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Demoralization and chronic illness in rural Australia: A cross-sectional survey

Published online by Cambridge University Press:  12 November 2019

Claire Bailey Open the ORCID record for Claire Bailey [Opens in a new window] ,
Zelda Doyle ,
John Dearin ,
Natasha Michael  and
David Kissane
Claire Bailey
Affiliation:
Lithgow Clinical School, University of Notre Dame, Lithgow, New South Wales, Australia
Zelda Doyle*
Affiliation:
Lithgow Clinical School, University of Notre Dame, Lithgow, New South Wales, Australia
John Dearin
Affiliation:
Lithgow Clinical School, University of Notre Dame, Lithgow, New South Wales, Australia
Natasha Michael
Affiliation:
Werribee Clinical School, University of Notre Dame, Werribee, Victoria, Australia
David Kissane
Affiliation:
School of Medicine, University of Notre Dame, Sydney, New South Wales, Australia
*
Author for correspondence: Zelda Doyle, The University of Notre Dame Australia, Lithgow Clinical School, 2 Col Drewe Dr, South Bowenfels, NSW2790, Australia. E-mail: [email protected]
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Abstract

Objective

Demoralization is prevalent in patients with life-limiting chronic illnesses, many of whom reside in rural areas. These patients also have an increased risk of disease-related psychosocial burden due to the unique health barriers in this population. However, the factors affecting demoralization in this cohort are currently unknown. This study aimed to examine demoralization amongst the chronically ill in Lithgow, a town in rural New South Wales, Australia, and identify any correlated demographic, physical, and psychosocial factors in this population.

Method

A cross-sectional survey of 73 participants drawn from Lithgow Hospital, the adjoining retirement village and nursing home, assessing correlating demographic, physical, psychiatric, and psychosocial factors.

Results

The total mean score of the DS-II was 7.8 (SD 26.4), and high demoralization scores were associated with the level of education (p = 0.01), comorbid condition (p = 0.04), severity of symptom burden (p = <0.001), depression (p = <0.001), and psychological distress (p = <0.001). Prevalence of serious demoralization in this population was 27.4% according to a cutoff of a DS-II score ≥11. Of those, 11 (15%) met the criteria for clinical depression, leaving 9 (12.3%) of the cohort demoralized but not depressed.

Significance of results

Prevalence of demoralization was high in this population. In line with the existing literature, demoralization was associated with the level of education, symptom burden, and psychological distress, demonstrating that demoralization is a relevant psychometric factor in rural populations. Further stratification of the unique biopsychosocial factors at play in this population would contribute to better understanding the burdens experienced by people with chronic illness in this population and the nature of demoralization.

Keywords

Chronic illnessDemoralizationDepressionDisease burdenRural health
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 3 , June 2020 , pp. 271 - 276
Copyright
Copyright © Cambridge University Press 2019

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