Demoralization: A systematic review on its clinical characterization

Psychological Medicine

Volumn 45, Issue 4, 2015, Pages 673-691

  Tecuta, L ^a   Tomba, E ^a   Grandi, S ^a   Fava, G A ^a,b  

^a UNIVERSITY OF BOLOGNA   (Italy)

^b UNIVERSITY AT BUFFALO   (United States)

Author keywords

Demoralization; depression; helplessness; hopelessness; medical illness

Indexed keywords

ADAPTIVE BEHAVIOR; CLASSIFICATION; DEPRESSIVE DISORDER, MAJOR; HUMAN; MORALITY;

ADAPTATION, PSYCHOLOGICAL; DEPRESSIVE DISORDER, MAJOR; HUMANS; MORALE;

EID: 84926297542     PISSN: 00332917     EISSN: 14698978     Source Type: Journal    
DOI: 10.1017/S0033291714001597     Document Type: Article

References (140)

1. Abbate-Daga G, Delsedime N, Nicotra B, Giovannone C, Marola E, Amianto F, Fassino S (2013). Psychosomatic syndromes and anorexia nervosa. BMC Psychiatry 13, 14.
2. Abramson LY, Metalsky GI, Alloy LB (1989). Hopelessness depression: a theory-based subtype of depression. Psychological Review 96, 358-372.
3. Adamson JD, Schmale AH (1965). Object loss, giving up, and the onset of psychiatric disease. Psychosomatic Medicine 28, 555-576.
4. APA (1994). Diagnostic and Statistical Manual for Mental Disorders, 4th edn. American Psychiatric Association: Arlington, VA.
5. APA (2013). Diagnostic and Statistical Manual for Mental Disorders, 5th edn. American Psychiatric Association: Arlington, VA.
6. Angelino AF, Treisman GJ (2001). Major depression and demoralization in cancer patients: diagnostic and treatment considerations. Support Care Cancer 9, 344-349.
7. Antonovsky A (1987). Unravelling the Mystery of Health: How People Manage Stress and Stay Well. Jossey-Bass: San Francisco, CA.
8. Beck AT, Weissman A, Lester D, Trexler L (1974). The measurement of pessimism: the Beck Hopelessness Scale. Journal Consult Clinical Psychology 42, 861-865.
9. Boscaglia N, Clarke DM (2007). Sense of coherence as a protective factor for demoralisation in women with a recent diagnosis of gynecological cancer. Psycho-Onocology 16, 189-195.
10. Bradburn NM (1969). The Structure of Psychological Well-being. Aldine: Chicago.
11. Carver CS (1997). You want to measure coping but your protocol's too long: consider the brief COPE. International Journal of Behavioral Medicine 4, 92-100.
12. Catanese A, John MS, Di Battista J, Clarke DM (2009). Acute cognitive therapy in reducing suicide risk following a presentation to an emergency department. Behaviour Change 26, 16-26.
13. Chaturvedi SK, Goswami K (2012). Feasibility of diagnostic criteria for psychosomatic research in India: a pilot qualitative evaluation. Psychotherapy and Psychosomatics 81, 320-321.
14. Chioqueta AP, Stiles TC (2003). Suicide risk in outpatients with specific mood and anxiety disorders. Crisis 24, 105-112.
15. Clarke DM, Kissane DW (2002). Demoralization: its phenomenology and importance. Australian and New Zealand Journal of Psychiatry 36, 733-742.
16. Clarke DM, Kissane DW, Trauer T, Smith GC (2005). Demoralization, anhedonia and grief in patients with several physical illness. World Psychiatry 4, 96-105.
17. Cockram CA, Doros G, de Figueiredo JM (2009). Diagnosis and measurement of subjective incompetence: the clinical hallmark of demoralization. Psychotherapy and Psychosomatics 78, 342-345.
18. Cockram CA, Doros G, de Figueiredo JM (2010). Subjective incompetence as the clinical hallmark of demoralization in cancer patients without mental disorder. Primary Psychiatry 17, 54-58.
19. Cohen S, Kamarck T, Mermelstein R (1983). A global measure of perceived stress. Journal of Health and Social Behavior 24, 385-396.
