Prevalence and factors associated with demoralization syndrome in patients with advanced disease: Results from a cross-sectional Portuguese study

Background: Demoralization syndrome (DS) within the context of the psychological experience at the end of life is an important and relevant medical issue and remains the subject of a growing area of research.

Method: Ours was a cross-sectional study designed to assess the prevalence and associated demographic, physical, psychiatric, and psychosocial factors for demoralization syndrome in Portuguese patients with advanced disease.

Results: Some 80 terminally ill patients were included in the analyses over a 28-month period of time. The prevalence of DS was found to be 52.5%. No statistical differences were observed among prevalence of DS within categories of all studied variables, with the exception of depression using DSM-IV criteria (prevalence ratio PR = 1.8, CI 95% = [1.18-2.74]) and desire for death (PR = 1.8, CI 95% = [1.25-2.56]). In the Poisson regression analyses predicting DS, none of the latter factors emerged as significant (DSM-IV criteria: PR = 1.6, CI 95% = [0.84-3.08]; and desire for death: PR = 1.5, CI 95% = [0.74-2.99]). Thirty percent of participants met both criteria for demoralization syndrome and depression using the DSM-IV.

Significance of results: Prevalence of demoralization syndrome was high in this patient sample. Based on our results, we cannot determine if DS and depression are two distinct psychological entities. Identifying factors associated with DS could help provide efficacious interventions capable of diminishing suffering in terminally ill patients.