The Demoralization Interview: Reliability and validity of a new brief diagnostic measure among medically ill patients

Irene Bobevski; David Kissane; Dean McKenzie; Genevieve Murphy; Chelsea Perera; Isobel Payne; Jonathon Lennon; Natasha Michael; Christopher Grossman; Michael Franco

doi:10.1016/j.genhosppsych.2022.10.002

The Demoralization Interview: Reliability and validity of a new brief diagnostic measure among medically ill patients

Gen Hosp Psychiatry. 2022 Nov-Dec:79:50-59. doi: 10.1016/j.genhosppsych.2022.10.002. Epub 2022 Oct 11.

Authors

Affiliations

¹ School of Medicine, University of Notre Dame, Australia; School of Clinical Sciences, Monash Health and Monash University, Australia; Cabrini Health, Melbourne, Australia. Electronic address: irene.bobevski@nd.edu.au.
² School of Medicine, University of Notre Dame, Australia; School of Clinical Sciences, Monash Health and Monash University, Australia; Cabrini Health, Melbourne, Australia; St Vincent's Hospital, Sydney, Australia. Electronic address: david.kissane@nd.edu.au.
³ Research & Development, Epworth HealthCare, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
⁴ School of Medicine, University of Notre Dame, Australia; Cabrini Health, Melbourne, Australia.
⁵ School of Medicine, University of Notre Dame, Australia; Mercy Health, Werribee, Australia.
⁶ School of Medicine, University of Notre Dame, Australia; St Vincent's Hospital, Sydney, Australia.
⁷ School of Medicine, University of Notre Dame, Australia; School of Clinical Sciences, Monash Health and Monash University, Australia; Cabrini Health, Melbourne, Australia.
⁸ Calvary Health Care Bethlehem, Melbourne, Australia.
⁹ School of Clinical Sciences, Monash Health and Monash University, Australia.

PMID: 36274426
DOI: 10.1016/j.genhosppsych.2022.10.002

Abstract

Background: Demoralization is a state of low morale and poor coping that is being increasingly recognized in stressful circumstances, such as illness. Meta-analyses show prevalence of 30% in the medically and 50% in the mentally ill. A brief structured diagnostic interview is needed to assess for and diagnose demoralization.

Methods: The Demoralization Interview (DI) was designed from items of the Demoralization Scale-II (DS-II) and common items used in other clinical interviews. The resultant 26 items were administered to 264 patients with serious progressive medical illnesses, together with the DS-II, measures of depression, anxiety, and quality of life. Rasch analysis was used to co-calibrate the DI against the DS-II. Sensitivity, specificity, and area under the receiver operating characteristics curve (AUROC) were assessed. Concurrent validation was conducted against measures of anxiety, depression, and quality of life.

Results: A 14-item Demoralization Interview (DI) with a diagnostic threshold of 6 symptoms generated sensitivity of 78.0%, specificity of 90.9%, and AUROC of 0.84 against the DS-II. Unidimensionality was indicated, with a Cronbach's alpha of 0.81. For respondents with 6 or more symptoms on the DI, 98% recognized a current stressor and 66% described significant distress or functional impairment. Demoralized respondents carried significantly lower quality of life, higher physical disability, and higher depressive and anxiety symptoms.

Conclusions: The DI has good reliability and validity, with a threshold of 6 symptoms supporting a diagnosis of demoralization. It could be used as a stand-alone diagnosis, or as a specifier for adjustment disorder or depression.

Keywords: Adjustment; Coping; Demoralization; Depression; Diagnostic interview; Suicidality; Validation.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Demoralization*
Humans
Psychometrics
Quality of Life
Reproducibility of Results
Stress, Psychological / diagnosis