Does perceived burdensomeness erode meaning in life among older adults?

Mental pain as a mediator in the association between avoidant attachment and suicidal ideation among older men

OBJECTIVES

In the present study, our aim was to deepen the understanding of suicidality in older men by adopting a biopsychosocial approach. The study focused on older men as they face an elevated risk of suicide, surpassing not only other age groups but also exhibiting higher rates compared to women. We examined the contribution of mental pain as a mediator in the association between attachment avoidance and suicidal ideation among older men, taking into consideration the severity of their physical illnesses.

METHODS

Participants were 200 men in Israel, aged ≥65 years, living in the community and without cognitive impairment. Data collection was based on self-report measures of suicidal ideation (Beck Scale for Suicidal Ideation, BSSI), attachment (Experience in Close Relationships, ECR-R), mental pain (Orbach and Mikulincer Mental Pain Scale, OMMP), and the severity of physical illnesses (Cumulative Illnesses Rating Scale, CIRS).

RESULTS

Mental pain was found to mediate the association between attachment avoidance and suicidal ideation, but only among participants with higher levels of physical illnesses.

CONCLUSIONS

Mental pain should be considered as a complication of an avoidant coping strategy, which increases the risk of suicide among older men, especially those suffering from significant physical illnesses. The theoretical and clinical implications of these findings are discussed.

Pandemic Grief and Suicidal Ideation in Latin American Countries: A Network Analysis

This study aimed to characterize the network structure of pandemic grief symptoms and suicidal ideation in 2174 people from eight Latin American countries. Pandemic grief and suicidal ideation were measured using the Pandemic Grief Scale and a single item, respectively. Network analysis provides an in-depth characterization of symptom-symptom interactions within mental disorders. The results indicated that, "desire to die," "apathy" and "absence of sense of life" are the most central symptoms in a pandemic grief symptom network; therefore, these symptoms could be focal elements for preventive and treatment efforts. Suicidal ideation, the wish to die, and the absence of meaning in life had the strongest relationship. In general, the network structure did not differ among the participating countries. It identifies specific symptoms within the network that may increase the likelihood of their co-occurrence and is useful at the therapeutic level.

Dying by Suicide in Nursing Homes: A Preventable End of Life Outcome for Older Residents

Suicide research and suicide prevention have given comparatively little attention to the older adult residents of nursing homes. This population is characterized by advanced age, significant infirmity, limited autonomy and social connections, and other factors associated with high suicide risk such as self-neglect. However, little is known of the actual incidence and prevalence of suicide in older adults in such residential care settings, partly because of how such deaths are reported. Suicide risk screenings are nominal, facility staff lack training to identify signs of suicidality, and suicide prevention programs are not common in the nursing home industry. These deficits can be remedied by increasing awareness among family members, facility caregivers, contracted providers, community aging services, accrediting and regulatory agencies, and residents.

Questioning the value of present life: The lived experience of older people who see no future for themselves

OBJECTIVES

To describe the lived experience of older people who see no future for oneself in the context of aging and the possible development of a wish to die.

METHODS

Data were collected from 34 interviews with people of 55-92 years. A phenomenological hermeneutical analysis was performed using crafted stories as an analytical device.

RESULTS

Four intertwined constituents together with the essence of the phenomenon provide a layered description of what it means to see no future for oneself. In all constituents: 1) not sharing everyday life, 2) looking for new commitments, 3) facing present losses and future fears and 4) imagining not waking up in the morning, the essence losing zest for life seeped through their daily experiences.

CONCLUSIONS

As their horizon of future possibilities is shrinking, older people in our study experience a loss of zest for life and start to questioning the value of their present lives. And although a certain languishing mood can be discovered, the phenomenon 'seeing no future for oneself' does not entail a wish to die.

