Characterizing demoralization in the medically ill: a cluster analysis-derived grouping.

Introduction: There is increasing awareness of the clinical relevance of demoralization among patients with medical disorders. The aim of this investigation was to use both DSM-IV categories and the Diagnostic Criteria for Psychosomatic Research (DCPR) for subtyping demoralization in the setting of medical disease. Methods: A cross-sectional assessment, using both DSM-IV and DCPR structured clinical interviews, was conducted in 1560 patients recruited from 8 medical centers in the Italian Health System who agreed to participate. A diagnosis of demoralization, according to the DCPR, was established in 373 (23.9%) patients. Data were submitted to cluster analysis. Results: Four clusters were identified: demoralization and comorbid depression; demoralization and comorbid somatoform/adjustment disorders; demoralization and comorbid anxiety; demoralization without any comorbid DSM disorder. The first cluster included 27.6% of the total sample and was characterized by the presence of co-morbid DSM-IV mood disorders (mainly major depressive disorder). The second cluster had 18.2% of the cases and contained both DSM-IV somatoform (particularly, undifferentiated somatoform disorder and hypochondriasis) and adjustment disorders in comorbidity with demoralization. In the third cluster (24.7%), comorbid DSM-IV anxiety disorders (particularly, generalized anxiety disorder, agoraphobia, panic disorder and obsessive-compulsive disorder) were predominant. The fourth cluster contained 29.5% of the patients and was characterized by the absence of any psychiatric comorbidity. Conclusions: The findings indicate the importance of adding supplementary clinical information to the customary psychiatric evaluation in the medically ill. Subtyping demoralization may yield improved targets for psychosomatic research and treatment trials.