Italian version of Demoralization Scale: a validation study

Objective. Demoralization and depressive symptoms are very common in chronic organic diseases. The aim of the present study is to evaluate reliability and psychometric properties of the Italian version of the Demoralization Scale (DS) in patients with advanced cancer. Methods. The Italian version of DS was administered to a sample consisting of 100 patients affected by different forms of cancer. The following scales were also administered: Patient Health Questionnaire, Beck Depression Inventory (BDI), Mini-Mental Adjustment to Cancer (MAC) and Karnofsky Performance Status Scale. Results. The total mean score of the DS was 23.9 +/- 14.5. The study showed a good degree of stability and internal consistency of DS total score (alpha=0.90) and the 5 factors represented by loss of meaning and purpose (alpha=0.69), dysphoria (alpha=0.72), disheartenment (alpha=0.84), helplessness (alpha=0.50) and sense of failure (alpha=0.74). Significant correlations were found between DS total score and BDI (r=0.74) and between DS factors and BDI (r=0.64 for loss of meaning and purpose; r=0.55 for dysphoria; r=0.71 for disheartenment; r=0.51 for helplessness; r=0.46 for sense of failure). Good correlations were also found between DS total score and Hopelessness scale of MAC (r=0,51). According to different cut-off values, between 28 and 32 patients were seriously demoralized and 40 had moderate levels of demoralization. Between 6 and 20 patients were seriously demoralized but not clinically depressed; between 16 and 31 patients with moderate levels of demoralization had no depression. Conclusion. Results provide further evidence that the DS is a valid and reliable instrument of high clinical relevance in patients with advanced cancer and confirm the hypothesis of the ontological difference between demoralization and depression.