Perceived stress from interpersonal relations predicts suicidal ideation in Chinese university students: Roles of meaning in life and coping humor

Existing studies emphasize that interpersonal relationships are closely associated with the increased risk of suicidal ideation (SI). However, the mechanism underlying this association remains poorly understood. In this study, we investigated how and under what conditions the perceived stress from interpersonal relations links to SI. Also we explored the possible important roles of meaning in life and coping humor. A total of 1472 Chinese freshmen completed self-reported questionnaires of thwarted belongingness (TB), fear of negative evaluation (FNE), meaning in life, coping humor, and SI. Our results showed that SI was associated with more TB and FNE, and it was linked to less meaning in life and coping humor. Importantly, two dimensions of meaning in life mediated the associations between TB, FNE, and SI. Specifically, TB increased SI by destroying both presence of meaning and search for meaning while FNE increased SI by destroying presence of meaning, but not by search for meaning. Additionally, coping humor attenuated the effect of FNE on SI. Our findings highlight the protective roles of meaning in life and coping humor in the link between perceived stress from interpersonal relations and SI among Chinese university students. These results provide feasible advices for practitioners to carry out suicide prevention and intervention.

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.

Reciprocal/Authoritarian Filial Piety and Mental Well-Being in the Chinese LGB Population: The Roles of LGB-Specific and General Interpersonal Factors

Although filial piety is considered as a salient value in the Chinese culture, studies on the mental well-being of Chinese lesbian, gay, and bisexual (LGB) individuals rarely take filial piety into account or examine it in relation to other variables to clarify the mechanism between filial piety and mental well-being. A total of 1453 LGB participants from 30 provinces and regions in Mainland China completed the online survey. They provided demographic information and completed measures of filial piety, a general interpersonal factor (i.e., perceived burdensomeness and thwarted belongingness), an LGB-specific interpersonal factor (i.e., perceived parental support for sexual orientation), and mental well-being. Structural equation modelling results indicated that higher reciprocal filial piety was directly, and indirectly through lower thwarted belongingness, associated with better mental well-being. Lower authoritarian filial piety was indirectly associated with better mental well-being through higher perceived parental support for sexual orientation and lower thwarted belongingness. In addition, reciprocal filial piety had a stronger effect on perceived parental support for sexual orientation and perceived burdensomeness among lesbians and bisexual women than gay and bisexual men. These findings suggest that reciprocal filial piety is a protective factor, whereas authoritarian filial piety is a risk factor, for the mental well-being of Chinese LGB persons. Moreover, perceived parental support for sexual orientation and thwarted belongingness might be the mechanisms underlying the effect of reciprocal/authoritarian filial piety on mental well-being. Implications of findings for practice and research are discussed.

Validating the interpersonal theory of suicide among older adultspre- and peri-COVID-19 pandemic

OBJECTIVES

Global suicide rates are highest among older adults, and especially older men, yet proximal predictors of suicidal ideation in older age remain poorly understood. This study tested the Interpersonal Theory of Suicide in older men and women by investigating whether perceived burdensomeness and thwarted belongingness and/or their interaction are proximal predictors of suicidal ideation before versus during the global COVID-19 pandemic.

METHODS

The sample (N = 208) included healthy community-dwelling older Australian persons surveyed face-to-face pre-pandemic (n = 102), or online peri-pandemic (n = 106). Depression, social interaction, social satisfaction, thwarted belongingness, and perceived burdensomeness were assessed as predictors of suicidal ideation.

RESULTS

Perceived burdensomeness was a more proximal predictor of suicidal ideation among older adults than depression or thwarted belongingness. Suicidal ideation and perceived burdensomeness were higher in men than women, but sex did not moderate the influence of perceived burdensomeness, thwarted belongingness or social satisfaction on suicidal desire. The interaction between perceived burdensomeness and thwarted belongingness predicted more additional variance in suicidal ideation in the older persons surveyed during the COVID-19 pandemic relative to those surveyed before the pandemic.

CONCLUSION

Suicidal ideation among older persons peri-pandemic is discussed, and recommendations are made for age-specific suicide prevention strategies.

