Kissane, DW and Bobevski, I and Gaitanis, P and Brooker, J and Michael, N and Lethborg, C and Richardson, G and Webster, P and Hempton, C, Exploratory examination of the utility of demoralization as a diagnostic specifier for adjustment disorder and major depression, General Hospital Psychiatry, 46 pp. 20-24. ISSN 0163-8343 (2017) [Refereed Article]
© 2017 Elsevier Inc.
Objective: Demoralization, a state of lowered morale and poor coping, has a prevalence of 13-18% among patients with advanced cancer. We surveyed clinicians' perspectives of the utility of "with demoralization" as a diagnostic specifier for adjustment and depressive disorders.
Method: Using comparative clinical vignettes in a field survey, clinicians from a range of disciplines were asked their perception of the utility of diagnosis and treatment options. Response frequencies were compared using Cochran's Q and McNemar's tests, with sensitivity and specificity rated against expert rankings of diagnosis. Analysis of variance and paired t-tests examined significant differences in ratings of utility.
Results: Vignettes were assessed by 280 clinicians; 77% supported utility of the category 'adjustment disorder with demoralization' compared to 33% supporting 'adjustment disorder with anxiety' (McNemar test, p<0.001), while 83% supported the utility of 'with demoralization' for major depressive episode, matching 83% perceiving utility for 'with melancholia.' Sensitivity and specificity ratings were 77% and 94% for adjustment disorder with demoralization and 83% and 91% for major depression with demoralization.
Conclusion: Clinicians perceived the specifier 'with demoralization' to deepen diagnostic understanding, treatment choice, and ability to communicate with clinicians and patients, particularly for the category of adjustment disorder with demoralization.
|Item Type:||Refereed Article|
|Keywords:||utility, demoralization, diagnostic specifiers, adjustment disorder, depression, oncology|
|Research Division:||Health Sciences|
|Research Group:||Health services and systems|
|Research Field:||Health systems|
|Objective Group:||Evaluation of health and support services|
|Objective Field:||Evaluation of health outcomes|
|UTAS Author:||Lethborg, C (Dr Carolyn Lethborg)|
|Web of Science® Times Cited:||15|
|Deposited By:||UTAS Centre for Rural Health|
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