Demoralization Syndrome

Xingxing Shen et al. (2026) · Journal of medical Internet research

This mixed-methods study with 305 survey participants, 14 interviewees and a 72-person randomised trial explored why people on long-term hemodialysis lose hope and whether a mobile mindfulness course can help. Hemodialysis is a life-sustaining kidney treatment, and many patients develop demoralization, a state of helplessness, hopelessness and loss of meaning that tends to follow a heavy burden of physical symptoms such as fatigue, pain and poor sleep. Mindfulness here means paying attention to present-moment experience with acceptance, and the researchers asked whether being naturally mindful buffers the link between symptoms and demoralization and whether training can raise it. At a hospital dialysis centre in Jiangsu, China, patients aged 18 to 65 first completed questionnaires on demoralization, mindfulness, coping style and symptoms, and 14 were interviewed. Then 72 patients with moderate-to-severe demoralization were randomly assigned to a 6-week course delivered through the WeChat app or to usual care. The course asked for one 10- to 15-minute session each day, with audio-guided practice such as body scans, reminders and a moderated support group, while usual care meant health education messages. Heavier symptom burden went with more demoralization, partly because patients coped by avoidance (steering away from thinking about the illness), and higher mindfulness weakened both links (interaction β = −0.11 and −0.07). In the trial, demoralization scores were 5.06 points lower with the course than with usual care (95% CI −6.92 to −3.20, p < .001), a difference large enough that the group-by-time effect was highly significant (F = 93.63). Symptom burden was 29.15 points lower (p = .002), mindfulness was 6.48 points higher, and avoidance coping was 4.84 points lower, while confrontation coping, meaning facing the illness directly, was 5.89 points higher. Four of 36 people in the course group dropped out in week 2, mostly because daily practice felt burdensome on dialysis days, and 32 of 36 met the full-usage criterion. The authors conclude that avoidance coping is a key pathway and that a dialysis-tailored mobile mindfulness course looks promising, and they call for longer follow-up, implementation studies and cost analysis. The evidence has limits: there was no attention-matched comparison group, the support group may have contributed to the benefit, follow-up ended right after the six weeks so durability is unknown, outcomes were self-reported, participants knew their group, and the trial was registered after it had finished.