Meaning in Life and Meaning of Life in Mental Health Care: An Integrative Literature Review

Factors associated with the level of self-management in elderly patients with chronic diseases: a pathway analysis

BACKGROUND

To analyze the effects and pathways of factors such as psychological capital, family functioning, and sources of meaning in life on the level of self-management in elderly patients with chronic diseases and to provide a basis for the development of relevant nursing interventions in the future.

METHODS

Convenience sampling was used to select elderly patients with chronic diseases who underwent medical checkups and consultations at three community hospitals in Jinzhou city from March 2023 to October 2023, and the self-designed General Information Questionnaire (GIS), Psychological Capital of the Elderly Scale (PCE), Family Functioning Index Questionnaire (APGAR), Sources of Meaning of Life Scale for Older Adults(SMSE), and Self-Management Behavior of Chronic Patients Scale (SMCS) were used. SPSS 26.0 was used for data entry, one-way analysis, Pearson correlation analysis, and multiple linear regression were used to analyze the data, and Amos 17.0 was used to construct the structural equation model.

RESULTS

A total of 355 elderly patients with chronic diseases were included, and their self-management score was 74.75 ± 12.93, which was moderate. The results of the influencing factor analysis showed that the influencing factors of the self-management level of elderly chronic disease patients were age, years of illness, psychological capital, family functioning, and sources of meaning in life (p < 0.05). Path analysis revealed that sources of meaning in life were a partial mediator of the relationship between psychological capital and self-management, with an effect value of 0.166 (95% CI: 0.042,0.391), accounting for 37.6% of the total effect; life meaning was a partial mediator of family functioning and self-management level, with an effect value of 0.231 (95% CI: 0.040,0.452), accounting for 54.0% of the total effect. accounting for 54.0% of the total effect.

CONCLUSION

The self-management of elderly patients with chronic diseases is intermediate. Healthcare professionals should actively implement holistic healthcare management measures from the family aspect to help patients understand the meaning of life and improve the level of patients' psychological capital to improve the self-management level of elderly patients with chronic diseases.

Effects of meaning therapy on spirituality, psychological health, and quality of life in patients with cancer: A systematic review and meta-analysis of randomized controlled trials

Objective

This study aimed to systematically review studies of meaning therapy on patients with cancer and to evaluate its effectiveness on spiritual outcomes, psychological outcomes, and quality of life (QOL).

Methods

A comprehensive literature search were performed in five international databases (PubMed, Embase, Web of Science, The Cochrane Library, and CINAHL) and four Chinese databases (CNKI, Wanfang Data, VIP, and CBM) from the inception to August 2023. The methodological quality of each included studies was evaluated by using the revised Cochrane risk-of-bias tool for randomized trials. The random-effects model or fixed-effects model was utilized for effect size analysis, and the standardized mean difference (SMD) or mean difference (MD) along with its corresponding 95% confidence interval (CI) was computed. Meta-analysis was conducted by using the RevMan software 5.4.1.

Results

Eight randomized controlled trials with 1251 participants were included in this review. Meta-analyses revealed that meaning therapy can significantly improve the spiritual outcomes including meaning in life (SMD = -0.48; 95% CI = -0.89 to -0.07; P = 0.02), hopelessness (SMD = -0.30; 95% CI = -0.51 to -0.09; P = 0.005), self-esteem (MD = -2.74; 95% CI = -4.17 to -1.32; P = 0.0002) and spiritual well-being (MD = -3.32; 95% CI = -5.63 to -1.01; P = 0.005), psychological outcomes including anxiety (MD = -0.66; 95% CI = -1.30 to -0.01; P = 0.05), depression (SMD = -0.37; 95% CI = -0.55 to -0.20; P < 0.0001), psychological distress (SMD = -0.35; 95% CI = -0.70 to -0.01; P = 0.04) and desire for hastened death (MD = -0.76; 95% CI = -1.47 to -0.05; P = 0.04), and QOL (SMD = -0.29; 95% CI = -0.50 to -0.09; P = 0.006) in patients with cancer.

Conclusions

Meaning therapy has positive effects on improving spirituality, psychological health, and QOL of patients with cancer. More high-quality randomized controlled trials with larger sample sizes are warranted to confirm the results of our review and to clarify the long-term effects of meaning therapy in the future.

Systematic review registration

PROSPERO (No. CRD42021278286).

Forms of Peer Victimization and School Adjustment Among Japanese Adolescents: A Multilevel Analysis

The psychosocial correlates and consequences of peer victimization are well documented. However, there is limited knowledge about whether different forms of peer victimization (relational and physical) are predictive of school-based social and motivational factors among adolescents from non-Western cultures. The present study examined the relationship between individual and school-level forms of peer victimization and school adjustment among Japanese adolescents, and the mediating role that these factors may play. The Japanese sample (N = 6109 from 185 schools, Mage = 15.78, SD = 0.29, 51% girls and 49% boys) was drawn from a large international dataset, the Organization for Economic Cooperation and Development (OECD) Programme for International Student Assessment (PISA) 2018. Results showed that school-level relational victimization was associated with individual-level relational victimization, and school-level physical victimization was associated with individual-level physical victimization, after controlling for age, gender, and socioeconomic status. Individual-level relational victimization was also uniquely associated with indices of school adjustment (negative affect, positive affect, and fear of failure) over and above physical victimization. While controlling for relational victimization, individual-level physical victimization was associated with indices of school adjustment (positive affect and meaning in life). In further findings, school-level relational and physical victimization were indirectly, but not directly, related to some of students' school adjustment through individual-level relational and physical victimization. These parallel and differential associations suggest the importance of considering the role of relational and physical victimization in school adjustment among Japanese adolescents.

Social contributions to meaning in life: the role of romantic relationship quality, parenting, and gender

Introduction

The present study tests the association between romantic relationship quality and number of children on meaning in life (i.e., sense of purpose, coherence, and significance) and considers interactions between these constructs and gender.

Methods

A survey was conducted approximately one year into the pandemic among 473 individuals in the United States.

Results

Models demonstrated that relationship quality and number of children are positively associated with meaning, though relationship quality was more strongly related to meaning for men than women. We showed that for women there was an equally positive link between relationship quality and meaning regardless of number of children. However, for men, the positive association between relationship quality and meaning was strongest for those with more than one child, decreased in magnitude for those with one child, and was no longer significant for men with more than one child.

