Demoralization: its phenomenology and importance

Clarke, David M.; Kissane, David W.

doi:10.1046/j.1440-1614.2002.01086.x

Cited by 590Mental Health and PsychiatryOptimism, Hope, and Well-beingPsychosomatic Disorders and Their Treatments

Demoralization: its phenomenology and importance

Clarke, David M., Kissane, David W.·2002·Australian & New Zealand Journal of Psychiatry

DOI 10.1046/j.1440-1614.2002.01086.x

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Abstract

Objective: Demoralization, as described by Jerome Frank, is experienced as a persistent inability to cope, together with associated feelings of helplessness, hopelessness, meaninglessness, subjective incompetence and diminished self-esteem. It is arguably the main reason people seek psychiatric treatment, yet is a concept largely ignored in psychiatry. The aim here is to review and summarize the literature pertaining to demoralization in order to examine the validity of the construct. Method: A narrative review of demoralization and the related concepts of hope, hopelessness, and meaning is presented, drawing on a range of empirical and observational studies in the medical and psychiatric literature. Results: An examination of the concepts of the ‘Giving Up–Given Up’ syndrome (George Engel), ‘suffering’ (Eric Cassell), and demoralization (Jerome Frank), demonstrate considerable convergence of ideas. Demoralization has been commonly observed in the medically and psychiatrically ill and is experienced as existential despair, hopelessness, helplessness, and loss of meaning and purpose in life. Although sharing symptoms of distress, demoralization is distinguished from depression by subjective incompetence in the former and anhedonia in the latter. Demoralization can occur in people who are depressed, cancer patients who are not depressed and those with schizophrenia. Hopelessness, the hallmark of demoralization, is associated with poor outcomes in physical and psychiatric illness, and importantly, with suicidal ideation and the wish to die. Conclusions: Demoralization is an important construct with established descriptive and predictive validity. A place needs to be found for it in psychiatric nomenclature.

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The core symptoms of demoralization are a loss of hope and meaning, with a loss of anticipatory pleasure rather than general anhedonia.
“whereas the core symptoms of demoralization are a loss of hope and meaning, with a loss of anticipatory pleasure rather than general anhedonia.1,3”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [3]
The core symptoms of depression include a loss of pleasure and interest in the present moment.
“the core symptoms of depression include a loss of pleasure and interest in the present moment”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [3]
A number of medically ill patients will not develop a clinical depression, yet develop a desire to die based on suicidal thinking.
“which is relevant as a number of medically ill patients will not develop a clinical depression, yet develop a desire to die based on suicidal thinking.1,3”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [3]
A number of medically ill patients are not diagnosed with depression because they lack anhedonia, yet develop a desire to die because of feelings of pointlessness and meaninglessness.
“As noted in the Introduction, this is essential given that a number of medically ill patients are not diagnosed with depression because they lack anhedonia, yet develop a desire to die because of feelings of pointlessness and meaninglessness.1,3”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [3]
Establishing consistency in diagnostic criteria will presume an accepted definition of demoralization, leading to an increased opportunity to empirically validate the syndrome across clinical settings and cultures.
“Establishing consistency in diagnostic criteria will presume an accepted definition of demoralization, leading to an increased opportunity to empirically validate the syndrome across clinical settings and cultures.3,6”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [3]

Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Stress, appraisal, and coping
Eysenck, H. J. (1985) · Behaviour Research and Therapy · doi:10.1016/0005-7967(85)90087-7 · Cited by 32,026 · see citing works
“Stress: appraisal and coping,”
Folkman, S. (2013) · Encyclopedia of Behavioral Medicine · doi:10.1007/978-1-4419-1005-9_215 · Cited by 27,833 · see citing works
The Reflective Practitioner: How Professionals Think in Action
Checkoway, B. N., & Schön, D. A. (1985) · Journal of Policy Analysis and Management · doi:10.2307/3324262 · Cited by 21,311 · see citing works
The reflective practitioner: How professionals think in action
Stewart, C. J. (1984) · Patient Education and Counseling · doi:10.1016/0738-3991(84)90022-3 · Cited by 19,751 · see citing works
Journal of Clinical Psychiatry
(2018) · Journal of Clinical Psychiatry · doi:10.5505/kpd · Cited by 13,703 · see citing works
Untitled work
(1975) · Medical Entomology and Zoology · Cited by 7,245 · see citing works
On death and dying.
Kübler-Ross, E. (1975) · PubMed · Cited by 4,937 · see citing works
The Reflective Practitioner: How Professionals Think in Action
Schön, D. A., & DeSanctis, V. (1986) · The Journal of Continuing Higher Education · doi:10.1080/07377366.1986.10401080 · Cited by 3,234 · see citing works
Cognitive Therapy and the Emotional Disorders
Ince, L. P. (1977) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1977.31.4.633 · Cited by 2,889 · see citing works
Australian Family Physician.
(1984) · PubMed · Cited by 2,436 · see citing works
THE NATURE OF SUFFERING AND THE GOALS OF MEDICINE
Cassel, E. J. (1982) · New England Journal of Medicine · doi:10.1056/nejm198203183061104 · Cited by 2,149 · see citing works
Meaning in the context of stress and coping
Park, C. L., & Folkman, S. (1997) · Review of General Psychology · doi:10.1037/1089-2680.1.2.115 · Cited by 1,821 · see citing works
Assumptive Worlds and the Stress of Traumatic Events: Applications of the Schema Construct
Janoff‐Bulman, R. (1989) · Social Cognition · doi:10.1521/soco.1989.7.2.113 · Cited by 1,771 · see citing works
Persuasion and Healing: A Comparative Study of Psychotherapy
Frank, J. D. (1961) · Cited by 1,391 · see citing works
Bereavement: Studies of grief in adult life
(1976) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(76)90065-9 · Cited by 1,241 · see citing works
Positive illusions and well-being revisited: Separating fact from fiction.
Taylor, S. E., & Brown, J. D. (1994) · Psychological Bulletin · doi:10.1037/0033-2909.116.1.21 · Cited by 1,205 · see citing works
The Nature of Suffering and the Goals of Medicine
Cassell, E. J. (1998) · Loss Grief & Care · doi:10.1300/j132v08n01_18 · Cited by 1,178 · see citing works
Depression, Hopelessness, and Desire for Hastened Death in Terminally Ill Patients With Cancer
Breitbart, W. (2000) · JAMA · doi:10.1001/jama.284.22.2907 · Cited by 1,110 · see citing works
Persuasion and Healing
Frank, J. (1993) · doi:10.56021/9780801840678 · Cited by 1,094 · see citing works
Nonspecific Psychological Distress and Other Dimensions of Psychopathology
Dohrenwend, B. P. (1980) · Archives of General Psychiatry · doi:10.1001/archpsyc.1980.01780240027003 · Cited by 947 · see citing works
Influence of psychological response on survival in breast cancer: a population-based cohort study
Watson, M., Haviland, J., Greer, S., Davidson, J., & Bliss, J. (1999) · The Lancet · doi:10.1016/s0140-6736(98)11392-2 · Cited by 705 · see citing works
The Principle of Hope
MacKinnon, D. M., & Bloch, E. (1988) · Scottish Journal of Theology · doi:10.1017/s0036930600040813 · Cited by 646 · see citing works
Demoralization Syndrome — a Relevant Psychiatric Diagnosis for Palliative Care
Kissane, D. W., Clarke, D. M., & Street, A. F. (2001) · Journal of Palliative Care · doi:10.1177/082585970101700103 · Cited by 624 · see citing works
Self-citation
Hope: Its Spheres and Dimensions
Dufault, K., & Martocchio, B. C. (1985) · Nursing Clinics of North America · doi:10.1016/s0029-6465(22)00328-0 · Cited by 606 · see citing works
Hopelessness and Risk of Mortality and Incidence of Myocardial Infarction and Cancer
