Protective Factors of Demoralization among Cancer Patients in Taiwan: An Age-matched and Gender-matched Study

Li, Yuchi; Ho, Chung‐Han; Wang, Hsiu‐Hung

doi:10.1016/j.anr.2017.07.001

Cited by 13 publications

(23 citation statements)

References 27 publications

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“…Family, friends and partners are among the most often mentioned areas relevant to the meaning of life (Fegg et al, 2008 ). Higher income was associated with lower demoralization which is in accordance with findings describing monthly income as protective factor of demoralization (Lee et al, 2012 ; Li et al, 2017 ). This could be due to existential concerns as a result of financial insecurity.…”

Section: Discussionsupporting

confidence: 89%

Norm Values and Psychometric Properties of the 24-Item Demoralization Scale (DS-I) in a Representative Sample of the German General Population

et al. 2021

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Purpose: The Demoralization scale (DS-I) is a validated and frequently used instrument to assess existential distress in patients with cancer and other severe medical illness. The purpose of this study was to provide normative values derived from a representative German general population sample and to analyze the correlational structure of the DS-I.Methods: A representative sample of the adult German general population completed the DS-I (24 Items), the Emotion Thermometers (ET) measuring distress, anxiety, depression, anger, need for help, and the Functional Assessment of Chronic Illness Therapy Fatigue Scale (FACIT-fatigue).Results: The sample consists of N = 2,407 adults (mean age = 49.8; range = 18–94 years), 55.7% women). The percentages of participants above the DS-I cutoff (≥30) was 13.5%. The mean scores of the DS-I dimensions were as follows: (1) loss of meaning and purpose: M = 2.78 SD = 4.49; (2) disheartenment: M = 3.19 SD = 4.03; (3) dysphoria M = 4.51 SD = 3.20; (4) sense of failure: M = 6.24 SD = 3.40; and for the DS-I total score: M = 16.72 SD = 12.74. Women reported significantly higher levels of demoralization than men, with effect sizes between d = 0.09 (Loss of Meaning) and d = 0.21 (Dysphoria). Age was not associated with demoralization in our sample. DS-I reliability was excellent (α = 0.94) and DS-I subscales were interrelated (r between 0.31 and 0.87) and significantly correlated with ET, especially depression, anxiety, and need for help and fatigue (r between 0.14 and 0.69).Conclusions: In order to use the DS-I as a screening tool in clinical practice and research the normative values are essential for comparing the symptom burden of groups of patients within the health care system to the general population. Age and sex differences between groups of patients can be accounted for using the presented normative scores of the DS-I.

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Section: Discussionsupporting

confidence: 89%

Norm Values and Psychometric Properties of the 24-Item Demoralization Scale (DS-I) in a Representative Sample of the German General Population

et al. 2021

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“…There were 34 cross-sectional studies, 5 longitudinal studies and 1 randomised controlled trial included in this review. Two studies (Li et al, 2016(Li et al, , 2017 included in this review reported different relevant analysis findings based on the same study population.…”

Section: Resultsmentioning

confidence: 99%

“…Some studies identified no demographic factors as being predictive of higher levels of demoralisation, although cohort sizes were smaller for some (see Table 3) with potential sample bias resulting (Arts-de Jong et al, 2018; Bovero et al, 2019; Cersonsky et al, 2019; Quintero Garzón et al, 2018). Other studies reported that patients with lower education (Bailey et al, 2020; Bobevski et al, 2015; Hsu et al, 2021; Ko et al, 2018; Li et al, 2016; Tang et al, 2020; Wu et al, 2018), lower income level (Cheng et al, 2019; Hsu et al, 2021; Li et al, 2016, 2017; Tang et al, 2020), female gender (De Weert et al, 2017; Ignatius and De La Garza, 2019; Ko et al, 2018; Li et al, 2016) and younger age (De Weert et al, 2017; Ignatius and De La Garza, 2019; Koo et al, 2018; Vehling et al, 2015) were relatively more demoralised. Additionally, being single/non-partnered (Ignatius and De La Garza, 2019; Li et al, 2016) and having poor social support were found to mediate higher demoralisation (An et al, 2018; Li et al, 2017; Philipp et al, 2020; Quintero Garzón et al, 2018).…”

Section: Resultsmentioning

confidence: 99%

“…Other studies reported that patients with lower education (Bailey et al, 2020; Bobevski et al, 2015; Hsu et al, 2021; Ko et al, 2018; Li et al, 2016; Tang et al, 2020; Wu et al, 2018), lower income level (Cheng et al, 2019; Hsu et al, 2021; Li et al, 2016, 2017; Tang et al, 2020), female gender (De Weert et al, 2017; Ignatius and De La Garza, 2019; Ko et al, 2018; Li et al, 2016) and younger age (De Weert et al, 2017; Ignatius and De La Garza, 2019; Koo et al, 2018; Vehling et al, 2015) were relatively more demoralised. Additionally, being single/non-partnered (Ignatius and De La Garza, 2019; Li et al, 2016) and having poor social support were found to mediate higher demoralisation (An et al, 2018; Li et al, 2017; Philipp et al, 2020; Quintero Garzón et al, 2018). The demographic factors associated with demoralisation are summarised in Table 3.…”