Discussion

These findings provide empirical evidence that social relationships benefit meaning in life and underscore the complexity of these associations. Results have implications for theoretical perspectives on meaning in life, as well as for policies that encourage family wellbeing.

Social exclusion and suicide intention in Chinese college students: a moderated mediation model

Given the growing incidence rates of suicide among college students and the potential lifelong consequences of suicide, it is imperative to better understand the factors that reduce the rates at which college students in a clinical sample engage in suicide. This study examines the relationship between social exclusion and suicide intention, the mediating effect of depression, and the moderating effect of meaning in life. Two hundred and ninety-nine Chinese college students, aged from 18 to 22 years (56.86% female, M age = 20.14, SD = 1.27) completed questionnaires assessing their social exclusion, suicide intention, depression, and meaning in life. The result revealed that social exclusion was positively associated with suicide intention, and depression mediated this relationship. In addition, this mediating effect of depression was moderated by meaning in life. That is, the mediation effect was stronger for students with a higher level of meaning in life. These findings provide educational suggestions for preventing and intervening in suicide intention among college students.

Existential meaning, spiritual unconscious and spirituality in Viktor Frankl

There is robust evidence to support the relationship between spirituality and mental health, but the mechanisms of this association are not well-understood. The existential meaning provided by spirituality may be one of these mechanisms. This was the central theme of Viktor Frankl's psychology, which he explained using the notion of the spiritual unconscious. Thus, we sought to explain how Frankl understands this spiritual unconscious and the two pieces of evidence he presents for its existence: the phenomenological description of responsible action and the analysis of dreams. Lastly, we discuss his contribution to the current understanding of the relationship between having an overarching purpose and/or religious meaning and improvement in mental health.

Physical exercise can enhance meaning in life of college students: the chain mediating role of self-efficacy and life satisfaction

Meaning in life refers to an individual's capacity to understand and grasp the meaning of their own existence, as well as being aware of the goals, tasks, or missions in their personal life. Previous studies have found that college students lack meaning in life, but physical exercise can enhance it. In this study, 3,196 college students completed self-report questionnaires to assess self-efficacy, life satisfaction, physical exercise, and meaning in life. The results revealed that the physical exercise not only influenced an individual's perceived meaning in life directly, but also influenced it through self-efficacy. Furthermore, it confirmed the chain mediating role of self-efficacy and life satisfaction, whereby engaging in physical exercise can ultimately impact meaning in life through self-efficacy and life satisfaction. This discovery can help educators create interventions to improve college students' physical exercise engagement and overall life satisfaction.

Sources of empowerment and mental health among retired men and women: An ecological perspective

AIMS

The overarching goal of the present study was to examine the contribution of various sources of empowerment to mental health during retirement with an added emphasis on gender differences. The empowerment sources that were examined corresponded with three distinct ecological systems: (1) Chronosystem-resource gains from the pre- to post-retirement period and satisfaction with the prior working period; (2) Microsystem-marital power dynamics (measured by the division of household labor and decision-making in the marital relationship) and the presence of a confidant; (3) Ontogenetic system-a sense of meaning in one's life during the retirement period and an assessment of absolute resources.

METHOD

The research sample consisted of 160 Israeli retirees (78 women and 82 men) who had retired within the previous eight years. Data were collected by the Panels Research Institute in Israel using the institute's database of members. Participants completed an online questionnaire accessible via a website link. Statistical processing was performed using ANOVA and hierarchical regression analysis.

RESULTS

The results indicated that retirees' reports of resource gains after retirement, their sense of meaning in life, their satisfaction with their working period prior to retirement, and their perceived level of absolute resources were all associated with mental health. Additionally, the more participants (both men and women) rated that the husband was involved in household labor, the better retirees reported their mental health to be. Gender differences were found in regard to some empowerment sources during retirement: retired women reported lower levels of mental health and prior work satisfaction compared to retired men, and men's assessments of their participation in household labor and decision-making were higher than women's assessments of their husbands' involvement. The proportion of men who reported that their wives were their confidants was higher than the proportion of women who reported that their husbands were their confidants.

SUMMARY AND CONCLUSIONS

Overall, men experienced more sources of empowerment than women during retirement, but findings suggest that men's emotional dependence on their wives is greater than women's emotional dependence on their husbands. Based on the study's findings, recommendations are offered to professionals who work with retirees.

Evolution of psychopathology, purpose in life, and moral courage in healthcare workers during the COVID-19 pandemic: a longitudinal study

Introduction

Almost 2 years and five infection waves after the COVID-19 pandemic started, healthcare workers continued dealing with the pandemic situation and facing the health consequences and the mental health disorders it caused. This study aimed to evaluate the onset and progression of psychopathology as well as the role of predictor variables such as purpose in life and moral courage among healthcare workers during this time.

Materials and methods

This was a longitudinal prospective study carried out with 45 Spanish healthcare workers who answered two questionnaires, the first questionnaire in April-May 2020 (T1) and the second questionnaire in September-October 2021 (T2).

Results

Although 29.5% of the sample considered that their mental health had improved over this time, almost half of them (47.7%) said it had not changed, while 22.7% reported a decline in their mental health from the first time they were asked. Specifically, 46.8% presented anxiety, 23.4% depression, and 42.6% acute stress at T1, and 38.3% had anxiety, 17% depression, and 27.7% post-traumatic stress disorder at T2. Despite this, there were no differences between T1 and T2 anxiety scores (p = 0.53), although there was a decrease in depression (p = 0.03) and acute stress (p = 0.02) scores. Predictor variable outcomes such as purpose in life (p = 0.88) and moral courage (p = 0.86; p = 0.38) did not change over time, but when modelling the data, purpose in life predicted psychopathology at T1, which in turn affected the psychopathology results at T2.

Conclusion

This study showed that, although psychopathology decreased over the months, its prevalence remained high. Even though the purpose in life predicted psychopathology at T1, it seems that once the psychopathology is established (T2), the factors that would improve it would be different from the protective factors that prevented its establishment, which become secondary.

