 2022: 14 · 2021: 6 · 2020: 9 · 2019: 4 · 2018: 2
- FWCI
- 1.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psycho-Oncology (publishedVersion)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT) (submittedVersion, other-oa)
- Institutional Research Information System University of Ferrara (University of Ferrara) (submittedVersion, other-oa)
- Funders
- Fondazione Alazio, Palermo, Italy and Università degli Studi di Ferrara (Fondazione Alazio Project on Demoralization)
- University Research Funds, Università degli Studi di Ferrara
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Keywords
- demoralization syndrome, cancer patients, anxiety, depression, quality of life, suicidal ideation, Demoralization Scale, prevalence, Southern Europe, Italy, Portugal
- MeSH terms
- Adult, Aged, Anxiety, Cross-Sectional Studies, Depression, Female, Humans, Italy, Male, Middle Aged, Morale, Neoplasms, Portugal, Psychometrics, Quality of Life, Surveys and Questionnaires, Sensitivity and Specificity, Stress, Psychological, Prevalence, Suicidal Ideation
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