20. Cohen SR, Mount BM, Strobel MG, Bui F (1995). The McGill quality of life questionnaire: a measure of quality of life appropriate for people with advanced disease. A preliminary study of validity and acceptability. Palliative Medicine 9, 207-219.
21. de Figueiredo JM (1993). Depression and demoralization: phenomenologic differences and research perspectives. Comprehensive Psychiatry 34, 308-311.
22. de Figueiredo JM (2013). Distress, demoralization and psychopathology: diagnostic boundaries. The European Journal of Psychiatry 27, 61-73.
23. de Figueiredo JM, Frank JD (1982). Subjective incompetence: the clinical hallmark of demoralization. Comprehensive Psychiatry 23, 353-363.
24. de Figueiredo JM, Slavney P (2000). Diagnosing demoralization in consultation psychiatry [Letter to the editor]. Psychosomatics 41, 449-450.
25. Dohrenwend BP, Shrout PE, Egri G, Mendelsohn FS (1980). Non-specific psychological distress and other dimensions of psychopathology. Archives of General Psychiatry 37, 1229-1236.
26. Dozois DJ, Dobson KS, Ahnberg JL (1998). A psychometric evaluation of the BDI-II. Psychological Assessment 10, 83-89.
27. Emmrich A, Beesdo-Baum K, Gloster AT, Knappe S, Höfler M, Arolt V, Deckert J, Gerlach AL, Hamm A, Kircher T, Lang T, Richter J, Ströhle A, Zwanzger P, Wittchen HU (2012). Depression does not affect the treatment outcome of CBT for panic and agoraphobia: results from a multicenter randomized trial. Psychotherapy and Psychosomatics 81, 161-172.
28. Engel GL (1968). A life setting conducive to illness: the giving up-given up complex. Annals of Internal Medicine 69, 293-300.
29. Fava GA, Fabbri S, Sirri L, Wise T (2007). Psychological factors affecting medical condition: a new proposal for DSM V. Psychosomatics 48, 103-111.
30. Fava GA, Freyberger HJ, Bech P, Christodoulou G, Sensky T, Wise TN (1995). Diagnostic criteria for use in psychosomatic research. Psychotherapy and Psychosomatics 63, 1-8.
31. Fava GA, Guidi J, Porcelli P, Rafanelli C, Bellomo A, Grandi S, Grassi L, Mangelli L, Pasquini P, Picardi A, Quartesan R, Rigatelli M, Sonino N (2012a). A cluster analysis-derived classification of psychological distress and illness behavior in the medically ill. Psychological Medicine 42, 401-407.
32. Fava GA, Guidi J, Semprini F, Tomba E, Sonino N (2010a). Clinical assessment of allostatic load and clinimetric criteria. Psychotherapy and Psychosomatics 79, 280-284.
33. Fava GA, Porcelli P, Rafanelli C, Mangelli L, Grandi S (2010b). The spectrum of anxiety disorders in the medically ill. Journal of Clinical Psychiatry 71, 910-914.
34. Fava GA, Rafanelli C, Tomba E, Guidi J, Grandi S (2011). The sequential combination of cognitive behavioral treatment and well-being therapy in cyclothymic disorder. Psychotherapy and Psychosomatics 80, 136-143.
35. Fava GA, Tomba E (2009). Increasing psychological well-being and resilience by psychotherapeutic methods. Journal of Personality 77, 1903-1934.
36. Fava GA, Tomba E, Sonino N (2012b). Clinimetrics: the science of clinical measurements. The International Journal of Clinical Practice 66, 11-15.
37. Feldman D, Rabinowitz J, Ben-Yehuda Y (1995). Detecting psychological distress among patients attending secondary health care clinics. Self-report and physician rating. General Hospital Psychiatry 17, 425-432.
38. Ferrari S, Galeazzi GM, Mackinnon A, Rigatelli M (2008). Frequent attenders in primary care: impact of medical, psychiatric and psychosomatic diagnoses. Psychotherapy and Psychosomatics 77, 306-314.
39. Ferrari S, Monzani D, Baraldi S, Simoni E, Prati G, Forghieri M, Rigatelli M, Genovese E, Pingani L (2013). Vertigo "in the pink": the impact of female gender on psychiatric-psychosomatic comorbidity in benign paroxysmal positional vertigo patients. Psychosomatics. Published online: 4 June 2013. doi:10.1016/j. psym.2013.02.00.