Sources of meaning in life among older adults during the COVID-19 pandemic: A qualitative study

AIM

This study aims to explore the sources of meaning in life (MIL) and its impact on South Korean older adults during the coronavirus disease 2019 (COVID-19) pandemic.

DESIGN

This study had a qualitative descriptive study design.

METHODS

The study participants included 18 older adults. Six focus group interviews were conducted. Data were analysed using content analysis.

RESULTS

The subcategories 'Continued learning and growth', 'Self-transcending practices' and 'Efforts to maintain good health' were extracted under the category 'Sources of MIL for older adults'. Similarly, the subcategories 'Tremendous changes brought about by the virus' and 'Varying patterns of adjustment to the pandemic' were extracted under the category 'Changes in the sources of MIL since the COVID-19 outbreak'.

PUBLIC CONTRIBUTION

Our study provides an in-depth understanding of the changed sources of MIL for older adults during the COVID-19 pandemic. The findings serve as useful guidance for planning interventions for older adults to lead meaningful lives during the COVID-19 pandemic and post-pandemic crises.

Alexithymia and Internet Addiction in Children: Meaning in Life as Mediator and Reciprocal Filial Piety as Moderator

Purpose

To explore the psychological mechanism between alexithymia and Internet addiction, the present study constructed a moderated mediation model based on the problem behavior theory.

Methods

A total of 899 middle school students (Mage=13.95, SD=1.10) were surveyed using the 20-item Toronto-alexithymia-scale, meaning in life questionnaire, dual filial piety scale, and Internet addiction disorder diagnostic scale.

Results

First, alexithymia was significantly negatively correlated with meaning in life and reciprocal filial piety, and positively correlated with Internet addiction; meaning in life was significantly positively correlated with reciprocal filial piety, and negatively correlated with Internet addiction; reciprocal filial piety was significantly positively correlated with authoritarian filial piety, and negatively correlated with Internet addiction. Second, alexithymia could not only directly predict Internet addiction, but also indirectly predict Internet addiction through meaning in life. Third, reciprocal filial piety played a moderating role between meaning in life and Internet addiction, while authoritarian filial piety did not. For middle school students with low reciprocal filial piety, meaning in life can negatively predict Internet addiction; for those with high reciprocal filial piety, there is no correlation between meaning in life and Internet addiction.

Conclusion

This study reveals the internal mechanism of the relationship between alexithymia and Internet addiction in middle school students, emphasizes the role of positive psychology and family environment, and provides specific evidence and theoretical guidance for preventing Internet addiction in middle school students.

Meaning in life and smartphone addiction among Chinese female college students: The mediating role of school adjustment and the moderating role of grade

Background

The fact that female college students are more addicted to smartphones than male college students has raised public concerns. However, previous studies have rarely explored the mechanism of female college students' smartphone addiction. Previous studies have shown that identity may affect the formation process of female college students' smartphone addiction, and the identity of female college students in different grades may be different. Nonetheless, few studies have explored the grade differences in the formation process of female college students' smartphone addiction.

Methods

The present study examined the relationship between meaning in life, school adjustment, and smartphone addiction among Chinese female college students using a moderated mediation model in which school adjustment played a mediating role and grade played a moderating role. A total of 1,076 Chinese female college students (Age: 19.83 ± 1.11; 369 freshmen, 379 sophomores, and 328 juniors) completed an online questionnaire regarding meaning in life, school adjustment, and smartphone addiction.

Results

(1) School adjustment mediated the relationship between meaning in life and smartphone addiction. (2) School adjustment had a partial mediating effect between meaning in life and smartphone addiction for female freshmen and sophomores, but it did not exist among female juniors. (3) The influence of school adjustment on female sophomores' smartphone addiction was significantly stronger than that of female freshmen.

Conclusion

The findings of this study advance our understanding of the potential impacts of meaning in life on smartphone addiction and provide a grade perspective for targeted prevention or intervention with female college students' smartphone addiction.

The Development of the Existential Empathy Questionnaire

Therapist empathy toward existential concerns might be a critical component of clinical practice. This study aims to explore the psychometric properties of the Existential Empathy Questionnaire (EEQ), a self-report instrument developed to measure levels of existential empathy among mental health professionals. The EEQ was completed by a sample of 393 therapists recruited in Belgium, along with measures of general empathy, experiential avoidance, and existential avoidance. To assess the test–retest reliability, 353 participants of the same sample completed the EEQ a second time 2 weeks later. Clinical experience and therapeutic theoretical background were assessed to inform professional characteristics. The results support the use of the EEQ as a unidimensional measure of existential empathy. It demonstrates good internal reliability and temporal stability. A principal components analysis indicates three components with small to moderate intercorrelations, labeled as “Communication,” “Avoidance and Overwhelming Feelings,” and “Resonance and Presence.” EEQ total scores show a moderate positive association with general empathy and a moderate negative association with experiential and existential avoidance. Furthermore, the EEQ significantly uniquely predicts experiential and existential avoidance after controlling for general empathy. Years of clinical practice and a humanistic-oriented therapeutic approach correlated moderately with high EEQ scores.

Suffering, authenticity, and meaning in life: Toward an integrated conceptualization of well-being

Most conceptions of well-being either ignore suffering or assume an ideal version of human life in which suffering would be eliminated. This trend is especially emblematic of positive psychology. Recent research on well-being indicates a mediating function of meaning in life between suffering and well-being demonstrating that making sense of past experiences is significantly correlated with high presence of meaning in life. Hence, meaning-making serves the role of an active coping mechanism that alleviates suffering. This and related strategies of defining, measuring, and augmenting well-being however overlook a form of suffering that is ineliminable and in fact essential to personal growth. In this paper the insights of the existentialist philosopher Søren Kierkegaard are developed to formulate an integrated conceptualization of well-being that regards "negative" affects as crucial for a rich and complete life. The complexity of the relationship between meaning in life, suffering, and authenticity concerning well-being are discussed. A synthetic perspective on the subjective dimension of the experience of suffering and on the objective nature of human limitations that often cause suffering is discussed in relation to the notions of meaning in life and authenticity. Finally, an integrated conceptualization of well-being is posited. It entails suffering as constitutive of meaning in life and authenticity, which are key components of a well-lived life.

