Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Pain Symptom Manage. 2011 Nov;42(5):768-76. doi: 10.1016/j.jpainsymman.2011.02.013. Epub 2011 May 18.
The concept of demoralization has been widely used to describe states of existential distress and a self-perceived incapacity to deal effectively with a specific stressful situation.
To evaluate the psychometric properties of the German adaptation of the Demoralization Scale (DS) in patients with advanced cancer.
Participants with heterogeneous tumor sites were recruited in several treatment and rehabilitation facilities. Concurrent and divergent validity of the DS was analyzed through associations with and group differences between measures of distress, depression, anxiety, and meaning-related life attitudes.
From a total sample of 1102 patients, 516 individuals (45%) with advanced cancer were enrolled (male 53%, median age 58 years [range 18-88], breast cancer 21%, prostate cancer 17%). The total mean score of the DS was 29.8 (SD=10.41). Four factors were extracted by exploratory factor analysis, which accounted for 59% of the variation (Cronbach α=0.84): loss of meaning and purpose (α=0.88), disheartenment (α=0.88), dysphoria (α=0.80), and sense of failure (α=0.76). DS dimensions shared between 12% and 62% of the variance. Demoralization was significantly associated with anxiety (r=0.71), depression (r=0.61), and distress (r=0.42). Fifty-seven percent of patients had high distress, 24% depression, and 11% high anxiety. According to different cutoff values, between 16% and 39% were seriously demoralized and 73% had moderate levels of demoralization. Between 5% and 20% of patients were seriously demoralized but not clinically depressed; 60% of patients with moderate levels of demoralization had no depression.
Results provide further evidence that the DS is a valid and reliable instrument of high clinical relevance in patients with advanced cancer.
道德低落的概念已被广泛用于描述存在困境和自我感知无法有效应对特定压力情况的状态。
评估德语版道德低落量表（DS）在晚期癌症患者中的心理测量特性。
在多个治疗和康复设施中招募了具有不同肿瘤部位的参与者。通过与痛苦、抑郁、焦虑和与意义相关的生活态度的测量结果进行关联分析和组间差异，分析 DS 的同时效性和区分效度。
从总共 1102 名患者中，招募了 516 名（45%）晚期癌症患者（男性 53%，中位年龄 58 岁[范围 18-88]，乳腺癌 21%，前列腺癌 17%）。DS 的总平均得分为 29.8（SD=10.41）。通过探索性因素分析提取了四个因素，占总变异的 59%（Cronbach α=0.84）：意义和目的丧失（α=0.88）、灰心（α=0.88）、不适（α=0.80）和失败感（α=0.76）。DS 维度共享 12%至 62%的方差。道德低落与焦虑（r=0.71）、抑郁（r=0.61）和痛苦（r=0.42）显著相关。57%的患者有高度痛苦，24%有抑郁，11%有高度焦虑。根据不同的截断值，16%至 39%的患者严重道德低落，73%的患者有中度道德低落。5%至 20%的患者严重道德低落但无临床抑郁；60%的中度道德低落患者无抑郁。
结果进一步证明，DS 是一种在晚期癌症患者中具有高度临床相关性的有效且可靠的工具。