Everson‐Rose, S. A., Goldberg, D. E., Kaplan, G. A., Cohen, R. D., Pukkala, ., Tuomilehto, J., & Salonen, J. T. (1996) · Psychosomatic Medicine · doi:10.1097/00006842-199603000-00003 · Cited by 591 · see citing works
Consensus criteria for traumatic grief: A preliminary empirical test
Prigerson, H. G., Shear, M. K., Jacobs, S. C., Reynolds, C. F., Maciejewski, P. K., Davidson, J. R. T., Rosenheck, R., Pilkonis, P. A., Wortman, C. B., Williams, J. B. W., et al. (1999) · British Journal of Psychiatry · doi:10.1192/bjp.174.1.67 · Cited by 561 · see citing works
Journal of psychosomatic research
Antoni, M. H., & Pitts, M. K. (2003) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(03)00018-7 · Cited by 549 · see citing works
Symposium on compassionate care and the dying experience. Hope: its spheres and dimensions.
Dufault, K., & Bc, M. (1985) · PubMed · Cited by 547 · see citing works
The Nature of Suffering
Cassell, E. J. (1991) · doi:10.1093/oso/9780195052220.001.0001 · Cited by 495 · see citing works
Boundaries of Major Depression: An Evaluation of DSM-IV Criteria
Kendler, K. S., & Gardner, C. O. (1998) · American Journal of Psychiatry · doi:10.1176/ajp.155.2.172 · Cited by 430 · see citing works
Psychotherapy: The Restoration of Morale
Frank, J. D. (1974) · American Journal of Psychiatry · doi:10.1176/ajp.131.3.271 · Cited by 401 · see citing works
The doctor and the soul : from psychotherapy to logotherapy
FRANKL, V. E., Winston, R., & Winston, C. (1973) · Andalas University Repository (Andalas University) · Cited by 380 · see citing works
Diagnostic Criteria for Use in Psychosomatic Research
Fava, G. A., Freyberger, H. J., Bech, P., Christodoulou, G. N., Sensky, T., Theorell, T., & Wise, T. N. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000288931 · Cited by 379 · see citing works
Depression, Hopelessness, and Suicidal Ideation in the Terminally Ill
Chochinov, H. M., Wilson, K. G., Enns, M., & Lander, S. (1998) · Psychosomatics · doi:10.1016/s0033-3182(98)71325-8 · Cited by 363 · see citing works
Depression, demoralization and control over psychotic illness: a comparison of depressed and non-depressed patients with a chronic psychosis
Birchwood, M. J., Mason, R., MacMillan, F., & Healy, J. (1993) · Psychological Medicine · doi:10.1017/s0033291700028488 · Cited by 354 · see citing works
Successful Aging and the Role of the Life Review*
Butler, R. N. (1974) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.1974.tb04823.x · Cited by 342 · see citing works
Hope and Hopelessness: Critical Clinical Constructs
Farran, C. J., Herth, K., & Popovich, J. M. (1995) · Medical Entomology and Zoology · Cited by 299 · see citing works
‘Subthreshold’ mental disorders
Pincus, H. A., Davis, W., & McQueen, L. E. (1999) · The British Journal of Psychiatry · doi:10.1192/bjp.174.4.288 · Cited by 283 · see citing works
Interest in physician-assisted suicide among ambulatory HIV-infected patients
BREITBART, W. S., Rosenfeld, B. D., & Passik, S. D. (1996) · American Journal of Psychiatry · doi:10.1176/ajp.153.2.238 · Cited by 282 · see citing works
The healer's power
(1992) · Choice Reviews Online · doi:10.5860/choice.29-6215 · Cited by 261 · see citing works
The Revolution of Hope, Toward a Humanized Technology
Fromm, E. (1968) · DigitalGeorgetown (Georgetown University Library) · Cited by 260 · see citing works
Hopelessness and 4-Year Progression of Carotid Atherosclerosis
Everson‐Rose, S. A., Kaplan, G. A., Goldberg, D. E., Salonen, R. M., & Salonen, J. T. (1997) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.17.8.1490 · Cited by 234 · see citing works
Hope and Hopelessness: Critical Clinical Constructs
Clarke, L. (1995) · Journal of Advanced Nursing · doi:10.1046/j.1365-2648.1995.22040816-6.x · Cited by 228 · see citing works
Depression and demoralization: Phenomenologic differences and research perspectives
de Figueiredo, J. M. (1993) · Comprehensive Psychiatry · doi:10.1016/0010-440x(93)90016-w · Cited by 217 · see citing works
The Macquarie Dictionary
Delbridge, A., & Yallop, C. L. (1996) · English Today · doi:10.1017/s0266078400008725 · Cited by 217 · see citing works
The Denial of Stress
