What brings meaning to life in a highly secular society? A study on sources of meaning among Danes

Spiritual care in the intensive care unit. Is it already a reality?: an integrative review

INTRODUCTION

Spirituality has emerged as a phenomenon of interest in various global contexts. The adoption of spirituality as a fundamental aspect of healthcare remains underexplored, especially in critical environments such as intensive care units.

OBJECTIVE

To identify strategies for incorporating spiritual care into adult intensive care environments through an integrative literature review.

METHODS

An integrative review was conducted using the Embase, Web of Science, Medline/PubMed, PsycINFO, LILACS, and Cochrane Central databases. Twenty-one studies published in English, Spanish, or Portuguese over the last 10 years were selected.

RESULTS

Different approaches to spirituality were identified, including training implementation, individual interviews, meetings, educational programs, and practices involving healthcare professionals.

CONCLUSION

Spirituality in the intensive care environment has been a growing reality in recent years through efforts aimed at helping healthcare professionals integrate spirituality into the care provided in clinical practice. Individual interviews were the primary strategy for incorporating spiritual care in intensive care unit settings. Questionnaires were used to support these interviews, and the frequency and duration typically involved a single session, ranging from 15 to 60 min.

Meaning in life after cancer: Validation of the sources of meaning card method among participants in cancer rehabilitation

Cancer survivors may be struggling to re-create meaning in life. Addressing their personal sources of meaning can support them in this process. The sources of meaning card method (SoMeCaM) aims to map and explore personal sources of meaning in a 1-h session. It includes 26 cards, each with a statement on a source of meaning. The purpose of this study was to validate the statements on the sources of meaning cards for use among participants in cancer rehabilitation by examining whether participants attribute the same meaning to the statements as intended. The three step test interview method was used to assess response processes to the sources of meaning cards among 12 participants in a 5-day cancer rehabilitation program in Denmark. The interviews were transcribed verbatim and analyzed using framework analysis. Nineteen of the 26 statements were interpreted congruently, that is, in line with the underlying theory, by all participants. Issues of incongruency, ambiguity and confusion were observed in participants' interpretations of the statements on religiosity (n = 6), spirituality (n = 10), and reason (n = 6). Minor issues were observed for the statements on practicality, achievement, knowledge, and attentiveness. In most statements, cancer survivors' interpretation aligned with the underlying theory. Problems were apparent regarding the sources of meaning religiosity, spirituality and reason, and a reconsideration of the wording of the statements is recommended. These problems may be due to cultural and linguistic interpretations rather than to being a cancer survivor. Future studies could focus on these issues in other target populations. Despite these minor issues, the SoMeCaM has proven useful in addressing the important topic of meaning in life in the cancer rehabilitation setting. Clinicians should pay attention to nuances in participants' understanding of the cards.

Meaning in life of elite athletes: A person-oriented study

People's subjective sense of meaning in life is a flourishing research topic in psychology but remains underexplored in sport psychology. This study uses a person-oriented method to shed light on meaning in the lives of elite athletes (i.e., latent profile analysis) to identify distinct profiles of sources of meaning in life, and compare the extent to which these profiles differ in relation to athletic identity, life satisfaction, and self-esteem. A sample of 593 Swiss elite athletes (50.4% women, 49.6% men; Mage = 24.78 years, SD = 4.93) participated in the study. The Meaning and Purpose Scales (MAPS) were used to assess athletes' perceptions of meaningfulness, crisis of meaning, and sources of meaning. Athletes demonstrated higher overall meaningfulness, lower crisis of meaning, and prioritized different sources of meaning compared to the general population. Latent profile analysis revealed three distinct meaning profiles: (1) athletes with multiple meanings (n = 351), (2) athletes with low meaning (n = 126), and (3) faith-based athletes (n = 110). Notably, the athletes in the first and last profile exhibited higher life satisfaction and self-esteem. The identified profiles demonstrate that athletes differ both in the degree and the types of meaning in life. The findings align with studies outside of sport that suggest that meaning in life, in addition to being an end-value in itself, is also related to enhanced life satisfaction and self-esteem. Personalized meaning-focused interventions can be valuable for applied practice with elite athletes.

The Sources of Meaning and Meaning in Life (SoMe) questionnaire in Finnish: Sociodemographic findings of meaningfulness and crisis of meaning in the Finnish context

BACKGROUND

Psychological research about meaningfulness is concerned with a subjective sense of meaning of one's own life, that is, meaning in life. Empirical research in this field is attracting interest, as meaning in life has wide-ranging positive implications for mental health and well-being.

AIM

The aim of this article is to test the validity of the Finnish translation of the Sources of Meaning and Meaning in Life (SoMe) questionnaire. In the article, meaningfulness and crisis of meaning are correlated with sources of meaning, and results are compared with other validation studies in Norway, Denmark, and Brazil as well as with the original German questionnaire.

METHODS

To meet our aim, 551 participants were recruited to answer the Finnish questionnaire. The internal and construct validity of the Finnish questionnaire were tested with reliability analysis, confirmatory factor analysis, exploratory factor analysis, and analysis of intercorrelations of items in the questionnaire.

