Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia.
Department of Psychiatry, Austin Health, Heidelberg, VIC, Australia.
Aust N Z J Psychiatry. 2022 Sep;56(9):1104-1129. doi: 10.1177/00048674211060746. Epub 2021 Dec 8.
Demoralisation is a state of poor coping characterised by low morale, hopelessness, subjective incompetence, and loss of meaning and purpose in life. While studied extensively in oncology and palliative care, there has been recent exploration in broader medical and mental health settings. The aim was to investigate the prevalence of demoralisation and associated sociodemographic and psychological factors across these clinical settings.
Six electronic databases were used to locate articles from January 2014 to March 2020. A pre-publication update of non-oncology populations was completed in September 2021. The review has been reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled prevalence of demoralisation was determined through % prevalence and mean demoralisation score; this was synthesised through meta-analysis of single means to determine pooled mean prevalence of Demoralisation Scale scores using the 'R' statistical software.
Demoralisation has been examined in 52 studies ( = 11,670) and found to be prevalent in 24-35% of oncology and non-oncology, including mental health, populations. The mean score on the Demoralisation Scale was 24.3 (95% confidence interval, CI = [21.3, 27.3]). There was evidence of divergent validity in addition to significant comorbidity between depression, demoralisation and suicidal ideation. Burdensome physical symptoms, and psychological and demographic factors are strongly correlated with demoralisation.
There remains a need to recognise demoralisation in various clinical and cultural settings and to strongly consider its inclusion as a 'specifier' within formal nosological systems for adjustment and depressive disorders. This is important to initiate targeted interventions and prevent significant morbidity.
沮丧是一种应对能力差的状态，其特征为士气低落、绝望、主观无能以及丧失生活的意义和目标。虽然在肿瘤学和姑息治疗中进行了广泛研究，但最近在更广泛的医学和心理健康环境中也进行了探索。目的是调查这些临床环境中沮丧的流行率及其相关的社会人口学和心理因素。
使用六个电子数据库从 2014 年 1 月至 2020 年 3 月查找文章。2021 年 9 月完成了非肿瘤人群的预出版更新。本综述按照系统评价和荟萃分析的首选报告项目进行了报告。通过 %患病率和平均沮丧评分来确定沮丧的总患病率；通过单均值的荟萃分析综合起来，使用“R”统计软件确定沮丧量表评分的总平均患病率。
沮丧已在 52 项研究（n=11670）中进行了检查，发现肿瘤学和非肿瘤学（包括心理健康）人群中有 24%-35%存在沮丧。沮丧量表的平均得分为 24.3（95%置信区间，CI=[21.3, 27.3]）。除了抑郁、沮丧和自杀意念之间存在显著的共病性外，还存在明显的区别效度。身体负担症状以及心理和人口统计学因素与沮丧密切相关。
在各种临床和文化环境中仍需要认识到沮丧，并强烈考虑将其作为正式分类系统中抑郁障碍的“特征”纳入其中。这对于启动针对性干预和预防严重发病率非常重要。
