Systematic review of meaning in life assessment instruments

Adolescent mental time travel predicting meaning in life: The potential mediating role of self-continuity

INTRODUCTION

Knowing who we are and what we are living for helps us to better adjust in everyday life and confront negative life events, especially for adolescents who are going through critical developmental periods when changes in life could bring both psychopathology risk yet opportunity to achieve a better self. The current study focused on mental time travel, the mental visit to the past or future, and examined the impact on adolescents' perceived meaning in life, with the potential mediating factor of self-continuity.

METHODS

A total of 1543 high school students aged 12 to 18 years old (Mage = 15.02, SDage = 1.58, 52% girls) from Jiangsu Province, China were recruited in a two-wave longitudinal survey that separated by an interval of 6 months. Participants reported their proneness to engage in nostalgia or future prospection at T1 and sense of self-continuity at T2, while the perceived meaning in life were reported at both time points. The latent structural equation models were established with items as indicators for all study variables.

RESULTS

Mental time travel, including both nostalgia and future prospection, facilitated adolescent meaning in life via increased self-continuity, except that future prospection showed only positive indirect effect, while nostalgia demonstrated direct yet negative impact on meaning in life after accounting for the positive mediation effect.

CONCLUSIONS

Findings highlighted the distinct effects of the past- and future-oriented mental time travel on adolescent meaning in life, and provided insights for promoting adolescent psychological adjustment.

The Meaning in Life Questionnaire: Revisiting the Evidence of Validity and Measurement Invariance Using the Exploratory Structural Equation Modeling

The Meaning in Life Questionnaire (MLQ) assesses two distinct dimensions of meaning in life: presence of meaning and search for meaning. The MLQ is the most widely used instrument for measuring meaning in life, yet there is a limited variety of validity evidence on the originally proposed two-factor confirmatory factor analysis (CFA) solution. In this light, the present research examined, across five studies (total N = 3,205), several aspects of the MLQ's validity and tested cross-gender and cross-national measurement invariance. We also examined the usefulness of the exploratory structural equation model (ESEM) of the MLQ as an alternative to the standard CFA model. The results obtained provide evidence for: (a) the validity (structural, convergent, concurrent, and incremental) of the MLQ ESEM factors; (b) full scalar invariance of the MLQ ESEM model across gender and partial measurement invariance across four countries; and (c) similar cross-national relationships between MLQ ESEM factors and measures of depression and life satisfaction. The present research provides support for the value of applying the ESEM framework in overcoming limitations of the CFA model when examining evidence on the MLQ's validity.

Lost and changed meaning in life of people with Long Covid: a qualitative study

Long Covid (LC) has been called the greatest mass-disabling event in human history. For patients, LC not only has implications for quality of life but also for meaning in life: how one's life and the world are understood and what is seen as valuable in one's life. This qualitative empirical study used a Constructivist Grounded Theory approach to investigate the meaning in life of people struggling with LC through ten patient interviews. This study shows that patients lose their prior understanding of life and come to a changed meaning in life, in part due to the experienced (social) isolation and loss of (both physical and cognitive) abilities caused by LC. Moreover, patients struggled with acceptance, uncertainty, and the inherent incomprehensibility and uncontrollability that living with LC entails, though this simultaneously co-existed with hope, optimism and acceptance. Additionally, dimensions of meaning intersect; a patient having some understanding of their illness (dimension of meaning: comprehension) required an understanding Other (dimension of meaning: connection). Emerging from lockdown brought the challenge and isolation of adjusting to chronic illness in society as usual (albeit divided about COVID-19 measures). This study thus offers novel insights regarding changed, present, and sought meaning in life for LC patients.

A conceptualization and psychometric evaluation of positive psychological outcome measures used in adolescents and young adults living with HIV: A mixed scoping and systematic review

INTRODUCTION

Sub-Saharan Africa bears the greatest burden of HIV, with comorbid mental conditions highly prevalent in people living with HIV. It is important to evaluate the mental health of adolescents and young adults living with HIV (AYALHIV) comprehensively by measuring both negative and positive psychological constructs. There has been a proliferation of interest in positive psychological outcome measures, but the evidence of their psychometric robustness is fragmented. This review sought to: 1) Identify positive psychological outcomes and corresponding outcome measures used in AYALHIV in sub-Saharan Africa. 2) Critically appraise the psychometrics of the identified outcome measures.

METHODS AND ANALYSIS

Two reviewers independently searched articles in PubMed, Scopus, Africa-Wide Information, CINAHL, Psych INFO and Google Scholar. Searches were conducted from November 2022 to February 2023. Two separate reviewers independently reviewed retrieved articles. We applied a narrative synthesis to map the key constructs. The risk of bias across studies was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The quality of the psychometric properties was rated using the COSMIN checklist and qualitatively synthesized using the modified Grading of Recommendations Assessment, Development, and Evaluation checklist.

RESULTS

We identified 15 positive psychological constructs: body appreciation, confidence, coping, flourishing, meaningfulness, personal control, positive outlook, resilience, self-management, self-compassion, self-concept, self-efficacy, self-esteem, self-worth and transcendence, that had been used to assess ALHIV. The most measured constructs were resilience, self-concept, self-esteem, coping and self-efficacy. Construct validity and internal consistency were the properties most frequently considered, while content validity and structural validity were assessed less often.

CONCLUSIONS

Few studies performed complete validations; thus, evidence for psychometric robustness was fragmented. However, this review shows the initial evidence of the feasibility of using positive psychological outcomes in low-resource settings. Instead of creating new outcome measures, researchers are recommended to leverage the existing measures, adapt them for use and, if appropriate, strive to maintain the factorial structure to facilitate comparisons.

REGISTRATION

PROSPERO-CRD42022325172.

How meaning in life and vitality are associated with posttrauma outcomes: A systematic review

When confronted with a traumatic event, people may suffer from adverse posttraumatic outcomes, such as posttraumatic stress disorder (PTSD) or complex PTSD (CPTSD). Positive psychology research has shown that meaning in life and vitality are potentially correlated protective factors against negative developments following trauma exposure that can lead to PTSD or CPTSD. This systematic review aimed to synthesize global empirical research findings, emphasizing the impact of meaning in life and vitality on both PTSD and CPTSD. A search of empirical studies was performed within the Embase, Scopus, and Web of Science core collection databases, as well as PsycInfo, using the PRISMA checklist. A total of 29 studies were included after a systematic exclusion process. The collective findings from 22 studies examining meaning in life and five studies focusing on vitality revealed a consistent negative association with symptoms of PTSD. No study that explored the associations among meaning in life, vitality, and CPTSD was found. In contrast to vitality, meaning in life has been extensively studied in relation to traumatic stress worldwide, and few discrepancies in results were found. This systematic review identified the need to intensify scientific efforts in capitalizing on meaning in life as a possible target for psychological interventions, especially for trauma survivors globally, and to consider vitality as a protective factor that needs more empirical attention in relation to posttraumatic stress. Furthermore, there is a need for studies that encompass diverse target samples and employ longitudinal study design to examine the associations between protective factors and CPTSD.

