The Mediating Role of Meaning in the Association between Stress and Health

Relationship between Experiential Avoidance and Emotional Disturbances in Coping with Disease in Patients with Multiple Sclerosis

Multiple sclerosis (MS) is a neurodegenerative disease that presents with both motor and non-motor symptoms, with anxiety and depression being prominent and potentially exacerbated by negative thoughts. Therefore, the experiential avoidance (EA) exhibited by patients post diagnosis is particularly relevant. This study aimed to measure the degree of EA in patients with MS and determine its relationship with emotional disturbances. A cross-sectional descriptive study was conducted using a sample of 64 patients diagnosed with MS. In October 2018, these patients underwent evaluations of functional and cognitive variables, such as anxiety, depression, and avoidant behaviors towards the disease, using the Expanded Disability Status Scale, Acceptance and Action Questionnaire-II, Self-Compassion Scale Short Form, Five Facet Mindfulness Questionnaire-15, prefrontal symptoms inventory, Beck Depression Inventory II, and State-Trait Anxiety Inventory to assess coping mechanisms in handling the disease. Higher levels of state anxiety (β = 0.79; p < 0.001), trait anxiety (β = 0.82; p < 0.001), and depression (β = 0.62; p < 0.001) were observed in patients with MS as their EA and psychological inflexibility increased. Participants with high self-compassion/self-acceptance tended to have fewer negative thoughts and exhibited better coping with the disease, which may, in turn, affect patterns of psychological rigidity or inflexibility. Dimensions such as kindness and humility could act as positive factors in coping with the disease, whereas self-judgment and isolation are negative elements often associated with avoidant behaviors that hinder effective coping with the illness.

A "Patient Preference" Model of Recruitment for Research from Primary-Care-Based Memory Clinics: A Promising New Approach

Recruiting persons with dementia for clinical trials can be challenging. Building on a guide initially developed to assist primary-care-based memory clinics in their efforts to support research, a key stakeholder working group meeting was held to develop a standardized research recruitment process, with input from patients, care partners, researchers, and clinicians. Discussions in this half-day facilitated meeting focused on the wishes and needs of patients and care partners, policy and procedures for researchers, information provided to patients, and considerations for memory clinics. Patients and care partners valued the opportunity to contribute to science and provided important insights on how to best facilitate recruitment. Discussions regarding proposed processes and procedures for research recruitment highlighted the need for a new, patient-driven approach. Accordingly, a key stakeholder co-designed "Memory Clinic Research Match" program was developed that has the potential to overcome existing barriers and to increase recruitment for dementia-related research.

Meaning in life among nursing students: a latent profile analysis

BACKGROUND

Meaning in life, defined by an individual's understanding and appreciation of life, is a vital aspect of a positive psychological state, that has a significant influence on physical and mental health. Therefore, improving the sense of meaning in life among nursing students has emerged as a crucial concern in nursing education. This study aimed to clarify the profiles and influencing factors of meaning in life among nursing students.

METHODS

A descriptive cross-sectional online survey was conducted among nursing students in China from November 16, 2022, to January 17, 2023. The demographic information questionnaire and the meaning in life questionnaire (MLQ) were used to collect data. Latent profile analysis (LPA) was used to identify groups exhibiting distinct levels of meaning in life. Additionally, univariate analysis and multinominal logistic regression analysis were used to investigate the factors influencing each group. The reporting of this study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist.

RESULTS

A total of 10,583 valid responses were received, and the analysis revealed four distinct profiles. The profiles identified were the medium meaning group (C1, 41.4%), medium fluctuation meaning-no motivation group (C2, 8.7%), lower meaning group (C3, 9.7%), and higher meaning group (C4, 40.2%). The univariate analysis revealed that age, gender, ethnicity, marital status, educational level, grade, university classification, student leadership experience, and political affiliation were factors that influenced the four latent profiles (P < 0.05). The multinomial logistic regression analysis showed that age, gender, ethnicity, education level, and student leadership experience were significant predictors of the various profiles (P < 0.05).

