The Demoralization Interview: Reliability and validity of a new brief diagnostic measure among medically ill patients
Publication Details
Bobevski, I.,
Kissane, D.,
McKenzie, D.,
Murphy, G.,
Perera, C.,
Payne, I.,
Lennon, J.,
Michael, N.,
Grossman, C.,
&
Franco, M.
(2022).
The Demoralization Interview: Reliability and validity of a new brief diagnostic measure among medically ill patients.
General Hospital Psychiatry, 79, 50-59.
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
demoralization, diagnostic interview, validation, adjustment, depression, coping, suicidality
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