The relationship between fear of cancer recurrence and death anxiety among Chinese cancer patients: the serial mediation model

AIMS

This study aims to investigate the association between fear of cancer recurrence (FCR) and death anxiety (DA) among Chinese cancer patients, while considering the mediating effects of experiential avoidance (EA) and meaning in life (MIL).

METHODS

From February to June 2023, convenience sampling was used to select newly diagnosed cancer patients in a tertiary Cancer Hospital in Chinese Hunan Province as the survey objects. A total of 436 cancer patients completed the Fear of Cancer Recurrence Inventory, the Meaning in Life Questionnaire, the Acceptance and Action Questionnaire-II, and the Templer's death anxiety scale. Descriptive analysis and Pearson correlation analysis were conducted using SPSS 28.0 software. Serial mediation analysis was performed by Hayes' PROCESS macro.

RESULTS

Gender, age, educational level, marital status, residence, occupation, per capita monthly household income, tumor type, and cancer stage were controlled in the model. The results revealed that fear of cancer recurrence had a significant direct effect on death anxiety (Effect = 0.075, 95% CI: 0.064 to 0.087). Additionally, three indirect pathways were identified: (1) through experiential avoidance (Effect = 0.037, 95% CI: 0.026 to 0.049), (2) through meaning in life (Effect = 0.022, 95% CI: 0.014 to 0.031), and (3) through the serial mediators involving meaning in life and experiential avoidance (Effect = 0.016, 95% CI: 0.010 to 0.023). The total indirect effect of the three mediation paths was 63.56%.

CONCLUSION

Fear of cancer recurrence is a significant psychological distress experienced by cancer patients, which not only directly contributes to death anxiety but also may triggers changes, such as experiential avoidance and meaning in life. Ultimately, this comprehensive psychological distress leads to death anxiety.

Characteristics and Correlates of Meaning in Life Profiles among Chinese Rural Adolescents

The meaning in life (MIL) in adolescence is crucial in the developmental process of life. Anchored in the Integrated Model of Meaning Making and the Dual-Systems Model of Meaning, the present study aimed to explore the MIL profiles among Chinese rural adolescents and their characteristics, as well as the role of depression, well-being, character strengths, and academic encouragement in differentiating the MIL profiles. A sample of 579 adolescents from rural China (Mean age = 15.33, SD = 1.69, aged from 12 to 19, female = 56.47%) participated in the survey. Latent profile analysis examined six dimensions of MIL: search for meaning, presence of meaning, need for meaning, meaning confusion, meaning anxiety, and meaning avoidance. Four profiles with different meaning characteristics were revealed: Meaning Oriented profile (18.48%), Bewildered profile (17.62%), Perfunctory profile (51.47%), and Indifferent profile (12.44%). The Meaning Oriented profile had the highest well-being scores and the lowest depression scores compared to the other three profiles. Adolescents with higher character strengths or academic encouragement were less likely to be in the other three profiles than in the Meaning-Oriented profile. The current findings suggest the need for targeted intervention strategies for adolescents with different MIL profiles.

The Farsi version of meaning of life in Iranian patients with cancer: A psychometric study

BACKGROUND

Having meaning in life is a protective factor for psychological well-being. Accurate assessment of this construct needs a valid and reliable tool.

PURPOSE

This study aims to evaluate the psychometric properties of the Farsi version of the meaning of life questionnaire in patients with cancer.

METHOD

In this cross-sectional study, after translating the questionnaire to Farsi, in a sample of 212 patients with cancer, feasibility, content and convergent validity, exploratory and confirmatory factor analysis, internal consistency, stability, and responsiveness were evaluated.

RESULTS

The results show that the content validity ratio of all ten items was greater than 0.49. Also, the modified Kappa coefficient of each item was greater than 0.6. The maximum likelihood exploratory factor analysis extracted one factor, which explains 76.13% of the total variance of the sample. Item nine was removed. The confirmatory factor analysis results show that the one-factor model had good fit indices. The Cronbach's alpha, McDonald's omega, composite reliability, MaxR, and intraclass correlation coefficient were 0.96, 0.96, 0.96, 0.96, and 0.98, respectively. The questionnaires had responsiveness and its response time was 3 s.

CONCLUSION AND POLICY SUMMARY

The nine-item Farsi version of the meaning of life questionnaire has good validity and reliability and responsiveness.

A Multimodal Prevention Program for Stress Reduction

BACKGROUND

Stress-reducing preventive measures and the elements of which they are made up have been inadequately studied to date. In this trial, we studied the stress experienced over the twelve months from the beginning of the intervention by subjects who underwent a two-week-long multimodal prevention program for stress reduction with a psycho-educative component, with a refresher at six months, compared to that experienced by subjects in two control groups (CG-B: prevention program without psychoeducation, CG-C: no intervention).

METHODS

Adults with an elevated stress exposure who were at risk of stressinduced health impairment were the subjects of a prospective, three-armed, randomized controlled trial. The subjects who participated in the two preventive programs (IG [intervention group], CG-B) traveled to a health resort. They were blinded with respect to their group assignment and the content of their intervention. The primary outcomes were subjectively experienced stress (Perceived Stress Questionnaire, PSQ) and chronic stress experience (Screening scale of the Trier Inventory for Chronic Stress, TICS-SSCS), assessed one, three, six, and twelve months after the start of the intervention. The groups were compared with univariate and multivariate analyses. Trial registry number: DRKS00011290.

RESULTS

Among 120 candidates who expressed interest in participation and were randomly allotted to one of the three groups, 87 persons (67.8% female) with a mean age of 50.5 years (SD 8.8 years) were included in the study. Subjects in the IG with psychoeducation had a lower degree of perceived stress at twelve months than those in either one of the control groups, with controlling for baseline values, as measured by both of the instruments used: PSQ (ANCOVA: F[2, 77] = 11.77; p < 0.001, strong effect: ηp² = 0.234) and TICS-SSCS (ANCOVA: F[2, 78] = 3.93; p = 0.024, moderate effect: ηp² = 0.091).

CONCLUSION

This exploratory trial reveals a lessening of subjectively experienced stress after participation in a two-part prevention program for stress reduction with a specific psychoeducative component.

