Validation of the Demoralization Scale in an Irish advanced cancer sample

Abstract

The results of the current study show that, in an Irish palliative care context, demoralization is not differentiated from depression. Additional factor analytic studies are needed to validate the Demoralization Scale.

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

“…In accordance with Kissane et al [29], those scoring ≥30 points (84 participants, 42 %) can be regarded as severely demoralized. An alternative suggested by Mullane et al [31] was to categorize patients as demoralized according to the criterion of mean ± 1 standard deviation; by that criterion, 31 participants (15.5 %) scoring >42 points (mean + SD = 28.26 + 13.32 = 41.58) could be categorized as highly demoralized. There were significant differences in level of demoralization with respect to current hospitalization status ( t  = −3.35, p  < 0.01), whether treatment was continued or discontinued ( t  = 2.23, p  < 0.05), type of malignancy ( t  = 2.56, p  < 0.05), and time since diagnosis ( F  = 2.86, p  < 0.05).…”

“…Aside from the elevated incidence of depression in patients with cancer, there is also a higher incidence of demoralization syndrome; studies conducted in Australia [29], America [30], Ireland [31], Western Europe [32], Germany [33], Hungary [34], and Taiwan [35] have produced similar results. 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].…”

A Systematic Review and Meta-Analysis of Demoralization and Depression in Patients With Cancer

“…For example, Mullane et al 25 suggested that future demoralization studies should add analysis of other factors or conduct verification using other groups, such as patients with motor neuron disease, immigrants, and refugees, to be more comprehensive. The DS has been used in various countries and is an effective psychometric instrument, with a preliminary finding for the differences between depression and demoralization in patients with cancer.…”

A Review of the Construct of Demoralization

“…The questionnaire was initially validated with 100 patients with advanced cancer and its factor structure involved 5 facets, loss of meaning in life, dysphoria, disheartenment, helplessness, and sense of failure. Since the original validation study was published, 4 additional validation studies have been published, [67][68][69][70] and the DS has been translated into several languages: Dutch, German, Hungarian, Italian, Lithuanian Mandarin, Portuguese, and Spanish. Overall, the DS has adequate psychometric properties, although confirmatory factor analysis has been recommended and test-retest reliability has yet to be examined.…”

“…Overall, the DS has adequate psychometric properties, although confirmatory factor analysis has been recommended and test-retest reliability has yet to be examined. [66][67][68][69][70] The establishment of divergent validity has also remained an issue, as there is a high level of convergence between depression and demoralization. As mentioned in the introduction section of this article, rates of severe demoralization range from 13% to 18% in patients with cancer or progressive disease.…”