Assessing Demoralization and Depression in the Setting of Medical Disease

Lara Mangelli, PhD; Giovanni A. Fava, MD; Silvana Grandi, MD; Luigi Grassi, MD; Fedra Ottolini, PhD; Piero Porcelli, PhD; Chiara Rafanelli, MD, PhD; Marco Rigatelli, MD; Nicoletta Sonino, MD

J Clin Psychiatry 2005;66(3):391-394

Article Abstract

Objective: The aim of this study was to assess the presence of demoralization and major depression in the setting of medical disease.

Method: 807 consecutive outpatients recruited from different medical settings (gastroenterology, cardiology, endocrinology, and oncology) were assessed according to DSM-IV criteria and Diagnostic Criteria for Psychosomatic Research, using semistructured research interviews.

Results: Demoralization was identified in 245 patients (30.4%), while major depression was present in 135 patients (16.7%). Even though there was a considerable overlap between the 2 diagnoses, 59 patients (43.7%) with major depression were not classified as demoralized, and 169 patients (69.0%) with demoralization did not satisfy the criteria for major depression.

Conclusions: The findings suggest a high prevalence of demoralization in the medically ill and the feasibility of a differentiation between demoralization and depression. Further research may determine whether demoralization, alone or in association with major depression, entails prognostic and clinical implications.