The ability of case managers to clinically judge demoralization within substance dependent outpatients

Abstract

English abstract Background: Substance dependent outpatients are at risk of demoralization. Early identification of demoralization may play a key role in order to reduce destructive behavior such as relapse in drugs and suicide. Therefore it is important that case managers are able to identify demoralization of substance dependent outpatients. Aim: The aim of this study is to explore the ability of case managers, working in Flexible Assertive Community Treatment (FACT) teams specialized in addiction, to clinically judge demoralization of substance dependent outpatients, compared to patients’ self-reported demoralization. Methods: A cross-sectional, observational design was used. Case managers were invited to complete a clinical judgement questionnaire and also self-rate their degree of certainty of their answers. Patients were invited to complete a self-report Demoralization Scale (DS). Differences in clinical judgement between the case managers and patients’ DS were explored using the sensitivity and specificity. The degree of certainty is analyzed using an independent t-test. Results: Twenty-one case managers and 79 patients from two FACT teams were included. The prevalence of demoralization, using a cut-off score for demoralization of ≥ 46, was 43%, with a sensitivity of case mangers clinical judgement of 0.85 and specificity of 0.62. Based on independent t-test analysis, to detect the differences in the correct and incorrect answers of the degree of certainty of case managers’ clinical judgement, there were no significant differences (p = .147). Conclusion and implications of key findings: This study highlights that the clinical judgement by case managers did not cover the whole diagnosing process. Further research should determine what the needs of case managers are to be able to identify demoralization within patients.