Assessing demoralization in medically ill patients: Factor structure of the Italian version of the demoralization scale and development of short versions with the item response theory framework

Murri, Martino Belvederi; Zerbinati, Luigi; Ounalli, Heifa; Kissane, David W.; Casoni, Beatrice; Leoni, Marta; Rossi, Giorgia; Dall'Olio, Riccardo; Caruso, Rosangela; Nanni, Maria Giulia; Grassi, Luigi

doi:10.1016/j.jpsychores.2019.109889

Cited by 24 publications

(20 citation statements)

References 71 publications

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“…The limitations of our study are: (1) the small sample size of our population that does not allow us to generalize our results and (2) the lack of control group of patients with other kidney conditions. Further multicenter studies on larges cohort of KTRs could be conducted using a short form of PTGI [ 8 , 63 , 64 ], after its validation in the kidney transplant setting. Furthermore, (3) in our cohort the main cause of CKD was quite different from other investigated populations, however this variable seems not to be correlated with PTG score [ 24 , 25 ].…”

Section: Discussionmentioning

confidence: 99%

“…Recently, demoralization, a psychological syndrome distinct from depression [ 7 ], has been diagnosed in a high percentage of medically ill patients [ 8 ], particularly with a high prevalence of up to 86% in KTRs [ 9 ]. That is a condition described as a state of existential distress, characterized by loss of meaning and purpose in life, hopelessness and helplessness and feelings of “being trapped” because of persistently being unable to cope with a particular stressful situation [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

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Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

Battaglia

Zerbinati

Murri

et al. 2021

JCM

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Although kidney transplant can lead to psychiatric disorders, psychosocial syndromes and demoralization, a positive post-traumatic growth (PTG) can occur in kidney transplant recipients (KTRs). However, the PTG-Inventory (PTGI), a reliable tool to measure PTG is scarcely used to explore the effect of this stressful event in KTRs. Thus, the purpose of our study was to assess the level of PTG and its correlation with demoralization, physical and emotional symptoms or problems via network analysis in KTRs. Additionally, we aimed at exploring the association of PTG with psychiatric diagnoses, Diagnostic Criteria for Psychosomatic Research (DCPR) conditions, and medical variables. A total of 134 KTRs were tested using MINI International Neuropsychiatric Interview 6.0 (MINI 6.0), DCPR interview, PTGI, Edmonton Symptom Assessment System (ESAS), Canadian Problem Checklist (CPC) and Demoralization scale (DS-IT). PTGI was used to investigate the positive psychological experience of patients after KT. It consists of 21 items divided in five factors. Routine biochemistry, immunosuppressive agents, socio-demographic and clinical data were collected. A symptom network analysis was conducted among PTGI, ESAS and DS-IT. Mean score of PTGI total of sample was 52.81 ± 19.81 with higher scores in women (58.53 ± 21.57) than in men (50.04 ± 18.39) (p < 0.05). PTGI-Relating to Others (16.50 ± 7.99) sub-score was markedly higher than other PTGI factor sub-scores. KTRs with DCPR-alexithymia or International Classification of Diseases, tenth revision (ICD-10) anxiety disorders diagnosis had lower PTGI total score and higher PTGI-Personal Strength sub-score, respectively (p < 0.05). The network analysis identified two communities: PTGI and ESAS with DS-IT. DS-IT Disheartenment, DS-IT Hopelessness and PTGI Relating to Others were the most central items in the network. After 1000 bootstrap procedures, the Exploratory graph analysis revealed the presence of a median of two communities in the network in 97.5% of the bootstrap iterations. A more extensive use of PTGI should be encouraged to identify and enhance the positive psychological changes after KT.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

Battaglia

Zerbinati

Murri

et al. 2021

JCM

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“…These additional items do not contribute to the total score of this measure and will not be included in our data analysis but will be used to trigger a risk assessment protocol. The Italian PHQ9 version [ 46 ] shows high internal consistency and discriminates well between individuals with and without depressive disorders for cut-offs of 9 and 10) [ [46] , [47] , [48] ].…”

Section: Trial Conditionsmentioning

confidence: 99%

“…Low levels of demoralization were indicated by a score 10, moderate demoralization by a score 11–36, and high demoralization by a score >37. The Italian version showed a good degree of stability and internal consistency [ 48 , 51 , 52 ].…”

Section: Trial Conditionsmentioning

confidence: 99%

Effectiveness of a brief manualized intervention, Managing Cancer and Living Meaningfully (CALM), adapted to the Italian cancer care setting: Study protocol for a single-blinded randomized controlled trial

