Clinical utility of demoralization: A systematic review of the literature

Demoralization is a complex clinical phenomenon which has raised a growing interest in clinical and research realms. The present systematic review of the literature aimed at (1) updating on demoralization prevalence in different populations, (2) identifying the instruments more largely used to assess demoralization, and (3) verifying whether new tools of assessment have been proposed. PubMed and Web of Science were searched from inception to April 2022. Search terms were: demoralization/demoralized/demoralizing/demoralised/demoralising. PRISMA guidelines were followed. GRADE rating system was used. A total of 188 papers were included. Demoralization appeared to be a distinctive psychological state common in medical, psychiatric, and non-clinical settings, thus not limited to life-threatening diseases. Diagnostic Criteria for Psychosomatic Research (DCPR) and Demoralization Scale (DS) are the most commonly used tools to assess it. DCPR allow to diagnose demoralization as a manifestation of dealing with chronic stress. DS captures dimensionally a psychological distress related to end of life. Demoralization is associated with clinical features encompassing allostatic overload, quality of life, wellbeing/euthymia. Implications on health outcomes and treatment are discussed. Demoralization warrants careful consideration in clinical contexts through valid assessment procedures. DCPR are recommended to diagnose it, DS can be helpful to capture clinical details.

Who will treat older patients? Should medical education focus more on activities aimed at displaying positive attitudes toward older people? The prevalence of ageism among students of medical and health sciences

In the conditions of an aging society, a justification is found to explain the issue of the attitude of future health care workers, who are to care for elderly people in the future, toward these people, which will make it possible to predict in advance what problems related to the care of seniors may soon arise. After clarifying this issue, it will be important to distinguish the individual factors influencing this attitude in order to determine which social phenomena will require special attention. Eight hundred and three medical and health sciences students participated in the research from various fields of medical studies. A Survgo system was used, where an online questionnaire was placed and then posted in social media. Only students of medicine and healthcare facilities participated in the study. The first questionnaire contained socio-demographic questions. Then, the KOAP questionnaire and Welch's t-test were used, and finally the proprietary questionnaire on contact with seniors. Analyses were conducted using the R Statistical language. Scores on the KAOP questionnaire ranged from 122.4 to 134.57. The highest scores were shown for physiotherapy students and the lowest for pharmacy students. The highest level of attitude toward elderly was reported in students of 1st to 3rd year of study. For 4th-5th year or supplementary level students, attitude levels were decreasing. Welch's t-test showed that the level of attitude toward old people in men was significantly higher than in women. There was no significant correlation between the age factor on the quotient scale and the KOAP score. Married individuals had significantly higher KAOP scores compared to singles and those in an informal relationship. No significant differences between the study stage factor and KAOP score have been found. Those who live and/or have regular contact with the elderly were characterized by higher KAOP questionnaire scores. The attitude toward the elderly depends on many factors, such as the chosen field of study, stage of education, contact with the elderly, gender or marital status. In order to develop proper contact with seniors, the solution may be to influence modifiable factors, especially the correct education of future health care workers.

Cross-cultural validity of the WHO-5 Well-Being Index and Euthymia Scale: A clinimetric analysis

BACKGROUND

The assessment of psychological well-being and euthymia represents an emerging issue in clinical psychology and psychiatry. Rating scales and indices such as the 5-item version of the World Health Organization Well-Being Index (WHO-5) and the Euthymia Scale (ES) were developed but insufficient attention has been devoted to the evaluation of their cross-cultural validity. This is the first study using Clinimetric Patient-Reported Outcome Measures (CLIPROM) criteria to assess cross-cultural validity and sensitivity of five different versions of the WHO-5 and ES.

METHODS

A multicenter cross-sectional study involving a total of 3762 adult participants from different European (i.e., Italy, Poland, Denmark) and non-European (i.e., China, Japan) countries was conducted. Item Response Theory models (Mokken and Rasch analyses) were applied.

RESULTS

Mokken coefficients of scalability were found to range from 0.42 to 0.84. The majority of the versions of the WHO-5 fitted the Rasch model expectations. Paired t-tests revealed that the Italian and Danish WHO-5 versions were unidimensional. Person Separation Reliability indices showed that the Polish, Danish, and Japanese ES versions could reliably discriminate between subjects with different levels of euthymia.

LIMITATIONS

A convenience sampling was used, thus limiting the generalizability of study findings. In addition, no measures of negative mental health were administered.

CONCLUSIONS

WHO-5 can be used in international studies for cross-cultural comparisons since it covers transcultural components of subjective well-being. Findings also suggest that the ES can be used as a cross-cultural screening tool since it entailed the clinimetric property of sensitivity.

Attitudes Towards the Elderly in Polish Society: Is Knowledge About Old Age and Personal Experiences a Predictor of Ageism?

Purpose

The aim of the study was to determine the prevalence and characteristics of ageism in Polish society. In addition, the relationships of opinions with demographic data, knowledge about aging and individual contact with the elderly, in the context of knowledge about their exclusion, were examined.

Patients and methods

The study involved 923 individuals in Poland. Their demographic characteristics were recorded, and all subjects were assessed using Kogan’s Attitudes toward Old People (KOAP) scale and asked to complete the Facts on Aging Quiz. Subjects were also asked about their knowledge of the definition of ageism and asked to explain it.

Results

The KOAP scale as a function of predictors was modeled using Bayesian robust linear regression with t distribution. The subjects had a mean (SD) KAOP score of 90.88 (17.41), with the central 50% of the observations ranging from 83 to 101 points. Three statistically credible relationships with responses to the questionnaires were observed. Respondents attending school had slightly lower average KAOP scores than respondents with other professional status. In addition, FAQ was negatively and moderately related to KAOP, whereas contacts with elderly people were positively and moderately related to KAOP.

Conclusion

Knowledge of aging and contact with elderly individuals significantly affected attitudes and behaviors regarding ageism. Many study subjects were characterized by having unfavorable attitudes towards the elderly.

[Psychological factors affecting medical conditions--a method of measurement]

Improving the way of diagnosing diseases is reflected in changes which are being introduced into the existing systems of classifications. Researchers aim to create such a system that will be free of assumptions that are controversial and difficult to approve on the medical basis. Currently completed works associated with the preparation and introduced the DSM-5, in which they prepared criteria for the assessment psychological factors affecting medical conditions and their method of measurement. An interview which is presented in this article has been created for the evaluation of those groups of syndromes and has been translated into the Polish language.