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

摘要： 背景　失志综合征是指由一系列负性生活事件引发的一种心理痛苦的状态，其是精神心理学科的一个新的诊断，且与自杀意愿密切相关。失志综合征在癌症患者中发生率高，有效的评估能对癌症患者自杀意愿作出提前预警和干预。但是，目前国内缺乏失志综合征评估工具。目的　汉化癌症患者失志综合征量表Ⅱ（DS-Ⅱ）并进行信效度检验。方法　2019年8月—2020年1月通过招募将来自湖南省衡阳市南华大学附属南华医院住院癌症患者作为研究对象，采用自编社会人口学和疾病相关信息表（Cronbach's α系数为0.87）、中文版DS-Ⅱ（通过正译、回译、专家审查以及预试验研究形成）、医院焦虑抑郁量表（HADS）、埃德蒙顿症状评估量表（ESAS）进行调查。按照总分的高低对410例患者进行排序，分别筛选出分数排名在前27%（高分组）和后27%（低分组）的患者，比较两组间中文版DS-Ⅱ各条目得分有无差异。评价中文版DS-Ⅱ的内容效度、结构效度、效标关联效度、区分效度以及内部一致性。结果　高分组和低分组的16个条目得分比较，差异均有统计学意义（P<0.05）。各条目得分与总分之间的相关系数为0.532~0.663（P<0.05）。中文版DS-Ⅱ的总量表内容效度指数（S-CVI）为0.94，条目内容效度指数（I-CVI）为0.83~1.00。探索性因子分析结果显示：KMO值为0.887，Bartlett's球形检验χ2=4 018.126，P<0.001。采用方差最大正交旋转，提取特征根>1的2个公因子，累积方差贡献率为61.342%，各条目载荷值均>0.400，无双载荷现象。因子1和因子2均包含8个条目，且条目的因子归属与原量表一致。各条目与对应维度之间的相关系数为0.60~0.86，两个维度之间的相关系数为0.15。中文版DS-Ⅱ总分与HADS总分（r=0.581）及其焦虑（r=0.443）、抑郁（r=0.655）子量表呈正相关，与ESAS总分（r=0512）及疼痛（r=0.393）、疲倦（r=0.266）、抑郁（r=0.497）、焦虑（r=0.418）子条目也呈正相关（P<0.05），但是中文版DS-Ⅱ总分与Karnofsky功能状态评分标准（KPS）评分（r=-0.249）呈负相关（P<0.05）。中文版DS-Ⅱ的Cronbach's ɑ系数为0.877。结论　中文版DS-Ⅱ具有良好的心理学测量特性，可能是评估中国癌症患者失志综合征的可靠工具。

关键词: 失志, 失志综合征, 癌症, 信度, 效度, 量表