RESULTS

The analysis demonstrated similar reliability to other validation studies of the questionnaire and results highly comparable to the Norwegian study regarding the internal structure of the questionnaire. Results of intercorrelations of items within the questionnaire were also comparable to the other validation studies.

Efficacy of patient education and duloxetine, alone and in combination, for patients with multisystem functional somatic disorder: Study protocol for the EDULOX trial

BACKGROUND

Multisystem functional somatic disorder is characterized by specific patterns of persistent physical symptoms with a complex biopsychosocial etiology. The disorder can lead to disability and personal suffering. Current treatment options require specialized settings, therefore patients often wait a long time to receive specific treatment. Patient education is considered important in most treatment programs, but has only been investigated sparsely as a stand-alone treatment. Pharmacological treatment is limited to tricyclic antidepressants in low doses with no antidepressant properties. Duloxetine has been found effective in single organ functional disorders. As a treatment for multisystem functional somatic disorder, duloxetine could reduce symptoms and treat comorbid anxiety and depression. It may furthermore enhance the effect of patient education through a hypothesized effect on cognitive functioning. The purpose of the EDULOX trial is to study psycho-EDUcation and duLOXetine alone and in combination.

METHODS

This is a nested study design. The parent trial "EDULOX1" (n = 424) will compare a patient education program with enhanced usual care in an open-labelled, randomized controlled trial. In addition to this, eligible participants will furthermore receive either duloxetine or active placebo in the nested, double-blinded, randomized controlled trial, "EDULOX2" (n = 212). Patient and clinician reported outcomes will be collected through questionnaires.

CONCLUSION

The EDULOX trial may establish evidence for treatments applicable for the majority of patients with multisystem functional somatic disorder. If effective, duloxetine would be a more tolerable pharmacological treatment option that can target comorbid depression and anxiety, and potentially boost the effect of patient education. Trial registration number The study is registered at www.

CLINICALTRIALS

gov (NCT06232473) and the internal list of research projects at the Region of Central Denmark (Case number 1-16-02-305-23). Approval from the Danish Medical Research Ethics Committees (Case number: 2212291) and the Danish Medicines Agency was obtained under EudraCT Number: 2022-002780-30 and Sponsor's Protocol Code Number: 9515.

The Meaning and Purpose Scales (MAPS): development and multi-study validation of short measures of meaningfulness, crisis of meaning, and sources of purpose

BACKGROUND

Meaning in life is multidimensional. It encompasses different qualities of meaning, such as meaningfulness, crisis of meaning, or existential indifference, as well as the sources from which people draw meaning, or purpose. For both research and practice, it is of high value to know not only the extent of meaningfulness, or its absence, but also its sources. How do these relate to meaningfulness and mental health? Are they accessible to people of different sociodemographic and economic backgrounds alike? For therapeutic and counseling practice, knowledge of experiences and sources of meaning is needed to support a clearer self-understanding in patients or clients and to encourage them to make authentic life choices. The Meaning and Purpose Scales (MAPS) presented here enable researchers and practitioners to gain insights into these dimensions of meaning in life, and, with only 23 items, to do so in a short time.

METHODS

Using five independent and two follow-up samples with a total N of 7,500, this paper examined the MAPS' internal consistency, test-retest reliability, and convergent, divergent, criterion, factorial, and predictive validity.

RESULTS

Principal axis factoring identified two meaning scales, Meaningfulness and Crisis of Meaning, and five purpose scales, Sustainability, Faith, Security, Community, and Personal Growth. The scales proved consistent, stable over four weeks and two months, and valid in multiple respects. In a representative German population sample, Personal Growth, Sustainability, and Community exhibited large, Faith and Security medium positive relationships with Meaningfulness, whereas Crisis of Meaning showed small to moderate negative correlations. Meaningfulness was positively, and Crisis of Meaning negatively predicted by age, partnership, parenthood, and religious affiliation. Financial hardship correlated positively with Crisis of Meaning and negatively with Meaningfulness, Community, and Personal Growth. Meaningfulness and Crisis of Meaning explained 21%, the sources of purpose 6% of additional variance in general mental distress (PHQ-4), beyond sociodemographics. Except for Faith (unrelated), all sources exhibited moderate negative correlations with the PHQ-4.

CONCLUSION

As this series of studies demonstrates, the MAPS provide a highly economic and valid assessment of two qualities of meaning, Meaningfulness and Crisis of Meaning, and five sources of purpose: Sustainability, Faith, Security, Community, and Personal Growth.

Religiosity, Theism, Perceived Social Support, Resilience, and Well-Being of University Undergraduate Students in Singapore during the COVID-19 Pandemic

The COVID-19 pandemic infection control measures severely impacted mental well-being, allowing insight into possible protective parameters. With religion playing a role during challenging times, this study investigated theism and religiosity on the mental well-being of university students during the COVID19 pandemic and how social support and resilience can mediate this effect. One hundred eighty-five university students between 17 and 42 years old responded to online surveys on their theism, religious affiliations, religiosity, well-being, perceived support, and resilience. Pearson's correlations and single and sequential mediation analyses showed that theism did not significantly predict well-being (r = 0.049), but religiosity mediated the relationship (r = 0.432, effect size = 0.187). Sequential mediation analysis showed that resilience did not mediate the relationship between religiosity and well-being, but perceived social support significantly positively mediated religiosity and well-being with an effect size of 0.079. The findings reveal that factors, such as religiosity and social support could thus aid in the mental well-being of future challenging times such as the pandemic.

