Relationship of demoralization with anxiety, depression, and quality of life: A Southern European study of Italian and Portuguese cancer patients

Maria Giulia Nanni, Rosangela Caruso, Luzia Travado, Cidalia Ventura, Alessandra Palma, Alejandra M. Berardi, Elena Meggiolaro, Federica Ruffilli, Cristina Martins, David Kissane, Luigi Grassi

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: Demoralization syndrome is a significant condition that has not been greatly studied in Southern European countries. Aims: To extend the knowledge of demoralization in Southern Europe by examining its prevalence according to different methods of assessment, its relationship with anxiety and depression, and its impact on quality of life (QoL) among cancer patients. Methods: A convenience sample of 195 cancer outpatients from two oncology centers (102 from Lisbon, Portugal, and 93 from Ferrara, Italy) participated in an observational, cross-sectional study using the Diagnostic Criteria of Psychosomatic Research-Demoralization interview (DCPR/D) and psychometric tools (Demoralization scale-DS; Patient Health Questionnaire–9/PHQ-9; Hospital Anxiety Depression Scale-HADS; and European Quality of Life-5-EQ-5D). Results: A 25.1% prevalence (CI 95%, 0.19-0.31) of clinically relevant demoralization was reported on the DCPR/D interview. A total demoralization score cutoff score ≥ 25 maximized sensitivity (81.6%), and specificity (72.6%) in identifying DCPR/D demoralized patients. The DCPR/D and DS were associated with poorer levels of QoL. About half of the patients who were demoralized were not clinically depressed (PHQ-9). Self-reported suicidal ideation (PHQ-9 item 9) was found in a minority of patients (8.2%), most of whom (77%) were cases of depression (PHQ-9), but one-quarter (23%) were not depressed, yet moderately/severely demoralized (DCPR/D and DS). Conclusions: This Southern European study confirms the importance of demoralization in cancer patients as a different condition with respect to depression and its relationship with poor QoL and suicidal ideation.

Original languageEnglish
Pages (from-to)2616-2622
Number of pages7
JournalPsycho-Oncology
Volume27
Issue number11
DOIs
Publication statusPublished - 1 Nov 2018

Keywords

  • cancer
  • demoralization
  • depression
  • oncology
  • psychiatry
  • psycho-oncology
  • quality of life

Cite this

Nanni, Maria Giulia ; Caruso, Rosangela ; Travado, Luzia ; Ventura, Cidalia ; Palma, Alessandra ; Berardi, Alejandra M. ; Meggiolaro, Elena ; Ruffilli, Federica ; Martins, Cristina ; Kissane, David ; Grassi, Luigi. / Relationship of demoralization with anxiety, depression, and quality of life : A Southern European study of Italian and Portuguese cancer patients. In: Psycho-Oncology. 2018 ; Vol. 27, No. 11. pp. 2616-2622.
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title = "Relationship of demoralization with anxiety, depression, and quality of life: A Southern European study of Italian and Portuguese cancer patients",
abstract = "Background: Demoralization syndrome is a significant condition that has not been greatly studied in Southern European countries. Aims: To extend the knowledge of demoralization in Southern Europe by examining its prevalence according to different methods of assessment, its relationship with anxiety and depression, and its impact on quality of life (QoL) among cancer patients. Methods: A convenience sample of 195 cancer outpatients from two oncology centers (102 from Lisbon, Portugal, and 93 from Ferrara, Italy) participated in an observational, cross-sectional study using the Diagnostic Criteria of Psychosomatic Research-Demoralization interview (DCPR/D) and psychometric tools (Demoralization scale-DS; Patient Health Questionnaire–9/PHQ-9; Hospital Anxiety Depression Scale-HADS; and European Quality of Life-5-EQ-5D). Results: A 25.1{\%} prevalence (CI 95{\%}, 0.19-0.31) of clinically relevant demoralization was reported on the DCPR/D interview. A total demoralization score cutoff score ≥ 25 maximized sensitivity (81.6{\%}), and specificity (72.6{\%}) in identifying DCPR/D demoralized patients. The DCPR/D and DS were associated with poorer levels of QoL. About half of the patients who were demoralized were not clinically depressed (PHQ-9). Self-reported suicidal ideation (PHQ-9 item 9) was found in a minority of patients (8.2{\%}), most of whom (77{\%}) were cases of depression (PHQ-9), but one-quarter (23{\%}) were not depressed, yet moderately/severely demoralized (DCPR/D and DS). Conclusions: This Southern European study confirms the importance of demoralization in cancer patients as a different condition with respect to depression and its relationship with poor QoL and suicidal ideation.",
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author = "Nanni, {Maria Giulia} and Rosangela Caruso and Luzia Travado and Cidalia Ventura and Alessandra Palma and Berardi, {Alejandra M.} and Elena Meggiolaro and Federica Ruffilli and Cristina Martins and David Kissane and Luigi Grassi",
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Nanni, MG, Caruso, R, Travado, L, Ventura, C, Palma, A, Berardi, AM, Meggiolaro, E, Ruffilli, F, Martins, C, Kissane, D & Grassi, L 2018, 'Relationship of demoralization with anxiety, depression, and quality of life: A Southern European study of Italian and Portuguese cancer patients' Psycho-Oncology, vol. 27, no. 11, pp. 2616-2622. https://doi.org/10.1002/pon.4824