CONCLUSION

There is heterogeneous in meaning in life among nursing students in China. Nursing educators need to provide tailored guidance based on the latent classification characteristics of meaning in life among nursing students, aiming at improving their meaning in life and promoting the development of the nursing workforce.

Investigating the Link Between IADL and Depressive Symptoms in Older Adults: A Cross-Sectional Serial Mediation Model

OBJECTIVES

There is a dearth of research on the psychological processes that underlie the negative relation between impaired instrumental activities of daily living (IADL) and depressive symptoms in older adults. Drawing on the stress process model and the resilience framework, we investigated whether purpose in life and resilience serially mediate the relationship between impaired IADL and depressive symptoms.

METHODS

We recruited 111 cognitively healthy community-dwelling older adults (ages 54-85; M = 66.5) who scored a minimum of 25 points on the Mini-Mental State Examination.

RESULTS

We found that purpose in life and resilience serially mediated the relationship between IADL and depressive symptomatology in older adults. This association held true when we controlled for covariates. Additional sensitivity analyses also supported these findings.

CONCLUSIONS

This study extends our understanding of how IADL limitations contribute to depressive symptoms. Using a community-dwelling, cognitively healthy sample, we demonstrate that functional limitations indirectly influence older adults' depressive symptoms through a decreased sense of purpose in life and decreased resilience.

CLINICAL IMPLICATIONS

Our findings have implications for intervention programs that aim to alleviate IADL limitations and mental health issues in an aging population and promote healthy aging by improving psychosocial resources (i.e., purpose in life and resilience).

Relationships among nursing students’ self-concept clarity, meaning in life, emotion regulation ability and depression: Testing a moderated mediation model

Objective

Self-concept clarity as an inducing factor of depressive symptoms has been confirmed in previous studies. However, little is known about how and when it induces depressive symptoms in nursing students. The study is to examine the potential mediating role of meaning in life and the moderation of emotion regulation ability in the association between self-concept clarity and depressive symptoms among college nursing students.

Materials and Methods

A sample of 488 college nursing students participated in this study Southeast China. The Chinese adaptations of Self-concept clarity Scale, Sense of life Scale, Depression scale, Emotion regulation scale were used. Mediation and moderation analyses were carried out in the SPSS macro PROCESS.

Results

Self-concept clarity was significantly and negatively associated with depression in nursing students, meaning in life had a partial mediating effect on the relationship between self-concept clarity and depression. Furthermore, emotion regulation ability moderated the direct effect of self-concept clarity on depression.

Conclusion

The findings enrich the knowledge of the mediating and moderating mechanisms to explain the association between self-concept clarity and depression in nursing students. There have been proposed interventions concerning increasing self-concept clarity, meaning in life and emotion regulation ability training which could help help reduce the depression among nursing students.

Trajectory Analysis of Suicidal Ideation in Spanish College Students Using Ecological Momentary Assessment

Introduction

Suicide is a preventable death in young people. It is well known that suicide behavior is a multicausal phenomenon. However, suicidal ideation (SI) commonly underlies suicide, and Ecological Momentary Assessment (EMA) can help us to better characterize it and its risk and protective factors in the short term. We aimed, first, to investigate the estimated prevalence and trajectories of SI in a community sample of Spanish college students using an EMA methodology and, second, explore the associations between risk and protective factors and SI categorized as moderate or low.

Materials and Methods

A total of 737 participants followed the EMA during a period of 6 months. We estimated the prevalence and trajectories of SI and the associations between depressive symptoms, positive and negative affect, thwarted belongingness, perceived burdensomeness, cognitive reappraisal, emotional suppression, and purpose in life with the MEmind smartphone App. SI was assessed 14 times during this period.

