title: A Systematic Review and Meta-Analysis of Demoralization and Depression in Patients With Cancer.
abstract: BACKGROUND
  Demoralization is a psychological response that is frequently observed in patients with cancer or advanced diseases. Depression and demoralization syndrome in patients with cancer are closely related to suicidal behavior.
  
  
  OBJECTIVE
  The purpose of this study was to explore the factors affecting demoralization of patients with cancer from a depression perspective, to assist with distinguishing patient emotions and provide appropriate intervention as early as possible, thereby enabling patients to receive proper care.
  
  
  METHODS
  A systematic review and meta-analysis was employed in this study. The databases included Cumulative Index for Nursing and Allied Health Literature, Cochrane, PubMed/ MEDLINE, PsycINFO, and Centre for European Policy Studies, and reference lists of articles. Experts in this field also were contacted. Based on inclusion criteria, 2 investigators selected the research and reviewed each study's quality according to the Newcastle-Ottawa Scale. Five correlational studies with 32 subjects were identified.
  
  
  RESULTS
  The countries of studies included Australia, Germany, Taiwan, and the United States. There was a statistically significant difference in depression between patients with cancer in the high-demoralization group and those of the low-demoralization group (odds ratio = 9.65, 95% CI: 6.99-13.33, Z = 15.002, p < 0.0001). Four studies regarded demoralization and depression as distinguishable.
  
  
  CONCLUSIONS
  The demoralization of patients with cancer was highly correlated with depression. Therefore, the suicide risk of demoralized patients without depression must also be assessed to prevent patients with high suicide risk from being neglected. If medical staff can perceive patient's demoralization issues earlier, they can more effectively prevent patients' depression from occurring, which benefits suicide prevention.
authors.affiliation: Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, ROC.
authors.forename: Pei-Ling
authors.initials: PL
authors.lastname: Tang
authors.affiliation: Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, ROC.
authors.forename: Hsiu-Hung
authors.initials: HH
authors.lastname: Wang
authors.affiliation: Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung City, Taiwan, ROC; College of Nursing, Kaohsiung Medical University, Kaohsiung City, Taiwan, ROC. Electronic address: fanhao@kmu.edu.tw.
authors.forename: Fan-Hao
authors.initials: FH
authors.lastname: Chou
mesh_terms: D001294:Attitude to Health; D001315:Australia; D003866:Depressive Disorder / Q000150:complications* / Q000523:psychology*; D005858:Germany; D006801:Humans; D009369:Neoplasms / Q000150:complications* / Q000523:psychology*; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology; D059020:Suicidal Ideation; D011795:Surveys and Questionnaires; D013577:Syndrome; D013624:Taiwan; D014481:United States