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

Is Humor a Meaning Making Process? Investigating the Effects of Absurd Humor and Mortality Salience on Meaning in Life, Moral Identity, Belongingness, and Belief in a Just World

Both mortality salience and absurd humor have been found to elicit fluid compensation - the automatic process of strengthening unrelated beliefs in response to a meaning threat. Previous research has suggested that perceiving absurd humor to be funny decreases people's tendency to fluid compensate, suggesting that humor is a meaning-making process. However, these results may have been confounded by mortality salience effects. Furthermore, few studies have investigated the effects of absurd humor and mortality salience on multiple beliefs. In the current study, we aimed to conceptually replicate previous research on the fluid compensatory effects of absurd humor and mortality salience under more stringent conditions and in response to a wider variety of beliefs. Participants (N = 590) recruited via MTurk were randomly assigned to a reading condition and thereafter completed a series of measures of meaning in life, moral identity, belongingness, and belief in a just world. Participants found humor in each reading condition and did not fluid compensate, suggesting that humor is a meaning-making process. Implications and directions for meaning making and humor research are discussed.

A mind-body resilience intervention for emotional distress in cardiac arrest survivors and their informal caregivers - Recovering together after cardiac arrest: Protocol for an open pilot trial

Background

Chronic emotional distress among cardiac arrest (CA) survivors and their caregivers is prevalent and worsens quality of life and recovery. Interventions to prevent chronic distress post-CA are needed. We developed Recovering Together after Cardiac Arrest (RT-CA), an intervention to increase resiliency in CA survivor-caregiver dyads (pairs).

Method

We will conduct an open pilot clinical trial of RT-CA to examine preliminary feasibility and refine the intervention based on participant feedback. We will enroll at least 7 CA survivor-caregiver dyads during their hospitalization at a single academic medical center. We will identify eligible survivors by screening admission reports and through referrals from medical staff. Inclusion criteria: Survivors - sufficient cognitive status to meaningfully participate (Short Form of the Mini Mental State Exam ≥5). Dyads - English-speakers; one member must have clinically significant distress (≥8 on either Hospital Anxiety and Depression Scale subscale). Procedure: dyads will participate in 6, 30-45 min sessions with a study clinician. Sessions will include mind-body coping skills training and provision of anticipatory guidance and resources to navigate CA-survivorship. Dyads will complete pre- and post-test measures of emotional distress and treatment targets. We will calculate frequencies and proportions of our primary outcomes (feasibility - recruitment, assessments, adherence, therapist fidelity and acceptability/credibility). After completing post-test assessments, dyads will provide feedback via exit interviews. We will integrate qualitative and quantitative data using explanatory-sequential mixed-methods.

Discussion

We will use our findings to refine RT-CA content and study procedures. If successful, RT-CA has potential to significantly improve quality of survivorship for CA survivors and their caregivers.

Latent profile analysis of sense of coherence and relationship with meaning of life and professional identity among nursing undergraduate

BACKGROUND

Enhancing nursing undergraduates' sense of coherence is crucial for the growth of the nursing workforce. Yet, existing research primarily examines the aggregate level of sense of coherence among nursing undergraduates and its correlations with other variables, overlooking the individual heterogeneity in nursing undergraduates' sense of coherence in nursing. This study aimed to identify different subgroups of nursing undergraduates' sense of coherence and explore the influencing factors pertinent to each subgroup.

METHODS

A cross-sectional study was conducted from May to June 2020 among 1,251 nursing undergraduates using convenience sampling. Latent profile analysis was employed to identify subgroups of nursing undergraduates' sense of coherence, and multiple logistic regression was utilized to analyze the factors associated with each subgroup.

RESULTS

Four potential subtypes of nursing undergraduates' sense of coherence were identified: low sensitivity-low coping group (25.7%), high sensitivity-high coping group (29.7%), moderate sensitivity-moderate coping group (17.8%), and high sensitivity-low coping group (26.8%). Multiple logistic regression analysis revealed that factors influencing nursing undergraduates' sense of coherence included family financial situation, high school subject choice, religious beliefs, belief in having good interpersonal relationships, meaning in life, and professional identity.

CONCLUSION

The heterogeneity of nursing undergraduates' sense of coherence suggests that nursing educators should provide targeted intervention guidance according to the potential category characteristics of nursing undergraduates' sense of coherence; at the same time, they should strengthen the cultivation of nursing undergraduates' meaning of life and professional identity to improve their level of sense of coherence, so as to promote the growth of the nursing workforce.

