Clinical utility of demoralization: A systematic review of the literature

Clinimetric properties of the diagnostic criteria for psychosomatic research among the elderly

“…On the contrary, the GDS has only two items addressing hopelessness ( ‘Are you hopeful about your future?’ and ‘Do you feel that your situation is hopeless?’) , whereas the others focus on depressive symptoms characteristics of old age, such as somatic and cognitive complaints, motivation, self‐image, loss and agitation (Yesavage et al, 1982). In addition, it is widely known that even though demoralization may overlap with depression, it may also be an independent clinical phenomenon (De Figueiredo, 1993; Woźniewicz & Cosci, 2023). Finally, DCPR‐R is a clinician‐administered interview while GDS is a self‐rated scale; thus, the point of view of the evaluator might contribute in different results.…”

“…Fear of disease was observed (Alzheimer's Association, 2014; Bystad et al, 2016; Cantegreil‐Kallen & Pin, 2012; Vrinten et al, 2014) and associated with increasing age (Noyes et al, 2004) due to the proximity to end‐of‐life and illness themes (Cantegreil‐Kallen & Pin, 2012). Demoralization, measured via the Demoralization Scale which seems to capture demoralization differently from DCPR (Woźniewicz & Cosci, 2023), was found to be related in the elderly to the loss of relationships, meaning and purposes in life (Kissane et al, 2001). Alexithymia is widely described (Gunzelmann et al, 2002; Onor et al, 2010) and associated with increasing age (Mattila et al, 2006) because of age‐related changes in emotional experiences (Onor et al, 2010) and neuroanatomical alteration in limbic structures (Paradiso et al, 2008).…”

“…DCPR‐R‐SSI represents a reliable and valid tool that could effectively fill in the gap in assessing psychosomatic syndromes in the elderly (Andreas et al, 2021; Mangelli et al, 2006; Mansueto et al, 2022; Wijeratne et al, 2003; Wijeratne & Hickie, 2001). DCPR‐R allow to add clinically useful information since DCPR‐R syndromes are associated with poor well‐being (Mansueto et al, 2022), DCPR demoralization is associated with clinically relevant features (Woźniewicz & Cosci, 2023) and DCPR alexithymia is associated with negative mood (Gunzelmann et al, 2002). Assessing old subjects via DCPR‐R is the first step to empower psychosocial factors protective in terms of morbidity and mortality.…”

“…Possible explanations are (a) the poor clinical utility of the current nosography (e.g. Diagnostic and Statistical Manual of Mental Disorders‐5 [DSM‐5]) (Cosci & Fava, 2016; Rapoport, 2014), which does not include psychosocial aspects affecting medical conditions (Cosci & Fava, 2016, 2019; Guidi et al, 2013; Hanel et al, 2009; Piolanti et al, 2019; Vanheule et al, 2014) even though they play a role in the causation, development, and healing process of physical disease (Basińska & Wozniewicz, 2016; Schulz & Albert, 2009); (b) elderly often has physical symptoms related to poor physical health, which might be erroneously interpreted as somatic symptom disorders (Rapoport, 2014); (c) psychological manifestations, such as demoralization and irritable mood, which pertain to the sphere of mood dysregulation, are at risk of being inappropriately diagnosed as major depressive or adjustment disorder (De Figueiredo, 1993, 2013; Marsa et al, 2020; Salazar et al, 2015; Woźniewicz & Cosci, 2023) also in old adults.…”

Clinical Characterization of Demoralization

“…After two decades of research and clinical use, the possibility of indicating hopelessness (when the individual feels he/she alone is responsible for the situation and there is nothing he/she or anyone else can do to overcome the problem) as a clinical specifier was included in the DCPR [9]. The aim of this paper was to outline the clinical characterization and implications of DCPR demoralization, as it has emerged from a large body of investigations summarized in two systematic reviews [10, 11] and from our extensive clinical experience.…”