(1984) · Journal of Gerontology · doi:10.1093/geronj/39.6.764b · Cited by 208 · see citing works
Bereavement: Studies of grief in adult life, 2nd ed.
Parkes, C. M. (1987) · Cited by 194 · see citing works
Mental adjustment to cancer: its measurement and prognostic importance.
Greer, S., & Watson, M. (1987) · PubMed · Cited by 193 · see citing works
The Social Breakdown Syndrome-Some Origins
Gruenberg, E. M. (1967) · American Journal of Psychiatry · doi:10.1176/ajp.123.12.1481 · Cited by 191 · see citing works
Dimensions of neuroses seen in primary-care settings
Goldberg, D. P., Bridges, K. W., Duncan‐Jones, P., & Grayson, D. A. (1987) · Psychological Medicine · doi:10.1017/s0033291700025022 · Cited by 178 · see citing works
Critical Issues in the Evaluation of Comorbidity of Psychiatric Disorders
Wïttchen, H. (1996) · The British Journal of Psychiatry · doi:10.1192/s000712500029836x · Cited by 167 · see citing works
Hypertension Incidence Is Predicted by High Levels of Hopelessness in Finnish Men
Everson‐Rose, S. A., Kaplan, G. A., Goldberg, D. E., & Salonen, J. T. (2000) · Hypertension · doi:10.1161/01.hyp.35.2.561 · Cited by 165 · see citing works
Hopelessness, depression, and suicide intent.
Wetzel, R. D., Margulies, T., Davis, R., & Karam, E. (1980) · PubMed · Cited by 163 · see citing works
What becomes of redundant world models? A contribution to the study of adaptation to change
Parkes, C. M. (1975) · British Journal of Medical Psychology · doi:10.1111/j.2044-8341.1975.tb02315.x · Cited by 158 · see citing works
The Healer's Power
Brody, H. A. (1992) · Yale University Press eBooks · doi:10.12987/9780300156966 · Cited by 149 · see citing works
The Concepts of Mild Depression
Snaith, R. P. (1987) · The British Journal of Psychiatry · doi:10.1192/bjp.150.3.387 · Cited by 145 · see citing works
Depression, Hopelessness, and Self‐Esteem: Accounting for Suicidality in Adolescent Psychiatric Inpatients
Dori, G. A., & Overholser, J. C. (1999) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.1999.tb00526.x · Cited by 129 · see citing works
Psychosocial Influences on Cancer Incidence and Progression
Spiegel, D., & Kato, P. M. (1996) · Harvard Review of Psychiatry · doi:10.3109/10673229609030518 · Cited by 125 · see citing works
A Psychological Setting of Somatic Disease: The ‘Giving up — Given Up’ Complex
Engel, G. L. (1967) · Proceedings of the Royal Society of Medicine · doi:10.1177/003591576706000618 · Cited by 112 · see citing works
Personal hopefulness: A conceptual review of the relevance of the perceived future to psychiatry
Nunn, K. P. (1996) · British Journal of Medical Psychology · doi:10.1111/j.2044-8341.1996.tb01866.x · Cited by 106 · see citing works
The construction and characteristics of an instrument to measure personal hopefulness
Nunn, K., Lewin, T. J., Walton, J. M., & Carr, V. J. (1996) · Psychological Medicine · doi:10.1017/s0033291700035613 · Cited by 96 · see citing works
‘Psyche’ – Spirit as well as Mind?
Sims, A. C. P. (1994) · The British Journal of Psychiatry · doi:10.1192/bjp.165.4.441 · Cited by 96 · see citing works
Diagnosing Demoralization in Consultation Psychiatry
Slavney, P. R. (1999) · Psychosomatics · doi:10.1016/s0033-3182(99)71227-2 · Cited by 88 · see citing works
Comparative Studies on Vascular Endothelium in vitro
Klein, C. L., Köhler, H., Bittinger, F., Wagner, M., Hermanns, I., Grant, K., Lewis, J. C., & Kirkpatrick, C. J. (2008) · Pathobiology · doi:10.1159/000163911 · Cited by 84 · see citing works
Psychospiritual and existential distress. The challenge for palliative care.
Kissane, D. W. (2000) · PubMed · Cited by 79 · see citing works
Self-citation
The Revolution of Hope. Toward a Humanized Technology, New York (American Mental Health Foundation) 2010.
Fromm, E. (1968) · Cited by 77 · see citing works
Dimensions of Psychopathology in the Medically Ill
Clarke, D. M., Mackinnon, A. J., Smith, G. C., McKenzie, D. P., & Herrman, H. (2000) · Psychosomatics · doi:10.1176/appi.psy.41.5.418 · Cited by 75 · see citing works
Self-citation
An empirically derived taxonomy of common distress syndromes in the medically ill
