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Dimensions of Psychopathology in the Medically Ill

A Latent Trait Analysis

Received November 24, 1999; revised February 4, 2000; accepted April 27, 2000. From the Consultation-Liaison Psychiatry Research Unit and the Mental Health Research Institute, Department of Psychological Medicine, Monash University; the Victorian Transcultural Psychiatry Unit; and the Department of Psychiatry, University of Melbourne, Australia. Address correspondence and reprint requests to Dr. Clarke, Department of Psychological Medicine, Monash Medical Center, 246 Clayton Road, Clayton, Victoria 3168, Australia; e-mail: david.clarke{at}med.monash edu.au

The authors examined the latent structure of psychiatric symptoms occurring in patients with medical illness. Symptom data were collected from 312 hospitalized medically ill patients using the Monash Interview for Liaison Psychiatry and subjected to latent trait analysis. A model with 5 dimensions provided an acceptable fit to the data. Dimensions were characterized as demoralization, anhedonia, autonomic anxiety, somatic symptoms, and grief. The demoralization dimension was similar to the concept of demoralization described by Frank and to the "giving up-given up complex" described by Engel. The concepts of demoralization, grief, and anhedonia may be useful in increasing understanding of the minor depressions in people with medical illness and in increasing the specificity of psychological and pharmacological treatments for these disorders.

Key Words: Grief • Demoralization • Depression

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