Skip to main content

Advertisement

Log in

Global meaning and meaning-related life attitudes: exploring their role in predicting depression, anxiety, and demoralization in cancer patients

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Goal of work

While significance of the concept of meaning in understanding adaptation to cancer is widely accepted, it has been little studied, especially in longitudinal data. This study aims to clarify the role of global meaning and meaning-related life attitudes (death acceptance and goal seeking) in predicting different aspects of psychological and existential distress by reference to a specified research model.

Patients and methods

At baseline (T1), a sample of 270 cancer patients was recruited. Data from 178 patients could be obtained after 3 months at T2. Patients completed the Life-Attitude-Profile—Revised assessing global meaning and meaning-related life attitudes, the Hospital Anxiety and Depression Scale, and the Demoralization Scale. Hierarchical regression analyses were carried out in two steps. Sociodemographic and physical factors were controlled.

Results

Global meaning emerged as a significant negative predictor of depression (β = −0.27) (p ≤ 0.001) and demoralization (β = −0.27) (p ≤ 0.001). Death acceptance was a predictor of anxiety only (β = −0.21) (p ≤ 0.003), whereas goal seeking was a positive predictor of depression (β = 0.29) (p ≤ 0.001), anxiety (β = 0.36) (p ≤ 0.001), and demoralization (β = 0.35) (p ≤ 0.001).

Discussion

Findings confirm a global sense of meaning as an important protecting factor regarding the development of distress symptoms. Results suggest that different dimensions of meaning contribute to different dimensions of psychological well-being, as they refer to different existential problems. The need for and relevance of meaning-focused interventions in cancer patients is strengthened.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Adelbratt S, Strang P (2000) Death anxiety in brain tumour patients and their spouses. Palliat Med 14(6):499–507

    Article  PubMed  CAS  Google Scholar 

  2. Boscaglia N, Clarke DM (2007) Sense of coherence as a protective factor for demoralisation in women with a recent diagnosis of gynaecological cancer. Psychooncology 16(3):189–195

    Article  PubMed  Google Scholar 

  3. Breitbart W (2002) Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer 10(4):272–280

    Article  PubMed  Google Scholar 

  4. Breitbart W, Gibson C, Poppito SR, Berg A (2004) Psychotherapeutic interventions at the end of life: a focus on meaning and spirituality. Can J Psychiatry 49(6):366–372

    PubMed  Google Scholar 

  5. Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, Nelson C, Tomarken A, Timm AK, Berg A, Jacobson C, Sorger B, Abbey J, Olden M (2009) Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology 19:21–28. doi:10.1002/pon.1556

    Google Scholar 

  6. Brennan J (2001) Adjustment to cancer—coping or personal transition? Psychooncology 10(1):1–18

    Article  PubMed  CAS  Google Scholar 

  7. Cella DF, Tross S (1987) Death anxiety in cancer survival: a preliminary cross-validation study. J Pers Assess 51(3):451–461

    Article  PubMed  CAS  Google Scholar 

  8. Clarke DM, Kissane DW (2002) Demoralization: its phenomenology and importance. Aust N Z J Psychiatry 36(6):733–742

    Article  PubMed  Google Scholar 

  9. Folkman S (1997) Positive psychological states and coping with severe stress. Soc Sci Med 45(8):1207–1221

    Article  PubMed  CAS  Google Scholar 

  10. Folkman S, Moskowitz JT (2000) Positive affect and the other side of coping. Am Psychol 55(6):647–654

    Article  PubMed  CAS  Google Scholar 

  11. Frankl VE (1984) Der leidende Mensch: Anthropologische Grundlagen der Psychotherapie, 2nd edn. Huber, Bern

    Google Scholar 

  12. Frankl VE (1991) Der Wille zum Sinn - Ausgewählte Vorträge über Logotherapie, 2nd edn. Piper, München

    Google Scholar 

  13. Frankl VE (2005) Ärztliche Seelsorge. Grundlagen der Logotherapie und Existenzanalyse. Zehn Thesen über die Person, 11th edn. Deuticke, Wien

  14. Hermann C, Buss U, Snaith RP (1995) Hospital anxiety and depression scale – Deutsche version. Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Huber, Bern

    Google Scholar 

  15. Holland JC, Reznik I (2005) Pathways for psychosocial care of cancer survivors. Cancer 104(11):2624–2637

    Article  PubMed  Google Scholar 

  16. Jim HS, Andersen BL (2007) Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. Br J Health Psychol 12(3):363–381

    Article  PubMed  Google Scholar 

  17. Jim HS, Richardson SA, Golden-Kreutz DM, Andersen BL (2006) Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychol 25(6):753–761

    Article  PubMed  Google Scholar 

  18. Johnson-Vickberg SM, Duhamel KN, Smith MY, Manne SL, Winkel G, Papadopoulos EB, Redd WH (2001) Global meaning and psychological adjustment among survivors of bone marrow transplant. Psychooncology 10(1):29–39

    Article  PubMed  CAS  Google Scholar 

  19. Kissane DW, Bloch S, Smith GC, Miach P, Clarke DM, Ikin J, Love A, Ranieri N, McKenzie D (2003) Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Psychooncology 12(6):532–546