Internet-delivered treatment for patients suffering from severe functional somatic disorders: Protocol for a randomized controlled trial

Background

Functional somatic disorders (FSDs) with symptoms from multiple organs, i.e., multi-system type, are common in the general population and may lead to disability and reduced quality of life. Evidence for efficient treatment programs has been established, however, there is a need for making treatments accessible to a larger group of patients. Internet-delivered therapy has become prevalent and has proven as effective as face-to-face therapy, while providing a flexible and easily accessible treatment alternative. The aim of the current study is to compare the efficacy of the therapist-assisted internet-delivered treatment program One step at a time (OneStep) with the internet-delivered self-help program Get started (GetStarted).

Methods

A total of 166 participants aged 18-60 years diagnosed with multi-system FSD will be assessed and randomized to either 1) OneStep: a 14-week program consisting of 11 treatment modules based on principles from cognitive behavioural therapy or 2) GetStarted consisting of 1 module on psychoeducation. The primary outcome is physical health, assessed by a Short Form Health Survey (SF-36) aggregate score of the subscales vitality, physical functioning, and bodily pain 3 months after end-of-treatment and self-reported improvement assessed by the Clinical Global Improvement Scale. Secondary outcomes include symptom load, depression, anxiety, and illness worry. Process measures include emotional distress, illness perception, illness behaviour, and symptom interference.

Conclusions

This study is the first study to test an internet-delivered treatment program for FSD, multi-system type and has the potential to show the importance of making evidence-based internet-delivered treatment for FSD more accessible.

Compliance with COVID-19 public health guidelines: an attitude-behaviour gap bridged by personal concern and distance to conspiracy ideation

OBJECTIVE

This study examined predictors of compliance with public health guidelines to curb transmission of COVID-19.

DESIGN

Applying an exploratory longitudinal design, participants (N = 431) from Germany and Austria completed surveys in April/May 2020 (T1) and July/August 2020 (T2).

MEASURES

Three outcome measures operationalised compliance with public health guidelines at T2: self-reported adherence (behavioural), agreement and opposition (attitudinal). At T1, demographics, perceived distress (PHQ-4, crisis of meaning), resources (self-control, meaningfulness), locus of control, conspiracy mentality and social media use were assessed. At T2, situational variables were added (person at risk, infection of close person, fear of infection, COVID-19 stress). Temporal shifts from T1 to T2 were examined as complementary information.

RESULTS

An attitude-behaviour gap at T2 was identified, as agreement with and opposition to the guidelines were only modestly correlated with adherence to them. Measures of personal concern (fear of infection, person at risk) were associated with both adherence and positive attitudes towards the measures. COVID-19 stress and conspiracy mentality predicted negative attitudes, but not adherence. Age predicted adherence positively, social media use negatively.

CONCLUSION

The findings support the significance of personal concern for compliance with public health guidelines and suggest a critical impact of social media use and conspiracy mentality.

Prayer frequency and COVID-19 vaccine hesitancy among older adults in Europe

AIM

Differences in levels of vaccine uptake have emerged across Europe, and this may partly be explained by religious beliefs. Our aim is to study the association between religiosity, measured by prayer frequency, and vaccine hesitancy, and to examine how this association varies across European countries and regions.

METHODS

This study was based on 42,583 adults aged 50 years and above from 27 European countries in the Survey of Health, Ageing and Retirement in Europe (SHARE), waves 1-8, and the 2nd SHARE COVID-19 Survey. Logistic regression models were used to investigate the associations.

RESULTS

Participants were more likely to be vaccine-hesitant when praying 'weekly or less' (odds ratio (OR) 1.32 95 % confidence interval (CI) 1.23-1.42) or daily (OR 1.78 95 % CI 1.65-1.92). Praying 'weekly or less' was associated with increased vaccine hesitancy in Southern Europe (OR 1.48 95 % CI 1.17-1.87) and Central and Eastern (OR 1.35 95 % CI 1.24-1.47) Europe, while daily praying was associated with vaccine hesitancy in Western (OR 1.77 95 % CI 1.51-2.08), Southern (OR 1.30 95 % CI 1.03-1.64), Central and Eastern (OR 1.89 95 % CI 1.73-2.06) and Northern (OR 2.75 95 % CI 1.54-4.89) Europe.

CONCLUSIONS

These findings provide support for an association between daily prayer frequency and COVID-19 vaccine hesitancy, with a consistent pattern across European regions.