Clarke, D. M., Smith, G. C., Dowe, D. L., & McKenzie, D. P. (2003) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(02)00410-5 · Cited by 68 · see citing works
Self-citation
A pilot study of Interpersonal Psychotherapy by telephone with cancer patients and their partners
Donnelly, J. M., Kornblith, A. B., Fleishman, S., Zuckerman, E., Raptis, G., Hudis, C. A., Hamilton, N., Payne, D., Massie, M. J., Norton, L., et al. (2000) · Psycho-Oncology · doi:10.1002/(sici)1099-1611(200001/02)9:1 · Cited by 65 · see citing works
Psychological Care of the Medically Ill: A Primer in Liaison Psychiatry
Kiely, W. F. (1976) · Psychosomatic Medicine · doi:10.1097/00006842-197609000-00011 · Cited by 63 · see citing works
Cancer patients' attitudes to final events in life: Wish for death, attitudes to cessation of treatment, suicide and euthanasia
Owen, C. A., Tennant, C., Levi, J. A., & Jones, M. (1994) · Psycho-Oncology · doi:10.1002/pon.2960030103 · Cited by 61 · see citing works
Depression and Demoralization Among Russian-Jewish Immigrants in Primary Care
Gutkovich, Z. A., Rosenthal, R. N., GALYNKER, I. I., Muran, J. C., Batchelder, S. T., & Itskhoki, E. (1999) · Psychosomatics · doi:10.1016/s0033-3182(99)71257-0 · Cited by 61 · see citing works
Object Loss, Giving Up, and the Onset of Psychiatric Disease
Adamson, J. D., & Schmale, A. H. (1965) · Psychosomatic Medicine · doi:10.1097/00006842-196511000-00006 · Cited by 60 · see citing works
Psychological care of the medically ill : a primer in liaison psychiatry
Strain, J. J., & Grossman, S. (1975) · Appleton-Century-Crofts eBooks · Cited by 59 · see citing works
The Kuopio Ischaemic Heart Disease Risk Factor Study
Allhoff, P., Laaser, U., & Heinrich, J. (1991) · Springer eBooks · doi:10.1007/978-3-642-95642-3_36 · Cited by 51 · see citing works
Optimism, Pessimism, and Mortality
Seligman, M. E. P. (2000) · Mayo Clinic Proceedings · doi:10.4065/75.2.133 · Cited by 49 · see citing works
The Macquarie dictionary: 2nd ed.
Hannan, M. F. (1991) · Cross Connect (Southern Cross University) · Cited by 43 · see citing works
A Structure for Psychiatry at the Century's Turn-The View from Johns Hopkins
McHugh, P. R. (1992) · Journal of the Royal Society of Medicine · doi:10.1177/014107689208500819 · Cited by 38 · see citing works
Some issues in research on the epidemiology of demoralization
de Figueiredo, J. M. (1983) · Comprehensive Psychiatry · doi:10.1016/0010-440x(83)90103-7 · Cited by 29 · see citing works
Morale in old age: A review of the evidence
Wenger, G. C. (1992) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.930071003 · Cited by 25 · see citing works
The Diagnosis of Depression in Disorder
van Praag, H. M. (1998) · Australian & New Zealand Journal of Psychiatry · doi:10.3109/00048679809073863 · Cited by 24 · see citing works
‘The miserable hath no other medicine, but only hope’: Some conceptual considerations on hope and stress
Jacoby, R. (1993) · Stress Medicine · doi:10.1002/smi.2460090111 · Cited by 22 · see citing works
Diagnosing Demoralization in Consultation Psychiatry
de Figueiredo, J. M., & Slavney, P. R. (2000) · Psychosomatics · doi:10.1176/appi.psy.41.5.449 · Cited by 19 · see citing works
Models of Psychological Response to Suffering
Kissane, D. W. (1998) · Progress in Palliative Care · doi:10.1080/09699260.1998.11746816 · Cited by 17 · see citing works
Self-citation
Hope
Brody, H. A. (1981) · JAMA · doi:10.1001/jama.1981.03320130017014 · Cited by 15 · see citing works
Hopelessness and Suicidal Behavior: An Overview
Beck, A. T. (1975) · JAMA · doi:10.1001/jama.1975.03260240050026 · Cited by 11 · see citing works
Why We Need Poets in Palliative Care
Roy, D. J. (1999) · Journal of Palliative Care · doi:10.1177/082585979901500301 · Cited by 9 · see citing works
Mood disturbances and coronary heart disease: progress in the past decade
Tennant, C. C., & McLean, L. (2000) · The Medical Journal of Australia · doi:10.5694/j.1326-5377.2000.tb125536.x · Cited by 7 · see citing works
At the End of Life: Giving Thanks and Forgiving
Roy, D. J. (1999) · Journal of Palliative Care · doi:10.1177/082585979901500401 · Cited by 3 · see citing works

