Demoralization and depression in patients with advanced cancer: validation of the German version of the demoralization scale
Open accessAbstract
Context The concept of demoralization has been widely used to describe states of existential distress and a self-perceived incapacity to deal effectively with a specific stressful situation.Objectives To evaluate the psychometric properties of the German adaptation of the Demoralization Scale (DS) in patients with advanced cancer.Methods Participants with heterogeneous tumor sites were recruited in several treatment and rehabilitation facilities. Concurrent and divergent validity of the DS was analyzed through associations with and group differences between measures of distress, depression, anxiety, and meaning-related life attitudes.Results From a total sample of 1102 patients, 516 individuals (45%) with advanced cancer were enrolled (male 53%, median age 58 years [range 18-88], breast cancer 21%, prostate cancer 17%). The total mean score of the DS was 29.8 (SD=10.41). Four factors were extracted by exploratory factor analysis, which accounted for 59% of the variation (Cronbach α=0.84): loss of meaning and purpose (α=0.88), disheartenment (α=0.88), dysphoria (α=0.80), and sense of failure (α=0.76). DS dimensions shared between 12% and 62% of the variance. Demoralization was significantly associated with anxiety (r=0.71), depression (r=0.61), and distress (r=0.42). Fifty-seven percent of patients had high distress, 24% depression, and 11% high anxiety. According to different cutoff values, between 16% and 39% were seriously demoralized and 73% had moderate levels of demoralization. Between 5% and 20% of patients were seriously demoralized but not clinically depressed; 60% of patients with moderate levels of demoralization had no depression.Conclusion Results provide further evidence that the DS is a valid and reliable instrument of high clinical relevance in patients with advanced cancer.
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In four studies (n = 1631), demoralization was higher or more frequent in women.
“In four studies (n = 1631), demoralization was higher or more frequent in women.”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
Across three studies (n = 723), there is no association between demoralization and time since diagnosis.
“there is no association between demoralization and time since diagnosis (three studies, n = 723)”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
A negative correlation between age and demoralization was reported in two studies totaling 1266 subjects.
“a negative correlation between age and demoralization was reported in two studies totaling 1266 subjects.”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
In another large study involving patients with heterogeneous cancers, no association between cancer site and demoralization was found.
“in another large study involving patients with heterogeneous cancers, no association was found.”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
Spiritual problems were associated with higher demoralization.
“Spiritual problems were associated with higher demoralization”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
Across three studies (n = 723), having a partner was associated with lower levels of demoralization.
“There were similar findings for the relationship between marital status and demoralization with the results of three studies (n = 723) indicating that having a partner was associated with lower levels of demoralization.”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
Mehnert et al. reported higher levels of demoralization among participants living alone compared with those living with a partner.
“reported higher levels of demoralization among participants living alone compared with those living with a partner.”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
Across two studies (n = 602), demoralization has been positively related to distress.
“Demoralization has been positively related to distress (two studies, n = 602)”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
Across two studies (n = 611), demoralization was negatively associated with purpose in life.
“and with purpose in life (two studies, n = 611).”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
In four of the five validation studies, divergent validity was reported.
“In four of the five validation studies, divergent validity was reported.6,13,30,39”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
Severe demoralization can be comorbid with clinical depression.
“Severe demoralization may benefit from its separate syndromal diagnosis and can clearly be comorbid with clinical depression.30”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [30]
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- Authors
- Mehnert, A., Vehling, S., Höcker, A., Lehmann, C., & Koch, U.
- Affiliations
- University Medical Center Hamburg-Eppendorf (DE)
- Corresponding author
- Mehnert, Anja
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2011-11
- Volume
- 42
- Issue
- 5
- Pages
- 768-776
- ISSN
- 0885-3924 (ISSN-L)
- OpenAlex
- W1999136028
- Cited by
- 171
- References
- 29
- Citations by year
- 2026: 11 · 2025: 11 · 2024: 16 · 2023: 11 · 2022: 13 · 2021: 13 · 2020: 10 · 2019: 15 · 2018: 12 · 2017: 11 · 2016: 8 · 2015: 9 · 2014: 6 · 2013: 20 · 2012: 4
- FWCI
- 4.89
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Barbara and Michael Hell Stiftung Hamburg and German Cancer Aid
- Fritz und Hildegard Berg-Stiftung
- Stiftung Wissenschaft Hamburg
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Keywords
- demoralization, Demoralization Scale, advanced cancer, depression, anxiety, existential suffering, psychometric validation, German adaptation, meaninglessness, dysphoria, sense of failure, cancer patients
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Depression, Factor Analysis, Statistical, Female, Germany, Humans, Language, Male, Middle Aged, Neoplasms, Neuropsychological Tests, Psychometrics, Socioeconomic Factors, Stress, Psychological, Reproducibility of Results, Young Adult, Sense of Coherence
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