关键词: 失志, 失志综合征, 癌症, 信度, 效度, 量表

Abstract: Background　Demoralization syndrome is a kind of psychological pain caused by a series of negative life events. It is a new psychiatric diagnosis，and closely related to suicidal ideation. It has a high incidence in cancer patients，but relevant effective evaluation may be an early warning indicator for intervention. However，there is a lack of assessment tools for demoralization syndrome in China. Objective　 To develop a Chinese version of the Demoralization Scale-Ⅱ（DS-Ⅱ）and test its reliability and validity. Methods　From August 2019 to January 2020，410 cancer inpatients from Affiliated Nanhua Hospital，University of South China，Hengyang，Hunan Province were recruited and investigated with a self-compiled questionnaire named Socio-demographic and Disease-related Information（Cronbach's α=0.87），Chinese version of the DS-Ⅱ（formed by forward and backward translation，expert review and pre-testing research），Hospital Anxiety and Depression Scale（HADS），and Edmonton Symptom Assessment Scale（ESAS）. Item scores of the DS-Ⅱ were compared between high and low score groups（the top-ranked and bottom-ranked 27% of patients）. The content validity，construct validity，convergence validity，discrimination validity and internal consistency of the Chinese version of DS-Ⅱ were evaluated. Results　 Two groups showed significant differences in the score of each of the 16 items of the DS-Ⅱ（P<0.05）. The item-total correlation coefficients of the DS-Ⅱ ranged from 0.532 to 0.663（P<0.05）. The items of the scale had adequate content validity（I-CVI=0.83-1.00，S-CVI=0.94）. Exploratory factor analysis showed that KMO value was 0.887，Bartlett spherical test χ2=4 018.126，P<0.001. Two common factors with an eigenvalue greater than 1 were extracted by varimax rotation，which could explain 61.342% of the total variation. The load value of each item was more than 0.400，without double load. Both factors 1 and 2 contain 8 items，and the factor attribution of the item is consistent with the original scale. The item-domain correlation coefficients ranged from 0.60 to 0.86，and the inter-domain correlation coefficient was 0.15. The total score of the Chinese version of DS-Ⅱ was positively correlated with the total score（r=0.581），and the anxiety（r=0.443）and depression （r=0.655）subscales scores of the HADS，and also positively correlated with the total score of the ESAS（r=0.512） and its items including pain（r=0.393），tiredness（r=0.266），depression（r=0.497）and anxiety（r=0.418），but was negatively correlated with the score of KPS（r=-0.249，P<0.05）. The Cronbach's coefficient of the Chinese version of DS-Ⅱ was 0.877. Conclusion　The Chinese version of DS-Ⅱ has good psychometric properties，which may be a reliable tool for evaluating demoralization syndrome in Chinese cancer patients.

Key words: Demoralization, Demoralization syndrome, Cancer, Reliability, Validity, Scale