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Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the management of schizophrenia and related disorders
Galletly, C., Castle, D., Dark, F., Humberstone, V., Jablensky, A., Killackey, E., Kulkarni, J., McGorry, P., Nielssen, O., & Tran, N. (2016) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867416641195 · Cited by 877 · see citing works
The demoralization scale: a report of its development and preliminary validation
Kissane, D. W., Wein, S., Love, A., Lee, X. Q., Kee, P. L., & Clarke, D. M. (2004) · Journal of Palliative Care · doi:10.1177/082585970402000402 · Cited by 442 · see citing works
Self-citation
A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research
Robinson, S., Kissane, D. W., Brooker, J., & Burney, S. (2015) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2014.07.008 · Cited by 401 · see citing works
Self-citation
Psychiatric disorders in advanced cancer
Miovic, M., & Block, S. (2007) · Cancer · doi:10.1002/cncr.22980 · Cited by 376 · see citing works
Treatment of existential distress in life threatening illness: A review of manualized interventions
LeMay, K., & Wilson, K. G. (2008) · Clinical Psychology Review · doi:10.1016/j.cpr.2007.07.013 · Cited by 280 · see citing works
A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer
Fang, C.-K., Chang, M.-C., Chen, P.-J., Lin, C.-C., Chen, G.-S., Lin, J., Hsieh, R.-K., Chang, Y.-F., Chen, H.-W., Wu, C.-L., et al. (2014) · Supportive Care in Cancer · doi:10.1007/s00520-014-2290-4 · Cited by 211 · see citing works
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Mehnert, A., Vehling, S., Höcker, A., Lehmann, C., & Koch, U. (2011) · Journal of Pain and Symptom Management · doi:10.1016/j.jpainsymman.2011.02.013 · Cited by 171 · see citing works
Adjustment disorder: A diagnosis whose time has come
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Diagnostic criteria for psychosomatic research and psychosocial variables in breast cancer patients
Grassi, L., Rossi, E., Sabato, S., Cruciani, G., & Zambelli, M. (2004) · Psychosomatics · doi:10.1176/appi.psy.45.6.483 · Cited by 133 · see citing works
Use of the diagnostic criteria for psychosomatic research in oncology
Grassi, L., Sabato, S., Rossi, E., Biancosino, B., & Marmai, L. (2005) · Psychotherapy and Psychosomatics · doi:10.1159/000083168 · Cited by 123 · see citing works
Demoralization and death anxiety in advanced cancer
An, E., Lo, C., Hales, S., Zimmermann, C., & Rodin, G. (2018) · Psycho-Oncology · doi:10.1002/pon.4843 · Cited by 115 · see citing works
Feeling and time: The phenomenology of mood disorders, depressive realism, and existential psychotherapy
Ghaemi, S. N. (2006) · Schizophrenia Bulletin · doi:10.1093/schbul/sbl061 · Cited by 107 · see citing works
Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients
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Authors: Clarke, D. M., & Kissane, D. W.
Affiliations: Monash Medical Centre (AU)
The University of Melbourne (AU)
Corresponding author: Clarke, David M.
ORCID: Clarke, David M.
Kissane, David W.
Venue: Australian & New Zealand Journal of Psychiatry
Publisher: SAGE Publications
Published: 2002-12
Volume: 36
Issue: 6
Pages: 733-742
ISSN: 0004-8674 (ISSN-L)
1440-1614
DOI: 10.1046/j.1440-1614.2002.01086.x
OpenAlex: W2000720463
Cited by: 590
References: 90
Citations by year: 2026: 29 · 2025: 48 · 2024: 34 · 2023: 45 · 2022: 34 · 2021: 40 · 2020: 32 · 2019: 30 · 2018: 23 · 2017: 28 · 2016: 14 · 2015: 28 · 2014: 24 · 2013: 22 · 2012: 18
FWCI: 58.93
Type: journal article
Language: en
Open access: closed
Licence: journals.sagepub.com/page/policies/text-and-data-mining-license (tdm)
Locations: Australian & New Zealand Journal of Psychiatry (publishedVersion)
PubMed (publishedVersion)
Funders: Bethlehem Griffiths Research Foundation
National Health and Medical Research Council
National Medical Research Council
Topics: Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
Social Sciences › Psychology › Applied Psychology › Optimism, Hope, and Well-being
Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
Keywords: demoralization, hopelessness, hope, meaning in life, existential despair, anhedonia, depression, suicide, cancer patients, schizophrenia, construct validity, psychiatric terminology
MeSH terms: Mental Disorders, Humans, Morale

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Demoralization: its phenomenology and importance

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