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Demoralization and chronic illness in rural Australia: A cross-sectional survey

Published online by Cambridge University Press:  12 November 2019

Claire Bailey Open the ORCID record for Claire Bailey [Opens in a new window] ,
Zelda Doyle ,
John Dearin ,
Natasha Michael  and
David Kissane
Claire Bailey
Affiliation:
Lithgow Clinical School, University of Notre Dame, Lithgow, New South Wales, Australia
Zelda Doyle*
Affiliation:
Lithgow Clinical School, University of Notre Dame, Lithgow, New South Wales, Australia
John Dearin
Affiliation:
Lithgow Clinical School, University of Notre Dame, Lithgow, New South Wales, Australia
Natasha Michael
Affiliation:
Werribee Clinical School, University of Notre Dame, Werribee, Victoria, Australia
David Kissane
Affiliation:
School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
*
Author for correspondence: Zelda Doyle, The University of Notre Dame Australia, Lithgow Clinical School, 2 Col Drewe Dr, South Bowenfels, NSW2790, Australia. E-mail: zelda.doyle@nd.edu.au
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Abstract

Objective

Demoralization is prevalent in patients with life-limiting chronic illnesses, many of whom reside in rural areas. These patients also have an increased risk of disease-related psychosocial burden due to the unique health barriers in this population. However, the factors affecting demoralization in this cohort are currently unknown. This study aimed to examine demoralization amongst the chronically ill in Lithgow, a town in rural New South Wales, Australia, and identify any correlated demographic, physical, and psychosocial factors in this population.

Method

A cross-sectional survey of 73 participants drawn from Lithgow Hospital, the adjoining retirement village and nursing home, assessing correlating demographic, physical, psychiatric, and psychosocial factors.

Results

The total mean score of the DS-II was 7.8 (SD 26.4), and high demoralization scores were associated with the level of education (p = 0.01), comorbid condition (p = 0.04), severity of symptom burden (p = <0.001), depression (p = <0.001), and psychological distress (p = <0.001). Prevalence of serious demoralization in this population was 27.4% according to a cutoff of a DS-II score ≥11. Of those, 11 (15%) met the criteria for clinical depression, leaving 9 (12.3%) of the cohort demoralized but not depressed.

Significance of results

Prevalence of demoralization was high in this population. In line with the existing literature, demoralization was associated with the level of education, symptom burden, and psychological distress, demonstrating that demoralization is a relevant psychometric factor in rural populations. Further stratification of the unique biopsychosocial factors at play in this population would contribute to better understanding the burdens experienced by people with chronic illness in this population and the nature of demoralization.

Keywords

Chronic illnessDemoralizationDepressionDisease burdenRural health
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 3 , June 2020 , pp. 271 - 276
Copyright
Copyright © Cambridge University Press 2019

