Major depression and demoralization in cancer patients: diagnostic and treatment considerations

Angelino, Andrew F.; Treisman, Glenn J.

doi:10.1007/s005200000195

Cited by 92 publications

(68 citation statements)

References 39 publications

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“…Clarke and colleagues, using latent trait analysis, found that the dimension of demoralization can be separated from that of anhedonic depression 42,43 . Similar observations have been made with cancer patients 30 . In a study of monozygotic twins discordant for a lifetime history of major depression, one of the three clusters of variables that were significantly different between affected and non-affected twins included higher scores in the twins with major depression in "acting out", in alcohol dependence and in attributes that may be viewed as surrogate (proxy) indicators of SI-helplessness, such as powerlessness, lack of self-efficacy, and a diminished self-perceived sense of mastery 44 .…”

Section: Major Depressive Disordersupporting

confidence: 86%

“…The distinction between "distress" and "demoralization" is at the center of a debate whether demoralization is a "normal" (i.e., non-pathological) or homeostatic (and, therefore, not requiring any intervention) or "abnormal" (i.e., pathological) reaction to adversity [29][30][31] . In a community-based sample, the prevalence of demoralization as measured by DCPR was far less frequent than the rates found among medically ill patients, suggesting that demoralization does not simply identify generic psychological distress 32 .…”

Section: Passing or Transient Distress Or Non-specific Distressmentioning

confidence: 99%

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Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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-Background and Objectives:The objectives of the manuscript are: (a) to review the understanding of demoralization and its assessment; (b) to describe its clinical progression; (c) to explain the differences between demoralization and other form of psychological distress; (d) to propose a set of criteria for future research on demoralization.Methods: A MEDLINE search using the keywords distress, subjective incompetence, depression, demoralization, helplessness, hopelessness and psychopathology was conducted. This was supplemented by a manual search of the literature.Results: Demoralization can be distinguished from passing or transient distress, nonspecific distress, sub-threshold depression or anxiety, and certain mental disorders. Demoralization can be a risk factor for the manifestation of psychopathology, the prodromal phase of a mental disorder, or a trigger for exacerbation or recurrence of psychiatric distress symptoms. The domains of distress and demoralization are described and research diagnostic criteria for demoralization are presented.Conclusions: The scales discussed in this article differ in their time frames and have not yet been applied to the same population at the same time. The role of demoralization as a risk factor for mental disorders is just beginning to be understood. The domains and the diagnostic criteria for demoralization presented in this article need to be confirmed by epidemiological and empirical studies. Future research should continue to clarify its role in the pathogenesis of both mental disorders and physical illnesses and identify appropriate interventions for its arrest or prevention. ObjectivesThis article has the following objectives: (a) to review the evolving understanding of demoralization and the methods proposed for its assessment; (b) to describe the clinical progression of demoralization; (c) to explain the differences between demoralization and passing or transient distress, non-specific distress and sub-threshold depression or anxiety, as well as the differences between demoralization and mental disorders such as major depressive disorder, dysthymic disorder, acute stress disorder, posttraumatic stress disorder, and adjustment disorder; and (d) to propose a set of criteria that may be considered for future research on demoralization. Understanding demoralizationAs defined by Frank, demoralization is the state of mind of a person deprived of spirit or courage, disheartened, bewildered, and thrown into disorder or confusion. He proposed that this state of mind occurs in many persons who seek psychotherapy, whatever their diagnostic label 1,2 . Demoralization always takes place within the context of a past, present, anticipated or imagined stressful situation. To further characterize the concept of demoralization, it has been proposed that the clinical hallmark of demoralization is "subjective incompetence" (SI) and that demoralization involves both SI and symptoms of distress, such as depression, anxiety, resentment, anger, or combinations thereof 3,4 . S...

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Section: Major Depressive Disordersupporting

confidence: 86%

Section: Passing or Transient Distress Or Non-specific Distressmentioning

confidence: 99%

Distress, demoralization and psychopathology: Diagnostic boundaries

Figueiredo

2013

Eur. J. Psychiat.

