Exploring and assessing demoralization in patients with non-psychotic affective disorders

Luigi Grassi; Massimo Pasquini; David Kissane; Luigi Zerbinati; Rosangela Caruso; Silvana Sabato; Maria Giulia Nanni; Heifa Ounalli; Annalisa Maraone; Valentina Roselli; Martino Belvederi Murri; Bruno Biancosino; Massimo Biondi

doi:10.1016/j.jad.2020.05.043

Exploring and assessing demoralization in patients with non-psychotic affective disorders

J Affect Disord. 2020 Sep 1:274:568-575. doi: 10.1016/j.jad.2020.05.043. Epub 2020 May 23.

Authors

Affiliations

¹ Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44100 Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital, Ferrara, Italy. Electronic address: luigi.grassi@unife.it.
² Department of Human Neurosciences, SAPIENZA University of Rome, Rome Italy. Electronic address: massimo.pasquini@uniroma1.it.
³ Department of Palliative Medicine, University of Notre Dame Australia and Cunningham Centre, St Vincent's Hospital, Sydney, NSW, Australia; Szalmuk Family Research Unit at Cabrini Health, Victoria, Australia. Electronic address: David.kissane@nd.edu.au.
⁴ Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44100 Ferrara, Italy. Electronic address: luigi.zerbinati@unife.it.
⁵ Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44100 Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital, Ferrara, Italy. Electronic address: rosangela.caruso@unife.it.
⁶ Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44100 Ferrara, Italy. Electronic address: silvana.sabato@unife.it.
⁷ Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44100 Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital, Ferrara, Italy. Electronic address: mariagiulia.nanni@unife.it.
⁸ Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44100 Ferrara, Italy. Electronic address: heifa.ounalli@unife.it.
⁹ Department of Human Neurosciences, SAPIENZA University of Rome, Rome Italy. Electronic address: annalisamaraone@gmail.com.
¹⁰ Department of Human Neurosciences, SAPIENZA University of Rome, Rome Italy. Electronic address: vale.roselli3@gmail.com.
¹¹ Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Via Fossato di Mortara 64a, 44100 Ferrara, Italy; University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital, Ferrara, Italy. Electronic address: martino.belvederimurri@unife.it.
¹² University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital, Ferrara, Italy. Electronic address: b.biancosino@ausl.fe.it.
¹³ Department of Human Neurosciences, SAPIENZA University of Rome, Rome Italy. Electronic address: massimo.biondi@uniroma1.it.

PMID: 32663989
DOI: 10.1016/j.jad.2020.05.043

Abstract

Background: Demoralization, as assessed through the Diagnostic Criteria for Psychosomatic Research-Demoralization (DCPR/D) interview or the Demoralization Scale (DS), has been found to affect about 30% of patients with medical disorders, while few studies have been done in patients with psychiatric disorders.

Methods: A convenience sample of 377 patients with ICD-10 diagnoses of mood, anxiety, stress-related disorders or other non-psychotic disorders was recruited from two Italian university psychiatry centers. The DCPR/D interview and the Italian version of the DS (DS-IT) were used to assess demoralization and the Patient Health Questionnaire-9 (PHQ-9) to assess depression.

Results: Demoralization was diagnosable in more than 50% of the patients. Factor analysis of the DS-IT indicated four main factors, Meaninglessness/Helplessness, Disheartenment, Dysphoria and Sense of Failure, explaining 62% of the variance of the scale. Patients with bipolar or unipolar major depression and personality disorders had the highest prevalence of demoralization (DCPR/D) and the highest scores on all the DS-IT factors in comparison with patients with adjustment or anxiety disorders. About 50% of patients with moderate demoralization (DS-IT) were not clinically depressed (PHQ-9 <10), while almost all with severe demoralization were depressed.

Limitations: Prospective studies on larger samples with other psychiatric disorders, also taking into account subjective incompetence, are needed. Since the DCPR/D assesses demoralization as a categorical construct, a dimensional framework should be necessary.

Conclusions: The findings enrich the research on demoralization, showing for the first time the importance of this construct, as measured by the DCPR/D and the DS-IT, in patients with psychiatric disorders.

Keywords: Adjustment disorders; Affective disorders; Anxiety; Demoralization; Depression.

MeSH terms

Anxiety*
Demoralization*
Factor Analysis, Statistical
Humans
Italy
Prospective Studies