Psychometric Evaluation of the German Version of the Demoralization Scale-II and the Association Between Demoralization, Sociodemographic, Disease- and Treatment-Related Factors in Patients With Cancer

Abstract

Objective: To test the psychometric properties, internal consistency, dimensional structure, and convergent validity of the German version of the Demoralization Scale-II (DS-II), and to examine the association between demoralization, sociodemographic, disease- and treatment-related variables in patients with cancer.Methods: We recruited adult patients with cancer at a Psychosocial Counseling Center and at oncological wards. Participants completed the 16-item DS-II, Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Screener-2 (GAD-2), Distress Thermometer (DT), and Body Image Scale (BIS). We analyzed internal consistency of the DS-II using Cronbach‘s Alpha (α). We tested the dimensional structure of the DS-II with Confirmatory Factor Analyses (CFA). Convergent validity was expressed through correlation coefficients with established measures of psychological distress. The associations between demoralization, sociodemographic, disease- and treatment-related variables were examined with ANOVAs.Results: Out of 942 eligible patients, 620 participated. The average DS-II total score was M = 5.78, SD = 6.34, the Meaning and Purpose subscale M = 2.20, SD = 3.20, and the Distress and Coping Ability subscale M = 3.58, SD = 3.45. Internal consistency ranged from high to excellent with α = 0.93 for the DS-II total scale, α = 0.90 for the Meaning and Purpose subscale, and α = 0.87 for the Distress and Coping Ability subscale. The one-factor and the two-factor model yielded similar model fits, with CFI and TLI ranging between 0.910 and 0.933, SRMR < 0.05. The DS-II correlated significantly with depression (PHQ-9: r = 0.69), anxiety (GAD-2: r = 0.72), mental distress (DT: r = 0.36), and body image disturbance (BIS: r = 0.58). High levels of demoralization were reported by patients aged between 18 and 49 years (M = 7.77, SD = 6.26), patients who were divorced/separated (M = 7.64, SD = 7.29), lung cancer patients (M = 9.29, SD = 8.20), and those receiving no radiotherapy (M = 7.46, SD = 6.60).Conclusion: The DS-II has very good psychometric properties and can be recommended as a reliable tool for assessing demoralization in patients with cancer. The results support the implementation of a screening for demoralization in specific risk groups due to significantly increased demoralization scores.

Determining Psychometric Properties of the Persian Version of Demoralization Scale-II in Cancer Patients

“…(2016, b) reported α = 0.89 for the whole scale [20], and it was α = 0.93 in the study by Koranyi et al [19]. It…”

“…Originally introduced DS-II as a re ned measure of demoralization consisting of 16 items and 2 subscales: Meaning and Purpose and Distress and Coping Ability [20]. Koranyi et al (2021) used Con rmatory Factor Analyses to evaluate whether the proposed two-factor solution of the original DS-II scale [20] can be replicated with their sample of patients with cancer. They tested Two models: the one-factor model, aggregating across all 16 items, and the two-factor model according to the dimensional structure of two proposed subscales.…”

“…Nevertheless, there are some ambiguities in the factor structure of DS-II in the mentioned studies. For example, while Robinson et al )2016( introduced DS-II as a bifactor scale [20], Koranyi et al (2021) showed that the one-factor DS-II model is as t as the two-factor model of it [19]. This study aimed to determine the psychometric properties of DS-II in Iranian cancer patients with special analyses of the factor structure of DS-II.…”

Prevalence, Associated Factors and Adverse Outcomes of Demoralization in Cancer Patients: A Decade of Systematic Review

“…20,28,31,34 Two studies reported lower levels of demoralization in patients with shorter time since diagnosis, 44,46 but four studies reported that time since diagnosis was not associated with demoralization. 19,20,29,35 One study reported lower levels of demoralization in cancer patients who had radiotherapy, 28 but one study reported that radiotherapy was not associated with demoralization. 33 Five studies concluded that symptom burden was a positive predictor of demoralization, 17,18,30,37,43 but one study suggested that symptom burden was not significantly related to demoralization.…”

“…There was conflicting evidence for the relationship between the sociodemographic factors of age, gender, education, marital status, religion, employment status, monthly income, number of children, and demoralization. There was some evidence that cancer patients who were young, 28,29 single, [30][31][32] female, 30,32 unemployed, 32,33 and had low monthly income 31,32,34,35 have a higher probability of experiencing demoralization. Patients with at least one child 36 and those with religious beliefs 37 were less likely to experience demoralization.…”