Subtyping demoralization in the medically ill by cluster analysis

Abstract

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.

The association of demoralization with mental disorders and suicidal ideation in patients with cancer

“…6 Taking demoralization into account may add valuably to the picture of clinically relevant psychological distress in the context of life-threatening disease. 44 Future research should consider the interrelation of specific symptoms across these broader categories. This demoralization syndrome has distinct treatment implications.…”

“…Among those, it is possible that a prolonged loss of pleasure connects with a loss of hope and a feeling that life is no longer worth living. 44 Future research should consider the interrelation of specific symptoms across these broader categories. Identifying subtypes of symptom profiles could be of value in the development of psychological interventions; such profiles could also improve the evaluation of interventions when they are used as outcomes of effectiveness.…”

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

“…The DS has since been used in research on what factors are related to demoralization [13,14]. Although most research on demoralization has examined patients with serious illness [15], demoralization has been examined in other fields as well. For instance, some previous studies examined demoralization among refugee and migrant populations [16,17].…”

A correlational study of suicidal ideation with psychological distress, depression, and demoralization in patients with cancer

“…The concept of demoralization syndrome was proposed by Kissane and Clarke; it is experienced as a persistent inability to cope together with feelings of helplessness, hopelessness, and incompetence and the loss of aims and meaning in life [36]. However, some patients with cancer experience symptoms of demoralization without those of depression [29, 33, 35].…”