Association between Workplace Violence and Depressive Symptoms among Primary Healthcare Professionals in Shandong, China: Meaning in Life as a Moderator

BACKGROUND

Workplace violence (WPV) is common in healthcare settings. However, the association between WPV and depressive symptoms has not been explored among primary healthcare professionals, especially in China. The assumption of the moderating effort of meaning in life on the association has also not been tested. The purposes of the study are to investigate the relationship between WPV and depressive symptoms and identify the moderating role of meaning in life among primary healthcare professionals in China.

METHODS

In this study, we collected 2530 valid questionnaires. The participants were composed of primary healthcare professionals in Shandong province, China. WPV, meaning in life (including presence of life and search for life), depressive symptoms, and some social-demographic variables were evaluated. The SPSS macro was used to build the moderating relationship.

RESULTS

WPV was positively correlated with depressive symptoms (β = 9.09, p < 0.001), and meaning in life was negatively associated with WPV and depressive symptoms (β = -0.13, p < 0.05) among primary healthcare professionals in China. For primary healthcare professionals with low presence of life, presence of life aggravated the relationship.

CONCLUSIONS

The current study has verified the association between WPV and meaning in life, and the relationship between WPV and depressive symptoms has been supported among primary healthcare professionals in China. Meaning in life and presence of life as moderators play crucial roles in the relationship between WPV and depressive symptoms.

Associations between Drinking Behaviors and Meaning in Life: Evidence from Primary Care Professionals in China

(1) Background: Although the associations between drinking behaviors and emotional problems have been supported in several previous studies, the associations between drinking behaviors and meaning in life have not been explored until now. We aimed to test the associations between drinking behaviors and meaning in life among primary care professionals, after controlling for depression. (2) Methods: In the current study, we collected 1453 valid questionnaires based on a cross-sectional design. Meaning in life, drinking behaviors, physical diseases, depression, work-related variables, and some other social-demographic variables were evaluated. (3) Results: The results support that after controlling for depression, regular milk drinking (β = 1.387, p = 0.026), and regular juice drinking (β = 2.316, p = 0.030) were associated with higher meaning in life, while regular water drinking (β = −1.448, p = 0.019) was negatively associated with meaning in life. In addition to this, the results showed that the older age (β = 0.098, p = 0.001), preventive medicine majors (β = 4.281, p = 0.013), working fewer days per week (β = −0.942, p = 0.004), licensed (assistant) technician qualification (β = 2.921, p = 0.036), and no depression (β = −0.203, p < 0.001) were positively associated with meaning in life. (4) Conclusion: This study supported the association between drinking behaviors and meaning in life, even after controlling depression. These findings imply that we can further explore this association and its mechanisms in future studies.

Good Personality and Subjective Well-Being: Presence of Meaning in Life and Perceived Social Support as Mediators

BACKGROUND

Good personality is a positive moral personality in the context of Chinese Confucianism. Based on a social-cognitive model of normative well-being, we propose that good personality positively predicts subjective well-being, mediated by the perceived social support and presence of meaning in life in the context of Chinese culture.

METHODS

In this cross-sectional study, there were 665 Chinese adults (134 males and 531 females) who participated in the Good Personality Questionnaire, Multi-Dimensional Scale of Perceived Social Support, Presence of Meaning in Life Questionnaire, Positive and Negative Affect Scale, and Satisfaction with Life Scale.

RESULTS

Good personality was positively associated with subjective well-being (SWB). Both the presence of meaning in life and perceived social support independently mediated the link between good personality and subjective well-being (SWB), and in Chinese adults, perceived social support has a greater mediating effect than the presence of meaning in life.

CONCLUSION

These findings illustrate that the presence of meaning in life and perceived social support mediate the relationship between good personality and subjective well-being in the context of Chinese culture, which supports the model of normative well-being and can provide more targeted intervention guidance for research on promoting well-being in the Chinese context.

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.

Anxiety and Depression in a Non-Clinical Sample of Young Polish Adults: Presence of Meaning in Life as a Mediator

Early adulthood, between 18 and 25, is viewed as a decisive period of life for the prevention and treatment of anxiety and depression. Although the topic of their mutual relationship is well-known, little has been uncovered about the mechanism underlying this connection. To understand the indirect pathways between anxiety and depression, we chose the sense of meaning of life as a mediator because people's beliefs that their lives are or can be purposeful may protect against depression. The sample was composed of 277 Polish young adults. A small majority of the participants were women (58.8%). The mean age was M = 22.11 (SD = 1.72). We used in the research the Direct Behavior Rating-Scale Items Scale, the Meaning in Life Questionnaire, and the Brief Screen for Depression. Correlational analysis showed that, consistent with past findings, anxiety correlated positively with depression and searching for meaning. It was also negatively associated with presence of meaning. Moreover, depression was negatively linked to presence of meaning and positively with searching for meaning. Regression-based mediation analyses (PROCESS macro 3.4) proved that the relationship between anxiety and depression was mediated by presence of meaning in life, suggesting that having a sense of meaning may be a pathway by which feelings of tension relative to adverse events protect against depression.

Effect of an internet-based intervention for adjustment disorder on meaning in life and enjoyment

Introduction

Positive psychological variables, such as meaning in life and the capacity for enjoyment, are important resilience factors against negative behaviors and symptoms. These constructs are related to better emotional regulation strategies, a greater perception of control over one’s life, and better mental health in general. Adjustment disorder (AjD) is a prevalent condition defined as the failure to adapt to a stressful event.

Objective

This study presents secondary analysis data on the effect of an Internet-delivered cognitive-behavioral therapy intervention (iCBT) for AjD on meaning in life and capacity for enjoyment, compared to a control group.

Method

The sample consisted of 68 participants with AjD. 34 in the iCBT condition and 34 in the control group). Meaning in life was assessed by the Purpose-in-Life Test-10, and the Environmental Rewards Observation Scale was used to assess the capacity for enjoyment. The iCBT intervention focused on acceptance and processing of the stressful event. Intent-to-treat mixed-model analyses without any ad hoc imputations and using Cohen’s d effect comparisons were conducted.

Results

The results revealed a significant main effect of time and a significant group x time interaction in all the measures. Significantly higher pre-post score differences were found in the treatment condition.

