School of Nursing, Fujian Medical University, Fuzhou, China.
The 900th Hospital of Joint Logistics Support Force of the Chinese People's Liberation Army, Fuzhou, China.
Psychooncology. 2022 Dec;31(12):2036-2049. doi: 10.1002/pon.6023. Epub 2022 Sep 5.
Demoralization is a prevalent psychological problem among cancer patients and reflects a sense of subjective incompetence. This systematic review aims to identify factors influencing demoralization among cancer patients.
Eleven databases were systematically searched from database inception to 31 December 2020. Google Scholar and relevant reference lists were supplementarily searched. Studies reporting demoralization measured by Demoralization Scale and its influencing factors among cancer patients were included. A qualitative synthesis was conducted owing to the heterogeneity of the study outcome.
A total of 49 studies involving 10,712 participants were included in this review. The results showed substantial effect size variation, but the psychological factors showed the strongest magnitude of association. Among the biological factors, the number of physical symptoms (mean r values [rs]: 0.331) was associated with increased demoralization. Among the psychological factors, negative psychological factors include hopelessness (mean rs: 0.633), desire for death (mean rs: 0.620), dignity-related distress (mean rs: 0.595), depression (mean rs: 0.593), anxiety (mean rs: 0.589), psychological distress (mean rs: 0.465), and suicidal ideation (mean rs: 0.460) were related to increased demoralization; whereas positive psychological factors including hope (mean rs: -0.565), attachment security (mean rs: -0.530), and sense of coherence (mean rs: -0.453) were related to decreased demoralization. Among the social factors, social support (mean rs: -0.330) was negatively related to demoralization, and the demographic factors were still controversial. Quality of life was considered to be at the intersection of biopsychosocial factors and negatively associated with demoralization (mean rs: -0.599).
Demoralization is a consequence of the interaction of physical, psychological, and social factors among cancer patients. Factors with a significant effect should not be overlooked when designing an intervention to reduce demoralization. It is necessary to distinguish demoralization from other negative psychological states and further explore positive psychological factors influencing demoralization among cancer patients.
沮丧是癌症患者中普遍存在的心理问题，反映了一种主观无能感。本系统评价旨在确定影响癌症患者沮丧的因素。
从数据库建立到 2020 年 12 月 31 日，系统地搜索了 11 个数据库。此外，还补充搜索了 Google Scholar 和相关参考文献列表。纳入报告使用沮丧量表测量的沮丧和影响癌症患者沮丧的因素的研究。由于研究结果存在异质性，因此进行了定性综合。
本综述共纳入 49 项研究，涉及 10712 名参与者。结果显示，效应量变化很大，但心理因素的关联强度最大。在生物学因素中，躯体症状数量（均数 r 值[rs]：0.331）与沮丧程度增加相关。在心理因素中，负面心理因素包括绝望（均数 rs：0.633）、想死的愿望（均数 rs：0.620）、尊严相关痛苦（均数 rs：0.595）、抑郁（均数 rs：0.593）、焦虑（均数 rs：0.589）、心理困扰（均数 rs：0.465）和自杀意念（均数 rs：0.460）与沮丧程度增加相关；而积极的心理因素包括希望（均数 rs：-0.565）、依恋安全感（均数 rs：-0.530）和心理一致性感（均数 rs：-0.453）与沮丧程度降低相关。在社会因素中，社会支持（均数 rs：-0.330）与沮丧呈负相关，而人口统计学因素仍存在争议。生活质量被认为是生物心理社会因素的交叉点，与沮丧呈负相关（均数 rs：-0.599）。
沮丧是癌症患者生理、心理和社会因素相互作用的结果。在设计降低沮丧的干预措施时，不应忽视具有显著影响的因素。有必要将沮丧与其他负面心理状态区分开来，并进一步探讨影响癌症患者沮丧的积极心理因素。