Meaning in challenging times: Sense of meaning supports wellbeing despite pandemic stresses

The COVID-19 pandemic created stress and trauma for many individuals. Traumatic experiences often trigger reflection on meaning in life, with subsequent growth or despair. This study evaluates the role of meaning in life in buffering stressors in the early stages of the COVID-19 pandemic. The purpose of this study was to determine the extent to which the negative effects of COVID-19 stressors (self-perceived stress, emotional state, and cognitive adaptation to stress in the pandemic) are influenced by meaning in life in the context of the early stages of the pandemic. Further, this study described differences in meaning in life observed across demographic groups. Web-based surveys were completed by 831 Slovenian participants in April of 2020. Demographic data; perceptions of stressors related to lacking necessities, movement restrictions, and concerns at home; meaning in life; perceived overall health status; anxiety; emotional state; and perceived stress were measured. A moderately strong sense of meaning in life (M = 5.0, SD = 0.74, range 1-7) was reported by participants, and meaning in life was associated with enhanced wellbeing (B = 0.06-.28, p < .01). Both direct and indirect relationships were observed between stressors and wellbeing outcomes. The indirect effects of meaning in life were especially prominent in the relationship between stressors related to lacking necessities and concerns at home and outcomes of anxiety, perceived stress, and negative emotions, contributing 13-27% of the total observed effects. Increased meaning in life was observed across older age groups (F(5, 825) = 4.8, p < .001) and for those in partnered relationships (t(829) = -3.397, p <.001). A strong sense of meaning in life was associated with improved well-being, even for individuals who experienced pandemic-related stressors. Public health initiatives and media may help improve resilience to pandemic trauma by emphasizing the collective meaning in challenging situations.

Meaning and purpose in life, happiness, and life satisfaction in cancer: Systematic review with meta-analysis

OBJECTIVE

To summarize current evidence on the potential cross-sectional and longitudinal association between meaning or purpose in life and subjective happiness or life satisfaction among cancer patients.

METHODS

A systematic review with meta-analysis and meta-regression was conducted. CINAHL (via EBSCOhost), Embase, PubMed, and PsycINFO (via ProQuest) were searched from inception to 31 December 2022. In addition, manual searches were performed. The risk of bias in cross-sectional and longitudinal studies was assessed using the Joanna Briggs Institute Checklist for Analytical Cross-Sectional Studies and the Quality in Prognosis Studies tool, respectively. Certainty in the evidence was judged using the Grading of Recommendations, Assessment, Development, and Evaluations approach. Meta-regressions and sensitivity analyses were performed to explore potential sources of heterogeneity.

RESULTS

We included 13 cross-sectional studies, comprising 12 different samples, and a longitudinal study. A total of 4968 individuals with cancer were interviewed across included studies. Certainty in the evidence was judged as very low for all outcomes, which was associated to serious concerns on risk of bias and imprecision of the results, and very serious concerns on indirectness of evidence. The assessed studies showed a marked heterogeneity in terms of participants' clinical (i.e., disease stage) and sociodemographic factors. A lack of reporting of these clinical and sociodemographic aspects were also evident among included studies.

CONCLUSIONS

The wide number of methodological flaws detected in this systematic review preclude to make any clinical recommendation. More rigorous high-quality observational studies should guide future research on this topic.

Effect of Group Logotherapy on Anxiety About Death and Existential Loneliness in Patients With Advanced Cancer: A Randomized Controlled Trial

BACKGROUND

Although logotherapy has been shown to relieve other psychological symptoms of patients with cancer, no studies have specifically investigated the effect of logotherapy on anxiety about death and existential loneliness in these patients.

OBJECTIVE

The aim of this study was to determine the effect of group logotherapy on anxiety about death and existential loneliness in patients with advanced cancer.

METHODS

Sixty-three patients who were in the advanced stage of cancer were recruited from 2 hospital oncology services and were randomly assigned to either experimental (n = 31) or control group (n = 32). The intervention group received 10 weekly 2-hour group logotherapy. Templer's Death Anxiety Scale and ELQ were completed pre- and posttreatment.

RESULTS

A 2 × 2 mixed analysis of variance was used to determine the effect of the treatment on each of the dependent variables. The analyses revealed that patients in the logotherapy group reported a significant decrease in anxiety about death and existential loneliness after (vs before) the treatment. No significant decreases were observed in the waitlist control group.

CONCLUSIONS

These results have implications for treating death anxiety and feelings of existential loneliness among patients with advanced cancer. They suggest that group logotherapy is highly effective in reducing these existential concerns. Limitations and avenues for future research are discussed.

IMPLICATIONS FOR PRACTICE

The study emphasizes that group logotherapy can be considered in oncology care programs by healthcare professionals and in educational curriculums and is suggested for use among caregivers and patients with advanced cancer.

A growing concern for meaning: Exploring the links between ego development and eudaimonia

Introduction

Eudaimonia, in contrast to hedonia, is theorized to be a more complex type of positive functioning that involves personal growth and is guided by the pursuit of meaning. However, the existing evidence linking eudaimonia to personality development is rather scarce. To fill this gap, we aimed to explore whether ego development is related to eudaimonic well-being and eudaimonic orientations, most notably, the concern for meaning: we explored both the quantitative differences in the presence of meaning and the search for it, as well as qualitative differences in lay theories of meaning.

Methods

Russian-speaking volunteers recruited online (N = 364, aged 18 to 85, 63% female) completed measures of ego development (Washington University Sentence Completion Test), meaning in life (Meaning in Life Questionnaire), lay theories of meaning (and original 20-item measure), hedonic and eudaimonic motives for activities (HEMA), and well-being (Mental Health Continuum-Short Form).

Results

Ego development emerged as a weak, but significant positive predictor of well-being and this effect was fully mediated by the presence of meaning and eudaimonic motives. Latent profile analysis of the items tapping into lay theories of meaning revealed four distinct individual approaches to meaning that mainly differed in the subjective importance and salience of meaning. Participants with stronger concern for meaning revealed higher scores on ego development, both presence and search for meaning, eudaimonic motives, and well-being.

Discussion

The results add to the evidence concerning the links between ego development and well-being and are in line with the theoretical view of eudaimonia as a process of growth guided by personal concern for meaning. The findings suggest that eudaimonia might be more easily attained by individuals at higher stages of personal development.

Meaning in life, meaning-making and posttraumatic growth in cancer patients: Systematic review and meta-analysis

Introduction

The purpose of this systematic review and meta-analysis is to assess the association between meaning in life (MiL), meaning-making and posttraumatic growth (PTG) in the context of cancer.

Methods

A systematic search was conducted in eighteen electronic databases. The screening and selection process followed the PRISMA guidelines. For the purpose of the meta-analysis, the correlation coefficients between meaning in life and posttraumatic growth were extracted from the included studies. The effect size (r) was calculated using the restricted maximum-likelihood estimator, a random-effects model. Heterogeneity was assessed through the Q statistic, I² index and forest plot, while publication bias was analyzed with the use of the funnel plot and Egger's test.

