A Systematic Review of the Demoralization Syndrome in Individuals With Progressive Disease and Cancer: A Decade of Research

Abstract

Overall, this systematic review was limited by the extent of variability in the characteristics of studies. Patients who are single, isolated or jobless, have poorly controlled physical symptoms, or have inadequately treated anxiety and depressive disorders are at increased risk for demoralization. Clinical recognition of demoralization can trigger more focused interventions.

The association of demoralization with mental disorders and suicidal ideation in patients with cancer

“…1B), whereas half of those with an anxiety disorder were demoralized (Fig. 13 Applying this higher threshold did not affect the association of demoralization with anxiety disorders, adjustment disorders, and suicidal ideation (see online supporting information for detailed results). 1A).…”

“…[3][4][5] Given that psychological distress in cancer patients is not necessarily captured by such diagnoses, there is a need to identify clinically significant psychological problems that lie beyond the current psychiatric classification in this population. 12,13 Its severity may range from the middle of the distress spectrum, where adjustment disorders are located, to the extreme end. 7 Its historical understanding 8,9 has been applied to the cancer setting, in which a perceived lack of control, uncertainty, and the loss of social roles and life goals are common existential challenges.…”

Depressive Spectrum Disorders in Cancer: Diagnostic Issues and Intervention. A Critical Review

“…Demoralization has been shown to have a negative impact on cancer patients, such as poorer quality of life and higher levels of worries and preoccupation related to cancer (e.g., the illness itself, feeling different from others, the impact on sexual life), [42] loss of dignity, [43], and suicidal ideation [44]. Several recent systematic reviews on this topic are available [45•, 46•, 47] and confirm the importance of this syndrome in medical and oncology settings [48]. …”

Síndrome de desmoralización como alternativa diagnóstica al estado de ánimo deprimido en pacientes paliativos

“…La ruptura con la autoimagen física e incluso la pérdida del auto concepto y de referencia social en actividades y metas que se desvanecen son momentos cruciales en la EA y que inevitablemente hacen visible el sufrimiento existencial al final de la vida (FV) (2)(3)(4) . Frecuentemente estos signos de sufrimiento se han asociado con síntomas de ansiedad, crisis de pánico y síndrome de desmoralización (5)(6)(7) . Los aspectos relacionados con el sufrimiento existencial y las necesidades espirituales han recibido una mayor atención en esta última déca-da (2,8) .…”