title: The factor structure and use of the Demoralization Scale (DS-IT) in Italian cancer patients.
abstract: OBJECTIVE
  Demoralization is a commonly observed syndrome in cancer patients, deserving to be carefully assessed in cross-cultural contexts.
  
  
  OBJECTIVE
  To examine the factor structure and concurrent and divergent validity of the Italian version of the Demoralization Scale (DS-IT) in cancer patients.
  
  
  METHODS
  The sample included 194 Italian cancer outpatients who were assessed by using the DS-IT and the Diagnostic Criteria of Psychosomatic Research-Demoralization module to examine demoralization. The Patient Health Questionnaire-9 (PHQ-9) to explore depression and the Mini-Mental Adjustment-to-Cancer-Hopelessness/Helplessness scale (Mini-MAC-HH) to explore maladaptive coping were also administered.
  
  
  RESULTS
  Four factors were extracted by exploratory factor analysis on the DS-IT (disheartenment, α = .87; sense of failure, α = .77; dysphoria, α = .73; loss of meaning/purpose, α = .72; total = 0.91), accounting for 57.1% of the variance. The DS-IT factors shared between 17% and 36% of the variance. Patients reporting a diagnosis of demoralization on the Diagnostic Criteria of Psychosomatic Research-Demoralization module (23.7%) had higher scores on DS-IT loss of meaning/purpose, sense of failure, dysphoria, and DS-IT total. About half of those who were highly demoralized were not depressed and among those who had moderate or moderately severe demoralization, about 80% were not depressed on the PHQ-9. The DS-IT was significantly associated with PHQ-9 and Mini-MAC-HH.
  
  
  CONCLUSIONS
  The study presents further evidence that demoralization is a significant clinical condition and that the DS-IT demonstrates satisfactory levels of validity and reliability to support its use in patients in the ambulatory cancer setting.
authors.affiliation: Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.|University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital, Ferrara, Italy.
authors.forename: Luigi
authors.identifier: http://orcid.org/0000-0002-1050-4494
authors.initials: L
authors.lastname: Grassi
authors.affiliation: Psychoncology Unit, Sant'Andrea Hospital Sapienza, University of Rome, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Costantini
authors.affiliation: Department of Psychiatry, Monash University and Szalmuk Family Research Unit at Cabrini Health, Clayton, Victoria, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Kissane
authors.affiliation: Psychoncology Unit, Sant'Andrea Hospital Sapienza, University of Rome, Rome, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Brunetti
authors.affiliation: Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.|University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital, Ferrara, Italy.
authors.forename: Rosangela
authors.initials: R
authors.lastname: Caruso
authors.affiliation: Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Piazza
authors.affiliation: Medical Oncology, La Sapienza University of Rome and IDI-IRCCS, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Marchetti
authors.affiliation: Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.
authors.forename: Silvana
authors.initials: S
authors.lastname: Sabato
authors.affiliation: Institute of Psychiatry, Department of Biomedical and Specialty Surgical Sciences, University of Ferrara, Ferrara, Italy.|University Hospital Psychiatry Unit, Integrated Department of Mental Health and Addictive Behaviors, Health Authorities and University S. Anna Hospital, Ferrara, Italy.
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Nanni
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003863:Depression / Q000209:etiology / Q000523:psychology*; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D007558:Italy; D007802:Language; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000150:complications* / Q000208:ethnology / Q000523:psychology; D010045:Outpatients; D011569:Psychiatric Status Rating Scales; D011594:Psychometrics; D015203:Reproducibility of Results; D013315:Stress, Psychological / Q000150:complications / Q000523:psychology
keywords: cancer; demoralization; depression; oncology; psychiatry; psycho-oncology