Results

889 records were considered according to the inclusion criteria. A total of nine articles, published between 2006 and 2021, were included in the systematic review. More than half were published in the last five years. The sample was mostly diagnosed with breast cancer. The meta-analysis included five articles (N = 844) and the results indicate a significant moderate correlation between meaning in life and posttraumatic growth (r = 0.43, 95% IC [0.36, 0.50]).

Discussion

In conclusion, there is a clear association between meaning in life and posttraumatic growth in cancer patients. Future research should explore this relationship further, in order to better assist and guide meaning centered interventions that can potentiate a positive adjustment and possibly growth from the cancer experience.

Longitudinal measurement invariance of the meaning in life questionnaire in Chinese college students

The Meaning in Life Questionnaire (MLQ) is a popular tool to measure the presence of and one's search for meaning in life. Although the validity of the MLQ has been verified in previous studies, the evidence from longitudinal measurement invariance (LMI) of the MLQ is still lacking. The current study aimed to examine the LMI of the MLQ in a sample of Chinese college students (N = 328) at a 1-year interval. Multigroup confirmatory factor analysis (MCFA) was used to examine the LMI of the MLQ over four time points (over the course of 1 year). Results indicate that the MLQ has strict longitudinal invariance across 1-year in Chinese college students, and the latent means difference of MLQ-P is not significant differences across time, while the latent means difference of MLQ-S show significant differences between Time 1 and the other time points. Moreover, the internal consistency reliabilities (e.g., alpha and omega) of the MLQ scores were acceptable at all four time points, and the stability coefficients across time were moderate. These findings provide preliminary evidence that the MLQ has satisfactory longitudinal properties in Chinese college students.

Factors associated with changing alcohol consumption during the first UK lockdown

Background

In response to COVID-19 there have been lockdowns and restrictions to hospitality services. Drinking behaviours often change in response to traumatic events and changes in the drinking environment, and this is influenced by a range of factors. This study explores self-reported changes in alcohol consumption in the third month of the UK lockdown, associations with socio-demographics factors and with COVID-19-related concerns, and mental health and wellbeing.

Methods

The COVID-19 Psychological Wellbeing Study was a longitudinal, online, three-wave survey of 1958 UK adults. Data were collected during the first UK lockdown; wave 1 launched 23 March 2020, wave 2 was 1 month after and wave 3 2 months after completion of wave 1A hierarchical multinomial regression model was estimated to investigate factors associated with changes in perceived alcohol consumption in the third month of the lockdown.

Results

The majority of participants reported changes in drinking (62%) with over one-third indicating increased consumption. Student status and worries about the financial implications of COVID-19 were associated with lower odds of decreased alcohol consumption. Those with above average income and those with children in the household had lower odds of increased alcohol consumption, while younger adults had higher odds of increased alcohol consumption.

Conclusions

This study adds to the growing body of research showing changes in alcohol consumption behaviours during the COVID-19 lockdown restrictions, and identifies risk and protective factors which can aid in targeting intervention at those most in need of support.

Purpose in Life in Older Adults: A Systematic Review on Conceptualization, Measures, and Determinants

Purpose in life (PIL) is a psychological construct that reflects one’s life goals and the desire or determination to pursue them. Having a purpose provides an intrinsic motivation to adopt healthy behaviors as we age, which will help us to achieve positive health outcomes. Thus, promoting PIL is the cornerstone for successful aging and better health outcomes. This systematic review aims to identify how PIL is conceptualized, measured in the existing literature and what are the determinants of PIL in older adults (≥65 years). Electronic searches were conducted in five databases (Medline, PsychInfo, Embase, CINAHL and Web of Science). A total of 44 studies were included in the review. PIL was conceptualized in six different ways: health and well-being, meaningful goals and purpose, inner strength, social relationships, mattering to others, and spirituality and religiousness. There were six main questionnaires and semi structured interviews used to capture PIL. Female gender, higher education and income, being married, ethnicity, health and well-being, inner strength, social integration and spirituality were associated with PIL. Majority of the included studies had low to moderate Risk of Bias (RoB) assuring confidence in the results. The conceptual frameworks of PIL identified in the review underscore the complexity of the construct. Several sociodemographic and other determinants of PIL were identified.

Meaning in Life and the Acceptance of Cancer: A Systematic Review

Meaning in life and acceptance of cancer are critical for patients to adjust to a cancer diagnosis and to improve psychological wellbeing. Little is known about the relationship between meaning in life and the acceptance of cancer. This study provides a systematic review of the associations between meaning in life and the acceptance of cancer in cancer patients. CINAHL, MEDLINE, PsycINFO, and SCOPUS databases were searched until 15 March 2021. Studies were included if they quantitatively examined the association between meaning in life and the acceptance of cancer in adult cancer patients/survivors and if they were published in peer-reviewed journals or in books. The study quality was assessed using Joanna Briggs Institute critical appraisal tools. Of the 4907 records identified through database searches, only 3 studies quantitatively examined the associations between meaning in life and the acceptance of cancer. The total sample involved 464 women with cancer. All three studies reported positive correlations between meaning in life and the acceptance of cancer (ranging from r = 0.19 to r = 0.38), whereas meaning in life did not predict the acceptance of cancer. Overall, the meaning in life–acceptance relationship has not been sufficiently investigated, though it has relevant theoretical and clinical implications for coping with cancer. High-quality studies are needed to better understand the relationship between meaning in life and the acceptance of cancer.

A Generalizability Analysis of the Meaning in Life Questionnaire for Chinese Adolescents

The level of meaning in life not only affects the physical health of individuals, but also is closely related to their mental health. At present, many self-reported questionnaires are being used to measure the meaning in life of Chinese adolescents. Using the multivariate generalizability theory, this study investigated the psychometric properties and the internal structure of the Meaning in Life Questionnaires (MLQs), the most widely used questionnaire for assessing the level of meaning in life of Chinese adolescents. The data were sample of 1,951 junior high school students from Guizhou, China. Multivariate random measurement mode p × i° is the primary analytic approach. Results showed that the generalizability coefficient and dependability index of the scale were 0.86 and 0.85, respectively. The generalizability coefficients of presence of meaning and search for meaning were 0.76 and 0.85, respectively, and the dependability indexes were 0.75 and 0.85 for MLQ-P and MLQ-S, respectively. The design of each factor for MLQ is reasonable in terms of score ratio and the number of projects. In brief, the reliability and factor structure of the scale are satisfactory.