40. Fichter MM, Quadflieg N (2001). The structured interview for anorexic and bulimic disorders for DSM-IV and ICD-10 (SIAB-EX): reliability and validity. European Psychiatry 16, 38-48.
41. Fichter MM, Quadflieg N, Brandl B (1993). Recurrent overeating: an empirical comparison of binge eating disorder, bulimia nervosa, and obesity. International Journal of Eating Disorders 14, 1-16.
42. Forgeard MJC, Haigh EAP, Beck AT, Davidson RJ, Henn FA, Maier SF, Mayberg HS, Seligman ME (2011). Beyond depression: towards a process-based approach to research, diagnosis, and treatment. Clinical Psychology 18, 275-299.
43. Frank JB (2013). Teaching medical students to recognize demoralization. The European Journal of Psychiatry 27, 36-41.
44. Frank JD (1961). Persuasion and Healing. Johns Hopkins University Press: Baltimore.
45. Frank JD (1973). Persuasion and Healing. Johns Hopkins University Press: Baltimore.
46. Frank JD, Frank JB (1991). Persuasion and Healing. Johns Hopkins University Press: Baltimore.
47. Galeazzi GM, Ferrari S, Mackinnon A, Rigatelli M (2004). Inter-rater reliability, prevalence and relation to ICD-10 diagnoses of the diagnostic criteria for psychosomatic research in consultation-liaison psychiatry patients. Psychosomatics 45, 386-393.
48. Gallagher RM, Marbach JJ, Raphael KG, Handte J, Dohrenwend BP (1995). Myofascial face pain: seasonal variability in pain intensity and demoralization. Pain 61, 113-120.
49. Grandi S, Fabbri S, Tossani E, Mangelli L, Branzi A, Mangelli C (2001). Psychological evaluation after cardiac transplantation: the integration of different criteria. Psychotherapy and Psychosomatics 70, 176-183.
50. Grandi S, Sirri L, Tossani E, Fava GA (2011). Psychological characterization of demoralization in the setting of heart transplantation. Journal of Clinical Psychiatry 72, 648-654.
51. Grassi L, Mangelli L, Fava GA, Grandi S, Ottolini F, Porcelli P, Rafanelli C, Rigatelli M, Sonino N (2007). Psychosomatic characterization of adjustment disorders in the medical setting: some suggestions for DSM-V. Journal of Affective Disorders 101, 251-254.
52. Grassi L, Rossi E, Sabato S, Cruciani G, Zambelli M (2004). Diagnostic Criteria for Psychosomatic Research and psychosocial variables in breast cancer patients. Psychosomatics 45, 483-491.
53. Grassi L, Sabato S, Rossi E, Biancosino B, Marmai L (2005). Use of the diagnostic criteria for psychosomatic research in oncology. Psychotherapy and Psychosomatics 74, 100-107.
54. Guidi J, Fava GA, Picardi A, Porcelli P, Bellomo A, Grandi S, Grassi L, Pasquini P, Quartesan R, Rafanelli C, Rigatelli M, Sonino N (2011). Subtyping depression in the medically ill by cluster analysis. Journal of Affective Disorders 132, 383-388.
55. Guidi J, Rafanelli C, Roncuzzi R, Sirri L, Fava GA (2013). Assessing psychological factors affecting medical conditions: comparison between different proposals. General Hospital Psychiatry 35, 141-146.
56. Hamilton M (1967). Development of a rating scale for primary depressive illness. British Journal of Social and Clinical Psychology 6, 278-296.
57. Haslam N, Beck AT (1994). Subtyping major depression: a taxometric analysis. Journal of Abnormal Psychology 103, 686-692.
58. Iacoviello BM, Alloy LB, Abramson LY, Choi JY, Morgan JE (2013). Patterns of symptom onset and remission in episodes of hopelessness depression. Depression & Anxiety 30, 564-573.
59. Jackson ME, Tessler RC (1984). Perceived lack of control over life events: antecedents and consequences in a discharged patient sample. Social Science Research 13, 287-301.
60. Jacobsen J, Maytal G, Stern TA (2007). Demoralization in medical practice. Primary Care Companion to the Journal of Clinical Psychiatry 9, 139-143.
