Demoralization: A syndrome which should not be confused with depression

A group of Italian researchers headed by Prof. Giovanni Fava (University of Bologna) has published a multicenter investigation on demoralization in the setting of medical disease. Demoralization was defined according to diagnostic criteria encompassing unpleasant, distressing feelings of personal failure and inadequacies, with a loss of continuity in the sense of sequence between past and future.

The aim of this study was to assess the presence of demoralization and major depression in the setting of medical disease. 807 consecutive outpatients recruited from different medical settings (gastroenterology, cardiology, endocrinology and oncology) were assessed according to DSM-IV and DCPR criteria, using semistructured research interviews.

Demoralization was identified in 245 (30.4%) patients, while major depression was present in 135 (16.7%) patients. Even though there was a considerable overlap between the two diagnoses, 59 (43.7%) patients with major depression were not classified as demoralized, and 169 (69%) patients with demoralization did not satisfy the criteria for major depression.

The findings suggest a high prevalence of demoralization in the medically ill and the feasibility of a differentiation between demoralization and depression. Further research may determine whether demoralization, alone or in association with major depression, entails prognostic and clinical implications.