{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:02:00Z","timestamp":1789012920049,"version":"build-2803163510"},"reference-count":47,"publisher":"Wiley","issue":"17","license":[{"start":{"date-parts":[[2017,5,4]],"date-time":"2017-05-04T00:00:00Z","timestamp":1493856000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100005972","name":"Deutsche Krebshilfe","doi-asserted-by":"publisher","award":["107465"],"award-info":[{"award-number":["107465"]}],"id":[{"id":"10.13039\/501100005972","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancer"],"published-print":{"date-parts":[[2017,9]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Demoralization refers to a state in which there is a perceived inability to cope, that is associated with a sense of disheartenment and a loss of hope and meaning. This study investigated the co\u2010occurrence versus independence of demoralization with mental disorders and suicidal ideation to evaluate its features as a concept of distress in the context of severe illness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>In a cross\u2010sectional sample of 430 mixed cancer patients, we assessed demoralization with the Demoralization Scale (DS); the 4\u2010week prevalence of mood, anxiety, and adjustment disorders and suicidal ideation with the standardized Composite International Diagnostic Interview\u2013Oncology (CIDI\u2010O); and depressive symptoms with the Patient Health Questionnaire\u20109 (PHQ\u20109). We compared the relative risk (RR) for mental disorders associated with demoralization to that associated with self\u2010reported depression.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Clinically relevant levels of demoralization were present in 21% of the patients. Demoralization co\u2010occurred with a mood\/anxiety disorder in 7%; 14% were demoralized in absence of any mood\/anxiety disorder. Demoralization and adjustment disorders co\u2010occurred in 2%. The RR for any mood\/anxiety disorder was 4.0 in patients with demoralization (95% confidence interval [CI], 2.5\u20106.2) and 3.0 in those with depression (95% CI, 1.9\u20104.6). Demoralization, but not depression, was associated with a significantly increased risk for suicidal ideation after controlling for mental disorders (RR, 2.0; 95% CI, 1.1\u20103.5).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>\n                      Clinically relevant demoralization frequently occurs independently of a mental disorder in patients with cancer and has a unique contribution to suicidal ideation. Demoralization is a useful concept to identify profiles of psychological distress symptoms amenable to interventions improving psychological well\u2010being in this population.\n                      <jats:bold>\n                        <jats:italic>Cancer<\/jats:italic>\n                        2017;123:3394\u2010401\n                      <\/jats:bold>\n                      . \u00a9\n                      <jats:italic>2017 American Cancer Society<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/cncr.30749","type":"journal-article","created":{"date-parts":[[2017,5,4]],"date-time":"2017-05-04T13:06:49Z","timestamp":1493903209000},"page":"3394-3401","source":"Crossref","is-referenced-by-count":172,"title":["The association of demoralization with mental disorders and suicidal ideation in patients with 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