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Demoralization: a systematic review on its clinical characterization

Published online by Cambridge University Press:  17 July 2014

L. Tecuta
Affiliation:
Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
E. Tomba*
Affiliation:
Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
S. Grandi
Affiliation:
Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
G. A. Fava
Affiliation:
Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy Department of Psychiatry, State University of New York at Buffalo, Buffalo, New York, USA
*
*Address for correspondence: Dr E. Tomba, Department of Psychology, University of Bologna, Viale Berti Pichat 5, 40127 Bologna, Italy. (Email: elena.tomba@unibo.it)

Abstract

Background

Demoralization has been described as a psychological state characterized by helplessness, hopelessness, a sense of failure and the inability to cope.

Methods

We conducted a systematic review with qualitative data analysis following PRISMA criteria with the following aims: to review validated assessment instruments of the demoralization syndrome, report main findings regarding demoralization as measured by validated instruments that emerge in the literature, compare and report evidence for the clinical utility of the identified instruments. Utilizing the key word ‘demoralization’ in PubMed and PsycINFO databases, an electronic search was performed, supplemented by Web of Science and manual searches. Study selection criteria included the assessment of medical patients and use of instruments validated to assess demoralization. Seventy-four studies were selected.

Results

Four instruments emerged in the literature. Main findings concern prevalence rates of demoralization, evidence of discriminant validity from major depression, factors associated with demoralization and evidence of clinical utility. The instruments vary in their definition, the populations they aim to assess, prevalence rates they estimate and their ability to discriminate between different conditions. Nonetheless, demoralization appears to be a distinctive psychological state characterized by helplessness, hopelessness, giving up and subjective incompetence. It is not limited to life-threatening diseases such as cancer, but may occur in any type of clinical situation. It is associated with stress and adverse health outcomes.

Conclusions

Studies addressing the incremental value of demoralization in psychiatry and psychology are needed. However, demoralization appears to entail specific clinical features and may be a distinct condition from major depression.

Type
Review Articles
Copyright
Copyright © Cambridge University Press 2014 

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References

Abbate-Daga, G, Delsedime, N, Nicotra, B, Giovannone, C, Marola, E, Amianto, F, Fassino, S (2013). Psychosomatic syndromes and anorexia nervosa. BMC Psychiatry 13, 14.Google Scholar
Abramson, LY, Metalsky, GI, Alloy, LB (1989). Hopelessness depression: a theory-based subtype of depression. Psychological Review 96, 358372.Google Scholar
Adamson, JD, Schmale, AH (1965). Object loss, giving up, and the onset of psychiatric disease. Psychosomatic Medicine 28, 555576.Google Scholar
APA (1994). Diagnostic and Statistical Manual for Mental Disorders, 4th edn. American Psychiatric Association: Arlington, VA.Google Scholar
APA (2013). Diagnostic and Statistical Manual for Mental Disorders, 5th edn. American Psychiatric Association: Arlington, VA.Google Scholar
Angelino, AF, Treisman, GJ (2001). Major depression and demoralization in cancer patients: diagnostic and treatment considerations. Support Care Cancer 9, 344349.Google Scholar