Discussion

Meaning in life and capacity for enjoyment can change after an iCBT intervention for AjD. Therapeutic implications of the results and future lines of research about the role of meaning in life in AjD are discussed.

Effects of a Reminiscence Program on Meaning of Life, Sense of Coherence and Coping in Older Women Living in Nursing Homes during COVID-19

Aging is a dynamic process that can bring well-being but also physical and cognitive decline. Older adults can draw on their personal resources to help them cope and thrive through the aging process. Having personal resources to cope and ensure older adults’ well-being is important. Psychological strengths such as a sense of coherence, resilience, and coping are protective against the adversity associated with health problems such as those stemming from the COVID-19 pandemic. Our study’s purpose was to investigate the usefulness of reminiscence therapy for older women living in nursing homes during the COVID-19 pandemic. A sample composed of 29 older women was evaluated with the Purpose-in-Life Test (PIL), Sense of Coherence (SOC-13) and Brief Cope Inventory (COPE-28). Our reminiscence program consisted of 10 sessions lasting 60 min each. Reminiscence therapy is a psychological intervention for older adults to assist in remembering and interpreting the life events, feelings, and thoughts that define and give meaning to the person’s life. Reminiscence can lead to positive mental health and other elements of particular relevance to older adults. In each session, we worked on a different theme that promoted the memory of positive emotions: optimal experience, decisive moment, stresses, tensions, problems and solutions, memories of childhood, adolescence, maturity, significant people in life, sense of life, and future script. We compared an intervention group (n = 12) with a control group (n = 17) using a pre-post, single-blind design. Significant results were obtained and showed that reminiscence therapy was effective in increasing meaning of life, sense of coherence, and coping in older women. The reminiscence therapy applied yielded positive effects in older female participants living in a nursing home during COVID-19 pandemic.

Relationship between Psychopathology and Sources of Meaning in Psychotherapeutically Treated Patients: A Naturalistic Cross-Sectional Analysis

INTRODUCTION

The experience of meaning seems to be crucial for psychic well-being. In the literature, there are reports of relationships between personality, illness, and life meanings. The objective of this study was to investigate types of experiences of meaning (meaningfulness, crisis of meaning, existential indifference) and their associations with some psychopathological categories in a clinical population.

METHODS

In a naturalistic and cross-sectional design, 56 German patients in outpatient psychotherapy (29 women, 27 men; mean age = 42.8 years, standard deviation = 13.8) were assessed by the Sources of Meaning and Meaning in Life Questionnaire (SoMe) Questionnaire (meaning of life, hedonism, eudaemonia). Psychopathology (Beck Depression Inventory (BDI), Clinical Global Impression scale, Symptom Checklist (SCL)-90), self-esteem (Rosenberg scale), neuroticism (NEO-Five-Factor Inventory), and suicidality (Suicide Behaviors Questionnaire Revised (SBQ-R)).

RESULTS

Three distinct groups concerning the experience of meaning emerged: meaningfulness (33.9%), crisis of meaning (21.4%), and, as the largest group, existential indifference (42.9%). Eudaemonia as well as the hedonistic SoMe variables of fun and wellness were shown to be inversely related to psychopathology such as suicide risk (SBQ-R), general symptom distress (SCL-90), and depressive symptomatology (BDI-II).

CONCLUSION

This study highlights the importance of a differential consideration of existential factors, sources of meaning and life orientations for psychopathology in mental health, which should be more considered in standard psychotherapeutic situations.

Social Innovation Toward a Meaningful Everyday Life for Nursing Home Residents: An Ethnographic Study

Background: The literature shows that innovation, which includes culture change, may be important to create a meaningful everyday life for nursing home residents. However, there is a gap in how social innovation practices may contribute to this. The theoretical discourse for the study is person-centered care.

Aim: The main aim was to explore phenomena within social innovation that can contribute to improving nursing home residents’ everyday lives.

Design and Method: This study uses an ethnographic design with observations and interviews in two nursing homes in Southern Norway.

Findings: The main theme was that social innovation within working practices in nursing homes includes phenomena that contribute to a meaningful everyday life for the residents. This main theme includes five subthemes: (1) opening the nursing home to the surroundings; (2) expanding and strengthening the community of practice; (3) facilitating customized activities; (4) ensuring sufficient nutrition and facilitating enjoyable mealtimes; and (5) preventing unrest and disturbing behavior.

Conclusion: The study reveals that innovation practices grounded in person-centered care in nursing homes may contribute to opening the nursing home to the community and establishing a common community practice for all members of the nursing home. This enables residents to experience meaningful everyday life through customized activities, sufficient nutrition, and a pleasant milieu during mealtimes. Disturbing behavior is also prevented, making it possible to promote meaningful lives in nursing homes.

Theoretical Foundations to the Impact of Dog-Related Activities on Human Hedonic Well-Being, Life Satisfaction and Eudaimonic Well-Being

Cross-sectional comparisons of well-being between dog owners and non-owners commonly generate inconsistent results. Focusing on the uniqueness of the relationship might help address this issue and provide a stronger foundation for dog-related psychotherapeutic interventions. This study aims to evaluate the impact of dog-related activities (e.g., exercising the dog) on owner hedonic well-being, life satisfaction and eudaimonic well-being. It was also hypothesised that psychological closeness to the dog would affect these well-being outcomes. For this study, 1030 dog owners aged over 18 years old answered an online questionnaire about the impact of 15 groups of dog-related activities on their well-being. Ordinal regressions were used to estimate the mean response (and its uncertainty) for each outcome, while conditioning for psychological closeness to the dog and controlling for several key covariates. Tactile interactions and dog playing were significantly more beneficial than other activities for hedonic well-being, and dog training and dog presence for eudaimonic well-being. In contrast, dog health issues and behavioural problems were linked to decrements in these well-being outcomes. Higher psychological closeness to the dog predicted greater improvement in well-being in positive dog-related activities. Our quantitative study validates the general findings of previous qualitative work and lays the groundwork for future longitudinal studies.