Missing Piece of the Puzzle: Evaluating a General Meaning of Sex Measure

The presence of and search for meaning has divergent and salient outcomes for individuals' physical, mental, and emotional well-being. Although numerous domains of meaning have been examined, the literature on the meaning of sex is sparse and lacks a quantitative measure. In this study, we evaluated a new general Meaning of Sex (MOS) Measure that captured the presence of (MOS-P) and search for (MOS-S) the meaning of sex by analyzing how these subscales were associated with important relational and sexual outcomes (i.e., relationship stability and satisfaction and sexual satisfaction) in two samples. For Sample 1, all participants (N = 865) reported engaging in what they considered to be sexual intercourse and were either single or in a relationship. For Sample 2, all participants (N = 884) reported being in a committed relationship for at least two years. With both samples, confirmatory factor analyses showed good construct validity as the two subscales were distinct from one another and had good reliability. The analyses also demonstrated divergent validity between both scales and meaning in life, sexual motivations, sexual beliefs, and religiosity. The MOS-S had a strong (and negative) association with relationship stability in both samples. The MOS-P had a strong (and positive) association with relationship satisfaction in both samples.

Development and validation of the Sources of Meaning in Life Scale for the Elderly in China

OBJECTIVES

People who find meaning in life can endure 'any' pain. However, there were no tools to investigate elderly individuals' sources of meaning in life in China. This study aimed to develop the Sources of Meaning in Life Scale for the Elderly (SMSE), and examine the validation and reliability in Chinese elderly.

METHODS

A 43-item pool of SMSE was formed by combining the preliminary interview and literature review. A cross-sectional survey of 627 elderly people was then conducted in two community health service centers, two hospitals, and two nursing homes in Guangzhou by the convenience sampling method. Test-retest reliability was assessed with 24 elderly persons.

RESULTS

Six dimensions, containing family (four items), social support (four items), value (seven items), life security (four items), personal development (four items), and leisure activity (five items) explained 62.16% of the variance in total. Confirmatory factor analysis model fitting indices were χ² = 694.652, df = 330, χ²/df = 2.105, SRMR = 0.0695, GFI = 0.853, IFI = 0.905, TLI = 0.889, CFI = 0.903, and RMSEA = 0.062. The Cronbach's alpha value of the scale was 0.924, while that of each dimension was between 0.727 and 0.870. The inter-class correlation (ICC) of the scale was 0.856.

CONCLUSION

The SMSE has good reliability and validity that can be used to evaluate the sources of meaning and meaning in life for the elderly.

Exposure to authoritarian values leads to lower positive affect, higher negative affect, and higher meaning in life

Five studies tested the effect of exposure to authoritarian values on positive affect (PA), negative affect (NA), and meaning in life (MIL). Study 1 (N = 1,053) showed that simply completing a measure of right-wing authoritarianism (vs. not) prior to rating MIL led to higher MIL. Preregistered Study 2 (N = 1,904) showed that reading speeches by real-world authoritarians (e.g., Adolf Hitler) led to lower PA, higher NA, and higher MIL than a control passage. In preregistered Studies 3 (N = 1,573) and 4 (N = 1,512), Americans read authoritarian, egalitarian, or control messages and rated mood, MIL, and evaluated the passages. Both studies showed that egalitarian messages led to better mood and authoritarian messages led to higher MIL. Study 5 (N = 148) directly replicated these results with Canadians. Aggregating across studies (N = 3,401), moderational analyses showed that meaning in life, post manipulation, was associated with more favorable evaluations of the authoritarian passage. In addition, PA was a stronger predictor of MIL in the egalitarian and control conditions than in the authoritarian condition. Further results showed no evidence that negative mood (or disagreement) spurred the boost in MIL. Implications and future directions are discussed.

Meaningfulness among frail older adults receiving home-based care in Finland

Meaningfulness is a fundamental aspect in the promotion of frail older adults’ health and well-being. From a salutogenic point of view, meaningfulness is a vital component of a sense of coherence (SOC), since having a strong SOC aids toward assembling the resources needed to cope with stressors and manage tensions with success. In order to respond to the challenges of population aging and the need to enable frail older adults to live at home for as long as possible, it is important to explore their meaningfulness in the context of home-based care. A salutogenic framework was used to study meaningfulness. The aim was to explore what promotes meaningfulness among frail older adults. The study uses a hermeneutical approach and has a qualitative design. In total, 17 frail older adults were interviewed. The data were analyzed by content analysis. The results uncovered four themes that the respondents considered important in enhancing meaningfulness in daily life: home care personnel, outdoor activities and green spaces, cultural activities and spirituality. Our study revealed the important role of home care personnel as a resource in promoting meaningfulness in the context of home-based care. Hence, this group should be given sufficient resources, knowledge and competence for enabling meaningfulness and thus a SOC amongst frail older adults.

Religious fundamentalism, right-wing authoritarianism, and meaning in life

OBJECTIVE

Two studies examined the relationship between right-wing authoritarianism (RWA) and religious fundamentalism (RF), and tested their unique contributions to meaning in life (MIL).

METHOD

We recruited Amazon Mechanical Turk Participants located in the United States. Studies 1 (N = 827) included measures of RWA, RF, and global MIL. Study 2 (N = 809) additionally included measures of the facets of global MIL (existential significance, purpose, and coherence), and intrinsic religiosity.

RESULTS

In both studies, RWA, RF, and MIL were positively correlated. Partial correlations and structural equation modeling showed that, when modeled together, RF significantly contributes to MIL and RWA facets were either unrelated or negatively related. Study 2 extended these results to show that RF primarily contributed positively to global MIL through existential significance, rather than purpose or coherence. When modeled jointly with intrinsic religiosity, religious fundamentalism no longer contributed to MIL.

CONCLUSIONS

These studies demonstrate that RF positively contributes to the experience of MIL, and that the link between RWA and MIL arises from their mutual overlap with RF. The link between RF and MIL is about religiosity, rather than fundamentalism. Implications are discussed.

'Meaning in life? Make it as bearable, enjoyable and good as possible!': A qualitative study among community-dwelling aged adults who receive home nursing in the Netherlands

The population of adults ageing in place and using home-care services is growing rapidly worldwide. Meaning in life (MiL) of this group of clients is relevant for healthcare and social workers. MiL is associated with many positive outcomes, but can be challenging for aged persons. Objective of this study was to explore MiL in daily life of community-dwelling aged persons who receive homecare. A hermeneutic phenomenological approach was followed. Three waves of semi-structured interviews took place among 24 clients of a home-care organisation in the Netherlands between November 2015 and July 2018. Photo-elicitation was part of the interview procedure. Interpretative Phenomenological Analysis and dialogues enhanced understanding. Findings show that participants derived meaning from self, others, environment and living. The process of retaining MiL involved maintaining, adapting and discovering. We conclude that community-dwelling aged adults can draw MiL from many sources. Retaining MiL is interwoven in everyday life and requires continuous adaptation to ever-changing life conditions during later life. Although relevant general themes were sketched in this paper, the importance of each, and the connections between them, vary and come to light at the individual level. The themes in this paper and the cases in the appendices provide insights that may help professionals recognise MiL in their work. Besides listening to the stories of aged adults, person-centred interventions should support aged adult's strategy to retain MiL.

