The association of demoralization with mental disorders and suicidal ideation in patients with cancer

Sigrun Vehling, David W. Kissane, Christopher Lo, Heide Glaesmer, Tim J. Hartung, Gary Rodin, Anja Mehnert

Research output: Contribution to journalArticleResearchpeer-review

Abstract

BACKGROUND

Demoralization refers to a state in which there is a perceived inability to cope, that is associated with a sense of disheartenment and a loss of hope and meaning. This study investigated the co-occurrence versus independence of demoralization with mental disorders and suicidal ideation to evaluate its features as a concept of distress in the context of severe illness.
METHODS

In a cross-sectional sample of 430 mixed cancer patients, we assessed demoralization with the Demoralization Scale (DS); the 4-week prevalence of mood, anxiety, and adjustment disorders and suicidal ideation with the standardized Composite International Diagnostic Interview–Oncology (CIDI-O); and depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). We compared the relative risk (RR) for mental disorders associated with demoralization to that associated with self-reported depression.
RESULTS

Clinically relevant levels of demoralization were present in 21% of the patients. Demoralization co-occurred with a mood/anxiety disorder in 7%; 14% were demoralized in absence of any mood/anxiety disorder. Demoralization and adjustment disorders co-occurred in 2%. The RR for any mood/anxiety disorder was 4.0 in patients with demoralization (95% confidence interval [CI], 2.5-6.2) and 3.0 in those with depression (95% CI, 1.9-4.6). Demoralization, but not depression, was associated with a significantly increased risk for suicidal ideation after controlling for mental disorders (RR, 2.0; 95% CI, 1.1-3.5).
CONCLUSIONS

Clinically relevant demoralization frequently occurs independently of a mental disorder in patients with cancer and has a unique contribution to suicidal ideation. Demoralization is a useful concept to identify profiles of psychological distress symptoms amenable to interventions improving psychological well-being in this population.
Original languageEnglish
Pages (from-to)3394-3401
Number of pages8
JournalCancer
Volume123
Issue number17
DOIs
Publication statusPublished - 1 Sep 2017

Keywords

  • Adjustment disorder
  • Anxiety disorder
  • Cancer
  • Demoralization
  • Depression
  • Mental disorder
  • Mood disorder
  • Suicidal ideation

Cite this

Vehling, S., Kissane, D. W., Lo, C., Glaesmer, H., Hartung, T. J., Rodin, G., & Mehnert, A. (2017). The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer, 123(17), 3394-3401. https://doi.org/10.1002/cncr.30749
Vehling, Sigrun ; Kissane, David W. ; Lo, Christopher ; Glaesmer, Heide ; Hartung, Tim J. ; Rodin, Gary ; Mehnert, Anja. / The association of demoralization with mental disorders and suicidal ideation in patients with cancer. In: Cancer. 2017 ; Vol. 123, No. 17. pp. 3394-3401.
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title = "The association of demoralization with mental disorders and suicidal ideation in patients with cancer",
abstract = "BACKGROUNDDemoralization refers to a state in which there is a perceived inability to cope, that is associated with a sense of disheartenment and a loss of hope and meaning. This study investigated the co-occurrence versus independence of demoralization with mental disorders and suicidal ideation to evaluate its features as a concept of distress in the context of severe illness.METHODSIn a cross-sectional sample of 430 mixed cancer patients, we assessed demoralization with the Demoralization Scale (DS); the 4-week prevalence of mood, anxiety, and adjustment disorders and suicidal ideation with the standardized Composite International Diagnostic Interview–Oncology (CIDI-O); and depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). We compared the relative risk (RR) for mental disorders associated with demoralization to that associated with self-reported depression.RESULTSClinically relevant levels of demoralization were present in 21{\%} of the patients. Demoralization co-occurred with a mood/anxiety disorder in 7{\%}; 14{\%} were demoralized in absence of any mood/anxiety disorder. Demoralization and adjustment disorders co-occurred in 2{\%}. The RR for any mood/anxiety disorder was 4.0 in patients with demoralization (95{\%} confidence interval [CI], 2.5-6.2) and 3.0 in those with depression (95{\%} CI, 1.9-4.6). Demoralization, but not depression, was associated with a significantly increased risk for suicidal ideation after controlling for mental disorders (RR, 2.0; 95{\%} CI, 1.1-3.5).CONCLUSIONSClinically relevant demoralization frequently occurs independently of a mental disorder in patients with cancer and has a unique contribution to suicidal ideation. Demoralization is a useful concept to identify profiles of psychological distress symptoms amenable to interventions improving psychological well-being in this population.",
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author = "Sigrun Vehling and Kissane, {David W.} and Christopher Lo and Heide Glaesmer and Hartung, {Tim J.} and Gary Rodin and Anja Mehnert",
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Vehling, S, Kissane, DW, Lo, C, Glaesmer, H, Hartung, TJ, Rodin, G & Mehnert, A 2017, 'The association of demoralization with mental disorders and suicidal ideation in patients with cancer' Cancer, vol. 123, no. 17, pp. 3394-3401. https://doi.org/10.1002/cncr.30749

The association of demoralization with mental disorders and suicidal ideation in patients with cancer. / Vehling, Sigrun; Kissane, David W.; Lo, Christopher ; Glaesmer, Heide; Hartung, Tim J.; Rodin, Gary; Mehnert, Anja.