Addressing Suicide Risk in Patients Living With Dementia During the COVID-19 Pandemic and Beyond

Alzheimer's disease and related dementias (ADRD) are progressive illnesses characterized by decline in cognitive function that impairs performing daily activities. People with ADRD are at an increased risk of suicide, especially those who have comorbid mental health conditions, have specific types of ADRD, or have been recently diagnosed. The coronavirus disease 2019 (COVID-19) pandemic has increased the distress of people with ADRD, a population also at increased risk of contracting the COVID-19 virus. In this article, we draw on a case study and use the Interpersonal Theory of Suicide to help describe the association between ADRD and suicide risk. Secondly, we call for new strategies to mitigate suicide risk in people living with ADRD during and beyond the current pandemic by using lessons learned from cancer care. Our goal is not to dictate solutions but rather to start the conversation by outlining a framework for future research aimed at preventing death by suicide in people with ADRD. Specifically, we draw on the updated Framework for Developing and Evaluating Complex Interventions to reflect on the complexity of the issue and to break it down into achievable parts to reduce the risk of suicidal behavior (ideation, plans, attempts) in those living with ADRD.

Depressive rumination and life satisfaction among institution-dwelling Chinese older adults: the roles of perceived burdensomeness and social support from individuals within the institution

Objectives: We examined how institution-dwelling older adults' depressive rumination was associated with their life satisfaction by taking perceived burdensomeness as a mediator and social support from individuals within the institution (SSII) as a moderator.Method: A total of 194 older adults from 24 institutions in four provinces of China completed a questionnaire survey.Results: Depressive rumination was negatively associated with life satisfaction, and perceived burdensomeness mediated this association. Moreover, SSII moderated the indirect association between depressive rumination and life satisfaction through perceived burdensomeness. Specifically, depressive rumination had a negative effect on life satisfaction through perceived burdensomeness only for older adults with less SSII.Conclusion: Our study indicated that depressive rumination could damage older adults' life satisfaction by increasing their perceived burdensomeness. Fortunately, older adults' perception of social support from individuals within the institution could attenuate this negative effect. This study has implications for designing intervention programs to improve the institution-dwelling older adults' life satisfaction.

Meaning in life as a mediator of dark triad with confidence in treatment and subjective evaluation of treatment outcome among male drug abstainers

BACKGROUND

Although the roles of personality in predicting substance abuse have been widely documented, few studies have investigated the relationships the dark triad (DT) personalities had with confidence in treatment (CIT) and subjective evaluation of treatment outcome (SETO) in drug abstainers.

OBJECTIVE

This study examined the relationship between DT and treatment-relevant variables, and the potential effect of meaning in life (MIL) in these links.

METHODS

Participants were male inpatients who started substance abuse treatment between June and December 2018 in Henan Province, China. The inclusion criteria were the diagnosis of substance use disorders. The exclusion criteria were illiteracy, comorbidity with psychopathology disorders, intellectual disability, and refusal of consent. A total of 236 men (aged 21-62 years, M = 45.30, SD = 7.72) were randomly selected and reported their DT, MIL, CIT, and SETO.

RESULTS

Results showed that DT was negatively correlated with MIL, CIT, and SETO. MIL was positively correlated with CIT and SETO. The dark triad is associated with CIT both directly and indirectly via MIL. DT is indirectly correlated with SETO via MIL. Higher levels of DT in drug abstainers can reduce CIT and SETO by decreasing individual's MIL.

CONCLUSION

This study provides insights into the links between the DT and treatment-relevant variables, which can potentially impact the effectiveness of current substance abuse treatment programs.

Guilt for perceiving oneself as a burden in healthy older adults. Associated factors

METHODS

Participants were 317 community-dwelling people over 60 years without cognitive or functional limitations. A path model that explores the role of self-perceived burden in the relationship between negative self-perception of aging, perceived control, depressive symptoms and guilt associated with self-perception as a burden was analyzed.