The relationship between meaning in life and post-traumatic stress symptoms in US military personnel: A meta-analysis

BACKGROUND

Subjective meaning in life has been theorized to play a critical role in the adjustment to traumatic events. However, its association with post-traumatic stress symptoms has not been quantitatively reviewed.

METHODS

Informed by Park's integrated meaning-making model and evidenced-based psychological treatments for post-traumatic stress disorder, the goals of this meta-analysis were to: (1) to determine the direction and magnitude of the association between meaning in life and post-traumatic stress symptoms; and (2) to examine potential moderators of this association (i.e., age, sex, race, marital status, type of trauma, and meaning in life conceptualization). CINAHL, Embase, PILOT, PsycINFO, PubMed, and Web of Science core collection databases were searched.

RESULTS

A random-effects meta-analysis was conducted on 26 associations (N = 9,751). A significant, moderate, negative relationship was found between meaning in life and post-traumatic stress symptoms (r = -0.41; 95% CI: -0.47 to -0.35, k = 25). No significant moderators were detected.

CONCLUSIONS

Findings suggest that meaning in life plays a crucial role in adjustment to traumatic events. Development and testing of randomized controlled trials to determine whether increases in meaning in life result in reductions of post-traumatic stress in US military personnel may facilitate ongoing efforts aimed at recovery from trauma.

POSITIVE PSYCHIATRY INTERVENTIONS IN GERIATRIC MENTAL HEALTH

PURPOSE OF REVIEW

Positive psychiatry shifts the focus of geriatric mental healthcare beyond studying disorders and psychopathology to studying factors that contribute to mental well-being and successful aging. An increasing number of interventional studies are using treatments that target modifiable positive psychosocial characteristics (PPCs) and study their impact on mental health. Here we provide an overview of the literature on positive psychiatry interventions using illustrative examples of interventions targeting social connectedness, meaning in life, wisdom, and resilience.

RECENT FINDINGS

There is growing evidence that PPCs are modifiable constructs that may be associated with improved well-being, physical health, and mental health outcomes.

SUMMARY

The preliminary evidence summarized in this narrative review indicates that positive psychiatry interventions targeting social connectedness, meaning in life, wisdom, and resilience can improve overall well-being and other positive health outcomes amongst older adults. The effect sizes of these interventions reported in RCTs and meta-analyses are typically small to medium, but occasionally large effect sizes are also reported. Current literature is restricted by heterogeneous methodology, limiting clinicians' abilities to extrapolate these principles of positive psychiatry into everyday practice. With the expanding body of evidence, positive psychiatry may have the potential to transform the landscape of geriatric mental health.

The Psychometric Properties of the Meaning in Life Questionnaire (MLQ) in Patients with Life-Threatening Illnesses

Background

Meaning in life is one of the psychological domains that is most severely affected in patients with life-threatening illnesses. The importance of meaning-making mandates the development of reliable tools to assess this construct. Steger's Meaning in Life Questionnaire (MLQ) is one of the most valid and reliable instruments that determines the search for and presence of meaning in life. The present study was conducted to provide psychometric data on the MLQ in a sample of patients with life-threatening illnesses.

Methods

The MLQ was completed by 301 patients (aged 20–80 years) diagnosed with life-threatening illnesses (cancer and multiple sclerosis) and referred to hospitals. Confirmatory factor analysis and Pearson's correlation test were used to determine the construct validity of the questionnaire.

Results

The confirmatory factor analysis supported the original two-factor model of the MLQ, comprised of the presence of meaning (five items) and search for meaning (five items). The responses to the MLQ did not differ by sociodemographic factors. Most importantly, contrary to previous findings, the correlation between the two subscales, i.e., search for meaning and presence of meaning, was significant and positive.

Conclusion

The results showed that the MLQ is a valid and reliable measure for assessing meaning in life that can be applied in research on meaning in life among other patient populations.

The Science of Meaning in Life

Meaning in life has long been a mystery of human existence. In this review, we seek to demystify this construct. Focusing on the subjective experience of meaning in life, we review how it has been measured and briefly describe its correlates. Then we review evidence that meaning in life, for all its mystery, is a rather commonplace experience. We then define the construct and review its constituent facets: comprehension/coherence, purpose, and existential mattering/significance. We review the many experiences that have been shown to enhance meaning in life and close by considering important remaining research questions about this fascinating topic.

Social, Emotional, and Existential Loneliness: A Test of the Multidimensional Concept

Background and Objectives

Since the 1980s, most researchers have agreed on the concept of social and emotional loneliness as an unacceptable and negatively experienced discrepancy between realized and desired interpersonal relationships. For other researchers, existential loneliness stems from the realization that a human being is fundamentally alone, with the accompanying emptiness, sadness, and longing. This article examines whether instruments to measure these conceptualizations indicate a multidimensional concept.

Research Design and Methods

The 2019 observation of the Longitudinal Aging Study Amsterdam (N = 1,316; aged 61–101 years; 52% women) included five direct questions about loneliness, the 11-item de Jong Gierveld social and emotional loneliness scale, and 14 items from the translated Existential Loneliness Questionnaire. Confirmatory factor analysis was conducted in Mplus.

Results

Five factors were observed: direct questions, social and emotional loneliness, and loneliness in relationships and meaninglessness in life. The intercorrelations among all five factors were positive. Emotional loneliness correlated most strongly with direct questions.

Discussion and Implications

Loneliness is multifaceted and means that one is not embedded in a personal network, misses closeness and intimacy, and lacks meaning in life. The emotional loneliness items most closely represent what people mean when they report loneliness.

Nurse's attunement to patient's meaning in life - a qualitative study of experiences of Dutch adults ageing in place

BACKGROUND

Meaning in life (MiL) is considered to be an important part of health and is associated with many positive outcomes in older adults, such as quality of life and longevity. As health promotors, nurses may take patients' MiL into account in the care process. There is a knowledge gap in terms of what constitutes good care in relation to older patients' MiL, and what the benefits may be for patients when nursing is attuned to this aspect. The purpose of this study was to explore the experiences of home nursing older adults in relation to nurses' attunement to MiL.

METHODS

Gadamerian hermeneutic phenomenological design with semi-structured interviews. Participants were 24 aged home nursing patients. A framework of care ethical evaluation was used in the analysis. Multiple dialogues enhanced understanding.