    Article  PubMed  Google Scholar 

  20. Kissane DW, Clarke DM, Street AF (2001) Demoralization syndrome—a relevant psychiatric diagnosis for palliative care. J Palliat Care 17(1):12–21

    PubMed  CAS  Google Scholar 

  21. Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM (2004) The Demoralization Scale: a report of its development and preliminary validation. J Palliat Care 20(4):269–276

    PubMed  Google Scholar 

  22. Lee V (2008) The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning. Support Care Cancer 16(7):779–785

    Article  PubMed  Google Scholar 

  23. Lee V, Cohen RS, Edgar L, Laizner AM, Gagnon AJ (2006) Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Soc Sci Med 62(12):3133–3145

    Article  PubMed  Google Scholar 

  24. Lethborg C, Aranda S, Cox S, Kissane DW (2007) To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliat Support Care 5(4):377–388

    Article  PubMed  Google Scholar 

  25. Mehnert A (2008) Der Einfluss von religioeser und sinnbasierter Krankheitsverarbeitung auf Angst und Depressivitaet bei Brustkrebspatientinnen im Krankheitsverlauf. PIÖ 28(1):72–77

    Google Scholar 

  26. Mehnert A, Koch U (2008) Psychometric evaluation of the German version of the Life Attitude Profile—Revised (LAP-R) in prostate cancer patients. Palliat Support Care 6(2):119–124

    Article  PubMed  Google Scholar 

  27. Mehnert A, Mueller D, Koch U (2007) Die Erfassung von sinnbasierten Bewaeltigungsstrategien und Lebenseinstellungen. Die deutsche Adaptation des Life Attitude Profile-Revised (LAP-R) an einer repraesentativen Stichprobe von Brustkrebspatientinnen. Z Klin Psychol Psychother 36(3):176–188

    Article  Google Scholar 

  28. Mehnert A, Mueller D, Lehmann C, Koch U (2006) Die deutsche Version des NCCN Distress-Thermometers. Empirische Pruefung eines Screening-Instruments zur Erfassung psychosozialer Belastung bei Krebspatienten. ZPPP 54(3):213–223

    Google Scholar 

  29. Park CL, Edmondson D, Fenster JR, Blank TO (2008) Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs. J Consult Clin Psychol 76(5):863–875

    Article  PubMed  Google Scholar 

  30. Park CL, Folkman S (1997) Meaning in the context of stress and coping. Rev Gen Psychol 1(2):115–144

    Article  Google Scholar 

  31. Reker GT (1992) Manual of the life attitude profile-revised (LAP-R). Student Psychologists Press, Trent University, Peterborough

    Google Scholar 

  32. Reker GT (1997) Personal meaning, optimism, and choice: existential predictors of depression in community and institutional elderly. Gerontologist 37(6):709–716

    PubMed  CAS  Google Scholar 

  33. Reker GT (2000) Theoretical perspective, dimensions, and measurement of existential meaning. In: Reker GT, Chamberlain K (eds) Exploring existential meaning. Optimizing human development across the life span. Sage, Thousand Oaks, pp 39–55

    Google Scholar 

  34. Reker GT (2007) The search for meaning in life following traumatic brain injury: conceptual, measurement, and application issues. Paper presented at the State of the Science Conference for the RRTC on Community Integration of Persons with Traumatic Brain Injury, Arlington, Virginia

  35. Sigal JJ, Ouimet MC, Margolese R, Panarello L, Stibernik V, Bescec S (2008) How patients with less-advanced and more-advanced cancer deal with three death-related fears: an exploratory study. J Psychosoc Oncol 26(1):53–68

    Article  PubMed  Google Scholar 

  36. Simonelli LE, Fowler J, Maxwell GL, Andersen BL (2008) Physical sequelae and depressive symptoms in gynecologic cancer survivors: meaning in life as a mediator. Ann Behav Med 35(3):275–284

    Article  PubMed  Google Scholar 

  37. Vickberg SM, Bovbjerg DH, Duhamel KN, Currie V, Redd WH (2000) Intrusive thoughts and psychological distress among breast cancer survivors: global meaning as a possible protective factor. Behav Med 25(4):152–160

    Article  PubMed  CAS  Google Scholar 

  38. Westman B, Bergenmar M, Andersson L (2006) Life, illness and death—existential reflections of a Swedish sample of patients who have undergone curative treatment for breast or prostatic cancer. Eur J Oncol Nurs 10(3):169–176

    Article  PubMed  CAS  Google Scholar 

  39. White CA (2004) Meaning and its measurement in psychosocial oncology. Psychooncology 13(7):468–481

    Article  PubMed  Google Scholar 

  40. Xuereb MC, Dunlop R (2003) The experience of leukaemia and bone marrow transplant: searching for meaning and agency. Psychooncology 12(5):397–409

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Anja Mehnert.

Additional information

This research has been supported by a grant from the Barbara und Michael Hell Stiftung in Hamburg, Germany.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vehling, S., Lehmann, C., Oechsle, K. et al. Global meaning and meaning-related life attitudes: exploring their role in predicting depression, anxiety, and demoralization in cancer patients. Support Care Cancer 19, 513–520 (2011). https://doi.org/10.1007/s00520-010-0845-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-010-0845-6

Keywords

Navigation