Antonovsky, A (1987). Unravelling the Mystery of Health: How People Manage Stress and Stay Well. Jossey-Bass: San Francisco, CA.Google Scholar
Beck, AT, Weissman, A, Lester, D, Trexler, L (1974). The measurement of pessimism: the Beck Hopelessness Scale. Journal Consult Clinical Psychology 42, 861865.Google Scholar
Boscaglia, N, Clarke, DM (2007). Sense of coherence as a protective factor for demoralisation in women with a recent diagnosis of gynecological cancer. Psycho-Onocology 16, 189195.Google Scholar
Bradburn, NM (1969). The Structure of Psychological Well-being. Aldine: Chicago.Google Scholar
Carver, CS (1997). You want to measure coping but your protocol's too long: consider the brief COPE. International Journal of Behavioral Medicine 4, 92100.Google Scholar
Catanese, A, John, MS, Di Battista, J, Clarke, DM (2009). Acute cognitive therapy in reducing suicide risk following a presentation to an emergency department. Behaviour Change 26, 1626.Google Scholar
Chaturvedi, SK, Goswami, K (2012). Feasibility of diagnostic criteria for psychosomatic research in India: a pilot qualitative evaluation. Psychotherapy and Psychosomatics 81, 320321.Google Scholar
Chioqueta, AP, Stiles, TC (2003). Suicide risk in outpatients with specific mood and anxiety disorders. Crisis 24, 105112.Google Scholar
Clarke, DM, Kissane, DW (2002). Demoralization: its phenomenology and importance. Australian and New Zealand Journal of Psychiatry 36, 733742.Google Scholar
Clarke, DM, Kissane, DW, Trauer, T, Smith, GC (2005). Demoralization, anhedonia and grief in patients with several physical illness. World Psychiatry 4, 96105.Google Scholar
Cockram, CA, Doros, G, de Figueiredo, JM (2009). Diagnosis and measurement of subjective incompetence: the clinical hallmark of demoralization. Psychotherapy and Psychosomatics 78, 342345.Google Scholar
Cockram, CA, Doros, G, de Figueiredo, JM (2010). Subjective incompetence as the clinical hallmark of demoralization in cancer patients without mental disorder. Primary Psychiatry 17, 5458.Google Scholar
Cohen, S, Kamarck, T, Mermelstein, R (1983). A global measure of perceived stress. Journal of Health and Social Behavior 24, 385396.Google Scholar
Cohen, SR, Mount, BM, Strobel, MG, Bui, F (1995). The McGill quality of life questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliative Medicine 9, 207219.Google Scholar
de Figueiredo, JM (1993). Depression and demoralization: phenomenologic differences and research perspectives. Comprehensive Psychiatry 34, 308311.Google Scholar
de Figueiredo, JM (2013). Distress, demoralization and psychopathology: diagnostic boundaries. The European Journal of Psychiatry 27, 6173.Google Scholar
de Figueiredo, JM, Frank, JD (1982). Subjective incompetence: the clinical hallmark of demoralization. Comprehensive Psychiatry 23, 353363.Google Scholar
de Figueiredo, JM, Slavney, P (2000). Diagnosing demoralization in consultation psychiatry [Letter to the editor]. Psychosomatics 41, 449450.Google Scholar
Dohrenwend, BP, Shrout, PE, Egri, G, Mendelsohn, FS (1980). Non-specific psychological distress and other dimensions of psychopathology. Archives of General Psychiatry 37, 12291236.Google Scholar
Dozois, DJ, Dobson, KS, Ahnberg, JL (1998). A psychometric evaluation of the BDI-II. Psychological Assessment 10, 8389.Google Scholar
Emmrich, A, Beesdo-Baum, K, Gloster, AT, Knappe, S, Höfler, M, Arolt, V, Deckert, J, Gerlach, AL, Hamm, A, Kircher, T, Lang, T, Richter, J, Ströhle, A, Zwanzger, P, Wittchen, HU (2012). Depression does not affect the treatment outcome of CBT for panic and agoraphobia: results from a multicenter randomized trial. Psychotherapy and Psychosomatics 81, 161172.Google Scholar