Psychometric evaluation of the persian version of Existential Concern Questionnaire (ECQ) in Iranian general population: a cross-sectional study

BACKGROUND

Existential anxiety is the anxiety that goes beyond objective threats and is related to a person's existence. Due to the lack of appropriate instrument to measure all five domains of existential anxiety in the Iranian population, this study aimed to examine the psychometric properties of the Existential Concern Questionnaire (ECQ) in the Iranian general population.

METHODS

This online cross-sectional survey was conducted from October 9 to December 11, 2023 in Tehran, Iran. We used an Internet-based data collection method. A total of 549 participants completed the questionnaires. The research instruments included the Existential Concern Questionnaire, Existential Anxiety Questionnaire, Meaning in Life Questionnaire, Short version of the Beck Depression Inventory, Intolerance of Uncertainty Scale-12, and Death Attitude Profile Revised. Confirmatory factor analysis, convergent validity, and concurrent validity were used to measure the validity of ECQ. Cronbach's alpha and split-half methods were employed to assess the reliability of the ECQ.

RESULTS

Confirmatory factor analysis showed a good fit of the unidimensional model (CMIN/DF: 2.802, RMR: 0.066, GFI: 0.914, NFI: 0.911, CFI: 0.941, PNFI: 0.769, PCFI: 0.794, RMSEA: 0.057). Also, the correlation of ECQ with other variables was as expected except for the search for meaning in life (r: 0.010, P = 0.808), which indicates the validity of this questionnaire. The reliability of the questionnaire was also acceptable (Cronbach's Alpha: 0.935).

CONCLUSIONS

The results supported the validity and reliability of the ECQ. The mentioned questionnaire can be used in Iranian general population. Considering the importance of existential anxiety in etiology of some disorders, it is suggested that the future studies focus on validation of the ECQ in different clinical samples and cultures.

A repeated cross-sectional pilot study of the relationship between perceived a community with shared future for doctor-patient and benefit finding: the mediating role of health self-consciousness and moderating role of anxiety

OBJECTIVE

Since January 8, 2023, China has managed COVID-19 as a Class-B infectious disease, marking the epidemic's transition to a low-level stage. This study analyzes the relationship between the public's perceived a community with shared future for doctor-patient (PCSF), health self-consciousness, benefit finding, and anxiety in this stage. Additionally, it compares changes in these variables across different stages of COVID-19.

METHODS

Using a repeated cross-sectional design, three surveys were conducted respectively in three different stages of COVID-19 in China. Specifically, the first survey was conducted in Beijing, Dalian, Zhengzhou, Heihe, and Shangrao from November 13 to 20, 2021 in the outbreak stage of COVID-19, yielding 1,252 valid responses out of 1,534 collected questionnaires. The second survey was conducted in Dalian, Zhengzhou, Heihe, Shangrao, and Lanzhou from December 1 to 19, 2021 in the stable stage of COVID-19, with 872 valid responses obtained from 1,075 collected questionnaires. The third survey was conducted in Beijing, Dalian, Zhengzhou, Heihe, Shangrao, Lanzhou, and Chengdu from January 29 to February 4, 2023 in the low epidemic level stage of COVID-19, achieving 2,113 valid responses from the 2,461 questionnaires collected.

RESULTS

Unlike in the outbreak stage but similar to the stable stage, the public's anxiety, health self-consciousness and benefit finding decreased while PCSF was improved in the low epidemic level stage. Consistent with both the outbreak and stable stage, PCSF, health self-consciousness, benefit finding, and anxiety showed positive correlations in the low epidemic level stage, with health self-consciousness partially mediating the positive impact of PCSF on benefit finding. Unlike in the stable stage but similar to the outbreak stage, anxiety did not moderate the relationship between PCSF and health self-consciousness in the low epidemic level stage.

CONCLUSIONS

The public's health self-consciousness, benefit finding, and anxiety decreased, while PCSF increased in the low epidemic level stage. Furthermore, PCSF had a greater impact on benefit finding, and anxiety's impact on health self-consciousness was significantly reduced. Across different stages of COVID-19, PCSF directly increased benefit finding and also enhanced benefit finding by improving health self-consciousness. Thus, comprehensive intervention measures are beneficial in the low epidemic level stage.

Meaning in Life: A Novel Factor for Promoting Wellbeing in COPD

Introduction

Research evidence indicates that meaning in life (MIL) is a meaningful outcome in individuals living with chronic illness, but evidence is lacking for chronic obstructive pulmonary disease (COPD).

Objectives

We hypothesized that MIL is independently associated with clinically meaningful outcomes for patients with COPD.