Measuring Spiritual Needs in a Secular Society: Validation and Clinimetric Properties of the Danish 20-Item Spiritual Needs Questionnaire

In secular cultures, such as Denmark, tools to measure spiritual needs are warranted to guide existential and spiritual care. We examined the clinimetric properties of the Danish version of the Spiritual Needs Questionnaire (DA-SpNQ-20) based on a digital survey in a test-retest setup. A convenience sample was reached via social media and student platforms. A total of 325 (148 for retest) respondents were included in the analysis. The sample was randomly split into two groups (A and B) and used for exploratory (EFA) and confirmatory factor analysis (CFA) by structural equation modeling, respectively. SpNQ dimensions had an internal consistency with Cronbach's alpha between 0.73 and 0.93. The four factors of the SpNQ were supported by both EFA and CFA as follows: religious needs, existential needs, inner peace needs, and generativity needs. The instrument showed good internal consistency, good test-retest reliability, and acceptable structural validity in the sample of relatively young and healthy persons.

Meaningfulness protects from and crisis of meaning exacerbates general mental distress longitudinally

BACKGROUND

Reactions to the COVID-19 pandemic are diverse, and both mental distress and existential crises can arise. The identification of protective and exacerbating factors and their progress over time is therefore highly relevant. The current study examined longitudinal protective effects of meaningfulness and exacerbating effects of crisis of meaning on general mental distress.

METHODS

N = 431 participants from Germany and Austria (mean age: 42 years) completed an online survey in both April/May (T1) and July/August 2020 (T2). After determining temporal stability or changes in meaningfulness, crisis of meaning, and general mental distress (PHQ-4), we examined whether (i) meaningfulness and (ii) crisis of meaning, measured at T1, incrementally predicted PHQ-4 at T2, beyond baseline levels of PHQ-4. We further tested (iii) a within-subject mediation of temporal changes in PHQ-4 by changes in crisis of meaning.

RESULTS

Meaningfulness prospectively predicted lower PHQ-4, and crisis of meaning predicted higher PHQ-4. From the first wave of the pandemic until a slowdown three months later, meaningfulness was stable, and crisis of meaning and PHQ-4 decreased. Changes in crisis of meaning mediated the changes in PHQ-4.

CONCLUSIONS

Meaningfulness appears to have a protective, and crisis of meaning an exacerbating effect on psychological distress, as shown here for the time of the first pandemic wave until three months later. Attention to existential experiences of meaningfulness and loss of meaning thus proves relevant to the clinical and public health context. Measures that support meaningfulness will help coping with crises of meaning, which in turn supports overcoming general mental distress.

Meaning in life, psychological hardiness and death anxiety: individuals with or without generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) is a widespread psychiatric disorder. According to the transdiagnostic approach, death anxiety can underpin predominantly somatic manifestations of GAD. Personal resilience factors such as a sense of a meaningful life, and psychological hardiness, which can protect people from developing clinical symptoms, may be lower in individuals with GAD. So far, there has been no study examining the role of meaning in life dimensions, death anxiety, and hardiness in individuals with GAD in Turkey. Thus, we aimed to investigate to what extent the GAD sample differs from the non-anxious control group in terms of death anxiety, meaning in life dimensions, and hardiness. Secondly, we examined how conceptually predicted death anxiety by meaning in life dimensions and hardiness regardless of diagnosis, age, and gender. Just before the spread of the Covid-19 pandemic, we could only recruit 38 individuals with GAD and 31 non-anxious control subjects. The Death Anxiety Scale, The Meaning in Life Questionnaire and the Psychological Hardiness Scale were administered to all the participants. The one-way MANOVA results with Bonferroni adjustment revealed that individuals with GAD significantly differed from the control group in every way. Hierarchical regression analysis displayed that the presence of meaning made the most significant contribution in predicting death anxiety. In conclusion, existential issues such as death anxiety, hardiness, and meaningful life can be emphasized for the treatment of GAD, and the presence of meaning is the most crucial antidote to avoid death anxiety in all individuals.

Therapists and the Topic of Meaning in Life in Their Encounters With Adolescents With Developmental Trauma: A Qualitative Study

BACKGROUND

Meaning in life is important to achieve quality of life, psychological well-being and good mental health. Existential issues such as meaning in life have limited attention in mental health care and treatment for children and young people in Norway. People in crisis often ponder existential questions. We find little research on this topic in relation to therapists who work with adolescents with developmental trauma. The purpose of this study was to examine how meaning in life is understood and addressed from the perspectives of therapists working with adolescents struggling with trauma.

METHOD

The study has a qualitative design, based on focus groups with therapists in mental health care for children and adolescents. The interviews were transcribed and analyzed using systematic text condensation.

RESULTS

Therapists had limited professional experience and competence to address and explore meaning as a topic in therapy. Yet there was interest in the topic and they thought that young people with trauma experience may benefit from the incorporation of meaning perspectives into therapy.

CONCLUSION

Therapists at a mental health outpatient clinic for children and adolescents found the topic of meaning important but challenging to involve in the treatment of adolescents with developmental trauma. There is a need for more research to enhance understanding of what it means to include meaning as a topic in child and adolescent psychiatry, and what may be the specific benefit and challenges involved.

