Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Psychooncology. 2012 Jan;21(1):54-63. doi: 10.1002/pon.1866. Epub 2010 Nov 8.
This longitudinal study examines the extent to which global meaning, existential distress in terms of demoralization, and depression are predicted by tumor stage (UICC stages 0-II vs III/IV), palliative treatment, and physical problems in cancer patients.
N = 270 cancer patients were studied at baseline (T1, response rate: 41%) and after 3 months (T2) (N = 178, 72%). The following standardized self-report measures were used: Demoralization Scale, Life Attitude Profile--Revised, Hospital Anxiety and Depression Scale, NCCN DT (physical problems list).
Multivariate regression analyses controlling for sociodemographic variables showed the number of physical problems significantly predicting higher demoralization (β = 0.42, p<0.001) and depression (β = 0.34, p<0.001), but not global meaning. While palliative treatment intention was related to higher depression (β = 0.21, p = 0.03) and higher demoralization (ns), there was no effect of tumor stage on dependent variables. The hypothesized moderating effect of global meaning on the relation between physical problems and depression or demoralization, respectively, was not found.
Results indicate a risk of existential distress in cancer patients across all disease stages, possibly due to confrontation with, albeit different, existential stressors throughout the illness. The general protective effect of global meaning against distress, independent of the number of physical problems, underscores the notion of existential concerns being relevant to cancer patients more generally, rather than just to a subgroup. However, physical problems might play a central role in the process of becoming demoralized through impairing the sense of mastery and competence. Findings finally strengthen the difference between the concepts of demoralization and global meaning.
本纵向研究考察了在癌症患者中，总体意义、道德困境（表现为意志消沉）和抑郁分别在多大程度上受到肿瘤分期（UICC 分期 0-II 与 III/IV）、姑息治疗和身体问题的预测。
共纳入 270 例癌症患者，在基线时（T1，应答率：41%）和 3 个月后（T2）（N=178，72%）进行研究。采用以下标准化自我报告测量工具：道德困境量表、生活态度量表修订版、医院焦虑抑郁量表、NCCN DT（身体问题清单）。
控制社会人口统计学变量的多元回归分析显示，身体问题的数量显著预测更高的道德困境（β=0.42，p<0.001）和抑郁（β=0.34，p<0.001），但与总体意义无关。虽然姑息治疗意向与更高的抑郁（β=0.21，p=0.03）和更高的道德困境（ns）相关，但肿瘤分期对因变量没有影响。未发现总体意义对身体问题与抑郁或道德困境之间的关系的假设调节作用。
结果表明，所有疾病阶段的癌症患者都存在存在困境的风险，这可能是由于在整个疾病过程中面临着不同的存在压力源。总体意义对痛苦的普遍保护作用与身体问题的数量无关，这强调了存在问题与癌症患者更普遍相关，而不仅仅与亚组相关。然而，身体问题可能通过损害掌握感和能力感而在意志消沉的过程中发挥核心作用。研究结果最终加强了道德困境和总体意义这两个概念之间的区别。
