Demoralization and depression in Chinese cancer patients

Wu, Wenjing; Quan, Manman; Gao, Lei; Li, Qian; Yan, C. J.; Zhang, Qian; Shi, Bingjie

doi:10.1007/s00520-021-06195-9

Cited by 14 publications

(18 citation statements)

References 23 publications

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“…Despite the positive association between depression and demoralization, both constructs can be distinguished by its core symptoms (depression: loss of pleasure and interest vs. demoralization: a loss of meaning, Robinson et al, 2015 ) and a dimensional characterization of depressed/demoralized patients indicates possible implications for treatment ( Belvederi Murri et al, 2020a ). Recent research identified a proportion of patients [17% ( Wu et al, 2021 ) up to 28% ( Tang et al, 2020 )] with high levels of demoralization but low depression scores to whom special attention must be paid in clinical care. It is possible that these patients will be less likely to respond to antidepressants and are likely to respond best to meaning-centered psychotherapies ( Ignatius and De La Garza, 2019 ).…”

Section: Discussionmentioning

confidence: 99%

“…The Spanish DS-II version also showed a high internal consistency with α = 0.88 (total DS-II scale), α = 0.83 ( Meaning and Purpose) , and α = 0.79 ( Distress and Coping Ability ) ( Belar et al, 2019 ). Recently, a Chinese version of the DS-II was used in a cross-sectional study to assess demoralization in Chinese patients with advanced cancer ( Wu et al, 2021 ). The internal reliability of the Chinese DS-II was excellent, with α = 0.91 for the total scale, and α = 0.91 and α = 0.89 for its two subscales ( Wu et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

“…Recently, a Chinese version of the DS-II was used in a cross-sectional study to assess demoralization in Chinese patients with advanced cancer ( Wu et al, 2021 ). The internal reliability of the Chinese DS-II was excellent, with α = 0.91 for the total scale, and α = 0.91 and α = 0.89 for its two subscales ( Wu et al, 2021 ). However, although the DS-II had already been translated and used in various languages, it was not until the present study was conducted that it was translated into German or a psychometric evaluation of that version was carried out.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, the short version of the DS-II scale has also been used to investigate the association between demoralization and other established measures of psychological distress. For example, a strong positive association between DS-II and depression scores were reported ( Ignatius and De La Garza, 2019 ; Wu et al, 2021 ). Furthermore, various studies across different cancer populations have demonstrated strong associations between depression and body image disturbance, an issue which is known to greatly burden cancer survivors suffering from severe disease- and treatment-related body changes (e.g., body disfigurement, skin changes, weight gain or loss, scars, and hair loss) ( Hartung et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

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Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer

et al. 2021

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Objective: To test the psychometric properties, internal consistency, dimensional structure, and convergent validity of the German version of the Demoralization Scale-II (DS-II), and to examine the association between demoralization, sociodemographic, disease- and treatment-related variables in patients with cancer.Methods: We recruited adult patients with cancer at a Psychosocial Counseling Center and at oncological wards. Participants completed the 16-item DS-II, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-2 (GAD-2), Distress Thermometer (DT), and Body Image Scale (BIS). We analyzed internal consistency of the DS-II using Cronbach‘s Alpha (α). We tested the dimensional structure of the DS-II with Confirmatory Factor Analyses (CFA). Convergent validity was expressed through correlation coefficients with established measures of psychological distress. The associations between demoralization, sociodemographic, disease- and treatment-related variables were examined with ANOVAs.Results: Out of 942 eligible patients, 620 participated. The average DS-II total score was M = 5.78, SD = 6.34, the Meaning and Purpose subscale M = 2.20, SD = 3.20, and the Distress and Coping Ability subscale M = 3.58, SD = 3.45. Internal consistency ranged from high to excellent with α = 0.93 for the DS-II total scale, α = 0.90 for the Meaning and Purpose subscale, and α = 0.87 for the Distress and Coping Ability subscale. The one-factor and the two-factor model yielded similar model fits, with CFI and TLI ranging between 0.910 and 0.933, SRMR < 0.05. The DS-II correlated significantly with depression (PHQ-9: r = 0.69), anxiety (GAD-2: r = 0.72), mental distress (DT: r = 0.36), and body image disturbance (BIS: r = 0.58). High levels of demoralization were reported by patients aged between 18 and 49 years (M = 7.77, SD = 6.26), patients who were divorced/separated (M = 7.64, SD = 7.29), lung cancer patients (M = 9.29, SD = 8.20), and those receiving no radiotherapy (M = 7.46, SD = 6.60).Conclusion: The DS-II has very good psychometric properties and can be recommended as a reliable tool for assessing demoralization in patients with cancer. The results support the implementation of a screening for demoralization in specific risk groups due to significantly increased demoralization scores.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer

et al. 2021

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“…Three-point Likert scale was used, zero means never, one means sometimes, two means often. Total scores ranging between 0 and 32 and the partition criterion are defined as between 25 and 75th percentile as the author suggested [ 27 ]. In this study ≤ 5 points (0-25th percentile) means low demoralization, 5–17 points (25th-75th percentile) means moderate demoralization, and ≥ 18 points (≥ 75th percentile) means high demoralization.…”

