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Demoralization among cancer patients in mainland China: validity of the Demoralization Scale(DS)

Demoralization, characterized by hopelessness, helplessness, and loss of meaning and purpose, reflects existential distress. The objectives is To assess the validity of a Mainland Chinese versions of the demoralization scale (MC-DS) for using with Mainland Chinese cancer patients. In-patients sequentially recruited from a specialist tertiary-level cancer hospital in Beijing between January 2016-April 2016 completed Demoralization Scale, (DS) Patient Health Questionnaire-9 (PHQ-9), Revised Life Orientation Test (CLOT-R), Beck Hopelessness Scale (BHS), and provided sociodemographic and clinical information. We determined DS factor structure and convergent and divergent validity. 296/424 (70.0%) participants reported mean DS score=30.42(SD=13.00). EFA identified 3-factors explaining 21.4%, 17.8%, and 10.6% respectively of observed variance. Respective Cronbach Alphas were 0.88, 0.84, and 0.64 (0.90 full-scale). Convergent was shown by PHQ-9 scores correlating with Factor 2 (r=0.606), and BHS and C-LOT-R scores correlating (r=0.632,r=0.407 respectively) with Factor 1. Dichotomizing demoralization (high >30, low≦30) cross-tabulated against PHQ-9 score (mood) scores revealed 47% of patients exceeded demoralization cut-off, 60% of whom were not depressed. Using mean value±SD indicated demoralization cutoffs at <17.4 (low), 17.4-43.4 (medium) and >43.4 (high). Overall 71% met criteria for medium demoralization, and 15% for high demoralization. Sixty percent of all medium demoralization patients were not depressed, but only 5% of high demoralization patients were not depressed. The conclusion is that the Mainland Chinese Demoralization Scale is useful for detecting mild-to-moderate demoralization in cancer patients but at higher scores has poor specificity against depression.