Engel, GL (1968). A life setting conducive to illness: the giving up-given up complex. Annals of Internal Medicine 69, 293300.Google Scholar
Fava, GA, Fabbri, S, Sirri, L, Wise, T (2007). Psychological factors affecting medical condition: a new proposal for DSM V. Psychosomatics 48, 103111.Google Scholar
Fava, GA, Freyberger, HJ, Bech, P, Christodoulou, G, Sensky, T, Wise, TN (1995). Diagnostic criteria for use in psychosomatic research. Psychotherapy and Psychosomatics 63, 18.Google Scholar
Fava, GA, Guidi, J, Porcelli, P, Rafanelli, C, Bellomo, A, Grandi, S, Grassi, L, Mangelli, L, Pasquini, P, Picardi, A, Quartesan, R, Rigatelli, M, Sonino, N (2012 a). A cluster analysis-derived classification of psychological distress and illness behavior in the medically ill. Psychological Medicine 42, 401407.Google Scholar
Fava, GA, Guidi, J, Semprini, F, Tomba, E, Sonino, N (2010 a). Clinical assessment of allostatic load and clinimetric criteria. Psychotherapy and Psychosomatics 79, 280284.Google Scholar
Fava, GA, Porcelli, P, Rafanelli, C, Mangelli, L, Grandi, S (2010 b). The spectrum of anxiety disorders in the medically ill. Journal of Clinical Psychiatry 71, 910914.Google Scholar
Fava, GA, Rafanelli, C, Tomba, E, Guidi, J, Grandi, S (2011). The sequential combination of cognitive behavioral treatment and well-being therapy in cyclothymic disorder. Psychotherapy and Psychosomatics 80, 136143.Google Scholar
Fava, GA, Tomba, E (2009). Increasing psychological well-being and resilience by psychotherapeutic methods. Journal of Personality 77, 19031934.Google Scholar
Fava, GA, Tomba, E, Sonino, N (2012 b). Clinimetrics: the science of clinical measurements. The International Journal of Clinical Practice 66, 1115.Google Scholar
Feldman, D, Rabinowitz, J, Ben-Yehuda, Y (1995). Detecting psychological distress among patients attending secondary health care clinics. Self-report and physician rating. General Hospital Psychiatry 17, 425432.Google Scholar
Ferrari, S, Galeazzi, GM, Mackinnon, A, Rigatelli, M (2008). Frequent attenders in primary care: impact of medical, psychiatric and psychosomatic diagnoses. Psychotherapy and Psychosomatics 77, 306314.Google Scholar
Ferrari, S, Monzani, D, Baraldi, S, Simoni, E, Prati, G, Forghieri, M, Rigatelli, M, Genovese, E, Pingani, L (2013). Vertigo “in the pink”: the impact of female gender on psychiatric-psychosomatic comorbidity in benign paroxysmal positional vertigo patients. Psychosomatics. Published online: 4 June 2013. doi:10.1016/j.psym.2013.02.00.Google Scholar
Fichter, MM, Quadflieg, N (2001). The structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10 (SIAB-EX): reliability and validity. European Psychiatry 16, 3848.Google Scholar
Fichter, MM, Quadflieg, N, Brandl, B (1993). Recurrent overeating: an empirical comparison of binge eating disorder, bulimia nervosa, and obesity. International Journal of Eating Disorders 14, 116.Google Scholar
Forgeard, MJC, Haigh, EAP, Beck, AT, Davidson, RJ, Henn, FA, Maier, SF, Mayberg, HS, Seligman, ME (2011). Beyond depression: towards a process-based approach to research, diagnosis, and treatment. Clinical Psychology 18, 275299.Google Scholar
Frank, JB (2013). Teaching medical students to recognize demoralization. The European Journal of Psychiatry 27, 3641.Google Scholar
Frank, JD (1961). Persuasion and Healing. Johns Hopkins University Press: Baltimore.Google Scholar
Frank, JD (1973). Persuasion and Healing. Johns Hopkins University Press: Baltimore.Google Scholar
Frank, JD, Frank, JB (1991). Persuasion and Healing. Johns Hopkins University Press: Baltimore.Google Scholar
