Advertisement

Supportive Care in Cancer

, Volume 19, Issue 4, pp 513–520 | Cite as

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

  • Sigrun Vehling
  • Claudia Lehmann
  • Karin Oechsle
  • Carsten Bokemeyer
  • Andreas Krüll
  • Uwe Koch
  • Anja MehnertEmail author
Original Article

Abstract

Goal of work

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

Patients and methods

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

Results

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

Discussion

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

Keywords

Global meaning Death acceptance Goal seeking Demoralization Adjustment Cancer 

Notes

References

  1. 1.
    Adelbratt S, Strang P (2000) Death anxiety in brain tumour patients and their spouses. Palliat Med 14(6):499–507PubMedCrossRefGoogle Scholar
  2. 2.
    Boscaglia N, Clarke DM (2007) Sense of coherence as a protective factor for demoralisation in women with a recent diagnosis of gynaecological cancer. Psychooncology 16(3):189–195PubMedCrossRefGoogle Scholar
  3. 3.
    Breitbart W (2002) Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer 10(4):272–280PubMedCrossRefGoogle Scholar
  4. 4.
    Breitbart W, Gibson C, Poppito SR, Berg A (2004) Psychotherapeutic interventions at the end of life: a focus on meaning and spirituality. Can J Psychiatry 49(6):366–372PubMedGoogle Scholar
  5. 5.
    Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, Nelson C, Tomarken A, Timm AK, Berg A, Jacobson C, Sorger B, Abbey J, Olden M (2009) Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology 19:21–28. doi: 10.1002/pon.1556 Google Scholar
  6. 6.
    Brennan J (2001) Adjustment to cancer—coping or personal transition? Psychooncology 10(1):1–18PubMedCrossRefGoogle Scholar
  7. 7.
    Cella DF, Tross S (1987) Death anxiety in cancer survival: a preliminary cross-validation study. J Pers Assess 51(3):451–461PubMedCrossRefGoogle Scholar
  8. 8.
    Clarke DM, Kissane DW (2002) Demoralization: its phenomenology and importance. Aust N Z J Psychiatry 36(6):733–742PubMedCrossRefGoogle Scholar
  9. 9.
    Folkman S (1997) Positive psychological states and coping with severe stress. Soc Sci Med 45(8):1207–1221PubMedCrossRefGoogle Scholar
  10. 10.
    Folkman S, Moskowitz JT (2000) Positive affect and the other side of coping. Am Psychol 55(6):647–654PubMedCrossRefGoogle Scholar
  11. 11.
    Frankl VE (1984) Der leidende Mensch: Anthropologische Grundlagen der Psychotherapie, 2nd edn. Huber, BernGoogle Scholar
  12. 12.
    Frankl VE (1991) Der Wille zum Sinn - Ausgewählte Vorträge über Logotherapie, 2nd edn. Piper, MünchenGoogle Scholar
  13. 13.
    Frankl VE (2005) Ärztliche Seelsorge. Grundlagen der Logotherapie und Existenzanalyse. Zehn Thesen über die Person, 11th edn. Deuticke, WienGoogle Scholar
  14. 14.
    Hermann C, Buss U, Snaith RP (1995) Hospital anxiety and depression scale – Deutsche version. Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Huber, BernGoogle Scholar
  15. 15.
    Holland JC, Reznik I (2005) Pathways for psychosocial care of cancer survivors. Cancer 104(11):2624–2637PubMedCrossRefGoogle Scholar
  16. 16.
    Jim HS, Andersen BL (2007) Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. Br J Health Psychol 12(3):363–381PubMedCrossRefGoogle Scholar
  17. 17.
    Jim HS, Richardson SA, Golden-Kreutz DM, Andersen BL (2006) Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychol 25(6):753–761PubMedCrossRefGoogle Scholar
  18. 18.
    Johnson-Vickberg SM, Duhamel KN, Smith MY, Manne SL, Winkel G, Papadopoulos EB, Redd WH (2001) Global meaning and psychological adjustment among survivors of bone marrow transplant. Psychooncology 10(1):29–39PubMedCrossRefGoogle Scholar
  19. 19.
    Kissane DW, Bloch S, Smith GC, Miach P, Clarke DM, Ikin J, Love A, Ranieri N, McKenzie D (2003) Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Psychooncology 12(6):532–546PubMedCrossRefGoogle Scholar
  20. 20.
    Kissane DW, Clarke DM, Street AF (2001) Demoralization syndrome—a relevant psychiatric diagnosis for palliative care. J Palliat Care 17(1):12–21PubMedGoogle Scholar
  21. 21.
    Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM (2004) The Demoralization Scale: a report of its development and preliminary validation. J Palliat Care 20(4):269–276PubMedGoogle Scholar
  22. 22.
    Lee V (2008) The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning. Support Care Cancer 16(7):779–785PubMedCrossRefGoogle Scholar
  23. 23.