Caruso

Nanni

Rodin

et al. 2020

Contemporary Clinical Trials Communications

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Patients with advanced cancer suffer from psychosocial distress that may impair quality of life and that may be ameliorated by psychotherapeutic treatment. We describe here the methodology of a randomized controlled trial (RCT) to assess the effectiveness of a novel, brief, semi-structured psychotherapeutic intervention to reduce distress and increase well-being in patients with advanced or metastatic cancer. The intervention, called Managing Cancer and Living Meaningfully (CALM), was originally developed in Canada and we are now testing its Italian adaptation (CALM-IT). The study is a single-blinded phase III RCT with assessment at baseline, 3 and 6 months with two conditions: CALM-IT versus a nonspecific supportive intervention (SPI). Eligibility criteria include: ≥ 18 years of age; fluency in the Italian language; no cognitive deficit, and diagnosis of advanced or metastatic cancer with an expected survival of 12–18 months. CALM-IT includes up to 12 sessions, delivered over 6 months and covers 4 domains: i) Symptom Management and Communication with Health Care Providers; ii) Changes in Self and Relations with Close Others; iii) Sense of Meaning and Purpose; and iv) the Future and Mortality. The primary outcome is difference in severity of depressive symptoms between treatment arm and the primary endpoint is 6 months. The secondary endpoint is 3 months and secondary outcomes are: generalized anxiety, distress about dying and death, demoralization, spiritual well-being, attachment security, posttraumatic growth, communication with partners, quality of life, and satisfaction with clinical care. If shown to be effective, CALM-IT can be implemented nationally to relieve distress and to promote psychological well-being in patients with advanced cancer.

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“…In order to examine and screen for this condition, a specific psychometric tool, the Demoralization Scale (DS), has been developed [25]. Recent data have shown the validity of the DS when used in medical settings, including oncology, palliative care, and internal medicine [26][27][28], as well as psychiatry [29].…”

Section: Introductionmentioning

confidence: 99%

The Use of Demoralization Scale in Italian Kidney Transplant Recipients

Battaglia

Zerbinati

Piazza

et al. 2020

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Demoralization is a commonly observed syndrome in medically ill patients. The risk of demoralization may increase in patients after a kidney transplant (KTRs) because of the stressful nature of renal transplantation, psychosocial challenges, and adjustment needs. No study is available on demoralization amongst KTRs. The purpose of our study was to evaluate the validity of the Italian version of the Demoralization Scale (DS-IT) and the prevalence of demoralization in KTRs. Also, we aimed at exploring the association of the DS-IT with International Classification of Diseases (ICD) psychiatric diagnoses, post-traumatic growth (PTG), psychological and physical symptoms, and daily-life problems. A total of 134 KTRs were administered the MINI International Neuropsychiatric Interview 6.0. and the Diagnostic Criteria for Psychosomatic Research–Demoralization (DCPR/D) Interview. The DS-IT, the Edmonton Symptom Assessment System (ESAS), the Canadian Problem Checklist (CPC), were used to measure demoralization, physical and psychological symptoms, and daily-life problems; also, positive psychological experience of kidney transplantation was assessed with the PTG Inventory. Routine biochemistry and sociodemographic data were collected. Exploratory factor analysis demonstrated a four-dimensional factor structure of the DS-IT, explaining 55% of the variance (loss of meaning and purpose, disheartenment, dysphoria, and sense of failure). DS-IT Cronbach alpha coefficients indicated good or acceptable level of internal consistency. The area under the Receiving Operating Characteristics (ROC) curve for DS-IT (against the DCPR/D interview as a gold standard) was 0.92. The DS-IT optimal cut-off points were ≥20 (sensitivity 0.87, specificity 0.82). By examining the level of demoralization, 14.2%, 46.3%, 24.6%, and 14.6% of our sample were classified as having no, low, moderate, and high demoralization, respectively, with differences according to the ICD psychiatric diagnoses (p < 0.001). DS-IT Total and subscales scores were positively correlated with scores of ESAS symptoms and CPC score. A correlation between DS-IT loss of meaning and purpose subscale and PTGI appreciation of life subscale (p < 0.05) was found. This study shows, for the first time, a satisfactory level of reliability of the DS-IT and a high prevalence of severe demoralization in KTRs.

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Assessing demoralization in medically ill patients: Factor structure of the Italian version of the demoralization scale and development of short versions with the item response theory framework

Cited by 24 publications

References 71 publications

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

Effectiveness of a brief manualized intervention, Managing Cancer and Living Meaningfully (CALM), adapted to the Italian cancer care setting: Study protocol for a single-blinded randomized controlled trial

The Use of Demoralization Scale in Italian Kidney Transplant Recipients

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