title: A Review of the Construct of Demoralization: History, Definitions, and Future Directions for Palliative Care.
abstract: Demoralization has been the subject of discussion in relation to end-of-life care. It is characterized by hopelessness and helplessness due to a loss of purpose and meaning. The purpose of this review was to consolidate the conceptual understanding of demoralization and argue for its existence as a psychiatric syndrome. The history of the construct is explored, including the nature of existential distress and related psychological conditions that precipitate demoralization. Recent definitions of demoralization are described and differentiated from similar constructs. Future directions are highlighted, specifically in relation to the assessment, diagnosis, and treatment of demoralization in palliative care. Overall, demoralization is a clinically useful construct for those facing existential threat, guiding the clinician toward efforts to restore morale, meaning, and purpose.
authors.affiliation: School of Psychological Sciences, Monash University, Clayton, Australia Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia Cabrini Monash Psycho-oncology, Cabrini Health, Malvern, Australia.
authors.forename: Sophie
authors.initials: S
authors.lastname: Robinson
authors.affiliation: School of Psychological Sciences, Monash University, Clayton, Australia Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia Cabrini Monash Psycho-oncology, Cabrini Health, Malvern, Australia david.kissane@monash.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Kissane
authors.affiliation: Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia Cabrini Monash Psycho-oncology, Cabrini Health, Malvern, Australia.
authors.forename: Joanne
authors.initials: J
authors.lastname: Brooker
authors.affiliation: School of Psychological Sciences, Monash University, Clayton, Australia Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Australia Cabrini Monash Psycho-oncology, Cabrini Health, Malvern, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Burney
mesh_terms: D000223:Adaptation, Psychological; D001293:Attitude to Death; D001294:Attitude to Health; D006801:Humans; D007389:Internal-External Control; D009013:Morale; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D011788:Quality of Life; D019452:Terminally Ill / Q000523:psychology*
keywords: demoralization; depression; end of life; existential distress; loss of meaning; palliative care; terminal