Depression and demoralization as distinct syndromes: preliminary data from a cohort of advanced cancer patients
Open accessAbstract
The term demoralization has been used to describe existential distress and despair of patients with advanced disease. Aim: This study sought to determine whether a cluster of symptoms interpreted as demoralization could be identified and distinguished from a cluster of depressive symptoms. Materials and Methods: As part of the Coping with Cancer Study, a federally funded multi-site study of advanced cancer patients, 242 patients were interviewed on a broad range of mental health parameters related to depression, grief, quality of life, self-efficacy, coping and religiousness/spirituality. Results: A principal components analysis revealed separate depression and demoralization/despair factors. Seven symptoms constituted the demoralization/despair factor: loss of control, loss of hope, anger/bitterness, sense of failure, feeling life was a burden, loss of meaning and a belief that life′s meaning is dependent on health and were found to be internally consistent (Cronbach′s a = 0.78). Only 14.8% of subjects with "syndromal demoralization" met DSM-IV criteria for Major Depression (MDD); 7.4% for Minor Depression. Of those with MDD only 28.6% had syndromal level demoralization. Prior history of MDD predicted current MDD, but not syndromal demoralization. Demoralization, not MDD, was significantly associated with the patient′s reported level of inner peacefulness. When compared with MDD, syndromal demoralization was more strongly associated with wish to live and wish to die and equally predictive of mental health service use. Conclusion: The symptoms of demoralization are distinct from depressive symptoms and appear to be associated with the patient′s degree of inner peacefulness.
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There was a positive relationship between demoralization and inability to accept the cancer diagnosis.
“inability to accept the cancer diagnosis”
From A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: a decade of research (2015) · cites this paper as [41]
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“, 2006) Administration: self-report Items: 7 Response options and scoring not specified 242 advanced cancer patients United States (Jacobsen et al., 2006) None specified Internal consistency: a 1⁄4 0.”
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- Authors
- Jacobsen, J., Vanderwerker, L., Block, S., Friedlander, R., Maciejewski, P., & Prigerson, H.
- Affiliations
- Brigham and Women's Hospital (US)
- Venue
- Indian Journal of Palliative Care
- Publisher
- Scientific Scholar
- Published
- 2006
- Volume
- 12
- Issue
- 1
- Pages
- 8
- ISSN
- 0973-1075 (ISSN-L)
- OpenAlex
- W2112637670
- Cited by
- 61
- References
- 0
- Citations by year
- 2024: 3 · 2023: 3 · 2022: 3 · 2021: 6 · 2020: 5 · 2019: 1 · 2018: 3 · 2017: 2 · 2016: 5 · 2015: 4 · 2014: 5 · 2013: 5 · 2012: 3
- FWCI
- 0.69
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Indian Journal of Palliative Care (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Keywords
- demoralization, depression, advanced cancer, existential suffering, despair, major depressive disorder, desire for death, mental health service utilization, coping with cancer, hopelessness
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