Results

Twenty-eight participants referred to SI at least once in longitudinal assessments. We found a lack of curvature and, thus, a relatively stable trajectory of SI. Two groups of latent dimensions were observed related to risk and protective factors of SI. One latent dimension of the risk factors (higher levels of thwarted belongingness, perceived burdensomeness, depressive symptoms, negative affect, and emotional suppression) best represented the group with moderate levels of SI, and a second latent dimension of protective variables (positive affect, cognitive reappraisal, and purpose in life) best represented the group with lower levels of SI.

Discussion

These findings may indicate that students with a sense of having a life worth living, in addition to having the ability to reevaluate their negative beliefs, are less likely to experience high levels of SI. Therefore, purpose in life would be a protective factor against the presence of SI.

Interview-Rated Meaning and Survival Over 17 Years in People Living With HIV

OBJECTIVE

The primary purpose of this study was to determine whether meaning in life predicts survival in people living with HIV (PLWH) over 17 years. This study also examined whether interviewer- and transcript-rated meanings predict survival equivalently. A third purpose of the study was to investigate whether meaning in life adds to the prediction of survival over positive emotional expression.

METHODS

A diverse sample of people with HIV (n = 177) completed an interview on stress and coping at baseline and were followed up for survival up to 17 years. Meaning was measured by interviewer rating of four items (meaningful purpose, unfinished business, finding new meaning, and meaningful activities). Transcript-rated meaning was assessed by two independent raters. Cox proportional hazards regression was used to determine whether meaning predicted survival over 17 years.

RESULTS

Meaning in life predicted significantly greater survival, adjusting for biomedical and sociodemographic variables whether assessed by interviewer or by transcript raters. Hazard ratios suggest that the effect is moderate to large (2.66-3.45 for top versus bottom third; 2.05-2.49 for top versus bottom half). Significance was maintained after adjusting for positive emotion.

CONCLUSIONS

Meaning assessed by interview (by both interviewer and transcript ratings) predicted greater survival over 17 years in PLWH and did so above positive emotion. This adds to a literature that is primarily based on self-report questionnaires. Meaning may have beneficial effects for both psychological and physical health in PLWH.

An Integrative Framework of Appraisal and Adaptation in Serious Medical Illness

Multiple randomized clinical trials have demonstrated that palliative care improves the quality of life of individuals with serious medical illness. Research also suggests that in patients with advanced cancer, palliative care's focus on symptom management, coping with illness, goals of care, and treatment decisions may be associated with improved patient quality of life in part by increasing patients' use of active (vs. passive) and approach-oriented (vs. avoidant) coping strategies. However, without a framework outlining the process that individuals with serious medical illness and their loved ones undergo, it is challenging to discern exactly where, how, and why palliative care may affect the serious medical illness experience. To address this gap, we propose a clinically applicable framework, derived from existing theory and research in the social and behavioral sciences. This framework, called the Integrative Framework of Appraisal and Adaptation in Serious Medical Illness, describes how patients and their loved ones cognitively and emotionally process the various events that may occur as they navigate serious medical illness and the end of life. The framework also describes how individuals and their loved ones use that event processing to determine next steps, while considering the impact of their surrounding external environment, their individual social roles, and their connections on this decision making. The framework presented in this article is intended to improve our ability to understand and care for individuals with serious medical illness and their loved ones, while stimulating further discussion and research to test and refine these ideas.

Self-Efficacy and Psychological Well-Being in Cardiac Patients: Moderated Mediation by Affect and Meaning-Making

Prior research suggests a potential moderated mediation effect between self-efficacy and psychological well-being. Based on the Meaning Making Model and the Broaden-and-Build Theory, this study examines the relationship between self-efficacy and psychological well-being in the moderated mediation perspective of affect and meaning-making in coronary heart disease patients. The questionnaires measuring self-efficacy, psychological well-being, affect, and meaning-making were used to collect data from one hundred and fifty six patients (73 women and 83 men) who were suffering from coronary heart disease. The patients had a history of coronary heart disease in the previous .1‒7.9 years and were aged 47‒82. Findings demonstrated that meaning-making mediated the indirect relationship between self-efficacy and psychological well-being. In addition, the moderated mediation effect of positive affect, but not of negative affect was significant. Positive affect moderated the indirect effect between self-efficacy and psychological well-being through meaning-making; the indirect effect was stronger when positive affect was high as opposed to low. The results suggest the interplay of affective and meaning-making processes in the relationship between self-efficacy and well-being.