Galeazzi, GM, Ferrari, S, Mackinnon, A, Rigatelli, M (2004). Inter-rater reliability, prevalence and relation to ICD-10 diagnoses of the diagnostic criteria for psychosomatic research in consultation-liaison psychiatry patients. Psychosomatics 45, 386393.Google Scholar
Gallagher, RM, Marbach, JJ, Raphael, KG, Handte, J, Dohrenwend, BP (1995). Myofascial face pain: seasonal variability in pain intensity and demoralization. Pain 61, 113120.Google Scholar
Grandi, S, Fabbri, S, Tossani, E, Mangelli, L, Branzi, A, Mangelli, C (2001). Psychological evaluation after cardiac transplantation: the integration of different criteria. Psychotherapy and Psychosomatics 70, 176183.Google Scholar
Grandi, S, Sirri, L, Tossani, E, Fava, GA (2011). Psychological characterization of demoralization in the setting of heart transplantation. Journal of Clinical Psychiatry 72, 648654.Google Scholar
Grassi, L, Mangelli, L, Fava, GA, Grandi, S, Ottolini, F, Porcelli, P, Rafanelli, C, Rigatelli, M, Sonino, N (2007). Psychosomatic characterization of adjustment disorders in the medical setting: some suggestions for DSM-V. Journal of Affective Disorders 101, 251254.Google Scholar
Grassi, L, Rossi, E, Sabato, S, Cruciani, G, Zambelli, M (2004). Diagnostic Criteria for Psychosomatic Research and psychosocial variables in breast cancer patients. Psychosomatics 45, 483491.Google Scholar
Grassi, L, Sabato, S, Rossi, E, Biancosino, B, Marmai, L (2005). Use of the diagnostic criteria for psychosomatic research in oncology. Psychotherapy and Psychosomatics 74, 100107.Google Scholar
Guidi, J, Fava, GA, Picardi, A, Porcelli, P, Bellomo, A, Grandi, S, Grassi, L, Pasquini, P, Quartesan, R, Rafanelli, C, Rigatelli, M, Sonino, N (2011). Subtyping depression in the medically ill by cluster analysis. Journal of Affective Disorders 132, 383388.Google Scholar
Guidi, J, Rafanelli, C, Roncuzzi, R, Sirri, L, Fava, GA (2013). Assessing psychological factors affecting medical conditions: comparison between different proposals. General Hospital Psychiatry 35, 141146.Google Scholar
Hamilton, M (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278296.Google Scholar
Haslam, N, Beck, AT (1994). Subtyping major depression: a taxometric analysis. Journal of Abnormal Psychology 103, 686692.Google Scholar
Iacoviello, BM, Alloy, LB, Abramson, LY, Choi, JY, Morgan, JE (2013). Patterns of symptom onset and remission in episodes of hopelessness depression. Depression & Anxiety 30, 564573.Google Scholar
Jackson, ME, Tessler, RC (1984). Perceived lack of control over life events: antecedents and consequences in a discharged patient sample. Social Science Research 13, 287301.Google Scholar
Jacobsen, J, Maytal, G, Stern, TA (2007). Demoralization in medical practice. Primary Care Companion to the Journal of Clinical Psychiatry 9, 139143.Google Scholar
Jacobsen, J, Vanderwerker, LC, Block, SD, Friedlander, RJ, Maciejewski, PK, Prigerson, HG (2006). Depression and demoralization as distinct syndromes: preliminary data from a cohort of advanced cancer patients. Indian Journal of Palliative Care 12, 815.Google Scholar
Kissane, DW, Clarke, DM, Street, AF (2001). Demoralization syndrome-A relevant psychiatric diagnosis for palliative care. Journal of Palliative Care 17, 1222.Google Scholar
Kissane, DW, Patel, SG, Baser, RE, Bell, R, Farberov, M, Ostroff, JS, Li, Y, Singh, B, Kraus, DH, Shah, JP (2013). Preliminary evaluation of the reliability and validity of the Shame and Stigma Scale in head and neck cancer. Head & Neck 35, 172183.Google Scholar
Kissane, DW, Wein, S, Love, A, Lee, XQ, Kee, PL, Clarke, DM (2004). The Demoralization Scale: a report of its development and preliminary validation. Journal of Palliative Care 20, 269276.Google Scholar
Klein, DF, Davis, JM (1969). Diagnosis and Drug Treatment of Psychiatric Disorders. Williams & Wilkins: Baltimore, MD.Google Scholar