RESULTS

The model presented excellent fit to the data, explaining 41% of the depressive symptomatology and 45% of guilt for perceiving oneself as a burden. Negative self-perceptions of aging, lower sense of control, and a perception of being a burden were significantly associated with depressive symptoms and guilt for perceiving oneself as a burden.

DISCUSSION

This study documents potential correlates of psychological distress in older adults with no explicit physical or cognitive problems, suggesting paths through which feelings of guilt for perceiving oneself as a burden may be reported by this population.

The role of meaning in life as a protective factor in suicidal ideation among elderly men with physical illnesses

The highest suicide rates are among elderly men. The aim of the present study is to extend previous findings by focusing on meaning in life as a protective factor for suicidal ideation among elderly men. Self-report measures were administered to 170 elderly men aged 65 and over in community. Meaning in life and physical illness predicted suicidal ideation among elderly men. Physical illness moderated the association between meaning in life and suicidal ideation. In the young-old group (ages 65-74), meaning in life predicted suicidal ideation among those who reported higher rates of physical illness. This moderation effect was not found among the older group (aged 75 years and older). The findings of this study highlight the importance of age-differences in studying suicidal ideation among elderly men. Our findings emphasize the importance of cultivating and maintaining meaning in life when coping with chronic illnesses and point at meaning in life as a goal in therapeutic interventions designed to reduce suicidal ideation among elderly.

Examining the relations between hopelessness, thwarted interpersonal needs, and passive suicide ideation among older adults: does meaning in life matter?

Older adults are at an elevated risk for passive suicide ideation. The interpersonal theory of suicide and the 3-step theory may provide a framework to better understand factors that contribute to passive suicide ideation among older adults. Specifically, this study aimed to test components of prominent suicide theories and examine the role of meaning in life in the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Participants were 243 adults aged 60 and older recruited from primary care settings in the southwest United States. We hypothesized that high meaning in life would weaken the associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation. Results from moderation analyses indicate that meaning in life was a significant moderator of the associations between hopelessness and passive suicide ideation, thwarted belongingness and passive suicide ideation, and perceived burdensomeness and passive suicide ideation. These findings suggest that when meaning in life is low there are significant negative associations between hopelessness, thwarted belongingness, perceived burdensomeness and passive suicide ideation among older adults. Implications, limitations, and future directions are discussed.

A Pilot Randomized Trial of Engage Psychotherapy to Increase Social Connection and Reduce Suicide Risk in Later Life

BACKGROUND

Targeting social connection to prevent suicide in later life shows promise but requires additional study to identify the most effective and acceptable interventions. This study examines acceptability, feasibility, and efficacy of Engage Psychotherapy to improve subjective disconnection (target mechanisms: low belonging and perceived burden), and improve clinical and functional outcomes (depression, suicide ideation, quality of life).

METHODS

Pilot randomized trial with adults age 60 and older who reported feeling lonely and/or like a burden. Participants were randomly assigned to 10 sessions of 'Social Engage' (S-ENG; n = 32) or care-as-usual (CAU; n = 30), with follow-up assessments at 3 weeks, 6 weeks, and 10 weeks.

RESULTS

S-ENG is feasible to deliver over 10 sessions and acceptable to older adults who report social disconnection-a population at risk for suicide. Participants were willing and able to focus each session on social engagement and demonstrated high levels of compliance. Social Engage did not show preliminary evidence of impact on belonging or perceived burden but was effective in reducing depressive symptoms and improving social-emotional quality of life.

DISCUSSION

S-ENG holds promise for improving social-emotional quality of life and depressive symptoms. Future research is needed to identify and measure target mechanisms that account for clinical and functional improvement.

