# Psychometric properties of the Japanese version of the Demoralization Scale‐II (DS‐II) in cancer patients

## TL;DR

This study developed and validated a Japanese version of the Demoralization Scale-II for use in cancer patients, showing it is reliable and valid.

## Contribution

The study provides a culturally adapted and validated Japanese version of the DS-II for assessing demoralization in cancer patients.

## Key findings

- The DS-II-J showed high internal consistency with a Cronbach's α of 0.92.
- Strong correlations with PHQ-9 and GAD-7 scores supported convergent validity.
- EFA suggested a two-factor structure with different item composition, indicating cultural influences.

## Abstract

Demoralization, which is characterized by helplessness, hopelessness, and the loss of meaning, has gained increasing attention in psychiatry and palliative care. Robinson et al. developed the Demoralization Scale‐II (DS‐II) to assess this construct in a brief and reliable format. However, a validated Japanese version has not been developed to date. The purpose of this study was to develop a Japanese version of the DS‐II (DS‐II‐J) and to evaluate its psychometric properties in cancer patients.

A total of 147 cancer patients from 3 acute care hospitals in Japan were included in the study. Participants completed the DS‐II‐J, Patient Health Questionnaire‐9 (PHQ‐9), Generalized Anxiety Disorder 7‐item Scale (GAD‐7), and Edmonton Symptom Assessment System Revised Version (ESAS‐r). Internal consistency was assessed using Cronbach's α. Convergent validity was evaluated by examining correlations with the PHQ‐9, GAD‐7, and ESAS‐r. Confirmatory factor analysis (CFA) and exploratory factor analysis (EFA) were conducted to assess factor structure.

The DS‐II‐J demonstrated high internal consistency (α = 0.92). Strong positive correlations were found between DS‐II‐J scores and PHQ‐9 and GAD‐7 scores, and moderate correlations with selected ESAS‐r physical symptoms, supporting convergent validity. CFA results showed a suboptimal model fit for both a one‐factor model and the original two‐factor model proposed by Robinson et al. EFA supported a two‐factor structure, but with a different item composition, suggesting cultural influences.

The DS‐II‐J is a valid and reliable tool for assessing demoralization in Japanese cancer patients.