    Lee V, Cohen RS, Edgar L, Laizner AM, Gagnon AJ (2006) Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Soc Sci Med 62(12):3133–3145PubMedCrossRefGoogle Scholar
  24. 24.
    Lethborg C, Aranda S, Cox S, Kissane DW (2007) To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliat Support Care 5(4):377–388PubMedCrossRefGoogle Scholar
  25. 25.
    Mehnert A (2008) Der Einfluss von religioeser und sinnbasierter Krankheitsverarbeitung auf Angst und Depressivitaet bei Brustkrebspatientinnen im Krankheitsverlauf. PIÖ 28(1):72–77Google Scholar
  26. 26.
    Mehnert A, Koch U (2008) Psychometric evaluation of the German version of the Life Attitude Profile—Revised (LAP-R) in prostate cancer patients. Palliat Support Care 6(2):119–124PubMedCrossRefGoogle Scholar
  27. 27.
    Mehnert A, Mueller D, Koch U (2007) Die Erfassung von sinnbasierten Bewaeltigungsstrategien und Lebenseinstellungen. Die deutsche Adaptation des Life Attitude Profile-Revised (LAP-R) an einer repraesentativen Stichprobe von Brustkrebspatientinnen. Z Klin Psychol Psychother 36(3):176–188CrossRefGoogle Scholar
  28. 28.
    Mehnert A, Mueller D, Lehmann C, Koch U (2006) Die deutsche Version des NCCN Distress-Thermometers. Empirische Pruefung eines Screening-Instruments zur Erfassung psychosozialer Belastung bei Krebspatienten. ZPPP 54(3):213–223Google Scholar
  29. 29.
    Park CL, Edmondson D, Fenster JR, Blank TO (2008) Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs. J Consult Clin Psychol 76(5):863–875PubMedCrossRefGoogle Scholar
  30. 30.
    Park CL, Folkman S (1997) Meaning in the context of stress and coping. Rev Gen Psychol 1(2):115–144CrossRefGoogle Scholar
  31. 31.
    Reker GT (1992) Manual of the life attitude profile-revised (LAP-R). Student Psychologists Press, Trent University, PeterboroughGoogle Scholar
  32. 32.
    Reker GT (1997) Personal meaning, optimism, and choice: existential predictors of depression in community and institutional elderly. Gerontologist 37(6):709–716PubMedGoogle Scholar
  33. 33.
    Reker GT (2000) Theoretical perspective, dimensions, and measurement of existential meaning. In: Reker GT, Chamberlain K (eds) Exploring existential meaning. Optimizing human development across the life span. Sage, Thousand Oaks, pp 39–55Google Scholar
  34. 34.
    Reker GT (2007) The search for meaning in life following traumatic brain injury: conceptual, measurement, and application issues. Paper presented at the State of the Science Conference for the RRTC on Community Integration of Persons with Traumatic Brain Injury, Arlington, VirginiaGoogle Scholar
  35. 35.
    Sigal JJ, Ouimet MC, Margolese R, Panarello L, Stibernik V, Bescec S (2008) How patients with less-advanced and more-advanced cancer deal with three death-related fears: an exploratory study. J Psychosoc Oncol 26(1):53–68PubMedCrossRefGoogle Scholar
  36. 36.
    Simonelli LE, Fowler J, Maxwell GL, Andersen BL (2008) Physical sequelae and depressive symptoms in gynecologic cancer survivors: meaning in life as a mediator. Ann Behav Med 35(3):275–284PubMedCrossRefGoogle Scholar
  37. 37.
    Vickberg SM, Bovbjerg DH, Duhamel KN, Currie V, Redd WH (2000) Intrusive thoughts and psychological distress among breast cancer survivors: global meaning as a possible protective factor. Behav Med 25(4):152–160PubMedCrossRefGoogle Scholar
  38. 38.
    Westman B, Bergenmar M, Andersson L (2006) Life, illness and death—existential reflections of a Swedish sample of patients who have undergone curative treatment for breast or prostatic cancer. Eur J Oncol Nurs 10(3):169–176PubMedCrossRefGoogle Scholar
  39. 39.
    White CA (2004) Meaning and its measurement in psychosocial oncology. Psychooncology 13(7):468–481PubMedCrossRefGoogle Scholar
  40. 40.
    Xuereb MC, Dunlop R (2003) The experience of leukaemia and bone marrow transplant: searching for meaning and agency. Psychooncology 12(5):397–409PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Sigrun Vehling
    • 1
  • Claudia Lehmann
    • 1
  • Karin Oechsle
    • 2
  • Carsten Bokemeyer
    • 2
  • Andreas Krüll
    • 3
  • Uwe Koch
    • 1
  • Anja Mehnert
    • 1
    Email author
  1. 1.Department of Medical PsychologyUniversity Medical Center Hamburg–EppendorfHamburgGermany
  2. 2.Department of Oncology/Hematology/Bone Marrow Transplantation/Pneumology, Hubertus Wald Tumor Centrum–University Cancer Center HamburgUniversity Medical Center Hamburg–EppendorfHamburgGermany
  3. 3.Department of RadiotherapyUniversity Medical Center Hamburg–EppendorfHamburgGermany

Personalised recommendations