Impact of an artist-in-residence program in a complex continuing care hospital: a quality improvement investigation

Background: The objective was to assess the impact of an Artist-in-Residence (AiR) program on the quality of life of patients living at a complex continuing care hospital.Methods: In the AiR program, a professional Artist facilitated the creation of community art projects by patients in groups (before COVID-19) and individually (during COVID-19). Four patients, four staff and one family member involved with the program were interviewed to assess their experiences.Results: Themes identified included improvements in spiritual, mental and community health, creation of a sense of community, learning skills and knowledge surrounding art and culture, and the importance of the Artist's personal characteristics/personality. It was recommended to continue and expand the program.Conclusions: The patients deeply enjoyed the AiR program and working with the Artist. Non-patient participants also recognized benefits for the hospital community. Procurement of stable funding and expansion of the program are areas to focus on next.

Risk of Suicide Attempt in Patients With Recent Diagnosis of Mild Cognitive Impairment or Dementia

IMPORTANCE

Little is known about the association between mild cognitive impairment (MCI) and suicide. Most studies have focused on dementia and suicidal behavior, with inconsistent results.

OBJECTIVES

To examine the association between diagnoses of MCI and dementia and suicide attempt and explore potential psychiatric moderators and to assess whether the association differs based on recency of diagnosis.

DESIGN, SETTING, AND PARTICIPANTS

This nationwide cohort study integrated 5 national databases from the Department of Veterans Affairs (VA) and Centers for Medicare & Medicaid Services and included all VA medical centers in the US. US veterans 50 years or older with MCI diagnoses at baseline (October 1, 2011, to September 30, 2013) or earlier (October 1, 2007, to September 30, 2011) were propensity matched 1:3 with (1) patients with dementia diagnoses and (2) patients without either diagnosis based on demographic characteristics and the Charlson Comorbidity Index. Diagnoses of MCI or dementia were defined as recent if there were no diagnosis codes before baseline. Data were analyzed from March 16, 2020, to January 15, 2021.

MAIN OUTCOMES AND MEASURES

Information on suicide attempts through December 31, 2016, provided by the National Suicide Prevention Applications Network (nonfatal) and Mortality Data Repository (fatal).

RESULTS

The study population of 147 595 participants included 21 085 patients with MCI, 63 255 with dementia, and 63 255 in the propensity-matched comparison group. Participants had a mean (SD) age of 74.7 (10.3) years, 143 353 (97.1%) were men, 4242 (2.9%) were women, and 127 065 (86.1%) were non-Hispanic White. A total of 138 patients with MCI (0.7%) and 400 patients with dementia (0.6%) attempted suicide during follow-up, compared with 253 patients without MCI or dementia (0.4%). Exploratory analyses revealed that no psychiatric comorbidity moderated the association between MCI or dementia and suicide attempt. After adjustment for demographic details and medical and psychiatric comorbidities, risk of suicide attempt was consistently highest for patients with a recent MCI or dementia diagnosis, with adjusted hazard ratios (HRs) of 1.73 (95% CI, 1.34-2.22; P < .001) for recent MCI and 1.44 (95% CI, 1.17-1.77; P = .001) for recent dementia. Risk associated with prior diagnosis was not significant (HR for prior MCI, 1.03 [95% CI, 0.78-1.36; P = .84]; HR for prior dementia, 1.14 [95% CI, 0.95-1.36; P = .15]).

CONCLUSIONS AND RELEVANCE

This study found that older adults with recent MCI or dementia diagnoses were at increased risk of attempting suicide. These findings suggest that involvement of supportive services at the time of or soon after diagnoses of MCI or dementia may help mitigate risk of suicide attempts.

Loneliness and social integration as mediators between physical pain and suicidal ideation among elderly men

OBJECTIVES

Suicide in the elderly is a complex and significant public health problem. The purpose of our study was to examine the role of loneliness and social integration as potential mediators in the relationship between physical pain and suicidal ideation in the elderly.

DESIGN

Descriptive, bivariate correlations, and moderated mediation analyses were performed.

SETTING

Personal meetings were held with participants in their homes.

PARTICIPANTS

A total of 198 elderly men aged 65 and over.

MEASUREMENTS

Self-report measures: Beck Scale for Suicidal Ideation, Physical pain subscale, Multidimensional Social Integration in Later Life Scale, and University of California, Los Angeles (UCLA) Loneliness Scale (Version 3).