61. Jacobsen J, Vanderwerker LC, Block SD, Friedlander RJ, Maciejewski PK, Prigerson HG (2006). Depression and demoralization as distinct syndromes: preliminary data from a cohort of advanced cancer patients. Indian Journal of Palliative Care 12, 8-15.
62. Kissane DW, Clarke DM, Street AF (2001). Demoralization syndrome-A relevant psychiatric diagnosis for palliative care. Journal of Palliative Care 17, 12-22.
63. Kissane DW, Patel SG, Baser RE, Bell R, Farberov M, Ostroff JS, Li Y, Singh B, Kraus DH, Shah JP (2013). Preliminary evaluation of the reliability and validity of the Shame and Stigma Scale in head and neck cancer. Head & Neck 35, 172-183.
64. Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM (2004). The Demoralization Scale: a report of its development and preliminary validation. Journal of Palliative Care 20, 269-276.
65. Klein DF, Davis JM (1969). Diagnosis and Drug Treatment of Psychiatric Disorders. Williams & Wilkins: Baltimore, MD.
66. Klein DF, Gittelman R, Quitkin F, Rifkin A (1980). A Diagnosis and Drug Treatment of Psychiatric Disorders: Adults and Children. Wilkins & Wilkins: Baltimore, MD.
67. Kohn R (2013). Demoralization and the longitudinal course of PTSD following Hurricane Mitch. European Journal of Psychiatry 27, 18-26.
68. Kroenke K, Spitzer RL, Williams JBW (2001). The PHQ-9. Validity of a brief depression severity measure. Journal of General Internal Medicine 16, 606-613.
69. Lau R, Morse CA, Macfarlane S (2010). Psychological factors among elderly women with suicidal intentions or attempts to suicide: a controlled comparison. Journal of Women & Aging 22, 3-14.
70. Lee CY, Fang CK, Yang YC, Liu CL, Leu YS, Wang TE, Chen HW (2012). Demoralization syndrome among cancer outpatients in Taiwan. Support Care Cancer 20, 2259-2267.
71. Lennon MC, Dohrenwend BP, Zautra AJ, Marbach JJ (1990). Coping and adaptation to facial pain in contrast to other stressful life events. Journal of Personality and Social Psychology 59, 1040-1050.
72. Link B, Dohrenwend BP (1980). Formulation of hypotheses about the true prevalence of demoralization in the United States. In Mental Illness in the United States: Epidemiological Estimates (ed. B. P. Dohrenwend, B. S. Dohrenwend, M. Schwartz-Gould, B. Link, R. Neugebauer and R. Wunsch-Hitz), pp. 114-132. Praeger Press: New York.
73. Lipowski ZJ (1988). Somatization: the concept and its clinical application. American Journal of Psychiatry 145, 1358-1368.
74. Mangelli L, Fava GA, Grandi S, Grassi L, Ottolini F, Porcelli P, Rafanelli C, Rigatelli M, Sonino N (2005). Assessing demoralization and depression in the setting of medical disease. Journal of Clinical Psychiatry 66, 391-394.
75. Mangelli L, Rafanelli C, Porcelli P, Fava GA (2007). Interview for the diagnostic criteria of psychosomatic research (DCPR). Advances in Psychosomatic Medicine 28, 174-181.
76. Mangelli L, Semprini F, Sirri L, Fava GA, Sonino N (2006). Use of the diagnostic criteria for psychosomatic research (DCPR) in a community sample. Psychosomatics 47, 143-146.
77. Marbach JJ (1993). Is phantom tooth pain a deafferentation (neuropathic) syndrome? Part II: psychosocial considerations. Oral Surgery Oral Medicine Oral Pathology 75, 225-232.
78. Marbach JJ, Schleifer SJ, Keller SE (1990). Facial pain, distress and immune function. Brain, Behavior, and Immunity 4, 243-254.
79. Marchesi C, Maggini C (2007). Sociodemographic and clinical features associated with demoralization in medically ill in-patients. Social Psychiatry and Psychiatric Epidemiology 42, 824-829.
80. McEwen BS, Stellar E (1993). Stress and the individual: mechanisms leading to disease. Archives of Internal Medicine 153, 2093-2101.