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

Background/Objective

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

Method

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

Results

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

Conclusions

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

Meaning in life buffers the association between clinical anxiety and global maladjustment in participants with common mental disorders on sick leave

An important goal of mental health specialists is to improve the quality of life and the adaptation of people with common mental disorders on sick leave. Meaning in life is a protective factor for people adjusting to distress and negative events. This study explores the buffering role of meaning in life in the relationship between clinical anxiety or negative affect and maladjustment in participants with common mental disorders on sick leave. The sample was 167 participants with Adjustment, Anxiety and, Depressive Disorders; n = 115 were women and n = 52 men. Participants' mean age M = 42.16 (SD = 9.91) years. We performed zero-order correlations and hierarchical regression analyses. Meaning in life moderated and buffered the association between clinical anxiety or negative affect and global maladjustment to daily life. These findings suggest that Meaning in life is a relevant variable in the adjustment of common mental disorders on sick leave.

Meaning in life among adolescents: Factorial invariance of the purpose in life test and buffering effect on the relationship between emotional dysregulation and hopelessness

OBJECTIVE

The purpose of the present study was threefold: first, to analyse the psychometric properties of a 10-item Spanish version of the Purpose in Life Test, which assesses meaning in life (MiL), in a sample of community adolescents; second, to analyse the differences between the age and gender groups; and third, to analyse whether MiL buffers the relationship between emotional dysregulation and hopelessness.

METHOD

Participants were 1,599 adolescents from 12 to 19 years old, M = 15.69, SD = 2.14. The Purpose in Life Test-10 Items, the Beck Hopelessness Scale, and the Difficulties in Emotional Regulation Scale were used.

RESULTS

A nine-item version showed good fit, psychometric properties (internal consistency, construct, and concurrent validity), and factorial invariance across gender and age (12-15 years/16-19 years). Difference in MiL between boys and girls was not significant, whereas between age groups was significant. MiL had a strong buffering effect on the relationship between emotional dysregulation and hopelessness.

DISCUSSION

It is desirable to promote the sense of MiL in adolescents. MiL plays a significant and strong mediator role in the relationship between emotional dysregulation and hopelessness, reinforcing the positive role of MiL in mental health and as a resource for facing adversity.

Lab- and Field-Based Approaches to Meaning Threats and Restoration: Convergences and Divergences

Two distinct approaches to meaning—experimental lab-based research on meaning and its maintenance in response to situational cues and observational field research on meaning-focused coping following highly stressful or traumatic situations—have both produced important insights into the mechanics underlying responses to meaning-relevant threats. It has been suggested that although these 2 approaches focus on different, specific aspects of meaning, they converge on common underlying phenomena. The present article considers how lab-based and field-based approaches align and diverge on their answers to 4 questions: (1) How is meaning defined in the context of meaning violation and restoration? (2) What are threats to meaning? (3) How do people respond to these threats? and (4) Why does meaning restoration matter? Our comparison of these lab- and field-based approaches suggests that they share considerable commonalities in conceptualization, but they diverge in important ways in terms of emphasis and empirical considerations. We conclude that lab- and field-based approaches to meaning violation and restoration may be focusing on the same phenomena studied at different levels, but with some qualitative differences, and we offer suggestions for how lab- and field-based approaches can better inform one another. Considering these two approaches conjointly provides a more holistic and comprehensive understanding of the fundamental phenomena of meaning threat and restoration.