Methods

We performed cross-sectional analysis from a large cohort with moderate-severe COPD that participated in a home pulmonary rehabilitation study. MIL was measured using the Meaning in Life Questionnaire (MLQ), with domains of Presence and Search. The study included 340 participants: mean age 69 years old (standard deviation [SD] 9.4), 55.3% female, forced expiratory volume in 1 second (FEV1) 44.3% (SD 19.4), and a modified Medical Research Council (mMRC) dyspnea scale of 2.69 (SD 0.84).

Results

Patients with high MLQ Presence (versus low score) had meaningfully better scores (beyond the minimal clinically important difference) across all Chronic Respiratory Questionnaire (CRQ) domains: Dyspnea, Fatigue, Emotions, and Mastery (p≤0.02); self-management (p≤0.001); social support (p≤0.001); anxiety (p≤0.001); and depression (p≤0.01) scores. When adjusting for age, sex, FEV1, mMRC, social support, and anxiety, MLQ Presence was independently associated with CRQ domains Fatigue, Emotions, and self-management (p≤0.01). MLQ Search was independently associated with CRQ Dyspnea, Fatigue, and Mastery (p<0.05).

Conclusions

In patients with COPD, the perception that life has meaning or the willingness to search for MIL is associated with the outcomes that patients consider most important. Our results are novel as MIL is a potentially modifiable outcome that could complement person-centered conversations during clinical visits, pulmonary rehabilitation, and health coaching.

Development and Validation of a New Measurement Scale for Existential Loneliness

This article deals with the development and initial validation of the Existential Loneliness Scale (ELS). An initial pool of 40 items, generated based on literature review, qualitative studies, and previously developed scales, was evaluated by the experts' judgment, so 30 items were retained and then administered to an Iranian sample of 433 youth and adult participants aged 20 to 85 years. Participants also completed other measures relevant for construct validity: Existential Loneliness Questionnaire (ELQ), De Jong Gierveld Loneliness Scale (DJGLS-6), Existential Anxiety Questionnaire (EAQ), Meaning in Life Questionnaire (MLQ), Beck Depression Inventory (BDI-13), and Satisfaction with Life Scale (SWLS). Exploratory factor analysis and parallel analysis showed strong evidence of unidimensionality. This result was also supported by confirmatory factor analysis test. Finally, 19 items were kept, which were free from DIF by gender and by marital status. The scale had high internal consistency (α = .95 and ω = .95) and adequate test-retest reliability with a 1-month interval (r = .74). Examination of the ELS' correlation with criterion measures indicated that the scale has good concurrent, discriminant, and convergent validity. Findings revealed the ELS as a reliable, valid, and suitable instrument to measure existential loneliness in the Iranian adult population.

Interdisciplinary research approach based on a mixed-methods design to explore patient altruism at the end of life: a study protocol

INTRODUCTION

In the end of life context, patients are often seen as somewhat passive recipients of care provided by health professionals and relatives, with little opportunity to be perceived as autonomous and active agents. Since studies show a very high prevalence of altruistic dispositions in palliative care patients, we strive to investigate the concept of patient altruism in a set of six interdisciplinary studies by considering three settings: (1) in the general palliative context-by studying to what extent patient altruism is associated with essential psychological outcomes of palliative care (subproject 1a), how altruism is understood by patients (subproject 1b) and how altruism expressed by patients is experienced by palliative care nurses (subproject 1c); (2) in two concrete decision-making contexts-advance care planning (subproject 2a) and assisted suicide (subproject 2b); and (3) through verbal and non-verbal patient communication in palliative care settings (subproject 3).

METHODS AND ANALYSIS

Subproject 1a: a cross-sectional study using validated and standardised questionnaires. Subprojects 1b and 1c: a constructivist grounded theory method aiming at developing a novel theory from semistructured interviews in both patients and nurses. Subproject 2a: a thematic analysis based on (1) audio-recordings of advance care planning encounters and (2) follow-up semidirective interviews with patients and their relatives. Subproject 2b: a qualitative study based on thematic analysis of interviews with patients actively pursuing assisted suicide and one of their relatives.Subproject 3: a conversation analysis based on audio and video-recorded interactions in two settings: (1) palliative inpatient unit and (2) advance care planning discussions.

ETHICS AND DISSEMINATION

The study project was approved by the Ethics Committees of the Canton of Vaud, Bern and Ticino (no: 2023-00088). In addition to participation in national and international conferences, each project will be the subject of two scientific publications in peer-reviewed journals. Additional publications will be realised according to result triangulation between projects. A symposium opened to professionals, patients and the public will be organised in Switzerland at the end of the project.