Section: Resultsmentioning

confidence: 99%

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Mental state of demoralisation across diverse clinical settings: A systematic review, meta-analysis and proposal for its use as a ‘specifier’ in mental illness

Gan

Gong

Kissane

2021

Aust N Z J Psychiatry

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Objective: Demoralisation is a state of poor coping characterised by low morale, hopelessness, subjective incompetence, and loss of meaning and purpose in life. While studied extensively in oncology and palliative care, there has been recent exploration in broader medical and mental health settings. The aim was to investigate the prevalence of demoralisation and associated sociodemographic and psychological factors across these clinical settings. Method: Six electronic databases were used to locate articles from January 2014 to March 2020. A pre-publication update of non-oncology populations was completed in September 2021. The review has been reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled prevalence of demoralisation was determined through % prevalence and mean demoralisation score; this was synthesised through meta-analysis of single means to determine pooled mean prevalence of Demoralisation Scale scores using the ‘R’ statistical software. Results: Demoralisation has been examined in 52 studies ( n = 11,670) and found to be prevalent in 24–35% of oncology and non-oncology, including mental health, populations. The mean score on the Demoralisation Scale was 24.3 (95% confidence interval, CI = [21.3, 27.3]). There was evidence of divergent validity in addition to significant comorbidity between depression, demoralisation and suicidal ideation. Burdensome physical symptoms, and psychological and demographic factors are strongly correlated with demoralisation. Conclusion: There remains a need to recognise demoralisation in various clinical and cultural settings and to strongly consider its inclusion as a ‘specifier’ within formal nosological systems for adjustment and depressive disorders. This is important to initiate targeted interventions and prevent significant morbidity.

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“…It is suggested that depressive patients tend to perceive that the source of distress is internal to them and often lack motivation, while in contrast, demoralized patients perceive that the source of distress is external to them and frequently present with uncertainty about the direction their actions should follow, implying that their motivation is intact [1]. Multiple studies have shown that demoralization is more associated with psychological state rather than the physical condition [12][13][14]. Furthermore, for clinicians or medical staff devoted to caring for patients with cancer, patients under hospice care, or patients with chronic psychosis, the most important concern is not only to differentiate demoralized patients from depressive ones, but also to provide appropriate and efficient treatment strategies for patients with a high demoralization level [1].…”

Section: Open Accessmentioning

confidence: 99%

Demoralization level fluctuated at various time frame of radiotherapy for patients with different cancers: a longitudinal observational study

et al. 2022

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Background Demoralization is a psychological response that is frequently observed in patients with cancer or advanced diseases. It is affected by national characteristics, culture, disease characteristics and general conditions of the patient such as individual cultural features, nature of stress, personal expression preferences and social behavior. Compared with the results of previous studies on demoralization syndrome, patients with cancer in Taiwan exhibit a higher prevalence of demoralization. We aimed to investigate the prevalence of high demoralization and the changes in the level of demoralization in cancer patients during radiotherapy to explore the associated factors and the contributing factors to the high level of demoralization. Methods We used the Demoralization Scale-Mandarin Version to evaluate the demoralization level at six-time points in patients admitted for radiotherapy in a 3-month observational period. 101 patients allocated to three groups by cancer region completed the study. We applied the generalized estimating equation (GEE) to analyze the changes in the demoralization level among the three groups. The variables associated with the changes in the demoralization level were also investigated. Results In the analysis using univariate GEE, only patients in the chest and breast group exhibited significant changes at two different time points. The results obtained using multivariate GEE revealed that sociodemographic variables, stage of disease and use of surgery or chemotherapy had no impact on the changes in demoralization across three months. Conclusion The demoralization level certainly fluctuated in an extremely high range. The higher prevalence of demoralized patients may indicate that if medical staff neglect the importance of demoralization, demoralized patients with cancer may not receive appropriate care.

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Protective Factors of Demoralization among Cancer Patients in Taiwan: An Age-matched and Gender-matched Study

Cited by 13 publications

References 27 publications

Norm Values and Psychometric Properties of the 24-Item Demoralization Scale (DS-I) in a Representative Sample of the German General Population

Norm Values and Psychometric Properties of the 24-Item Demoralization Scale (DS-I) in a Representative Sample of the German General Population

Mental state of demoralisation across diverse clinical settings: A systematic review, meta-analysis and proposal for its use as a ‘specifier’ in mental illness

Demoralization level fluctuated at various time frame of radiotherapy for patients with different cancers: a longitudinal observational study

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