Klein, DF, Gittelman, R, Quitkin, F, Rifkin, A (1980). A Diagnosis and Drug Treatment of Psychiatric Disorders: Adults and Children. Wilkins & Wilkins: Baltimore, MD.Google Scholar
Kohn, R (2013). Demoralization and the longitudinal course of PTSD following Hurricane Mitch. European Journal of Psychiatry 27, 1826.Google Scholar
Kroenke, K, Spitzer, RL, Williams, JBW (2001). The PHQ-9. Validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606613.Google Scholar
Lau, R, Morse, CA, Macfarlane, S (2010). Psychological factors among elderly women with suicidal intentions or attempts to suicide: a controlled comparison. Journal of Women & Aging 22, 314.Google Scholar
Lee, CY, Fang, CK, Yang, YC, Liu, CL, Leu, YS, Wang, TE, Chen, HW (2012). Demoralization syndrome among cancer outpatients in Taiwan. Support Care Cancer 20, 22592267.Google Scholar
Lennon, MC, Dohrenwend, BP, Zautra, AJ, Marbach, JJ (1990). Coping and adaptation to facial pain in contrast to other stressful life events. Journal of Personality and Social Psychology 59, 10401050.Google Scholar
Link, B, Dohrenwend, BP (1980). Formulation of hypotheses about the true prevalence of demoralization in the United States. In Mental Illness in the United States: Epidemiological Estimates (ed. Dohrenwend, B. P., Dohrenwend, B. S., Schwartz-Gould, M., Link, B., Neugebauer, R. and Wunsch-Hitz, R.), pp. 114132. Praeger Press: New York.Google Scholar
Lipowski, ZJ (1988). Somatization: the concept and its clinical application. American Journal of Psychiatry 145, 13581368.Google Scholar
Mangelli, L, Fava, GA, Grandi, S, Grassi, L, Ottolini, F, Porcelli, P, Rafanelli, C, Rigatelli, M, Sonino, N (2005). Assessing demoralization and depression in the setting of medical disease. Journal of Clinical Psychiatry 66, 391394.Google Scholar
Mangelli, L, Rafanelli, C, Porcelli, P, Fava, GA (2007). Interview for the diagnostic criteria of psychosomatic research (DCPR). Advances in Psychosomatic Medicine 28, 174181.Google Scholar
Mangelli, L, Semprini, F, Sirri, L, Fava, GA, Sonino, N (2006). Use of the diagnostic criteria for psychosomatic research (DCPR) in a community sample. Psychosomatics 47, 143146.Google Scholar
Marbach, JJ (1993). Is phantom tooth pain a deafferentation (neuropathic) syndrome? Part II: psychosocial considerations. Oral Surgery Oral Medicine Oral Pathology 75, 225232.Google Scholar
Marbach, JJ, Schleifer, SJ, Keller, SE (1990). Facial pain, distress and immune function. Brain, Behavior, and Immunity 4, 243254.Google Scholar
Marchesi, C, Maggini, C (2007). Sociodemographic and clinical features associated with demoralization in medically ill in-patients. Social Psychiatry and Psychiatric Epidemiology 42, 824829.Google Scholar
McEwen, BS, Stellar, E (1993). Stress and the individual: mechanisms leading to disease. Archives of Internal Medicine 153, 20932101.Google Scholar
Mehnert, A, Vehling, S, Hocker, A, Lehmann, C, Koch, U (2011). Demoralization and depression in patients with advanced cancer: validation of the German version of the demoralization scale. Journal of Pain Symptom Management 42, 768776.Google Scholar
Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Journal of Clinical Epidemiology 62, 10061012.Google Scholar
Mullane, M, Dooley, B, Tiernan, E, Bates, U (2009). Validation of the Demoralization Scale in an Irish advanced cancer sample. Palliative and Supportive Care 7, 323330.Google Scholar
Ottolini, F, Modena, MG, Rigatelli, M (2005). Prodromal symptoms in myocardial infarction. Psychotherapy and Psychosomatics 74, 323327.Google Scholar
Page, RM, Cole, GE (1992). Demoralization and living alone: outcomes from an urban community study. Psychological Reports 70, 275280.Google Scholar