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“…Several studies confirmed a high prevalence of demoralization among patients with medical disorders, especially with life-threatening or disabling disorders [1][2][3][4][5][6][7] . Demoralization was also found to precede the onset of serious diseases, such as cancer, ischemic heart disease and stroke 1,6,8 .…”

Section: Introductionmentioning

confidence: 92%

Subtyping demoralization in the medically ill by cluster analysis

et al. 2013

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ITALY ABSTRACT -Background and Objectives:There is increasing interest in the issue of demoralization, particularly in the setting of medical disease. The aim of this investigation was to use both DSM-IV comorbidity and the Diagnostic Criteria for Psychosomatic Research (DCPR) in order to characterize demoralization in the medically ill.Methods: 1700 patients were recruited from 8 medical centers in the Italian Health System and 1560 agreed to participate. They all underwent a cross-sectional assessment with DSM-IV and DCPR structured interviews. 373 patients (23.9%) received a diagnosis of demoralization. Data were submitted to cluster analysis.Results: Four clusters were identified: demoralization and comorbid depression; demoralization and comorbid somatoform/adjustment disorders; demoralization and comorbid anxiety; demoralization without any comorbid DSM disorder. The first cluster included 27.6% of the total sample and was characterized by the presence of DSM-IV mood disorders (mainly major depressive disorder). The second cluster had 18.2% of the cases and contained both DSM-IV somatoform (particularly, undifferentiated somatoform disorder and hypochondriasis) and adjustment disorders. In the third cluster (24.7%), DSM-IV anxiety disorders in comorbidity with demoralization were predominant (particularly, generalized anxiety disorder, agoraphobia, panic disorder and obsessive-compulsive disorder). The fourth cluster had 29.5% of the patients and was characterized by the absence of any DSM-IV comorbid disorder.Conclusions: The findings indicate the need of expanding clinical assessment in the medically ill to include the various manifestations of demoralization as encompassed by the DCPR. Subtyping demoralization may yield improved targets for psychosomatic research and treatment trials.

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“…Mashhadi et al studied 400 patients with cancer after diagnosis of malignancy and before chemotherapy or radiotherapy and reported the prevalence of depression as 26.5% (17). Therefore, due to the high prevalence of depression in patients with cancer and its effects on cancer and disease process and response to treatment, researchers suggested experts and physicians to use counseling sessions and antidepressants drug as one of the main components of treatment for patients with cancer (18,19).…”

Section: Introductionmentioning

confidence: 99%

Prognostic Factors of Depression in Patients With Cancer Undergoing Chemotherapy and Radiotherapy

et al. 2014

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Background:Cancer is one of the chronic diseases, which increases the risk of depression. The main causes of depression among these patients are pain due to metastasis, limited social activities and disability. Objectives: The aim of this research was to determine the prevalence of depression and relevant factors in patients with cancer referred to Shiraz Nemazee hospital for chemotherapy and radiotherapy. Patients and Methods: This was a cross-sectional study on 260 patients with cancer. To diagnose depression, the Beck questionnaire was used. To analyze data, logistic regression was more appropriate than the univariate analysis, because it simultaneously considers the effects of each of the predictors. Results: The prevalence of depression was 47.4%. There was a statistically significant association between depression and income (P < 0.001), family history of depression (P = 0.001), satisfaction with her or his condition (P < 0.001), disease duration (P < 0.001) and education (P = 0.025). Logistic regression revealed that the main effective factors were disease duration more than five years (OR = 5.9, P = 0.013), lack of satisfaction with her or his condition (OR = 19.6, P < 0.001) and family history of depression (OR = 2.4, P = 0.049). Conclusions: Consultation sessions are necessary to reduce depression of patients with cancer. Since depression may reduce quality of life and reaction to treatment, curing depression may relatively reduce side effects of disease for patients to have less pain and problems.

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Major depression and demoralization in cancer patients: diagnostic and treatment considerations

Cited by 92 publications

References 39 publications

Distress, demoralization and psychopathology: Diagnostic boundaries

Distress, demoralization and psychopathology: Diagnostic boundaries

Subtyping demoralization in the medically ill by cluster analysis

Prognostic Factors of Depression in Patients With Cancer Undergoing Chemotherapy and Radiotherapy

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