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References

Australian Bureau of Statistics [ABS] (2016) 2016 Census QuickStats. Available at: http://quickstats.censusdata.abs.gov.au/census_services/getproduct/census/2016/quickstat/LGA14870?Opendocument (Last accessed August 1, 2018).Google Scholar
Australian Institute of Health and Welfare [AIHW] (2015) The Health and Welfare of Australia's Aboriginal and Torres Strait Islander Peoples: 2015. Canberra: AIHW.Google Scholar
Chang, VT, Hwang, SS, Thaler, HT, et al. (2004) Memorial Symptom Assessment Scale. Expert Review of Pharmacoeconomics & Outcomes Research 4(2), 171–178.CrossRefGoogle ScholarPubMed
Charlson, M, Pompei, P, Ales, K, et al. (1987) A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Disease 40, 373–383.CrossRefGoogle ScholarPubMed
Clarke, DM (2007) Growing old and getting sick: Maintaining a positive spirit at the end of life. Australian Journal of Rural Health 15(3), 148–154.CrossRefGoogle ScholarPubMed
Clarke, DM, McLeod, JE, Smith, GC, et al. (2005) A comparison of psychosocial and physical functioning in patients with motor neurone disease and metastatic cancer. Journal of Palliative Care 21(3), 173.CrossRefGoogle ScholarPubMed
Deshields, T, Penalba, V, Liu, J, et al. (2017) Comparing the symptom experience of cancer patients and non-cancer patients. Supportive Care in Cancer 25(4), 1103–1109. doi:10.1007/s00520-016-3498-2CrossRefGoogle ScholarPubMed
DoctorConnect. Australian Standard Geographical Classification - Remoteness Area [ASGC-RA 2006] (2018) Available at: http://www.doctorconnect.gov.au/internet/otd/publishing.nsf/content/ra-intro (retrieved from).Google Scholar
Grassi, L and Nanni, M (2016) Demoralization syndrome: New insights in psychosocial cancer care. Cancer 122(14), 2130–2133.CrossRefGoogle ScholarPubMed
IBM Corp (2017) IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp.Google Scholar
Jacobsen, J, Maytal, G and Stern, T (2007) Demoralization in medical practice. The Primary Care Companion to the Journal of Clinical Psychiatry 9(2), 139–143.CrossRefGoogle ScholarPubMed
Kirby, S, Barlow, V, Saurman, E, et al. (2016) Are rural and remote patients, families and caregivers needs in life-limiting illness different from those of urban dwellers? A narrative synthesis of the evidence. Australian Journal of Rural Health 24(5), 289–299.CrossRefGoogle Scholar
Kissane, DW (2014) Demoralization: A life-preserving diagnosis to make for the severely medically ill. Journal of Palliative Care 30(4), 255.CrossRefGoogle ScholarPubMed
Kissane, DW, Clarke, DM and Street, AF (2001) Demoralization syndrome – A relevant psychiatric diagnosis for palliative care. Journal of Palliative Care 17(1), 12–21.CrossRefGoogle ScholarPubMed
Kissane, D, Wein, S, Love, A, et al. (2004) The demoralization scale: A report of its development and preliminary validation. Journal of Palliative Care 20, 269–276.CrossRefGoogle ScholarPubMed
Ko, K, Lin, C, Pi, S, et al. (2018) Demoralization syndrome among elderly patients with cancer disease. International Journal of Gerontology 12, 12–16.CrossRefGoogle Scholar
Kroenke, K, Spitzer, R and Williams, W (2001) The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606–616.CrossRefGoogle ScholarPubMed
National Rural Health Alliance (NRHA) Inc. (2010) Fact sheet 23: Measuring the metropolitan-rural inequity. Retrieved from: http://ruralhealth.org.au/factsheets/thumbsGoogle Scholar
Phillips, A (2009) Health status differentials across rural and remote Australia. Australian Journal of Rural Health 17(1), 2–9.CrossRefGoogle ScholarPubMed
Robinson, S, Kissane, D, Brooker, J, et al. (2015) A systematic review of the demoralization syndrome in individuals with progressive disease and cancer: A decade of research. Journal of Pain and Symptom Management 49(3), 595–610.CrossRefGoogle ScholarPubMed
Robinson, S, Kissane, DW, Brooker, J, et al. (2016) Refinement and revalidation of the demoralization scale: The DS-II—external validity. Cancer 122(14), 2260–2267.CrossRefGoogle ScholarPubMed
Robinson, S, Kissane, DW, Brooker, J, et al. (2017) The relationship between poor quality of life and desire to hasten death: A multiple mediation model examining the contribution of depression, demoralization, loss of control and low self-worth. Journal of Pain and Symptom Management 52(2), 243–249.CrossRefGoogle Scholar
Sansone, RA and Sansone, LA (2010) Demoralization in patients with medical illness. Psychiatry 7(8), 42–45.Google ScholarPubMed
Tang, P, Wang, H and Chou, F (2015) A systematic review and meta-analysis of demoralization and depression in patients with cancer. Psychosomatics 56(6), 634–643.CrossRefGoogle ScholarPubMed
Tecuta, L, Tomba, E, Grandi, S and Fava, GA (2015) Demoralization: A systematic review on its clinical characterization. Psychological Medicine 45(4), 673–691.CrossRefGoogle ScholarPubMed
Tranmer, JE, Heyland, D, Dudgeon, D, et al. (2003) Measuring the symptom experience of seriously ill cancer and non-cancer hospitalized patients near the end of life with the memorial symptom assessment scale. Journal of Pain & Symptom Management 25(5), 420–429.CrossRefGoogle Scholar
Vehling, S., Kissane, D. W., Lo, C., et al. (2017). The association of demoralization with mental disorders and suicidal ideation in patients with cancer. Cancer, 123(17), 3394–3401.CrossRefGoogle ScholarPubMed