Parker, M (2004). Medicalizing meaning: demoralization syndrome and the desire to die. Australian and New Zealand Journal of Psychiatry 38, 765773.Google Scholar
Perera, FP, Wang, S, Rauh, V, Zhou, H, Stigter, L, Camann, D, Jedrychowski, W, Mroz, E, Majewska, R (2013). Prenatal exposure to air pollution, maternal psychological distress, and child behavior. Pediatrics 132, e1284e1294.Google Scholar
Picardi, A, Pasquini, P, Abeni, D, Fassone, G, Mazzotti, E, Fava, GA (2005). Psychosomatic assessment of skin diseases in clinical practice. Psychotherapy and Psychosomatics 74, 315322.Google Scholar
Picardi, A, Porcelli, P, Pasquini, P, Fassone, G, Mazzotti, E, Lega, I, Ramieri, L, Sagoni, E, Abeni, D, Tiago, A, Fava, GA (2006). Integration of multiple criteria for psychosomatic assessment of dermatological patients. Psychosomatics 47, 122128.Google Scholar
Pilowsky, I (1997). Abnormal Illness Behavior. John Wiley & Sons: New York.Google Scholar
Porcelli, P, Bellomo, A, Quartesan, R, Altamura, M, Iuso, S, Ciannameo, S, Piselli, M, Elisei, S (2009). Psychosocial functioning in consultation-liaison psychiatry patients: influence of psychosomatic syndromes, psychopathology and somatization. Psychotherapy and Psychosomatics 78, 352358.Google Scholar
Porcelli, P, De Carne, M, Fava, GA (2000). Assessing somatization in functional gastrointestinal disorders: integration of different criteria. Psychotherapy and Psychosomatics 69, 198204.Google Scholar
Porcelli, P, De Carne, M, Todarello, O (2004). Prediction of treatment outcomes of patients with functional gastrointestinal disorders by the diagnostic criteria for psychosomatic research. Psychotherapy and Psychosomatics 73, 166173.Google Scholar
Porcelli, P, Laera, D, Mastrangelo, D, Di Masi, A (2012). Prevalence of allostatic overload syndrome in patients with chronic cardiovascular disease. Psychotherapy and Psychosomatics 81, 375377.Google Scholar
Radloff, LS (1977). The CES-D scale: a self report depression scale for research in the general population. Applied Psychological Measurement 1, 385401.Google Scholar
Rafanelli, C, Gostoli, S, Roncuzzi, R, Sassone, B (2013). Psychological correlates of vasovagal versus medically unexplained syncope. General Hospital Psychiatry 35, 246252.Google Scholar
Rafanelli, C, Milaneschi, Y, Roncuzzi, R (2009). Minor depression as a short-term risk factor in outpatients with congestive heart failure. Psychosomatics 50, 493499.Google Scholar
Rafanelli, C, Milaneschi, Y, Roncuzzi, R, Pancaldi, LG (2010). Dysthymia before myocardial infarction as a cardiac risk factor at 2.5 year follow-up. Psychosomatics 51, 813.Google Scholar
Rafanelli, C, Offidani, E, Gostoli, S, Roncuzzi, R (2012). Psychological correlates in patients with different levels of hypertension. Psychiatric Research 198, 154160.Google Scholar
Rafanelli, C, Roncuzzi, R, Finos, L, Tossani, E, Tomba, E, Mangelli, L, Urbinati, S, Pinelli, G, Fava, GA (2003). Psychological assessment in cardiac rehabilitation. Psychotherapy and Psychosomatics 72, 343349.Google Scholar
Rafanelli, C, Roncuzzi, R, Milaneschi, Y (2006). Minor depression as a cardiac risk factor after coronary artery bypass surgery. Psychosomatics 47, 289295.Google Scholar
Rafanelli, C, Roncuzzi, R, Milaneschi, Y, Tomba, E, Colistro, MC, Pancaldi, LG, Di Pasquale, G (2005). Stressful life events, depression and demoralization as risk factors for acute coronary heart disease. Psychotherapy and Psychosomatics 74, 179184.Google Scholar
Raphael, KG, Dohrenwend, BP, Marbach, JJ (1990). Illness and injury among children of temporomandibular pain and dysfunction syndrome (TMPDS) patients. Pain 40, 6164.Google Scholar
