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Exploratory examination of the utility of demoralization as a diagnostic specifier for adjustment disorder and major depression


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]

Copyright Statement

2017 Elsevier Inc.

DOI: doi:10.1016/j.genhosppsych.2017.01.007


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 Details

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 Division:Health
Objective Group:Evaluation of health and support services
Objective Field:Evaluation of health outcomes
UTAS Author:Lethborg, C (Dr Carolyn Lethborg)
ID Code:153754
Year Published:2017
Web of Science® Times Cited:15
Deposited By:UTAS Centre for Rural Health
Deposited On:2022-10-05
Last Modified:2022-11-23

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