Diagnosis and Measurement of Subjective Incompetence: The Clinical Hallmark of Demoralization

<i>Background:</i> This article presents the development and application of a method to diagnose and measure subjective incompetence, the clinical hallmark of demoralization. <i>Methods: </i>The subjects (n = 112) were patients with cancer at a consultation clinic of a cancer center. They completed a questionnaire on general background information, the Brief Cope Scale, and a newly developed scale to measure subjective incompetence. The development and psychometric properties of this scale were studied. Data analysis included both univariate and bivariate statistical tests and an examination of the intercorrelations between the subjective incompetence scores and the scores on the Brief Cope Scale. <i>Results:</i> The scale for subjective incompetence was found to have adequate reliability and validity. <i>Conclusions:</i> The proposed scale will allow us to determine if the distinction between depression and demoralization has practical implications and to what extent and to further clarify the role of demoralization in the etiology and pathogenesis of both physical illnesses and mental disorders. The combined use of this scale with the existing criteria and scales for demoralization will highlight the role of subjective incompetence in converting what might have been a normal response to stress into an abnormal state requiring intervention.