Correlates of demoralization syndrome among patients with gastrointestinal tumors: A meta-analysis

BACKGROUND Demoralization syndrome (DS) is a prevalent form of psychological distress among cancer patients, which adversely affects treatment adherence and quality of life.Correlates of DS among gastrointestinal (GI) cancer patients have yielded inconsistent findings across individual observational studies.AIM To synthesize observational evidence and identify psychosocial correlates associated with DS in patients with GI tumors via meta-analysis.METHODS We search for relevant literature on correlates of DS in GI patients in databases such as China National Knowledge Infrastructure, Wanfang Data, China Biomedical Literature Database, Web of Science, PubMed, and EMBASE.The search period is from the establishment of the database to May 2026.Two researchers screened, evaluated, and collected data according to the literature inclusion and exclusion criteria.Meta-analysis was conducted using R (4.5.1) software. RESULTSThe pooled mean score was 35.01 [95% confidence interval (CI): 31.79-38.24]for the 24-item DS (10 studies, n = 1923) and 13.50 (95%CI: 8.89-18.11)for the 16-item DS-II (4 studies, n = 926).Social support factors showed a significant negative correlation with DS (summary r = -0.557,95%CI: -0.695 to -0.381;I 2 = 91.8%).Psychological resilience was also negatively associated (summary r = -0.722,95%CI: -0.938 to -0.103;I 2 = 96.8%).Among coping strategies, facing coping was negatively correlated with DS (summary r = -0.470,95%CI: -0.846 to -0.059;I 2 = 98.1%).Sensitivity analyses confirmed robust results for social support, psychological resilience and facing coping.No significant publication bias was detected. / 34CONCLUSION Social support and psychological resilience were associated with DS for GI cancer patients.These correlational findings may inform preliminary hypotheses for targeted psychological management.Nevertheless, findings should be interpreted with great caution given three key methodological constraints: All data are derived from Chinese cross-sectional studies, each correlational subgroup includes only 3-7 studies, and extreme heterogeneity is present for every pooled estimate.Causal evidence from longitudinal or interventional studies is required before clinical implementation.