Reyes, M, Perzanowski, MS, Whyatt, RM, Kelvin, EA, Rundle, AG, Diaz, DM, Hoepner, L, Perera, FP, Rauh, V, Miller, RL (2011). Relationship between maternal demoralization, wheeze, and immunoglobulin E among inner-city children. Annals of Allergy, Asthma and Immunology 107, 4249.Google Scholar
Rickelman, BL (2002). Demoralization as a precursor to serious depression. Journal of the American Psychiatric Nurses Association 8, 917.Google Scholar
Ritsner, M, Ponizovsky, A, Chemelevsky, M, Zetser, F, Durst, R, Ginath, Y (1996). Effects of immigration on the mentally ill-does it produce psychological distress? Comprehensive Psychiatry 37, 1722.Google Scholar
Roberts, RE, Vernon, SW (1981). Usefulness of the PERI demoralization scale screen for psychiatric disorder in a community sample. Psychiatry Research 5, 183193.Google Scholar
Rosenfeld, B, Breitbart, W, Galietta, M, Kaim, M, Funeste-Esch, J, Pessin, H, Nelson, CJ, Brescia, R (2000). The schedule of attitudes towards hastened death: measuring desire for death in terminally ill cancer patients. Cancer 88, 28682874.Google Scholar
Ryff, CD (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology 57, 10691081.Google Scholar
Ryff, CD, Love, GD, Urry, HL, Muller, D, Rosenkranz, MA, Friedman, EM, Davidson, RJ, Singer, BH (2006). Psychological well-being and ill-being: do they have distinct or mirrored biological correlates? Psychotherapy and Psychosomatics 75, 8595.Google Scholar
Sartorius, N, Kaelber, CT, Cooper, JE, Roper, MT, Rae, DS, Gulbinat, W, Ustün, TB, Regier, DA (1993). Progress towards achieving a common language in psychiatry: results from the field trials of the clinical guidelines accompanying the WHO classification of mental and behavioural disorders in ICD-10. Archives of General Psychiatry 50, 115124.Google Scholar
Sautier, LP, Vehling, S, Mehnert, A (2014). Assessment of patients' dignity in cancer care: preliminary psychometrics of the German version of the Patient Dignity Inventory (PDI-G). Journal of Pain and Symptom Management 47, 181187.Google Scholar
Schmale, AH (1972). Giving up as a final common pathway to changes in health. Advances in Psychosomatic Medicine 8, 2040.Google Scholar
Schmale, AH, Engel, GL (1967). The giving up-given up complex illustrated on film. Archives of General Psychiatry 17, 135145.Google Scholar
Seligman, ME (1975). Helplessness: on Depression, Development, and Death. WH Freeman: San Francisco.Google Scholar
Semprini, F, Fava, GA, Sonino, N (2010). The spectrum of adjustment disorders: too broad to be clinically helpful. CNS Spectrums 15, 382388.Google Scholar
Shahar, G, Bareket, L, Rudd, MD, Joiner, TE Jr. (2006). In severely suicidal young adults, hopelessness, depressive symptoms, and suicidal ideation constitute a single syndrome. Psychological Medicine 36, 913922.Google Scholar
Sirri, L, Fava, GA (2013). Diagnostic criteria for psychosomatic research and somatic symptom disorder. International Review of Psychiatry 25, 1930.Google Scholar
Sirri, L, Fava, GA, Guidi, J, Porcelli, P, Rafanelli, C, Bellomo, A, Grandi, S, Grassi, L, Pasquini, P, Picardi, A, Quartesan, R, Rigatelli, M, Sonino, N (2012). Type A behavior: a reappraisal of its characteristics in cardiovascular disease. International Journal of Clinical Practice 66, 854861.Google Scholar
Sirri, L, Fava, GA, Sonino, N (2013). The unifying concept of illness behavior. Psychotherapy and Psychosomatics 82, 7481.Google Scholar
Sirri, L, Potena, L, Masetti, M, Tossani, E, Magelli, C, Grandi, S (2010). Psychological predictors of mortality in heart transplanted patients: a prospective, 6-year follow-up study. Transplantation 89, 879886.Google Scholar