Addressing Religion in Secular Healthcare: Existential Communication and the Post-Secular Negotiation

This article aims to understand why religion has proven difficult to address in secular healthcare, although existential communication is important for patients’ health and wellbeing. Two qualitative data samples exploring existential communication in secular healthcare were analyzed following Interpretative Phenomenological Analysis, leading to the development of the analytical constructs of ‘the secular’ and ‘the non-secular’. The differentiation of the secular and the non-secular as different spheres for the individual to be situated in offers a nuanced understanding of the physician–patient meeting, with implications for existential communication. We conceptualize the post-secular negotiation as the attempt to address the non-secular through secular activities in healthcare. Employment of the post-secular negotiation enables an approach to existential communication where the non-secular, including religion, can be addressed as part of the patients’ life without compromising the professional grounding in secular healthcare. The post-secular negotiation presents potential for further research, clinical practice, and for the benefit of patients.

What Matters Most in Life? A German Cohort Study on the Sources of Meaning and Their Neurobiological Foundations in Four Age Groups

Existing work in the field of positive psychology suggests that people can draw meaning from a variety of sources. The present study aimed to identify the most important sources of meaning and to explore the role of age and neural adaptation processes in this context. As part of a large German cohort study, 1,587 individuals between 12 and 94 years were asked to provide a maximum of five responses to the question “What matters most to you in life?” We divided the study population into four age groups and analyzed the obtained answers qualitatively and quantitatively using (1) word clouds and (2) frequency comparisons based on a summarizing content analysis. A chi-squared test was used to test the observed differences between age groups. Identified sources of meaning could be clustered into 16 main and 76 subcategories, with relationships (by 90% of respondents) and health and well-being (by 65% of respondents) being the most frequently named main categories, followed by a good living environment (by 28%), (leisure) time (by 26%), and work (by 24%). The study revealed some remarkable age-related patterns. While the importance of partnership increased with age, social networks were less important to older individuals. We also found that, for example, the importance of self-realization, success and career decreased with age, while the opposite was true for life satisfaction and peace and harmony. Security was most important to individuals in the two middle age groups between 30 and 69 years. The study advances our understanding of meaning across various ages by showing that individuals of different ages perceive different things as meaningful to them. Interpreting our results in the light of a neurobiological model of motivation systems, we argue that neural adaptation processes may play an important role in the (changing) perceptions of meaning throughout life.

Relationships of Sources of Meaning and Resilience With Meaningfulness and Satisfaction With Life: A Population-Based Study of Norwegians in Late Adulthood

Health-promoting initiatives incorporating meaning-making to enhance the well-being of people in late adulthood are important, particularly as the number of older people is increasing. Resilience and sources of meaning may be related to individuals' experience of meaningfulness and satisfaction with life. However, few studies have investigated these relations among people in late adulthood. In the present exploratory study, we asked the following questions: What are the differences regarding scores on sources of meaning, resilience, meaningfulness, and satisfaction between people in late adulthood (≥65) and other adults (18-64)? What is the association between sources of meaning and meaningfulness, and between resilience and meaningfulness? What is the association between sources of meaning and satisfaction with life, and between resilience and satisfaction with life? A cross-sectional design was used. A population-based sample of 925 participants (aged 18-91 years) was recruited from the National Population Register in Norway. Of these, 219 participants were 65 years old and older (mean age 73 years). Additionally, sub-analyses for the age-group ≥ 75 (N = 71) were performed. Independent-samples t-tests, chi-square tests, one-way ANOVA, and linear regressions adjusted for demographics, anxiety, and depression were performed utilizing standardized questionnaires. It was found that people in late adulthood (≥65 years) scored significantly higher on meaningfulness compared to younger adults (18-64). Of the sources of meaning, vertical self-transcendence, including explicit religiosity and spirituality, had the strongest relation to meaningfulness for people in late adulthood, after adjusting for demographics, anxiety, and depression. For the same group, accomplishment, including generativity and unselfish engagement with the surroundings and future generations, also stood out as a prominent source of meaning when related to meaningfulness. No sources of meaning were associated with satisfaction with life in the older group. No associations between resilience and meaningfulness, nor between resilience and satisfaction with life, were found among people in late adulthood. However, positive associations were found between resilience and meaningfulness, as well as between resilience and satisfaction with life, in the 18-64 age group. Longitudinal research and interventional studies are needed to confirm whether the designated sources contribute to meaningfulness in a Norwegian context. The implications of the findings are discussed.

Same but different: meaning-making among refugee and non-refugee youths

Purpose

There is substantial research on the experiences, needs and well-being of unaccompanied refugee adolescents, but less is known about existential aspects of their lives. The purpose of the current study is to explore existential meaning-making among unaccompanied refugee children.

Design/methodology/approach

The informants in this study are young unaccompanied refugees (n = 30) living in Norway, and young Norwegians (n = 46). The authors undertook a secondary analysis of in-depth qualitative refugee interview data and a quantitative analysis of questionnaire data from Norwegian informants.

Findings

Both the refugee youths and the Norwegian youths expressed that social relationships and connections to others were most important for meaning. Moreover, both groups emphasized the importance of relatedness and generativity, i. e. commitment to worldly affairs beyond one’s immediate needs. The main differences between the two groups were related to the significance attached to religion and to loneliness.

