Exploratory examination of the utility of demoralization as a diagnostic specifier for adjustment disorder and major depression

D.W. Kissane, I. Bobevski, P. Gaitanis, J. Brooker, Natasha Michael, C. Lethborg, G. Richardson, P. Webster, C. Hempton

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Objective Demoralization, a state of lowered morale and poor coping, has a prevalence of 13–18% among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of “with demoralization” as a diagnostic specifier for adjustment and depressive disorders. Method Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility. Results Vignettes were assessed by 280 clinicians; 77% supported utility of the category ‘adjustment disorder with demoralization’ compared to 33% supporting ‘adjustment disorder with anxiety’ (McNemar test, p < 0.001), while 83% supported the utility of ‘with demoralization’ for major depressive episode, matching 83% perceiving utility for ‘with melancholia.’ Sensitivity and specificity ratings were 77% and 94% for adjustment disorder with demoralization and 83% and 91% for major depression with demoralization. Conclusion Clinicians perceived the specifier ‘with demoralization’ to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization.
Original languageEnglish
Pages (from-to)20-24
Number of pages5
JournalGeneral Hospital Psychiatry
Volume46
DOIs
Publication statusPublished - 2017

Keywords

  • Utility
  • Demoralization
  • Diagnostic specifiers
  • Adjustment disorder
  • Depression
  • Oncology

Cite this

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title = "Exploratory examination of the utility of demoralization as a diagnostic specifier for adjustment disorder and major depression",
abstract = "Objective Demoralization, a state of lowered morale and poor coping, has a prevalence of 13–18{\%} among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of “with demoralization” as a diagnostic specifier for adjustment and depressive disorders. Method Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility. Results Vignettes were assessed by 280 clinicians; 77{\%} supported utility of the category ‘adjustment disorder with demoralization’ compared to 33{\%} supporting ‘adjustment disorder with anxiety’ (McNemar test, p < 0.001), while 83{\%} supported the utility of ‘with demoralization’ for major depressive episode, matching 83{\%} perceiving utility for ‘with melancholia.’ Sensitivity and specificity ratings were 77{\%} and 94{\%} for adjustment disorder with demoralization and 83{\%} and 91{\%} for major depression with demoralization. Conclusion Clinicians perceived the specifier ‘with demoralization’ to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization.",
keywords = "Utility, Demoralization, Diagnostic specifiers, Adjustment disorder, Depression, Oncology",
author = "D.W. Kissane and I. Bobevski and P. Gaitanis and J. Brooker and Natasha Michael and C. Lethborg and G. Richardson and P. Webster and C. Hempton",
year = "2017",
doi = "10.1016/j.genhosppsych.2017.01.007",
language = "English",
volume = "46",
pages = "20--24",
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Exploratory examination of the utility of demoralization as a diagnostic specifier for adjustment disorder and major depression. / Kissane, D.W.; Bobevski, I.; Gaitanis, P.; Brooker, J.; Michael, Natasha; Lethborg, C.; Richardson, G.; Webster, P.; Hempton, C.

In: General Hospital Psychiatry, Vol. 46, 2017, p. 20-24.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Exploratory examination of the utility of demoralization as a diagnostic specifier for adjustment disorder and major depression

AU - Kissane, D.W.

AU - Bobevski, I.

AU - Gaitanis, P.

AU - Brooker, J.

AU - Michael, Natasha

AU - Lethborg, C.

AU - Richardson, G.

AU - Webster, P.

AU - Hempton, C.

PY - 2017

Y1 - 2017

N2 - Objective Demoralization, a state of lowered morale and poor coping, has a prevalence of 13–18% among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of “with demoralization” as a diagnostic specifier for adjustment and depressive disorders. Method Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility. Results Vignettes were assessed by 280 clinicians; 77% supported utility of the category ‘adjustment disorder with demoralization’ compared to 33% supporting ‘adjustment disorder with anxiety’ (McNemar test, p < 0.001), while 83% supported the utility of ‘with demoralization’ for major depressive episode, matching 83% perceiving utility for ‘with melancholia.’ Sensitivity and specificity ratings were 77% and 94% for adjustment disorder with demoralization and 83% and 91% for major depression with demoralization. Conclusion Clinicians perceived the specifier ‘with demoralization’ to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization.

AB - Objective Demoralization, a state of lowered morale and poor coping, has a prevalence of 13–18% among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of “with demoralization” as a diagnostic specifier for adjustment and depressive disorders. Method Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility. Results Vignettes were assessed by 280 clinicians; 77% supported utility of the category ‘adjustment disorder with demoralization’ compared to 33% supporting ‘adjustment disorder with anxiety’ (McNemar test, p < 0.001), while 83% supported the utility of ‘with demoralization’ for major depressive episode, matching 83% perceiving utility for ‘with melancholia.’ Sensitivity and specificity ratings were 77% and 94% for adjustment disorder with demoralization and 83% and 91% for major depression with demoralization. Conclusion Clinicians perceived the specifier ‘with demoralization’ to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization.

KW - Utility

KW - Demoralization

KW - Diagnostic specifiers

KW - Adjustment disorder

KW - Depression

KW - Oncology

U2 - 10.1016/j.genhosppsych.2017.01.007

DO - 10.1016/j.genhosppsych.2017.01.007

M3 - Article

VL - 46

SP - 20

EP - 24

JO - General Hospital Psychiatry

JF - General Hospital Psychiatry

SN - 0163-8343

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