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Psychological Characterization of Demoralization in the Setting of Heart Transplantation
Abstract
OBJECTIVE: The aims of this study were to examine the psychological features of demoralization and its overlap with major depressive disorder in a sample of cardiac transplant recipients, with special reference to psychological well-being, quality of life, and psychological distress. We also tested whether demoralization was significantly associated with demographic characteristics and clinical parameters, including survival status at a 6-year follow-up. METHOD: From May to December 2002, 95 heart transplanted patients were administered the Structured Clinical Interview for DSM-IV and the Diagnostic Criteria for Psychosomatic Research, leading to the identification of major depressive disorder and demoralization, respectively. Patients also completed Ryff's Scales of Psychological Well-Being, Kellner's Symptom Questionnaire, and the World Health Organization Quality of Life-Brief Version scale. RESULTS: Demoralization was related to impairments in physical, psychological, social, and environmental quality of life and in psychological well-being, especially self-acceptance and environmental mastery (all P ≤ .05). It was also associated with higher levels of psychological distress, and it was more frequent in women (P = .027) and in single patients (P = .038). The co-occurrence of a major depressive episode did not alter this pattern of associations. The addition of demoralization to major depressive disorder resulted in decreased Scales of Psychological Well-Being autonomy, positive relations, and self-acceptance (all P ≤ .05). Demoralization and major depressive disorder were identified in 31 (32.6%) and 14 (14.7%) patients, respectively. Among depressed subjects, 5 (35.7%) were not demoralized, and 22 (71%) of those with demoralization did not satisfy the criteria for major depressive disorder. Nine patients were both depressed and demoralized. CONCLUSION: Diagnostic Criteria for Psychosomatic Research-defined demoralization has some distinctive features that confirm previous phenomenological observations.
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Across four studies (n = 1153 subjects), there was consistent evidence of a relationship between a higher level of demoralization and reduced social support and social functioning.
“There was also consistent evidence for a relationship across four studies (n = 1153 subjects) between a higher level of demoralization and reduced social support and social functioning.”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [24]
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 [24]
In the five studies (n = 959 subjects) using the DCPR, the prevalence of demoralization ranged from 20.6% to 33.3%.
“In the five studies (n = 959 subjects) in which the DCPR was used, prevalence of demoralization ranged from 20.6% to 33.3%”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [24]
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 [24]
In the study by Grandi et al., demoralization was more frequent in single patients.
“demoralization was more frequent in single patients in the study by Grandi et al.”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [24]
There were consistent findings across four studies (n = 968) of a positive relationship between demoralization and anxiety.
“anxiety (four studies, n = 968)”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [24]
There was a positive relationship between demoralization and somatization and hostility.
“somatization and hostility”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [24]
Using the DCPR, 71% of participants classified as demoralized were not depressed.
“For instance, using the DCPR, 71% of participants classified as demoralized were not depressed.24”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [24]
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 [24]
When the DCPR was used as a categorical measure, rates of demoralization ranged from 21% to 33%.
“When the DCPR was used as a categorical measure, rates of demoralization ranged from 21% to 33%.24–28”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [24]
Across five studies (n = 675), the evidence uniformly indicated a strong negative relationship between demoralization and quality of life.
“Uniformly, the evidence indicated a strong negative relationship between demoralization and quality of life (five studies, n = 675).”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [24]
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Metadata
- Authors
- Grandi, S., Sirri, L., Tossani, E., & Fava, G. A.
- Affiliations
- University of Bologna (IT)
- Corresponding author
- Fava, Giovanni A.
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2010-12-14
- Volume
- 72
- Issue
- 05
- Pages
- 648-654
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W1990159744
- Cited by
- 52
- References
- 0
- Citations by year
- 2025: 4 · 2024: 5 · 2023: 5 · 2022: 4 · 2021: 4 · 2020: 2 · 2019: 1 · 2018: 5 · 2017: 5 · 2016: 2 · 2015: 3 · 2014: 3 · 2013: 4 · 2012: 5
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Archivio istituzionale della ricerca (Alma Mater Studiorum Università di Bologna) (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Transplantation › Organ and Tissue Transplantation Research
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- demoralization, heart transplantation, major depressive disorder, psychological well-being, quality of life, psychological distress, self-acceptance, environmental mastery, survival outcomes, sex differences, marital status
- MeSH terms
- Adaptation, Psychological, Depressive Disorder, Major, Major Depressive Disorder, Female, Humans, Interview, Psychological, Male, Middle Aged, Psychiatric Status Rating Scales, Psychological Tests, Quality of Life, Stress, Psychological, Heart Transplantation
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