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

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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.

Original languageEnglish
Pages (from-to)568-575
Number of pages8
JournalJournal of Affective Disorders
Publication statusPublished - 1 Sept 2020
Externally publishedYes


  • Adjustment disorders
  • Affective disorders
  • Anxiety
  • Demoralization
  • Depression

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