Research limitations/implications

The comparison between the two groups is only possible to some degree. Secondary analyses have some limitations, as well as strengths.

Practical implications

The findings may be useful for supporting young refugees, as they provide insights into less-studied aspects of their lives.

Originality/value

The originality of this study lies in the focus on and broad interpretation of meaning, of secondary data analyses, and of comparisons between youths that are refugees versus non-refugees.

A Randomized controlled trial of the Sources of Meaning Card Method: A new meaning-oriented approach predicts depression, anxiety, pain acceptance, and crisis of meaning in chronic pain patients

OBJECTIVE

Although considered the first-line psychological treatment of chronic pain, cognitive behavioural therapy has recently been criticized as being too limited, insufficient, and sometimes ineffective in the treatment of chronic pain patients. Moreover, important existential perspectives are sparsely or not at all integrated into CBT. We therefore propose to complement chronic pain treatment with a meaning-based intervention, the Sources of Meaning Card Method (SoMeCaM). This study tested its efficacy.

DESIGN

A randomized controlled trial was conducted with 42 chronic pain patients, comparing an intervention group (standard care and participation in the SoMeCaM, a meaning-oriented approach) with a control group (standard care). We evaluated both groups at baseline, 1 (t1) and 2 months (t2) after the intervention. The primary outcome assessed was pain acceptance, while depression, anxiety, pain intensity, pain medication, satisfaction with life, meaningfulness, and crisis of meaning were examined as secondary outcomes.

RESULTS

Comparisons within and between groups showed significant treatment effects at t1. Higher increases in pain acceptance and decreases in anxiety, depression and crisis of meaning were observed in the intervention group. Improvements in pain acceptance and anxiety persisted until t2, when pain intensity was also lower. Effect sizes at t2 were medium to large.

CONCLUSION

Our preliminary work demonstrates the importance of the existential perspective in chronic pain therapy.

Older Adults' Experience of Meaning at the End of Life in Two Danish Hospices: A Qualitative Interview Study

The aim of this study was to explore how older adults (aged > 65) confronted with imminent death express their thoughts and feelings about death and dying and verbalize meaning. Furthermore, the aim was to investigate how health professionals could better address the needs of this patient group to experience meaning at the end of life. The study applied a qualitative method, involving semi-structured interviews with 10 participants at two hospices. The method of analysis was interpretative phenomenological analysis. We found three chronological time-based themes: (1) Approaching Death, (2) The time before dying, and (3) The afterlife. The participants displayed scarce existential vernacular for pursuing meaning with approaching death. They primarily applied understanding and vocabulary from a medical paradigm. The participants' descriptions of how they experienced and pursued meaning in the time before dying were also predominantly characterized by medical vernacular, but these descriptions did include a few existential words and understandings. When expressing thoughts and meaning about the afterlife, participants initiated a two-way dialogue with the interviewer and primarily used existential vernacular. This indicates that the participants' scarce existential vernacular to talk about meaning might be because people are not used to talking with healthcare professionals about meaning or their thoughts and feelings about death. They are mostly "trained" in medical vernacular. We found that participants' use of, respectively, medical or existential vernacular affected how they experienced meaning and hope at the end of life. We encourage healthcare professionals to enter into existential dialogues with people to support and strengthen their experiences of meaning and hope at the end of life.

Does Reflection on Everyday Events Enhance Meaning in Life and Well-Being among Emerging Adults? Self-Efficacy as Mediator between Meaning in Life and Well-Being

In recent years, the issue of the meaning in life has aroused particularly great interest in researchers considering the question of whether and how, using simple interventions, outside the therapeutic office, the sense of meaning in life and well-being can be strengthened. The aim of this study was to explore whether interventions based on reflection on everyday, stressful situations can contribute to fostering the sense of meaning in life and psychological well-being among emerging adults. Additionally, we aimed to explore relationships between the above-mentioned constructs and self-efficacy. The research focuses on emerging adults, who, as statistics show, are the most vulnerable among all adults to various mental problems. A pretest–posttest control group design was used. The study involved 80 emerging adults (56 women and 24 men) who were randomly assigned to the experimental group, which completed specially prepared diaries for a week, or the control group. Participants completed the Meaning in Life Questionnaire, the Generalised Self-Efficacy Scale, and the Ryff Scales of Psychological Well-Being twice. In the experimental group, significant differences were noted between pretest and posttest in psychological well-being, especially in the area of relationships with others (M_pretest = 59.3; M_posttest = 65.07; t(39) = −11.40; p = 0.001) and purpose in life (M_pretest = 54.85; M_posttest = 58.21; t(39) = −3.15; p = 0.003), as well as self-efficacy (M_pretest = 28.06; M_posttest = 29.60; t(39) = −2.82; p = 0.007). There were no differences in the level of meaning in life. The analysis carried out showed that self-efficacy mediates the relationship between presence of meaning in life and psychological well-being (the Aroian test: z = 4.48; SE = 0.11; p = 0.0007).