Relationship of demoralization with anxiety, depression, and quality of life : A Southern European study of Italian and Portuguese cancer patients. / Nanni, Maria Giulia; Caruso, Rosangela; Travado, Luzia; Ventura, Cidalia; Palma, Alessandra; Berardi, Alejandra M.; Meggiolaro, Elena; Ruffilli, Federica; Martins, Cristina; Kissane, David; Grassi, Luigi.

In: Psycho-Oncology, Vol. 27, No. 11, 01.11.2018, p. 2616-2622.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Relationship of demoralization with anxiety, depression, and quality of life

T2 - A Southern European study of Italian and Portuguese cancer patients

AU - Nanni, Maria Giulia

AU - Caruso, Rosangela

AU - Travado, Luzia

AU - Ventura, Cidalia

AU - Palma, Alessandra

AU - Berardi, Alejandra M.

AU - Meggiolaro, Elena

AU - Ruffilli, Federica

AU - Martins, Cristina

AU - Kissane, David

AU - Grassi, Luigi

PY - 2018/11/1

Y1 - 2018/11/1

N2 - Background: Demoralization syndrome is a significant condition that has not been greatly studied in Southern European countries. Aims: To extend the knowledge of demoralization in Southern Europe by examining its prevalence according to different methods of assessment, its relationship with anxiety and depression, and its impact on quality of life (QoL) among cancer patients. Methods: A convenience sample of 195 cancer outpatients from two oncology centers (102 from Lisbon, Portugal, and 93 from Ferrara, Italy) participated in an observational, cross-sectional study using the Diagnostic Criteria of Psychosomatic Research-Demoralization interview (DCPR/D) and psychometric tools (Demoralization scale-DS; Patient Health Questionnaire–9/PHQ-9; Hospital Anxiety Depression Scale-HADS; and European Quality of Life-5-EQ-5D). Results: A 25.1% prevalence (CI 95%, 0.19-0.31) of clinically relevant demoralization was reported on the DCPR/D interview. A total demoralization score cutoff score ≥ 25 maximized sensitivity (81.6%), and specificity (72.6%) in identifying DCPR/D demoralized patients. The DCPR/D and DS were associated with poorer levels of QoL. About half of the patients who were demoralized were not clinically depressed (PHQ-9). Self-reported suicidal ideation (PHQ-9 item 9) was found in a minority of patients (8.2%), most of whom (77%) were cases of depression (PHQ-9), but one-quarter (23%) were not depressed, yet moderately/severely demoralized (DCPR/D and DS). Conclusions: This Southern European study confirms the importance of demoralization in cancer patients as a different condition with respect to depression and its relationship with poor QoL and suicidal ideation.

AB - Background: Demoralization syndrome is a significant condition that has not been greatly studied in Southern European countries. Aims: To extend the knowledge of demoralization in Southern Europe by examining its prevalence according to different methods of assessment, its relationship with anxiety and depression, and its impact on quality of life (QoL) among cancer patients. Methods: A convenience sample of 195 cancer outpatients from two oncology centers (102 from Lisbon, Portugal, and 93 from Ferrara, Italy) participated in an observational, cross-sectional study using the Diagnostic Criteria of Psychosomatic Research-Demoralization interview (DCPR/D) and psychometric tools (Demoralization scale-DS; Patient Health Questionnaire–9/PHQ-9; Hospital Anxiety Depression Scale-HADS; and European Quality of Life-5-EQ-5D). Results: A 25.1% prevalence (CI 95%, 0.19-0.31) of clinically relevant demoralization was reported on the DCPR/D interview. A total demoralization score cutoff score ≥ 25 maximized sensitivity (81.6%), and specificity (72.6%) in identifying DCPR/D demoralized patients. The DCPR/D and DS were associated with poorer levels of QoL. About half of the patients who were demoralized were not clinically depressed (PHQ-9). Self-reported suicidal ideation (PHQ-9 item 9) was found in a minority of patients (8.2%), most of whom (77%) were cases of depression (PHQ-9), but one-quarter (23%) were not depressed, yet moderately/severely demoralized (DCPR/D and DS). Conclusions: This Southern European study confirms the importance of demoralization in cancer patients as a different condition with respect to depression and its relationship with poor QoL and suicidal ideation.

KW - cancer

KW - demoralization

KW - depression

KW - oncology

KW - psychiatry

KW - psycho-oncology

KW - quality of life

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U2 - 10.1002/pon.4824

DO - 10.1002/pon.4824

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