81. Mehnert A, Vehling S, Hocker A, Lehmann C, Koch U (2011). Demoralization and depression in patients with advanced cancer: validation of the German version of the demoralization scale. Journal of Pain Symptom Management 42, 768-776.
82. Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Journal of Clinical Epidemiology 62, 1006-1012.
83. Mullane M, Dooley B, Tiernan E, Bates U (2009). Validation of the Demoralization Scale in an Irish advanced cancer sample. Palliative and Supportive Care 7, 323-330.
84. Ottolini F, Modena MG, Rigatelli M (2005). Prodromal symptoms in myocardial infarction. Psychotherapy and Psychosomatics 74, 323-327.
85. Page RM, Cole GE (1992). Demoralization and living alone: outcomes from an urban community study. Psychological Reports 70, 275-280.
86. Parker M (2004). Medicalizing meaning: demoralization syndrome and the desire to die. Australian and New Zealand Journal of Psychiatry 38, 765-773.
87. Perera FP, Wang S, Rauh V, Zhou H, Stigter L, Camann D, Jedrychowski W, Mroz E, Majewska R (2013). Prenatal exposure to air pollution, maternal psychological distress, and child behavior. Pediatrics 132, e1284-e1294.
88. Picardi A, Pasquini P, Abeni D, Fassone G, Mazzotti E, Fava GA (2005). Psychosomatic assessment of skin diseases in clinical practice. Psychotherapy and Psychosomatics 74, 315-322.
89. Picardi A, Porcelli P, Pasquini P, Fassone G, Mazzotti E, Lega I, Ramieri L, Sagoni E, Abeni D, Tiago A, Fava GA (2006). Integration of multiple criteria for psychosomatic assessment of dermatological patients. Psychosomatics 47, 122-128.
90. Pilowsky I (1997). Abnormal Illness Behavior. John Wiley & Sons: New York.
91. Porcelli P, Bellomo A, Quartesan R, Altamura M, Iuso S, Ciannameo S, Piselli M, Elisei S (2009). Psychosocial functioning in consultation-liaison psychiatry patients: influence of psychosomatic syndromes, psychopathology and somatization. Psychotherapy and Psychosomatics 78, 352-358.
92. Porcelli P, De Carne M, Fava GA (2000). Assessing somatization in functional gastrointestinal disorders: integration of different criteria. Psychotherapy and Psychosomatics 69, 198-204.
93. Porcelli P, De Carne M, Todarello O (2004). Prediction of treatment outcomes of patients with functional gastrointestinal disorders by the diagnostic criteria for psychosomatic research. Psychotherapy and Psychosomatics 73, 166-173.
94. Porcelli P, Laera D, Mastrangelo D, Di Masi A (2012). Prevalence of allostatic overload syndrome in patients with chronic cardiovascular disease. Psychotherapy and Psychosomatics 81, 375-377.
95. Radloff LS (1977). The CES-D scale: a self report depression scale for research in the general population. Applied Psychological Measurement 1, 385-401.
96. Rafanelli C, Gostoli S, Roncuzzi R, Sassone B (2013). Psychological correlates of vasovagal versus medically unexplained syncope. General Hospital Psychiatry 35, 246-252.
97. Rafanelli C, Milaneschi Y, Roncuzzi R (2009). Minor depression as a short-term risk factor in outpatients with congestive heart failure. Psychosomatics 50, 493-499.
98. Rafanelli C, Milaneschi Y, Roncuzzi R, Pancaldi LG (2010). Dysthymia before myocardial infarction as a cardiac risk factor at 2.5 year follow-up. Psychosomatics 51, 8-13.
99. Rafanelli C, Offidani E, Gostoli S, Roncuzzi R (2012). Psychological correlates in patients with different levels of hypertension. Psychiatric Research 198, 154-160.
100. Rafanelli C, Roncuzzi R, Finos L, Tossani E, Tomba E, Mangelli L, Urbinati S, Pinelli G, Fava GA (2003). Psychological assessment in cardiac rehabilitation. Psychotherapy and Psychosomatics 72, 343-349.