The Positive Side of Maximization: Linking Maximization Tendency With Meaning in Life Through Time Perspectives

The negative influence of maximization on well-being, that is, the maximization paradox, has received increased attention. However, few studies have shown the link between maximization tendency and meaning in life, which is one type of well-being, and no empirical literature has examined the mechanisms between them. We conducted an online survey in China to test the relationship between maximization tendency and meaning in life. Participants (N=2,987) were invited to report their maximization, time perspective, meaning in life, and other control variables and demographic variables. Multi-mediation path analysis was adopted in the data analysis. The results revealed that maximization was positively associated with meaning in life, which confirmed the positive aspect of the maximization tendency. Further analyses indicated that the time perspectives of past-positive and future mediated the positive relationship between maximization and meaning in life. In contrast, a present-fatalistic time perspective was a suppressor in the positive relationship. Our findings suggest that the maximization tendency has a positive aspect rather than the overall maximization paradox. An important means of elevating meaning in life is to encourage the time perspective of past-positive and future-oriented and reduce the present-fatalistic time perspective.

Gene-by-Crisis Interaction for Optimism and Meaning in Life: The Effects of the COVID-19 Pandemic

The corona virus disease 2019 (COVID-19) pandemic and the restrictions to reduce the spread of the virus has had a large impact on daily life. We investigated the individual differences in the effect of the COVID-19 pandemic and first lockdown on optimism and meaning in life in a sample from the Netherlands Twin Register. Participants completed surveys before (N = 9964, Mean age: 48.2, SD = 14.4) and during the first months of the pandemic (i.e. April–May 2020, N = 17,464, Mean age: 44.6 SD = 14.8), with a subsample completing both surveys (N = 6461, Mean age T1: 48.8, SD = 14.5). We applied genetic covariance structure models to twin data to investigate changes in the genetic architecture of the outcome traits due to the pandemic and the interaction of genes with the environmental exposure. Although 56% and 35% of the sample was negatively affected by the pandemic in their optimism and meaning in life, many participants were stable (32% and 43%) or even showed increased optimism and meaning in life (11% and 22%). Subgroups, specifically women, higher educated people, and people with poorer health, experienced larger negative effects. During the first months of the pandemic, slightly lower heritability estimates for optimism and meaning in life (respectively 20% and 25%) were obtained compared to pre-pandemic (respectively 26% and 32%), although confidence intervals overlap. The lower than unity genetic correlations across time (.75 and .63) suggest gene-environment interactions, where the expression of genes that influence optimism and meaning in life differs before and during the pandemic. The COVID-19 pandemic is a strong exposure that leads to imbalanced effects on the well-being of individuals. Some people decrease in well-being, while others get more optimistic and consider their lives as more meaningful during the pandemic. These differences are partly explained by individual differences in genetic sensitivity to extreme environmental change. More knowledge on the person-specific response to specific environmental variables underlying these individual differences is urgently needed to prevent further inequality.

Presence of Meaning in Life in Older Men and Women: The Role of Dimensions of Frailty and Social Support

Presence of meaning in life is an important component of eudemonic wellbeing while aging. While subjective health and interpersonal relationships are among important sources of meaning for older adults, less research has explored the gender differences in the potential contribution of these sources to the presence of meaning in late life. The current study aims to examine the associations of frailty dimensions (daily activities, health problems, and psychosocial functioning) and social support with the presence of meaning in late life, and whether these associations differ for older men and women. The study employs the data from the 65+ and Safe Study - a cross-sectional survey of residents of senior apartments. The data were collected in 2019 in a mid-sized Swedish municipality (N=618; age range from 64 to 106years, 60.5% female). Results showed significant associations of health problems, psychosocial functioning, and social support with the presence of meaning in life. Further, the results demonstrated no statistically significant gender differences in the associations between frailty dimensions, social support, and presence of meaning. However, since the interaction between health problems and gender approached statistical significance, this association was further explored indicating a more detrimental role of health problems in relation to the presence of meaning in life among older men than among older women. Overall, the study highlights the importance of physical and psychosocial health and social support for the presence of meaning in life among older adults and warrants further research on possible gender differences in the relation between health problems and meaning in late life.

The perceived social support by Iranian women with breast cancer: a qualitative study

BACKGROUND

Social support has an important role in improving health outcomes and is considered as one of the crucial aspects of the modern care in cancer patients. Therefore, this article aims to explain the perceived experiences of women suffering from breast cancer towards social support.

METHODS

In this qualitative study, 22 women with breast cancer were selected through purposive sampling from 5 hospitals affiliated to Urmia University of Medical Sciences. The data were collected through semi-structured interviews and were analyzed by the Conventional Qualitative Content Analysis and Graneheim's and Lundman's approach, using MAXQDA software, version 10.

RESULTS

After completion of the analyzing process, 6 categories were appeared including "creating an empathic atmosphere by family and community," "being in relationship with others," "adaption to disease," "giving meaning to life," "satisfaction with the role of healthcare providers," and "the impact of others support in fighting with the disease."

CONCLUSION

According to the findings, good social support during the illness can result in the spiritual, mental, and physical well-being of the patients and is one of the most effective factors in fighting the disease and feeling of recovery. The findings of this study can be used to develop plans to help the patients to achieve more support from the family, healthcare providers, and the community and even providing the required supportive care for this group of women.

Perceived risk, Positive Youth-Parent Relationships, and Internalizing Problems in Adolescents: Initial Development of the Meaningful School Questionnaire

This novel paper aimed to develop the Meaningful School Questionnaire (MSQ) to assess meaning in life in school context and examined whether meaningful school serves as a moderator on the links between the coronavirus risk, youth-parent relationships, and internalizing problems. Participants included 383 adolescents (38.4% male; Mean = 14.23 ± 2.04). Factor analysis yielded a two-factor solution: purpose-enjoyment and responsible understanding. Meaningful school moderated the mediating effect of positive youth-parent relations on the association between coronavirus risk and internalizing problems. Findings suggest that students with greater life meaning exhibit more internalizing problems when coronavirus risk is high and positive youth-parent relationships is low. This evidence supports that life meaning is key to foster the psychological health of young people during the pandemic. Thus, meaning-based intervention strategies could be developed to improve youths' sense of life meaning and purpose in the school context, which in turn enhance their resilience to foster their mental health and flourishing. These programs could facilitate youths to cope with stressful experiences such as the coronavirus pandemic by promoting their protective and promotive resources.