The influence of spirituality and religion on critical care nursing: An integrative review

BACKGROUND

Spiritual care could help family members and critically ill patients to cope with anxiety, stress and depression. However, health care professionals are poorly prepared and health managers are not allocating all the resources needed.

AIMS AND OBJECTIVES

To critically review the empirical evidence concerning the influence of spirituality and religion (S-R) on critical care nursing.

METHODS

An integrative review of the literature published in the last 10 years (2010-2019) was conducted in PubMed, Scopus, CINHAL, PsycINFO, Web of Science, Cochrane and LILACS. In addition, searches were performed in the System for Information on Grey Literature in Europe and the Grey Literature Report. Quantitative and/or qualitative studies, assessing S-R and including health care professionals caring for critically ill patients (i.e. adults or children), were included.

RESULTS

Forty articles were included in the final analysis (20 qualitative, 19 quantitative and 1 with a mixed methodology). The studies embraced the following themes: S-R importance and the use of coping among critical care patients and families; spiritual needs of patients and families; health care professionals' awareness of spiritual needs; ways to address spiritual care in the intensive care unit (ICU); definition of S-R by health care professionals; perceptions and barriers of addressing spiritual needs; and influence of S-R on health care professionals' outcomes and decisions. Our results indicate that patients and their families use S-R coping strategies to alleviate stressful situations in the ICU and that respecting patients' spiritual beliefs is an essential component of critical care. Although nurses consider spiritual care to be very important, they do not feel prepared to address S-R and report lack of time as the main barrier.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Critical care professionals should be aware about the needs of their patients and should be trained to handle S-R in clinical practice. Nurses are encouraged to increase their knowledge and awareness towards spiritual issues.

Meaning in Life and Self-Control Buffer Stress in Times of COVID-19: Moderating and Mediating Effects With Regard to Mental Distress

BACKGROUND

As evidenced by several studies, mental distress increased substantially during the COVID-19 pandemic. In this period, citizens were asked to exercise a high degree of self-control with regard to personal and social health behavior. At the same time, we witnessed an increase of prosocial acts and shared creative expressions, which are known to serve as sources of meaning. Meaning in life and self-control are acknowledged psychological resources. Especially in times of crisis, meaning in life has been shown to be a crucial factor for resilience and coping. However, threatening and stressful situations can also jeopardize existential security and trigger crises of meaning. The present study aimed to document levels of acute COVID-19 stress and general mental distress in Germany and Austria during the lockdown and in the weeks thereafter. In order to identify potential risk factors related to demographics and living conditions, their associations with COVID-19 stress were analyzed exploratively. The primary objective of the study, however, was to investigate the buffering effect of two psychological resources-meaningfulness and self-control-with regard to the relation between acute COVID-19 stress and general mental distress. Finally, a potential aggravation of mental distress due to the occurrence of crises of meaning was examined.

METHOD

A cross-sectional survey was conducted online during lockdown (survey group 1) and the subsequent weeks characterized by eased restrictions (survey group 2). A total of N = 1,538 German-speaking participants completed a questionnaire battery including a novel measure of acute COVID-19 stress, meaningfulness and crisis of meaning (SoMe), self-control (SCS-KD), and a screening of general mental distress, measured by core symptoms of depression and anxiety (PHQ-4). In a first step, associations between living conditions, demographics, and COVID-19 stress were explored. Second, a moderation and a mediation model were tested. Meaningfulness, a measure of presence of meaning in life, as well as self-control were proposed to serve as buffers in a time of crisis, thus moderating the relation between acute COVID-19 stress and general mental distress (double moderation). Crisis of meaning, operationalizing an experienced lack of meaning in life, was proposed to mediate the relationship between acute COVID-19 stress and general mental distress, with an assumed moderation of the association between COVID-19 stress and crisis of meaning by survey group (lockdown versus eased restrictions after lockdown), and a hypothesized moderation of the link between crisis of meaning and general mental distress by self-control (dual moderated mediation).

RESULTS

COVID-19 stress was slightly right-skewed. Scores were higher during lockdown than in the weeks thereafter. The rate of clinically significant general mental distress was high, exceeding prevalence rates from both the general population and clinical samples of the time before the pandemic. In the weeks following the lockdown (group 2), general mental distress and crisis of meaning were significantly higher than during lockdown (group 1), whereas meaningfulness and self-control were significantly lower. Demographically, age had the strongest association with COVID-19 stress, with older participants perceiving less acute stress (r = -.21). People who were partnered or married suffered less from COVID-19 stress (η2 = .01). Living alone (η2 = .006), living in a room versus a flat or house (η2 = .008), and being unemployed due to the pandemic (η2 = .008) were related to higher experience of COVID-19 stress. COVID-19 stress and general mental distress were strongly related (r = .53). Both meaningfulness and self-control were negatively associated with general mental distress (r = -.40 and -.36, respectively). They also moderated the relationship between COVID-19 stress and general mental distress: When meaningfulness was high, high COVID-19 stress was related to substantially lower PHQ-4 scores than when meaningfulness was low. The same held for self-control: High scores of self-control were associated with lower PHQ-4 scores especially when COVID-19 stress was high. Crisis of meaning mediated the relationship between COVID-19 stress and PHQ-4. There was a higher likelihood of crises of meaning occurring when COVID-19 stress was high; crisis of meaning, in turn, was associated with general mental distress. Survey group moderated the first path of this mediation, i.e., the relationship between COVID-19 stress and crisis of meaning: High scores of COVID-19 stress were associated more strongly with crisis of meaning in the second survey group (after the lockdown). Self-control moderated the second path, i.e., the relationship between crisis of meaning and PHQ-4: When a crisis of meaning was present, self-control could buffer its effect on general mental distress.