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

BACKGROUND

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSION AND POLICY SUMMARY

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

The differential mediating roles of resilience in the relationship between meaningful living and stress among college students during the COVID-19 pandemic

The current literature, mostly Euro-American based, indicates that the presence of meaning in life (MIL) improves resilience and lowers stress. However, the differential mediating roles of resilience in the relationship between the search for and presence of MIL, and stress have not been explored. This study aimed to investigate the differential mediating roles of resilience in the relationship between the presence of and search for MIL, and stress among Omani college students amid the COVID-19 pandemic. This cross-sectional study consisted of the Brief Resilience Scale, Perceived Stress Scale 4, and Meaning in Life Questionnaire, as well as socio-demographic questions. A path analysis model was used to examine the hypothesis. A total of 970 Omani college students responded to the questionnaire. Findings indicate that searching for MIL was significantly associated with a high level of stress directly (β = 0.023; p < 0.001) and indirectly, through a negative effect on resilience (β =  0.006; p < 0.001). Conversely, the presence of MIL was significantly associated with a decreased level of stress directly (β = - 0.045; p < 0.001) and indirectly via a positive effect on resilience (β = - 0.151; p < 0.001). In keeping with the proposed hypothesis, this study contributes to the current knowledge, by extrapolating the effect of searching for MIL on resilience and stress, and culturally re-contextualizing MIL research. University counseling centers could adopt meaning-based strategies to mitigate stress by promoting meaningful living and resilience.

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.

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.

Meaning of life questionnaire (MLQ) in peruvian undergraduate students: study of its psychometric properties from the perspective of classical test theory (CTT)

Background

The study of the meaning of life is essential since it plays a protective role in the mental health of university students. However, no studies have shown the adequate psychometric functioning of the MLQ in Latin American university students. For this reason, this research aims to evaluate the internal structure using CTT models, obtain evidence of validity based on the relationship with other variables, perform factorial invariance according to gender, and estimate the reliability of the MLQ.

Methods

A sample of 581 Peruvian undergraduate students of both sexes (29.5% men and 70.5% women) between the ages of 18 and 35 (M = 22.6; SD = 3.3) was collected. Along with the MLQ, other instruments were applied to measure satisfaction with life (SWLS), subjective well-being (WBI), and depression (PHQ-9).

Results

In the present study was evidenced that the model of two related factors of nine items presents better adjustment indices (RMSEA = .075; SRMR = .059; CFI = .97; TLI = .96) compared to other models. Also, it was shown that the factorial structure of the MLQ is strictly invariant for the group of men and women. It was also shown that the presence of meaning was positively related to satisfaction with life (.63) and well-being (.60) and negatively to depression (− .56). In contrast, the search for meaning was not significantly related to life satisfaction (− .05) and well-being (− .07); but yes, to depression (.19).

Conclusion

It is concluded that the MLQ from the perspective of CTT has shown adequate evidence of reliability and validity. Therefore, it could be used in future studies and evaluation and intervention processes. In addition, the study provides the first evidence of the psychometric functioning of the scale in university students from Latin America.

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.

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.

Assessing the adherence to treatment among patients with cardiovascular diseases in Kermanshah, Iran

Background: The present study aimed to investigate the psychological determinants of adherence to treatment among patients with cardiovascular diseases (CVDs) referring to Imam Ali Hospital in Kermanshah, Iran.

Methods: This cross-sectional study was conducted on 227 patients (mean age=58.10, SD = 13.44) with CVDs, randomly selected amongst those admitted to Imam Ali cardiovascular center of Kermanshah in 2018. Data were collected through Meaning in Life Questionnaire (MLQ), the Jefferson Scale of Patient’s Perceptions of Physician Empathy (JSPPPE), the Illness Perception Questionnaire (IPQ), and Adherence to Treatment Questionnaire. The relationships between the criterion and predictor variables were assessed using Pearson correlation coefficient and linear regression (stepwise method) in IBM SPSS Statistics-23.

Results: The adherence to treatment was associated with meaning in life (r=0.367), patients’ perceptions of physician empathy (r=0.218), and illness perception (r=-0.238), at the 0.01 level. Meaning in life, patient’s perceptions of physician empathy, and illness perception explained 18.6% of the variance in adherence to treatment. Meaning in life (beta=0.367 and P≤0.001) was the most influential predictor of adherence to treatment. Additionally, there was a significant difference in the score of adherence to treatment by gender (23.46±4.42 for female vs. 24.77±3.53 for male, P = 0.030).

Conclusion: The patients’ perceptions of physician empathy, meaning in life, and illness perception were important factors to predict adherence to treatment in patients with CVDs. Gender was a significant predictor of the adherence to treatment.