Demoralization syndrome: New insights in psychosocial cancer care

Abstract

The psychological reactions of patients in response to cancer have been the object of psycho-oncology research since the first studies carried out by Arthur M. Sutherland in the middle of the last century.1 Subsequent better designed investigations were carried out in many parts of the world using standardized psychiatric interviews according to the Diagnostic Statistical Manual for Mental Disorders (DSM) of the American Psychiatric Association and the International Classification of Diseases (ICD) of the World Health Organization. Meta-analyses of these studies are now available 2 and indicate that approximately 30% to 40% of patients with cancer meet the criteria for a psychiatric diagnosis-especially depressive disorders-that have extremely negative consequences for the patients and their families (eg, impairment of quality of life, longer rehabilitation processes, risk of suicide, reduction in adherence to treatment).It is clear that having a system to codify the psychiatric disorders observable in oncology, including depression, is extremely important for a whole-person-centered approach that includes psychosocial aspects as mandatory targets. However, the psycho-oncology literature has demonstrated that many other psychosocial dimensions not detectable with classical psychiatric nosology (ie, ICD and DSM) are extremely common and have a remarkable role in negatively influencing a patient's quality of life. 3,4 Demoralization is one of the most important among the aforesaid constructs. It can be clinically separated from depressive disorders, has a high prevalence in medical disorders, and thus needs to be carefully examined, correctly measured, and treated. There have been several recent reports about the importance of demoralization, particularly in the settings of cancer and palliative care. [5][6][7] In this issue of Cancer, Robinson et al 8,9 explore the application of a new, refined, 16-item, self-report measure of demoralization (Demoralization Scale-II [DS-II]) in patients with cancer or other progressive diseases who were receiving palliative care. The analyses by Robinson and colleagues highlight the need for clinicians to consider demoralization as a significant clinical entity to be taken seriously into account in cancer settings. Demoralization Syndrome and its AssessmentThe concept of demoralization

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

“…These results are comparable to those of Grassi et al, 36 who found combined diagnoses of depression and demoralization in 6% of patients with breast and gastrointestinal cancer, with 23% being demoralized but not depressed. 37 Demoralization was significantly associated with suicidal ideation in this study. 22,23,31 A similar rate of 19% was found with a revised version of the DS.…”

Spiritual Needs of PTSD Patients in Croatia and Bosnia-Herzegovina: A Quantitative Pilot Study

“…mindfulness-based and contemplative practices) have been translated into a (secular) set of behavioral skills and successfully implemented in dialectic behavior therapy (DBT) for suicidal patients (Linehan and Wilks 2015;Baumann 2016). Also, similar to PTSD patients, palliative care patients faced with a life-threatening, incurable illness often suffer from demoralization, that is, a feeling of hopelessness due to a loss of their sense of meaning in life (Grassi & Nanni 2016). One approach that has been developed for use in palliative care patients is Dignity Therapy (Chochinov 2005).…”

Screening for emotional disorders in patients with cancer using the Brief Symptom Inventory (BSI) and the BSI‐18 versus a standardized psychiatric interview (the World Health Organization Composite International Diagnostic Interview)

“…The importance of prospective evaluation was underlined in a recent, large, prospective German study, which reported a 31.8% prevalence of mental disorders 4 weeks after diagnosis and a 39.8% prevalence at 12 months using the same instrument we used (CIDI). Finally, although we used a formal, semistructured psychiatric interview as a current gold standard to make diagnoses according to the ICD‐10, it is possible that subthreshold disturbances or other clinical expressions of significantly maladaptive responses to cancer (eg, demoralization, abnormal illness behavior) may have gone unrecognized. These psychological reactions often are not picked up by classic psychiatric nosological systems but could affect from 15% to 20% of patients with cancer …”