RESULTS

Patients did not expect nurses' regard for their MiL. They rather expected 'normal contact' and adequate physical care. Nurses showed that they were open to patients' MiL by being interested in the patient as a person and by being attentive to specific and hidden needs. Participants explained that the nurse's behaviour upon arrival set the tone: they knew immediately if there was room for MiL or not. All participants had positive and negative experiences with nurses' behaviour in relation to MiL. Valued nursing care included maintaining a long, kind and reciprocal relationship; doing what was needed; and skilled personalised care. Participants mentioned 'special ones': nurses who attuned to them in a special way and did more than expected. Benefits of care that was attuned to patients' MiL were: experiencing a cheerful moment, feeling secure, feeling like a valuable person and having a good day. Older adults also stressed that consideration for MiL helps identify what is important in healthcare.

CONCLUSION

Aged homecare patients value nurses' attunement to their MiL positively. Although patients regard MiL mostly as their own quest, nurses play a modest yet important role. Managers and educators should support nurses' investment in reciprocal nurse-patient relationships.

Spanish adaptation of the Personal Meaning Profile-Brief: Meaning in life, psychological well-being, and distress

Background/Objective

This study aimed to adapt the Personal Meaning Profile-Brief (PMP-B) to the Spanish-speaking population and investigate its psychometric properties. The PMP-B is a 21-item instrument that assesses meaning in life through seven sources: relationship, intimacy, achievement, self-acceptance, self-transcendence, fair treatment, and religion.

Method

Participants were 546 Spanish adults comprised of a community sample (n = 171) and university students (n = 375). The PMP-B, the Ryff's Scales of Psychological Well-Being, and the Depression Anxiety Stress Scale were administrated.

Results

The PMP-B showed a bifactor structure with one general factor and seven subfactors. Measurement invariance was found across age, gender, and samples. Internal consistency and test-retest reliability were generally good. Older people showed higher PMP-B scores than younger people. The PMP-B scores, especially relational sources of meaning, were positively associated with psychological well-being and negatively related to psychological distress, mainly to depression.

Conclusions

The validity evidence gathered in this study supports the reliable use of the PMP-B to measure meaning in life. The PMP-B can be a noteworthy contribution to the meaning-centered research.

Testing a model of fear of cancer recurrence or progression: the central role of intrusions, death anxiety and threat appraisal

We recently proposed a model of cancer-related anxiety to account for the etiology and maintenance of clinically significant anxiety in the context of cancer. This study tested predictions arising from the model to explain fear of cancer recurrence or progression (FCR). Patients with cancer were recruited from a research registry or outpatient hospital clinics (n = 211). In bivariate analyses, FCR was associated with metacognitive beliefs, intolerance of uncertainty, core belief disruption, less meaning in life, social constraints, death anxiety, intrusions, threat appraisal, and coping. A hierarchical regression explained 65% of the variance in FCR. FCR was predicted by younger age, intrusions, death anxiety, threat appraisal and meta-cognitions. The findings highlight the importance of both cognitive processes and content in FCR, including intrusions, fears about death and dying, beliefs about worry, and threat appraisals.

Meaning in life of older adults in daily care: A qualitative analysis of participant observations of home nursing visits

AIM

To explore situations in daily home nursing regarding meaning in life of older adults.

DESIGN

Qualitative research design.

METHODS

In total, 197 participant observations were conducted during home nursing visits between September 2015-May 2018. Descriptions were thematically analysed. The themes of this analysis were subsequently linked to dimensions of meaning in life. Dialogue in research groups expanded understanding.

RESULTS/FINDINGS

Four main themes were found namely: being in a private environment; nurse-patient encounter embedded in a relationship; personal care; and conversation.

CONCLUSION

Meaning in life of older adults may come to light in every situation during daily care. Hence there are many opportunities for nurses to attune their work to patients' meaning in life. Nurse education and health management should enable them to do so.

How specialist palliative care nurses identify patients with existential distress and manage their needs

BACKGROUND

Existential distress is a term used when patients who are coming towards the end of their lives exhibit profound suffering, related particularly to their thoughts on life and existence. The clinical expression of this phenomenon has not been widely researched, and so specialist palliative care nurses were asked how they identify and manage this patient cohort.

AIMS

To explore how palliative-care nurses identify patients with existential distress and manage their needs.

METHODS

A qualitative descriptive design with thematic content analysis of transcribed interviews.

FINDINGS

Behavioural changes, agitation, social withdrawal and communication difficulties are identified as indicators of possible existential distress. Susceptible patient groups are identified. Nurses acknowledged that caring for patients with existential distress can be emotionally demanding. Being present and building relationships with patients are identified as enabling meaning-making. Sedation for refractory distress is seen as a last resort.

CONCLUSION

Early identification of existential distress by carers could enable timely intervention (counselling, psychotherapy and or spiritual guidance) to improve the patients' quality of life in the terminal phase of their illness and avoid intractable or refractory existential distress that may necessitate palliative sedation.

Challenges in a six-phase process of questionnaire adaptation: findings from the French translation of the Integrated Palliative care Outcome Scale

BACKGROUND

The Integrated Palliative care Outcome Scale (IPOS) was developed for evaluating essential outcomes for palliative care patients. Our objectives here are to describe the process of a six-phase cross-cultural adaptation of IPOS to French (IPOS-Fr), highlight the difficulties encountered and strategies to solve them, and discuss the implications that adaptation may have on the validity and reliability of a questionnaire.

METHODS

The adaptation of IPOS consisted of six phases: (i) literature review and interviews with target population; (ii) forward translation to French; (iii) backward translation to English; (iv) Expert Review; (v) cognitive interviews with target population; (vi) final review.

RESULTS

Translation, cognitive interviews, and exchanges with Expert Review members allowed to make changes adapted to the target language regarding item 5 ("vomiting") and 8 ("sore or dry mouth"), and to identify and address, in the original version of IPOS, syntactic inconsistencies in language used in items 11 to 15 and methodological problems with items 11 ("anxiety about treatment and illness"), 15 ("share … as much as you wanted") and 17 ("problems addressed"). The adaptation also indicated that patients might have difficulties in interpreting items 8 ("sore or dry mouth"), 10 ("poor mobility"), 11 ("anxiety"), 12 (projected feelings of family and friends), and 14 ("feeling at peace"), thus indicating the need of monitoring during the psychometric validation.

CONCLUSIONS

Following this process, IPOS-Fr has proved content and face validity. In our case, the adaptation allowed adjustments to be made to the questionnaire and, when this was not possible, highlighted potential biases and inconsistencies during the validation. The result relied on an intertwined and iterative process of seeking and reaching semantic, conceptual, and normative equivalence. We are now assessing the psychometrical properties of IPOS-Fr.