The 5Cs of Positive Youth Development, Purpose in Life, Hope, and Well-Being Among Emerging Adults in Malaysia

A substantial body of evidence supports Lerner and colleagues' 5Cs model of positive youth development (PYD) in the United States (U.S.). Nonetheless, it remains unclear whether the 5Cs can be used to identify positive development in the under-researched Asian contexts, such as Malaysia. Thus, this study examined the 5Cs of PYD (competence, confidence, character, connection, and caring) and their importance to purpose in life, hope, and well-being in a sample of emerging adult undergraduate university students in Malaysia. Data were collected from 400 participants from 15 Malaysian universities (132 males, 268 females; ages ranged from 18 to 26 years old, M = 22). A hierarchical multiple regression analysis indicated that two of the 5Cs of PYD (confidence and connection) as well as hope were important to explaining variation in well-being. The findings imply that there are strong links between PYD, especially confidence and connection, and well-being, while purpose in life and hope were indirectly related to the 2Cs (confidence and connection) of PYD and well-being. Therefore, mental health professionals are encouraged to review and redefine their treatment design to include confidence, connection, purpose in life and hope when working with Malaysian emerging adult university students.

"Healthcare Kamikazes" during the COVID-19 Pandemic: Purpose in Life and Moral Courage as Mediators of Psychopathology

Although the required personal protective equipment was not available during the first wave of the COVID-19 pandemic, Spanish healthcare workers continued to work, being dubbed as 'healthcare kamikazes'. Two possible reasons are moral courage and purpose in life that, in turn, would modulate the appearance of psychopathology. Cross-sectional study was carried out in 90 Spanish and 59 Mexican healthcare professionals, and 56 medical and nursing students. Spanish professionals had suffered more work and overall exposure (M = 8.30; SD = 2.57 and M = 9.03; SD = 2.66) than Mexican (M = 5.10; SD = 1.87 and M = 5.55; SD = 2.35). Mexican professionals had fewer anxiety disorders (30.5%; n = 18) and a lower depression score (M = 4.45; SD = 5.63) than the Spanish (43.7%; n = 38; and M = 8.69; SD = 8.07). Spanish professionals more often experienced acute stress disorder (32.6%; n = 29). Purpose in life, in addition to having a direct protective effect on psychopathology, also modulated the relationship between personal and family exposure and psychopathology. In conclusion, purpose in life protects against the appearance of psychopathology in healthcare workers with personal and family exposure to SARS-CoV-2.

Spirituality and Employment in Recovery from Severe and Persistent Mental Illness and Psychological Well-Being

People diagnosed with severe and persistent mental illness (SPMI) face multiple vulnerabilities, including when seeking employment. Among SPMI patients, studies show that a stronger sense of spirituality can help to reduce psychotic symptoms, increase social integration, reduce the risk of suicide attempts and promote adherence to psychiatric treatment. This study examined how the variables spirituality and employment affect the recovery process and psychological well-being of people with SPMI who attend employment recovery services. The sample consisted of 64 women and men diagnosed with an SPMI. The assessment instruments included the Recovery Assessment Scale, Ryff Psychological Well-Being Scale, Work Motivation Questionnaire, Daily Spiritual Experience Scale, and Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being (FACIT-Sp12). Hierarchical regression analyses were performed to compare three different models for each dependent variable (recovery and psychological well-being). The findings showed that job skills predicted psychological well-being and recovery. When spiritual variables were included in the model, job skills dropped out and the dimension meaning/peace of the FACIT-Sp12 emerged as the only significant predictor variable. Integrating spirituality into recovery programs for people with SPMI may be a helpful complement to facilitate the recovery process and improve psychological well-being.

Sources of well-being for older adults with and without dementia in residential care: relations to presence of meaning and life satisfaction

OBJECTIVES

To explore what sources of well-being are rated meaningful by older adults in residential care and how they are related to two important well-being outcomes.

METHOD

Two cross-sectional questionnaire studies were conducted in a sample of care residents without cognitive disability (n = 329) and with Alzheimer's disease (n = 104). Structural equation modelling was used to test a hypothesized and exploratory model of different sources as predictors of presence of meaning in life (POM) and satisfaction with life (SWL).

RESULTS

Family and Health were rated most meaningful by residents with and without dementia. In both studies, the hypothesized model showed adequate fit with the data. For cognitively intact residents, Personal Growth, Spirituality/Religion, and Interpersonal Relationships predicted POM, while Family and Leisure predicted SWL. Exploratory testing identified Leisure as a possible additional predictor of POM. For residents with Alzheimer's disease, Personal Growth and Society/Community predicted POM, while Family predicted SWL.

CONCLUSION

For older adults in residential care, many sources of well-being remain highly meaningful and some are directly related to the experience of meaning and life satisfaction. Both for residents with and without dementia, continued or increased investment in moments that foster personal growth and family relationships might be especially valuable.

Meaning in Life in Long-Term Recovery in First-Episode Psychosis: An Interpretative Phenomenological Analysis

Background: Meaning in Life (MIL) is a central aspect of service user defined personal recovery in mental health. It is unclear whether current knowledge regarding MIL is applicable to the lives of those who have experienced psychosis. As it was not possible to locate any study examining service user perspectives on MIL in first-episode psychosis (FEP), conducting in-depth qualitative research in this area offers an opportunity to develop a conceptualisation of MIL that may be transferable to the broad psychosis spectrum. Aim: The aim of the study was to explore how people find, develop, and maintain MIL approximately 21 years after their FEP diagnosis. Materials and Methods: The study aim was addressed using Interpretative Phenomenological Analysis (IPA). Participants were members of an epidemiologically complete FEP incidence cohort in Ireland. Purposive maximum variation sampling enabled the recruitment of a sample balanced across remission status, age at time of FEP onset, and gender. Semi-structured interviews were conducted circa 21 years post FEP with 16 participants. Data analysis was guided by IPA procedures. Results: Participants experienced MIL as awareness of connectedness to context - the interrelated conditions they existed in (their relationships with the self, others, systems, the environment, and time). Awareness of connectedness to context occurred in five main ways: Being myself - de-othering and authenticity (Enacting identity); Becoming significant where the self is witnessed (Belonging in life); Generating meaning within and beyond systems (Independence); Shaping and being shaped by life (Agency and patiency); and Integrating different perspectives of time (Reconciling temporality). Conclusions: Findings offer the first in-depth understanding of how people diagnosed with a FEP experience MIL in mid-later life recovery. Current tripartite MIL theories do not fully represent the array of MIL perspectives articulated by our participants. MIL concepts developed are potential areas for intervention for mental health services seeking to implement the recovery approach. Findings can be used to foster optimism among service users and their supporters for MIL attainment in psychosis and offer guidance for education, clinical practice, policy, and future research.

