Indian Journal of Palliative Care
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 ORIGINAL ARTICLE
Year : 2006  |  Volume : 12  |  Issue : 1  |  Page : 8--15

Depression and demoralization as distinct syndromes: Preliminary data from a cohort of advanced cancer patients


1 Harvard Medical School Center for Palliative Care & Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Founders 600, Boston, MA 02114, USA
2 Center for Psycho-oncology and Palliative Care Research, Dana Farber Cancer Institute, 44 Binney St, Boston, MA 02115 & Department of Psychiatry, Brigham and Women's Hospital, USA
3 Harvard Medical School Center for Palliative Care; Center for Psycho-oncology and Palliative Care Research, Dana Farber Cancer Institute, 44 Binney St, Boston, MA 02115 & Department of Psychiatry, Brigham and Women's Hospital, USA
4 New Hampshire Oncology-Hematology PA, 200 Technology Drive, Hooksett, NH 03106-2505, USA
5 Department of Psychiatry, Yale University School of Medicine, 34 Park St New Haven, CT 06519, USA

Correspondence Address:
Juliet C Jacobsen
Massachusetts General Hospital, 55 Fruit Street, Founders 600, Boston, MA 02114
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1075.25913

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The term demoralization has been used to describe existential distress and despair of patients with advanced disease. Aim: This study sought to determine whether a cluster of symptoms interpreted as demoralization could be identified and distinguished from a cluster of depressive symptoms. Materials and Methods: As part of the Coping with Cancer Study, a federally funded multi-site study of advanced cancer patients, 242 patients were interviewed on a broad range of mental health parameters related to depression, grief, quality of life, self-efficacy, coping and religiousness/spirituality. Results: A principal components analysis revealed separate depression and demoralization/despair factors. Seven symptoms constituted the demoralization/despair factor: loss of control, loss of hope, anger/bitterness, sense of failure, feeling life was a burden, loss of meaning and a belief that life's meaning is dependent on health and were found to be internally consistent (Cronbach's a = 0.78). Only 14.8% of subjects with "syndromal demoralization" met DSM-IV criteria for Major Depression (MDD); 7.4% for Minor Depression. Of those with MDD only 28.6% had syndromal level demoralization. Prior history of MDD predicted current MDD, but not syndromal demoralization. Demoralization, not MDD, was significantly associated with the patient's reported level of inner peacefulness. When compared with MDD, syndromal demoralization was more strongly associated with wish to live and wish to die and equally predictive of mental health service use. Conclusion: The symptoms of demoralization are distinct from depressive symptoms and appear to be associated with the patient's degree of inner peacefulness.






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