Italian Validation of the Meaning in Life Questionnaire: Factor Structure, Reliability, Convergent, and Discriminant Validity

Several studies highlighted the role of meaning in life as a major component of well-being and researchers have developed different measures to assess the features of this construct. In the present study, the psychometric properties of the Meaning in Life Questionnaire were investigated in the Italian context. The Meaning in Life Questionnaire is a 10-item scale measuring perceived presence of and search for meaning in life, conceptualized as two separate factors. The former refers to perceived meaning and purpose in life, the latter to the active commitment to find meaning in life. Participants were 464 adults aged 20 to 60 years ( M = 39.34; SD = 10.86; 54.7% women). Factor structure was inspected through exploratory and confirmatory factor analyses using a split-sample approach. Internal consistency was assessed through Cronbach’s alphas, interitem and item-scale correlations. Convergent and discriminant validity with measures of well-being, personality, mental health, and physical health were also evaluated. Factor analyses supported the adequacy of the Meaning in Life Questionnaire two-factor structure in the Italian context; internal consistency measures corroborated the measure’s reliability; and correlation matrix coefficients sustained convergent and discriminant validity. Results showed that the Meaning in Life Questionnaire is a valid and reliable measure to assess meaning in life and its relationship with well-being within the Italian context.

Experimentally-enhanced perceptions of meaning confer resilience to the interpersonal adversity implicated in suicide risk

BACKGROUND AND OBJECTIVES

The interpersonal theory of suicide proposes that perceived burdensomeness and thwarted belongingness (PB-TB) are proximal causes of suicidal desire. Here we test whether experimentally induced perceptions of meaningfulness can confer resilience against interpersonal adversity and enhance persistence, the erosion of which is a potential antecedent to suicide risk.

METHODS

Undergraduate university students (N = 93) were randomly allocated to complete a team task under conditions of high or low task-extrinsic meaning and high or low PB-TB. Participants in the high task-extrinsic meaning condition were given the opportunity to donate to a charity as part of their experimental participation, whereas those in the low task-extrinsic meaning condition were not.

RESULTS

Consistent with the buffering hypothesis that suicide resilience is active only when adversity is heightened, participants in the high task-extrinsic meaning condition who reported higher levels of perceived meaningfulness displayed greater willingness to persist in the face of experimentally-induced high PB and TB compared to those in the low task-extrinsic meaning condition and those in conditions where the interpersonal adversity was not induced (low PB and TB).

LIMITATIONS

The meaning induction was effective only in a subset of participants. The dual induction of PB and TB also precludes inferences about their independent causal effects on willingness to persist.

CONCLUSIONS

Meaning-making interventions may attenuate the impact of proximal interpersonal antecedents of suicidal desire. Enhancing resilience in this manner can potentially improve the efficacy of prevention efforts beyond the direct amelioration of suicide risk factors.

Mechanisms Behind Religiosity and Spirituality's Effect on Mental Health, Quality of Life and Well-Being

This cross-sectional study aims to evaluate the role of meaning, peace, faith and religiosity on mental health, quality of life (QOL) and well-being in 782 adults. We found associations between (a) meaning and peace with less depression and more QOL, (b) peace with less stress and (c) faith and religiousness with more psychological QOL. Meaning and peace were more strongly associated with health outcomes, and those with high levels of intrinsic religiosity but low levels of meaning/peace have worse outcomes than those with low religiousness and high meaning/peace. However, religious participants found great meaning and peace than nonreligious participants.

The effects of psychological meaning-centered therapies on quality of life and psychological stress: A metaanalysis

ABSTRACTObjective:Many psychotherapists speak with clients about meaning in life. Meaning is an neutral evidence-based term for a subjective sense of purpose, values, understanding, self-worth, action-directed goals, and self-regulation. Since little is known about its effectiveness, our study aimed to determine the effects of meaning-centered therapies (MCTs) on improving quality of life and reducing psychological stress.

METHOD

Independent researchers selected and scored articles in multiple languages in multiple search engines. Weighted pooled mean effects were calculated following a random-effects model. Sensitivity analyses included moderators, study and sample characteristics, risk of bias, randomization, types of MCT, control condition, and outcome instruments.

RESULTS

Some 52,220 citations included 60 trials (total sample N = 3,713), of which 26 were randomized controlled trials (N = 1,975), 15 nonrandomized controlled trials (N = 709), and 19 nonrandomized noncontrolled trials with pre/post measurements (N = 1,029). Overall analyses showed large improvements from baseline to immediate posttreatment and follow-up on quality of life (Hedges' g = 1.13, SE = 0.12; g = 0.99, SE = 0.20) and psychological stress (g = 1.21, SE = 0.10; g = 0.67, SE = 0.20). As effects varied between studies, further analyses focused only on controlled trials: MCT had large effect sizes compared to control groups, both immediate and at follow-up, on quality of life (g = 1.02, SE = 0.06; g = 1.06, SE = 0.12) and psychological stress (g = 0.94, SE = 0.07, p < 0.01; g = 0.84, SE = 0.10). Immediate effects were larger for general quality of life (g = 1.37, SE = 0.12) than for meaning in life (g = 1.18, SE = 0.08), hope and optimism (g = 0.80, SE = 0.13), self-efficacy (g = 0.89, SE = 0.14), and social well-being (g = 0.81, SE = 13). The homogeneity of these results was validated by the lack of significance of moderators and alternative ways of selecting studies. Metaregression analyses showed that increases in meaning in life predicted decreases in psychological stress (β = -0.56, p < 0.001).

SIGNIFICANCE OF RESULTS

MCT strongly improves quality of life and reduces psychological stress. MCT should be made more widely available, particularly to individuals in transitional moments in life or with a chronic or life-threatening physical illness as they explicitly report meaning-centered concerns.

A Comparative Study on the Meaning in Life of Patients with Cancer and Their Family Members

Introduction: The overwhelming effects of cancer could be catastrophic for the patients and their family members, putting them at risk of experiencing uncertainty, loss, and an interruption in life. Also, it can influence their sense of meaning, a fundamental need equated with the purpose in life. Accordingly, this study aimed to compare the meaning in life (MiL) of patients with cancer and their family members.

Methods: This descriptive comparative study was conducted on 400 patients with cancer and their family members admitted to university hospitals in Tabriz and Ardebil provinces, Iran. The participants were sampled conveniently and the Life Evaluation Questionnaire (LEQ) were used for collecting data analyzed through descriptive and inferential statistics in SPSS ver. 13 Software.

Results: The mean score for the MiL of the patients with cancer and their family members was 119 (16.92) and 146.2 (17.07), respectively. There was a significant difference between patients with cancer and their family members in terms of MiL.

Conclusion: The MiL of patients with cancer is lower than that of their family members, which indicates the need for further attention to the psychological processes and their modification in Iranian healthcare systems