Exploring and assessing demoralization in patients with non-psychotic affective disorders

Grassi, Luigi; Pasquini, Massimo; Kissane, David W.; Zerbinati, Luigi; Caruso, Rosangela; Sabato, Silvana; Nanni, Maria Giulia; Ounalli, Heifa; Maraone, Annalisa; Roselli, Valentina; Murri, Martino Belvederi; Biancosino, Bruno; Biondi, Massimo

doi:10.1016/j.jad.2020.05.043

Cited by 15 publications

(18 citation statements)

References 69 publications

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“…While previous studies have demonstrated a relationship between demoralization and suicidal risk, these studies examined only patients with cancer or organic illnesses [33][34][35][36]. In addition, only a few studies have investigated this relationship in patients affected by schizophrenia, suggesting that, for patients with high illness insight, both repeated psychotic crises and functional deterioration can increase suicidal risk [11][12][13][14][15][16][17][18][19][20][21][22][23]. In a previous article, Berardelli et al [23] proposed that the presence of demoralization symptoms moderates the association between depression and suicidal risk.…”

Section: Discussionmentioning

confidence: 99%

“…Only a few studies have investigated demoralization in psychiatric patients [11,12]. Drake described a model of demoralization syndrome in patients with schizophrenia, in which repeated exacerbations of psychotic symptoms and functional deterioration can precipitate suicidal risk, particularly during the period of clinical improvement following relapse [11].…”

Section: Introductionmentioning

confidence: 99%

“…Insight in psychosis has been extensively investigated because of its association with outcome [14,15]. The insight paradox theory [16,17] postulates that insight in psychosis is connected to depressive symptoms, the demoralization syndrome, and increased suicidal risk [11][12][13][14][15][16][17][18]. Previous studies have shown that high levels of insight may increase suicidal risk, while other studies find no relationships between insight and suicidality [19].…”

Section: Introductionmentioning

confidence: 99%

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Are Demoralization and Insight Involved in Suicide Risk? An Observational Study on Psychiatric Inpatients

Berardelli¹,

Innamorati²,

Sarubbi³

et al. 2021

Psychopathology

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Introduction: Several features contribute to determining suicide risk. This study was designed with the aim of evaluating whether insight into illness and demoralization are involved in suicide risk (active suicidal ideation or behavior). Methods: For this purpose, in a sample of 100 adult psychiatric inpatients, we used the Columbia Suicide Severity Rating Scale to assess suicide risk, the Demoralization Scale for demoralization symptoms, and the Insight Scale to assess illness insight. We also investigated several demographic and clinical features, including gender, age, duration of untreated illness, previous suicide attempts, and nonsuicidal self-injurious behavior. Results: The results demonstrated that patients with higher scores on the insight-high dimension had 1.35 greater odds of having a higher suicide risk, and those with lifetime suicide attempts had 7.45 greater odds of having a higher suicide risk. Among the various clinical factors, the study indicated that only nonsuicidal self-harm behaviors in the last 3 months was a risk factor for suicide risk. Conclusions: The results indicated that greater illness insight is involved in suicide risk regardless of demoralization.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Are Demoralization and Insight Involved in Suicide Risk? An Observational Study on Psychiatric Inpatients

Berardelli¹,

Innamorati²,

Sarubbi³

et al. 2021

Psychopathology

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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

JCM

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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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“…These syndromes tend to be recurrent or chronic, which can evoke a sense of demoralization. 20 Moreover, such patients have a higher incidence of suicidal behaviour and elevated suicide risk, 21 presenting challenges for management in the context of primary care. Though periodically requiring specialist involvement from psychiatry and outpatient mental health clinics, these patients often rely on their family physician as the backbone of formal support for their mental health difficulties.…”

Section: Introductionmentioning

confidence: 99%

Primary care and suicidality among psychiatric outpatients: The patient-doctor relationship matters

Schultz

Sandhu

Kealy

2020

Int J Psychiatry Med

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Objective The purpose of the current study is to examine the relationship between the quality of the Patient-Doctor Relationship and suicidality among patients seeking mental health care; specifically, whether patients who perceive having a more positive relationship with primary care physician will have lower levels of suicidality. Method Cross-sectional population-based study in Greater Vancouver, Canada. One-hundred ninety-seven participants were recruited from three Mental Health Clinics who reported having a primary care physician. Participants completed a survey containing questions regarding items assessing quality of Patient-Doctor Relationship, general psychiatric distress (K10), borderline personality disorder, and suicidality (Suicidal Behaviours Questionnaire-Revised-SBQ-R). Zero-order correlations were computed to evaluate relationships between study variables. Hierarchical regression analysis was used to control for confounding variables. Results The quality of the patient doctor relationship was significantly negatively associated with suicidality. The association between the quality of the patient-doctor relationship and suicidality remained significant even after controlling for the effects of psychiatric symptom distress and borderline personality disorder features. Conclusions The degree to which patients’ perceive their primary care physician as understanding, reliable, and dedicated, is associated with a reduction in suicidal behaviors. Further research is needed to better explicate the mechanisms of this relationship over time.

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Exploring and assessing demoralization in patients with non-psychotic affective disorders

Cited by 15 publications

References 69 publications

Are Demoralization and Insight Involved in Suicide Risk? An Observational Study on Psychiatric Inpatients

Are Demoralization and Insight Involved in Suicide Risk? An Observational Study on Psychiatric Inpatients

The Use of Demoralization Scale in Italian Kidney Transplant Recipients

Primary care and suicidality among psychiatric outpatients: The patient-doctor relationship matters

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