Demoralization as a distinct clinical phenomenon from major depressive disorder: a systematic review

Introduction: Demoralization constitutes a cluster of psychological symptoms particularly prevalent in the medical context. We conducted a systematic review with the aim of supporting the evidence for a differentiation of demoralization from major depressive disorder (MDD). Methods: A qualitative systematic review following PRISMA criteria was conducted. Utilizing the keyword “demoralization” in databases PubMed, PsycINFO, Web of Knowledge, an electronic search was performed, supplemented by a manual search. 60 studies were selected. Study selection criteria included the use of medical samples and of instruments validated to assess demoralization. Four instruments were identified. Three are self-report, the Demoralization Scale (DS), the Psychiatric Epidemiological Research Interview-Demoralization Scale (PERI-D), and the Subjective Incompetence Scale (SIS) and one is a structured interview for the Diagnostic Criteria for Psychosomatic Research (DCPR) (Mangelli et al., 2003). Results: Only the DCPR interview and the DS have been used to detect demoralized cases in absence of MDD. The DCPR interview was applied to assess demoralization across various medical conditions, finding a prevalence ranging from 7% in coronary heart disease to 40% in endocrine diseases. The DS has been administered mostly in cancer patients showing a prevalence of 5-27.4%. To date, no studies using the PERI-D and the SIS have focused on such a differentiation. Discussion/Conclusions: Using validated instruments, demoralization appears to entail specific clinical features and emerges as a distinct condition from MDD. However, the reported prevalence rates may vary due to the characteristics of the assessment instruments.