Demoralisation - A Useful Conceptualisation of Non-Specific Psychological Distress Among Refugees Attending Mental Health Services

Abstract

Background: Whilst it is recognised that many refugee and migrant clients present at mental health services with non-specific psychological distress there is little known about successful intervention strategies. Aims: The aim of this study was to systematically review clinical files to determine the degree of 'demoralisation' symptoms among a sample of refugee and migrant clients attending a community based mental health service. Method: One hundred closed cases were reviewed using a specifically designed case review sheet as a checklist which included diagnostic criteria proposed by Kissane (2001) for a Demoralisation Syndrome. Results: The findings indicated that while many of the refugee and migrant clients had attracted a diagnosis of major depressive disorder, in the main they did not benefit from a normal course of treatment. Further analysis suggested demoralisation may be a preferable concept for many of these clients rather than affective disorder. This finding does suggest that demoralisation may be a different construct than low mood or depression. Conclusions: The findings add support to the concept proposed by Kissane (2001) that demoralisation could be a distinct diagnostic entity and may be useful to clinicians attending refugee and migrant clients.