101. Rafanelli C, Roncuzzi R, Milaneschi Y (2006). Minor depression as a cardiac risk factor after coronary artery bypass surgery. Psychosomatics 47, 289-295.
102. Rafanelli C, Roncuzzi R, Milaneschi Y, Tomba E, Colistro MC, Pancaldi LG, Di Pasquale G (2005). Stressful life events, depression and demoralization as risk factors for acute coronary heart disease. Psychotherapy and Psychosomatics 74, 179-184.
103. Raphael KG, Dohrenwend BP, Marbach JJ (1990). Illness and injury among children of temporomandibular pain and dysfunction syndrome (TMPDS) patients. Pain 40, 61-64.
104. Reyes M, Perzanowski MS, Whyatt RM, Kelvin EA, Rundle AG, Diaz DM, Hoepner L, Perera FP, Rauh V, Miller RL (2011). Relationship between maternal demoralization, wheeze, and immunoglobulin E among inner-city children. Annals of Allergy, Asthma and Immunology 107, 42-49.
105. Rickelman BL (2002). Demoralization as a precursor to serious depression. Journal of the American Psychiatric Nurses Association 8, 9-17.
106. Ritsner M, Ponizovsky A, Chemelevsky M, Zetser F, Durst R, Ginath Y (1996). Effects of immigration on the mentally ill-does it produce psychological distress? Comprehensive Psychiatry 37, 17-22.
107. Roberts RE, Vernon SW (1981). Usefulness of the PERI demoralization scale screen for psychiatric disorder in a community sample. Psychiatry Research 5, 183-193.
108. Rosenfeld B, Breitbart W, Galietta M, Kaim M, Funeste-Esch J, Pessin H, Nelson CJ, Brescia R (2000). The schedule of attitudes towards hastened death: measuring desire for death in terminally ill cancer patients. Cancer 88, 2868-2874.
109. Ryff CD (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology 57, 1069-1081.
110. Ryff CD, Love GD, Urry HL, Muller D, Rosenkranz MA, Friedman EM, Davidson RJ, Singer BH (2006). Psychological well-being and ill-being: do they have distinct or mirrored biological correlates? Psychotherapy and Psychosomatics 75, 85-95.
111. Sartorius N, Kaelber CT, Cooper JE, Roper MT, Rae DS, Gulbinat W, Ustün TB, Regier DA (1993). Progress towards achieving a common language in psychiatry: results from the field trials of the clinical guidelines accompanying the WHO classification of mental and behavioural disorders in ICD-10. Archives of General Psychiatry 50, 115-124.
112. Sautier LP, Vehling S, Mehnert A (2014). Assessment of patients' dignity in cancer care: preliminary psychometrics of the German version of the Patient Dignity Inventory (PDI-G). Journal of Pain and Symptom Management 47, 181-187.
113. Schmale AH (1972). Giving up as a final common pathway to changes in health. Advances in Psychosomatic Medicine 8, 20-40.
114. Schmale AH, Engel GL (1967). The giving up-given up complex illustrated on film. Archives of General Psychiatry 17, 135-145.
115. Seligman ME (1975). Helplessness: on Depression, Development, and Death. WH Freeman: San Francisco.
116. Semprini F, Fava GA, Sonino N (2010). The spectrum of adjustment disorders: too broad to be clinically helpful. CNS Spectrums 15, 382-388.
117. Shahar G, Bareket L, Rudd MD, Joiner TE Jr. (2006). In severely suicidal young adults, hopelessness, depressive symptoms, and suicidal ideation constitute a single syndrome. Psychological Medicine 36, 913-922.
118. Sirri L, Fava GA (2013). Diagnostic criteria for psychosomatic research and somatic symptom disorder. International Review of Psychiatry 25, 19-30.
119. Sirri L, Fava GA, Guidi J, Porcelli P, Rafanelli C, Bellomo A, Grandi S, Grassi L, Pasquini P, Picardi A, Quartesan R, Rigatelli M, Sonino N (2012). Type A behavior: a reappraisal of its characteristics in cardiovascular disease. International Journal of Clinical Practice 66, 854-861.
120. Sirri L, Fava GA, Sonino N (2013). The unifying concept of illness behavior. Psychotherapy and Psychosomatics 82, 74-81.