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.

Neurobiology of Cancer: the Role of β-Adrenergic Receptor Signaling in Various Tumor Environments

The development and progression of cancer depends on both tumor micro- and macroenvironments. In addition, psychosocial and spiritual “environments” might also affect cancer. It has been found that the nervous system, via neural and humoral pathways, significantly modulates processes related to cancer at the level of the tumor micro- and macroenvironments. The nervous system also mediates the effects of psychosocial and noetic factors on cancer. Importantly, data accumulated in the last two decades have clearly shown that effects of the nervous system on cancer initiation, progression, and the development of metastases are mediated by the sympathoadrenal system mainly via β-adrenergic receptor signaling. Here, we provide a new complex view of the role of β-adrenergic receptor signaling within the tumor micro- and macroenvironments as well as in mediating the effects of the psychosocial and spiritual environments. In addition, we describe potential preventive and therapeutic implications.

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.

Living arrangements and life satisfaction: mediation by social support and meaning in life

BACKGROUND

Living arrangements have impact on life satisfaction among older adults. However, the mechanism how it works has received less attention. This study aims to examine the mediating role of meaning in life and social support in the relationship between living arrangements and life satisfaction.

METHODS

A total of 215 older adults from nine nursing homes and three communities were included in this study. The Social Support Rating Scale, Meaning in Life Questionnaire and Life Satisfaction Index A were adopted. Data were analyzed with Hayes' s bias-corrected bootstrapping method.

RESULTS

Both social support and presence of meaning in life had positive correlations with life satisfaction (p<0.001), and they were significant mediators between living arrangements and life satisfaction (p<0.01).

CONCLUSION

To improve the life satisfaction of nursing home residents, more emphasis should be placed on encouraging residents to seek or maintain a meaningful life and creating a more positive climate of social support.

The Presence and the Search Constructs of Meaning in Life in Suicidal Patients Attending a Psychiatric Emergency Department

Meaning in Life (MiL) is considered protective against suicidal behavior (SB). However, few studies specifically addressed the role of the constructs, "presence of MiL" and "search for MiL," and their dynamic interplay. In this cross-sectional study of patients with SB (N = 199) visiting a psychiatric Emergency Department for either suicidal ideation (SI) or suicide attempt (SA), we pursued the following objectives: 1) to explore the relationship between the two constructs; 2) to verify the protective value of presence of MiL on SB; and 3) to assess the influence of search for MiL on the relationship between presence of MiL and SI. The two constructs were found to be independent of one another. Higher presence of MiL was globally associated with lower SB levels, particularly SI. Search for MiL was not related to SB and did not moderate the relationship between presence of MiL and SI. In conclusion, formal support for the role of presence of MiL against SB in a psychiatric sample was demonstrated. These findings, with a view toward refinement of SB risk assessment and new psychotherapeutic approaches, may lead to an enrichment of the dialogue with suicidal patients to help alleviate their unbearable suffering. Our conclusions must be replicated in psychiatric clinical populations in settings other than a psychiatric ED and by using a longitudinal prospective and case-control study design.

Depression and hopelessness in Turkish healthcare workers: The moderating and mediating roles of meaning in life

Healthcare workers who served in southern cities of Turkey have been directly and indirectly affected by the civil war in Syria due to stress and trauma. Hopelessness in these healthcare workers can be a potential contributor to their levels of depression. On the other hand, meaning in life, as both moderating and mediating variable, can serve to counteract depression. This is a study of 286 Turkish healthcare workers who served in a southern border city of Turkey and Syria in February and March of 2018. The study examined the effects of hopelessness and meaning in life on depression level including the moderating and mediating effects of meaning in life on the relationship between hopelessness and depression. A hierarchical regression analysis and bootstrapping procedure were employed to test the research questions. This study found that hopelessness positively predicted depression and meaning in life negatively predicted depression. Meaning in life significantly moderated and partially mediated the association between hopelessness and depression. Healthcare workers who served in a conflict area experienced more depression when they had more hopelessness and less meaning in life. Moreover, meaning in life played a central role as both moderator and mediator. Results are discussed with implications and limitations.

The Meaning in Life in Suicidal Patients: The Presence and the Search for Constructs. A Systematic Review

Background and Objectives: Research on suicidal behavior (SB) has frequently focused more on risk factors than protective factors. Since the historic works of Viktor E. Frankl, who inquired how some Nazi concentration camps prisoners maintained their will to live though confronted with pervasive absurdity, Meaning in Life (MiL) has been interpreted as a potent resiliency factor. MiL then declined along a multitude of theoretical perspectives and was associated with various functioning domains of the individual. Surprising, few studies investigated the role of MiL on SB. We aimed to review and synthetize current literature on possible associations between MiL and SB, which included suicidal ideation (SI), suicidal attempts (SA), and completed suicide, focusing on two MiL constructs (the presence of MiL and search for MiL) from the Michael F. Steger’s recent conceptualization. Material andMethods: A systematic strategy following PRISMA guidelines was used to search for relevant articles in Pubmed/MEDLINE, Scopus, PsycINFO, and ScienceDirect (January 1980–February 2019) and yielded 172 articles, 37 of which met our inclusion criteria. Results: MiL emerged as a protective factor against SI, SA, and completed suicides, directly or through mediation/moderation models with other SB-related variables. When distinguishing the presence of MiL and the search for MiL, a consensual protective impact was described for the former. Data for the latter were less consistent but rather oriented towards a non-protective impact Conclusions: These findings could have clinical repercussions for SB prevention, in both suicide risk assessment refinement and psychotherapeutic interventions. Further research is needed to examine the dynamic interplay of the two constructs.