Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Cancer. 2017 Sep 1;123(17):3394-3401. doi: 10.1002/cncr.30749. Epub 2017 May 4.
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.
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.
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).
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. Cancer 2017;123:3394-401. © 2017 American Cancer Society.
沮丧是指一种无法应对的状态，与灰心丧气和失去希望和意义有关。本研究调查了沮丧与精神障碍和自杀意念的同时发生与独立性，以评估其在严重疾病背景下作为一种痛苦概念的特征。
在 430 名混合癌症患者的横断面样本中，我们使用沮丧量表（DS）评估沮丧；使用标准化的综合国际诊断访谈-肿瘤学（CIDI-O）评估 4 周内心境、焦虑和适应障碍以及自杀意念的患病率；并使用患者健康问卷-9（PHQ-9）评估抑郁症状。我们比较了与沮丧相关的精神障碍的相对风险（RR）与与自我报告的抑郁相关的精神障碍的相对风险。
21%的患者存在临床相关水平的沮丧。7%的患者同时存在心境/焦虑障碍和沮丧；14%的患者在没有任何心境/焦虑障碍的情况下出现沮丧。2%的患者同时存在沮丧和适应障碍。在沮丧的患者中，任何心境/焦虑障碍的 RR 为 4.0（95%置信区间[CI]，2.5-6.2），在抑郁的患者中为 3.0（95%CI，1.9-4.6）。在控制精神障碍后，沮丧但不是抑郁与自杀意念的风险显著增加相关（RR，2.0；95%CI，1.1-3.5）。
在癌症患者中，与精神障碍无关的临床相关沮丧经常发生，并且对自杀意念有独特的贡献。沮丧是一个有用的概念，可以识别出适合干预措施的心理困扰症状谱，从而改善该人群的心理健康。癌症 2017；123：3394-401。©2017 美国癌症协会。