In: Cancer, Vol. 123, No. 17, 01.09.2017, p. 3394-3401.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - The association of demoralization with mental disorders and suicidal ideation in patients with cancer

AU - Vehling, Sigrun

AU - Kissane, David W.

AU - Lo, Christopher

AU - Glaesmer, Heide

AU - Hartung, Tim J.

AU - Rodin, Gary

AU - Mehnert, Anja

PY - 2017/9/1

Y1 - 2017/9/1

N2 - BACKGROUNDDemoralization refers to a state in which there is a perceived inability to cope, that is associated with a sense of disheartenment and a loss of hope and meaning. This study investigated the co-occurrence versus independence of demoralization with mental disorders and suicidal ideation to evaluate its features as a concept of distress in the context of severe illness.METHODSIn a cross-sectional sample of 430 mixed cancer patients, we assessed demoralization with the Demoralization Scale (DS); the 4-week prevalence of mood, anxiety, and adjustment disorders and suicidal ideation with the standardized Composite International Diagnostic Interview–Oncology (CIDI-O); and depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). We compared the relative risk (RR) for mental disorders associated with demoralization to that associated with self-reported depression.RESULTSClinically relevant levels of demoralization were present in 21% of the patients. Demoralization co-occurred with a mood/anxiety disorder in 7%; 14% were demoralized in absence of any mood/anxiety disorder. Demoralization and adjustment disorders co-occurred in 2%. The RR for any mood/anxiety disorder was 4.0 in patients with demoralization (95% confidence interval [CI], 2.5-6.2) and 3.0 in those with depression (95% CI, 1.9-4.6). Demoralization, but not depression, was associated with a significantly increased risk for suicidal ideation after controlling for mental disorders (RR, 2.0; 95% CI, 1.1-3.5).CONCLUSIONSClinically relevant demoralization frequently occurs independently of a mental disorder in patients with cancer and has a unique contribution to suicidal ideation. Demoralization is a useful concept to identify profiles of psychological distress symptoms amenable to interventions improving psychological well-being in this population.

AB - BACKGROUNDDemoralization refers to a state in which there is a perceived inability to cope, that is associated with a sense of disheartenment and a loss of hope and meaning. This study investigated the co-occurrence versus independence of demoralization with mental disorders and suicidal ideation to evaluate its features as a concept of distress in the context of severe illness.METHODSIn a cross-sectional sample of 430 mixed cancer patients, we assessed demoralization with the Demoralization Scale (DS); the 4-week prevalence of mood, anxiety, and adjustment disorders and suicidal ideation with the standardized Composite International Diagnostic Interview–Oncology (CIDI-O); and depressive symptoms with the Patient Health Questionnaire-9 (PHQ-9). We compared the relative risk (RR) for mental disorders associated with demoralization to that associated with self-reported depression.RESULTSClinically relevant levels of demoralization were present in 21% of the patients. Demoralization co-occurred with a mood/anxiety disorder in 7%; 14% were demoralized in absence of any mood/anxiety disorder. Demoralization and adjustment disorders co-occurred in 2%. The RR for any mood/anxiety disorder was 4.0 in patients with demoralization (95% confidence interval [CI], 2.5-6.2) and 3.0 in those with depression (95% CI, 1.9-4.6). Demoralization, but not depression, was associated with a significantly increased risk for suicidal ideation after controlling for mental disorders (RR, 2.0; 95% CI, 1.1-3.5).CONCLUSIONSClinically relevant demoralization frequently occurs independently of a mental disorder in patients with cancer and has a unique contribution to suicidal ideation. Demoralization is a useful concept to identify profiles of psychological distress symptoms amenable to interventions improving psychological well-being in this population.

KW - Adjustment disorder

KW - Anxiety disorder

KW - Cancer

KW - Demoralization

KW - Depression

KW - Mental disorder

KW - Mood disorder

KW - Suicidal ideation

U2 - 10.1002/cncr.30749

DO - 10.1002/cncr.30749

M3 - Article

VL - 123

SP - 3394

EP - 3401

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 17

ER -