Slavney, PR (1999). Diagnosing demoralization in consultation psychiatry. Psychosomatics 40, 325329.Google Scholar
Sonino, N, Fallo, F, Fava, GA (2006). Psychological aspects of primary aldosteronism. Psychotherapy and Psychosomatics 75, 327330.Google Scholar
Sonino, N, Navarrini, C, Ruini, C, Ottolini, F, Paoletta, A, Fallo, F, Boscaro, M, Fava, GA (2004). Persistent psychological distress in patients treated for endocrine disease. Psychotherapy and Psychosomatics 73, 7883.Google Scholar
Sonino, N, Ruini, C, Navarrini, C, Ottolini, F, Sirri, L, Paoletta, A, Fallo, F, Boscaro, M, Fava, GA (2007). Psychosocial impairment in patients treated for pituitary disease: a controlled study. Clinical Endocrinology 67, 719726.Google Scholar
Sonino, N, Tomba, E, Genesia, ML, Bertello, C, Mulatero, P, Veglio, F, Fava, GA, Fallo, F (2011). Psychological assessment of primary aldosteronism: a controlled study. The Journal of Clinical Endocrinology & Metabolism 96, E878E883.Google Scholar
Spitzer, RL, Williams, JWB, Gibbon, M, First, MB (1992). The structured clinical interview for DSM-III-R (SCID). I. History, rationale and description. Archives of General Psychiatry 49, 624629.Google Scholar
Stewart, SM, Kennard, BD, Lee, PWH, Mayes, T, Hughes, C, Emslie, G (2005). Hopelessness and suicidal ideation among adolescents in two cultures. Journal of Child Psychology and Psychiatry 46, 364372.Google Scholar
Sweeney, DR, Tinling, DC, Schmale, AH (1970). Differentiation of the “giving-up” affects- helplessness and hopelessness. Archives of General Psychiatry 23, 378382.Google Scholar
Tomba, E, Bech, P (2012). Cinimetrics and clinical psychometrics: macro- and micro-analysis. Psychotherapy and Psychosomatics 81, 333343.Google Scholar
Tomba, E, Offidani, M (2012). A clinimetric evaluation of allostatic overload in the general population. Psychotherapy and Psychosomatics 81, 378379.Google Scholar
Tomba, E, Rafanelli, C, Grandi, S, Guidi, J, Fava, GA (2012). Clinical configuration of cyclothymic disturbances. Journal of Affective Disorders 139, 244249.Google Scholar
Tossani, E, Ricci Garotti, MG, Cosci, F (2013). The use of the diagnostic criteria for psychosomatic research in substance use disorder patient. Psychotherapy and Psychosomatics 82, 195196.Google Scholar
Vehling, S, Lehmann, C, Oechsle, K, Bokemeyer, C, Krüll, A, Koch, U, Mehnert, A (2011). Global meaning and meaning-related life attitudes: exploring their role in predicting depression, anxiety, and demoralization in cancer patients. Support Care Cancer 19, 513520.Google Scholar
Vehling, S, Lehmann, C, Oechsle, K, Bokemeyer, C, Krüll, A, Koch, U, Mehnert, A (2012). Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients. Psycho-oncology 21, 5463.Google Scholar
Vehling, S, Mehnert, A (2013). Symptom burden, loss of dignity, and demoralization in patients with cancer: a mediation model. Psycho-oncology. Published online: 14 October 2013. doi: 10.1002/pon.3417.Google Scholar
Vehling, S, Oechsle, K, Koch, U, Mehnert, A (2013). Receiving palliative treatment moderates the effect of age and gender on demoralization in patients with cancer. PLoS ONE 8, e59417.Google Scholar
Vernon, S, Roberts, R (1981). Measuring nonspecific psychological distress and other dimensions of psychopathology. Further observations on the problem. Archives of General Psychiatry 38, 12391247.Google Scholar
Wallace, D, Wallace, R, Rauh, V (2003). Community stress, demoralization, and body mass index: evidence for social signal transduction. Social Science & Medicine 12, 24672478.Google Scholar
Wise, T (2009). Diagnostic criteria for psychosomatic research are necessary for DSM V. Psychotherapy and Psychosomatics 78, 330332.Google Scholar
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