title: Demoralisation syndrome does not explain the psychological profile of community-based asylum-seekers.
abstract: BACKGROUND
  Demoralisation syndrome (DS) has been advanced as a construct that features hopelessness, meaninglessness, and existential distress. Demoralisation and DS have predominantly been considered secondary only to illness; hence there is scant research on demoralisation or DS in populations affected by extreme environmental stress.
  
  
  OBJECTIVE
  The current study aimed to determine the prevalence of demoralisation, its predictors, and the relevance of DS in a community-based forced-migrant population.
  
  
  METHODS
  A convenience sample of 131 adult asylum-seekers (n=98) and refugees (n=33) without recognised mental disorders in Melbourne, Australia, were assessed cross-sectionally on posttraumatic stress, anxiety, depression, post-migration stress, and demoralisation. Socio-demographic data were analysed with relevant clinical data. Predictive aims were investigated using bivariate statistical tests and exploratory aims were investigated using correlational and linear regression analyses.
  
  
  RESULTS
  Seventy nine percent of the sample met criteria for demoralisation (asylum-seekers=83%; refugees=66%), with asylum-seekers being 2.55 (95% C.I.=1.03-6.32, Z=2.03, p=.04) times more likely to be demoralised than refugees. No relationship between demoralisation and time in the refugee determination process emerged. The regression model explained 47.5% of variance in demoralisation scores for the total sample F(9,111)=13.07, p<.0001, with MDD and anxiety score making unique significant contributions.
  
  
  CONCLUSIONS
  Demoralisation was widespread through the asylum-seeker and refugee population and its prevalence was attributable to a range of social and psychiatric factors. However, DS had little explanatory power for psychiatric morbidity, which was more suggestive of a pan-distress symptom complex.
authors.affiliation: Florey Institute of Neuroscience and Mental Health, Parkville, VIC, Australia. Electronic address: debbie.hocking@florey.edu.au.
authors.forename: Debbie
authors.initials: D
authors.lastname: Hocking
authors.affiliation: Department of Psychiatry, Monash Medical Centre, Clayton, VIC, Australia. Electronic address: suresh.sundram@monash.edu.
authors.forename: Suresh
authors.initials: S
authors.lastname: Sundram
mesh_terms: D000275:Adjustment Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D000328:Adult; D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001315:Australia / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D044382:Population Groups; D012036:Refugees / Q000523:psychology*; D012111:Residence Characteristics; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D011795:Surveys and Questionnaires