CONCLUSIONS

Also in the present study among German-speaking participants, general mental distress was high. Scores were higher after than during the lockdown, indicating an ongoing destabilization for a significant part of the population. People who saw a meaning in their lives and who were capable of self-control reported substantially less mental distress. Meaningfulness and self-control also served as buffers between COVID-19 stress and general mental distress: When COVID-19 stress was high, the presence of meaningfulness and self-control accounted for lower general mental distress. Moreover, people who suffered strongly from COVID-19 stress were more likely to develop a crisis of meaning which, in turn, was associated with higher general mental distress. This suggests that ongoing anxiety and depression might (also) be based on existential struggles. Again here, self-control buffered the impact of crisis of meaning on general mental health. We conclude from these findings that public health policies can support citizens in coping with large-scale crises by enabling experiences of meaningfulness, e.g., through transparent and reliable modes of communicating goals and necessary intermediate steps. Moreover, health professionals are well advised to invite individuals to confront existential questions and struggles, and to encourage them to exercise self-control. The latter can be boosted by keeping higher-order goals salient-which again is inherently linked to an understanding of their meaning.

Associations of childhood trauma experiences with religious and spiritual struggles

Childhood trauma is associated with many interpersonal and psychosocial problems in adulthood. The aim of this study was to explore the associations with a spiritual area of personality, namely religious and spiritual struggles (R/S struggles). A nationally representative sample of 1,000 Czech respondents aged 15 years and older participated in the survey. All types of CT were associated with an increased level of all six types of R/S struggles, with the highest values for demonic struggles. Thus, the findings of this study might be important for clinical practice and pastoral care as well as a further research.

Flexibility in Existential Beliefs and Worldview: Testing Measurement Invariance and Factorial Structure of the Existential Quest Scale in an Italian Sample of Adults

The aim of the present study was to assess the psychometric properties of the Existential Quest (EQ) Scale, a nine-items instrument developed to assess openness to changing one's own convictions concerning existential issues. We developed the Italian version of the scale and examined factorial structure, internal consistency, discriminant validity, and measurement invariance across gender and age groups. A total of 291 Italian adults were recruited, and they completed a self-report questionnaire comprising measures of authoritarianism, cognitive closure, well-being, and religiousness, alongside the EQ. Confirmatory factor analysis showed that the original one-factor structure was replicated in this study, except for one-item that was removed from the subsequent analyses. Both the internal consistency of the eight-item scale as assessed by Cronbach's α and discriminant validity were in line with those of the original study. However, McDonald's reliability coefficient were quite low, and further researches employing repeated measures are needed in order to comprehend the contribution of the random error and that of the item specificity in lowering McDonald's coefficient. Finally, evidence of full measurement invariance across gender and partial measurement invariance across age was obtained. Overall, these findings suggest that the Italian version of the EQ is a promising tool for assessing flexibility about existential issues.

Bringing Giftedness to Bear: Generativity, Meaningfulness, and Self-Control as Resources for a Happy Life Among Gifted Adults

Meaning in life has been found to be of particular importance for the subjective well-being of intellectually gifted individuals. However, there is a lack of research about what contributes to gifted adults' meaning in life and how it could be enhanced. This study examined if the devotion of one's gift or talent to the well-being of others-i.e., the source of meaning "generativity"-would lead to a sense of meaning and, in further consequence, result in higher subjective well-being over time. Furthermore, we hypothesized that the effect of meaningfulness on subjective well-being was conditional on trait self-control. Longitudinal data of two gifted groups was obtained via an online study: 100 intellectually gifted individuals (55% female; mean age 43 ± 9 years) and 52 high academic achievers (29% female; mean age 57 ± 14 years). The former group experienced significantly lower levels of meaningfulness (p = 0.001, η2 = 0.076), self-control (p < 0.001, η2 = 0.090), and generativity (p = 0.025, η2 = 0.034) than the latter. As expected, the actualization of generative orientations in life enhanced both gifted groups' meaningfulness and, in further consequence, their subjective well-being over time. Furthermore, the positive association between life meaning and subjective well-being was enhanced by trait self-control among the intellectually gifted but not among the high academic achievers. However, as proposed, the latter's subjective well-being was strongly related to self-control. Results highlight that a generative orientation can help gifted individuals to advance a personal sense of meaning and happiness over time. In this context, intellectually gifted individuals appear to particularly benefit from self-control. Consequently, the intrinsic willpower to subdue inner responses, emotions as well as undesired behaviors might strengthen the positive effect between sources of meaning, life meaning, and subjective well-being.