Refinement and revalidation of the demoralization scale: the DS-II-external validity

BACKGROUND The recently refined Demoralization Scale‐II (DS‐II) is a 16‐item, self‐report measure of demoralization. Its 2 factors—Meaning and Purpose and Distress and Coping Ability —demonstrate sound internal validity, including item fit, unidimensionality, internal consistency, and test‐retest reliability. The convergent and discriminant validity of the DS‐II with various measures is reported here. METHODS Patients who had cancer or other progressive diseases and were receiving palliative care (n = 211) completed a battery of questionnaires, including the DS‐II and measures of symptom burden, quality of life, depression, and attitudes toward the end of life. Spearman ρ correlations were determined to assess convergent validity. Mann‐Whitney U tests with calculated effect sizes were used to examine discriminant validity and establish the minimal clinically important difference (MCID). Cross‐tabulation frequencies with chi‐square analyses were used to examine discriminant validity with major depression. RESULTS The DS‐II demonstrated convergent validity with measures of psychological distress, quality of life, and attitudes toward the end of life. It also demonstrated discriminant validity, as the DS‐II differentiated patients who had different functional performance levels and high/low symptoms, with a difference of 2 points between groups on the DS‐II considered clinically meaningful. Furthermore, discriminant validity was demonstrated, as comorbidity with depression was not observed at moderate levels of demoralization. CONCLUSIONS The DS‐II has sound psychometric properties and is an appropriate measure of demoralization. Given its structural simplicity and brevity, it is likely to be a useful tool in meaning‐centered therapies.