Section: Methodsmentioning

confidence: 99%

Risk factor analysis and nomogram construction for predicting suicidal ideation in patients with cancer

et al. 2022

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Background Suicidal ideation in cancer patients is a critical challenge. At present, few studies focus on factors associated with suicidal ideation, and predictive models are still lacking. This study aimed at investigating the risk factors for suicidal ideation among cancer patients, and developed a predictive nomogram to screen high risk cancer patients for early prevention and intervention. Methods A questionnaire survey was conducted among cancer patients between May 2021 and January 2022. The factors associated with suicidal ideation were used to construct a multivariate logistic regression model, which was visualized as a predictive nomogram to evaluate the risk of suicidal ideation. Areas under the curve, calibration plot, decision curve analysis, and internal and external validation were used to validate the discrimination, calibration and clinical usefulness of the model. Results A total of 820 patients with cancer were recruited for this study and 213 (25.98%) developed suicidal ideation. Levels of demoralization, depression and cancer staging, marital status, residence, medical financial burden, and living condition were influence factors for suicidal ideation. Comparing nomogram with Self-rating Idea of Suicide Scale (SIOSS), the nomogram had a satisfactory discrimination ability with an AUC of 0.859 (95% CI: 0.827–0.890) and 0.818 (95% CI: 0.764–0.873) in the training and validation sets, respectively. The calibration plot and decision curve analysis revealed that this nomogram was in good fitness and could be beneficial in clinical applications. Conclusions Suicidal ideation is common in cancer patients. Levels of demoralization, depression and cancer staging were independent predictors of suicidal ideation. The nomogram is an effective and simple tool for predictive suicidal ideation in cancer patients.

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An investigation of the effect of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function in Iranian women with breast cancer: a randomized controlled trial

Soleymani Moghadam,

Parvizifard,

Foroughi

et al. 2024

J Cancer Res Clin Oncol

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Background Breast cancer is an extremely unpleasant and unbearable experience that can have a profound impact on a person’s life. Compared to other types of cancer, breast cancer has a more severe psychological impact on women. Purpose This study aimed to investigate the effect of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function in Iranian women with breast cancer. Method A sample of 30 women with breast cancer were randomly divided into intervention and control groups. The research was conducted in the oncology division of Imam Reza Hospital in Kermanshah by the clinical trial method with a two-group pretest–posttest design and a 2 month follow-up. Participants in the intervention group received Mindfulness-integrated cognitive behavior therapy for eight sessions. The intervention was carried out individually in weekly 60 min sessions. While the control group received self-help treatment (through an educational book). A demographic questionnaire, Demoralization Scale (DS-II), Body Image Scale (BIS), and Female Sexual Function Index (FSFI) were used to collect data. For data analysis, means and standard deviations were calculated and repeated measures and the Bonferroni test was conducted using SPSS 26. Results The results showed the effectiveness of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function (p < 0.05). Concerning demoralization in the intervention group, the pre-test mean was 16.73 ± 3.33, and it reduced to 11.93 ± 1.49 in the post-test. The body image mean score showed a decreasing trend in the intervention group, from 12.47 ± 1.88 in the pre-test to 8.80 ± 3.21 in the post-test. The mean score for sexual function showed an increasing trend, increasing from 18.06 ± 2.29 in the pre-test to 23.07 ± 0.91 in the post-test. There was no significant difference in the mean score of the post-test compared to the pre-test and follow-up in the control group (p < 0.05). Conclusion MICBT can be used in conjunction with pharmaceuticals and medical treatments to improve the psychological symptoms of women with breast cancer, according to this study’s results. Trial registration (IRCT20160103025817N6). 2022-04-06.

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Demoralization and depression in Chinese cancer patients

Cited by 14 publications

References 23 publications

Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer

Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer

Risk factor analysis and nomogram construction for predicting suicidal ideation in patients with cancer

An investigation of the effect of mindfulness-integrated cognitive behavior therapy on demoralization, body image, and sexual function in Iranian women with breast cancer: a randomized controlled trial

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