title: Psychological characterization of demoralization in the setting of heart transplantation.
abstract: OBJECTIVE
  The aims of this study were to examine the psychological features of demoralization and its overlap with major depressive disorder in a sample of cardiac transplant recipients, with special reference to psychological well-being, quality of life, and psychological distress. We also tested whether demoralization was significantly associated with demographic characteristics and clinical parameters, including survival status at a 6-year follow-up.
  
  
  METHODS
  From May to December 2002, 95 heart transplanted patients were administered the Structured Clinical Interview for DSM-IV and the Diagnostic Criteria for Psychosomatic Research, leading to the identification of major depressive disorder and demoralization, respectively. Patients also completed Ryff's Scales of Psychological Well-Being, Kellner's Symptom Questionnaire, and the World Health Organization Quality of Life-Brief Version scale.
  
  
  RESULTS
  Demoralization was related to impairments in physical, psychological, social, and environmental quality of life and in psychological well-being, especially self-acceptance and environmental mastery (all P ≤ .05). It was also associated with higher levels of psychological distress, and it was more frequent in women (P = .027) and in single patients (P = .038). The co-occurrence of a major depressive episode did not alter this pattern of associations. The addition of demoralization to major depressive disorder resulted in decreased Scales of Psychological Well-Being autonomy, positive relations, and self-acceptance (all P ≤ .05). Demoralization and major depressive disorder were identified in 31 (32.6%) and 14 (14.7%) patients, respectively. Among depressed subjects, 5 (35.7%) were not demoralized, and 22 (71%) of those with demoralization did not satisfy the criteria for major depressive disorder. Nine patients were both depressed and demoralized.
  
  
  CONCLUSIONS
  Diagnostic Criteria for Psychosomatic Research-defined demoralization has some distinctive features that confirm previous phenomenological observations.
authors.affiliation: Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Grandi
authors.forename: Laura
authors.initials: L
authors.lastname: Sirri
authors.forename: Eliana
authors.initials: E
authors.lastname: Tossani
authors.forename: Giovanni A
authors.initials: GA
authors.lastname: Fava
mesh_terms: D000223:Adaptation, Psychological; D003865:Major Depressive Disorder / Q000209:etiology / Q000523:psychology; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects / Q000523:psychology*; D006801:Humans; D007406:Interview, Psychological; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D011581:Psychological Tests; D011788:Quality of Life / Q000523:psychology; D013315:Stress, Psychological / Q000209:etiology / Q000523:psychology