The Use of Demoralization Scale in Italian Kidney Transplant Recipients

Abstract

<jats:p>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 &lt; 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 &lt; 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.</jats:p>

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

“…Heterogeneity: Battaglia et al, 2020Murri et al, 2020bBerardelli et al, 2021Costanza et al, 2020aGrassi et al, 2020Hsu et al, 2021Koo et al, 2021Sadeghpour et al, 2020Van Tongeren et al, 2021Zhu et al, 202116.98] [36.58;40.42] [32.89;40.59] [58.89;63.31] [37.07;41.13] [24.21;30.71] [24.44;32.16] [33.24;39.26] [36.80;45.00] [ 8.50;14.10] 10.0% 10.1% 9.9% 10.1% 10.1% 10.0% 9.9% 10.0% 9.9% 10.0%…”

Psychosocial Dimensions in Hemodialysis Patients on Kidney Transplant Waiting List: Preliminary Data

“…Kidney transplantation (KT) is considered a more cost-effective treatment compared to dialysis [1] due to a reduced cardiovascular risk and overall mortality, but also because of better individual health-related quality of life (HRQoL) [2][3][4]. However, the disparity between the shortage of available kidney and the high demand for renal allografts cause an increasing average waiting period for deceased graft [5].…”

Exploring the Level of Post Traumatic Growth in Kidney Transplant Recipients via Network Analysis

“…The Italian Version of the Demoralization Scale (DS-IT) [ 41 ] is a widely valid tool for measuring the demoralization in medical setting and also more recently in KTRs, over the past 2 weeks [ 9 ]. It consists in 24 items which compose four subscales: loss of meaning and purpose, dysphoria, disheartenment, and sense of failure.…”

“…Recently, demoralization, a psychological syndrome distinct from depression [ 7 ], has been diagnosed in a high percentage of medically ill patients [ 8 ], particularly with a high prevalence of up to 86% in KTRs [ 9 ]. That is a condition described as a state of existential distress, characterized by loss of meaning and purpose in life, hopelessness and helplessness and feelings of “being trapped” because of persistently being unable to cope with a particular stressful situation [ 10 ].…”

“…Notably, although PTGI has been extensively used in traumatized healthy people [ 13 ], it has been also validated in several settings of medicine, such as psycho-oncology [ 14 ], neurology [ 15 ], hematopoietic stem cell [ 16 ] or liver transplantation [ 17 ] and dialysis [ 18 ]. Demoralization and PTG can be conceptualized as opposite reactions to a stressful event and, to date, little is known about the relationship between these two dimensions [ 9 ]. Thus, a network approach to psychopathology represents an intriguing option to investigate the associations between these two dimensions [ 19 , 20 ].…”