121. Sirri L, Potena L, Masetti M, Tossani E, Magelli C, Grandi S (2010). Psychological predictors of mortality in heart transplanted patients: a prospective, 6-year follow-up study. Transplantation 89, 879-886.
122. Slavney PR (1999). Diagnosing demoralization in consultation psychiatry. Psychosomatics 40, 325-329.
123. Sonino N, Fallo F, Fava GA (2006). Psychological aspects of primary aldosteronism. Psychotherapy and Psychosomatics 75, 327-330.
124. Sonino N, Navarrini C, Ruini C, Ottolini F, Paoletta A, Fallo F, Boscaro M, Fava GA (2004). Persistent psychological distress in patients treated for endocrine disease. Psychotherapy and Psychosomatics 73, 78-83.
125. Sonino N, Ruini C, Navarrini C, Ottolini F, Sirri L, Paoletta A, Fallo F, Boscaro M, Fava GA (2007). Psychosocial impairment in patients treated for pituitary disease: a controlled study. Clinical Endocrinology 67, 719-726.
126. Sonino N, Tomba E, Genesia ML, Bertello C, Mulatero P, Veglio F, Fava GA, Fallo F (2011). Psychological assessment of primary aldosteronism: a controlled study. The Journal of Clinical Endocrinology & Metabolism 96, E878-E883.
127. Spitzer RL, Williams JWB, Gibbon M, First MB (1992). The structured clinical interview for DSM-III-R (SCID). I. History, rationale and description. Archives of General Psychiatry 49, 624-629.
128. Stewart SM, Kennard BD, Lee PWH, Mayes T, Hughes C, Emslie G (2005). Hopelessness and suicidal ideation among adolescents in two cultures. Journal of Child Psychology and Psychiatry 46, 364-372.
129. Sweeney DR, Tinling DC, Schmale AH (1970). Differentiation of the "giving-up" affects-helplessness and hopelessness. Archives of General Psychiatry 23, 378-382.
130. Tomba E, Bech P (2012). Cinimetrics and clinical psychometrics: macro- and micro-analysis. Psychotherapy and Psychosomatics 81, 333-343.
131. Tomba E, Offidani M (2012). A clinimetric evaluation of allostatic overload in the general population. Psychotherapy and Psychosomatics 81, 378-379.
132. Tomba E, Rafanelli C, Grandi S, Guidi J, Fava GA (2012). Clinical configuration of cyclothymic disturbances. Journal of Affective Disorders 139, 244-249.
133. Tossani E, Ricci Garotti MG, Cosci F (2013). The use of the diagnostic criteria for psychosomatic research in substance use disorder patient. Psychotherapy and Psychosomatics 82, 195-196.
134. Vehling S, Lehmann C, Oechsle K, Bokemeyer C, Krüll A, Koch U, Mehnert A (2011). Global meaning and meaning-related life attitudes: exploring their role in predicting depression, anxiety, and demoralization in cancer patients. Support Care Cancer 19, 513-520.
135. Vehling S, Lehmann C, Oechsle K, Bokemeyer C, Krüll A, Koch U, Mehnert A (2012). Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients. Psycho-oncology 21, 54-63.
136. Vehling S, Mehnert A (2013). Symptom burden, loss of dignity, and demoralization in patients with cancer: a mediation model. Psycho-oncology. Published online: 14 October 2013. doi: 10.1002/pon.3417.
137. Vehling S, Oechsle K, Koch U, Mehnert A (2013). Receiving palliative treatment moderates the effect of age and gender on demoralization in patients with cancer. PLoS ONE 8, e59417.
138. Vernon S, Roberts R (1981). Measuring nonspecific psychological distress and other dimensions of psychopathology. Further observations on the problem. Archives of General Psychiatry 38, 1239-1247.
139. Wallace D, Wallace R, Rauh V (2003). Community stress, demoralization, and body mass index: evidence for social signal transduction. Social Science & Medicine 12, 2467-2478.
140. Wise T (2009). Diagnostic criteria for psychosomatic research are necessary for DSM V. Psychotherapy and Psychosomatics 78, 330-332.