RESULTS

Our findings showed that the association between physical pain and suicidal ideation was mediated by loneliness and social integration. Further analyses revealed that this mediation model was significant among single, but not married, men.

CONCLUSIONS

Physical pain and social factors are both important in understanding suicidality in late life. Elderly single men who experience physical pain may be lonelier and less socially integrated, and these factors may contribute to higher risk of suicidal ideation.

Linking Service Quality Attributes to Meaning-in-Life Outcomes for Residents Who Have Transitioned to an Assisted Living Community

The growing number of persons aged 65 and older, combined with their greater reliance on care outside the family unit, has contributed to the rapid growth of older people residing in assisted living (AL) communities. Given the increased attention paid to service standards in older adults' housing models, this qualitative study was conducted in AL to generate residents' perspectives on service and meaning-in-life outcomes. Utilizing the attributes of service quality through a transition theory lens, the data revealed empathy and responsiveness as most essential to the perceptions of service and meaning-in-life among residents. Theoretical results from this study suggest that linking current service theory to meaning-in-life outcomes would be of benefit to AL service standards research. Practical application of the research outcomes revealed how appropriate personalized attention provided in a timely manner to residents is critical to their well-being, and to their successful transition to AL.

The Role of Demoralization and Meaning in Life (DEMIL) in Influencing Suicidal Ideation Among Patients Affected by Chronic Pain: Protocol of a Single-Center, Observational, Case-Control Study

BACKGROUND

Chronic pain is a significant risk factor for suicidal ideation (SI) and suicidal behavior (SB), including a 20%-40% prevalence rate of SI, a prevalence between 5% and 14% of suicide attempts, and a doubled risk of death by suicide in patients with chronic pain compared to controls. In most studies, associations between chronic pain and suicidality are robust, even after adjusting for the effect of sociodemographics and psychiatric comorbidity, and particularly for depressive conditions. A number of specific conditions that can modulate suicidality risk in patients with chronic pain have been investigated, but there is a need for their more specific characterization. Numerous recent studies have shown that demoralization and meaning in life (MiL) constructs affect suicidality as risk and protective factors, respectively. These constructs have been mainly investigated in patients with somatic illness and in community-dwelling individuals who may present with SI or SB independently of a psychiatric diagnosis of depression. However, a paucity of studies investigated them in suicidal patients affected by chronic pain.

OBJECTIVE

The primary objective of this project is to investigate the relationship between demoralization and MiL on SI risk in patients with chronic pain. The secondary objectives are (1) to test whether demoralization can occur independently of depression in patients with chronic pain and SI, (2) to examine whether the expected association between demoralization and SI may be explained by a sole dimension of demoralization: hopelessness, (3) to examine whether the presence of MiL, but not the search for MiL, is associated with less SI, and (4) to explore whether previously described MiL profiles (ie, high presence-high search, high presence-low search, moderate presence-moderate search, low presence-low search, and low presence-high search) emerge in our cohort.

METHODS

This project is a single-center, observational, case-control study-the Demoralization and Meaning in Life (DEMiL) study-conducted by the Division of Clinical Pharmacology and Toxicology, the Multidisciplinary Pain Centre, and the Service of Liaison Psychiatry and Crisis Intervention at the Geneva University Hospitals. Self- and hetero-administered questionnaires were conducted among patients and controls, matched by age and gender. The Ethics Committee of the Canton of Geneva approved the scientific utilization of collected data (project No. 2017-02138; decision dated January 25, 2018). Data have been analyzed with SPSS, version 23.0, software (IBM Corp).

RESULTS

From March 1, 2018, to November 30, 2019, 70 patients and 70 controls were enrolled. Statistical analyses are still in progress and are expected to be finalized in November 2020. To date, we did not observe any unfavorable event for which a causal relationship with the collection of health-related personal data could be ruled out. Results of this study are expected to form the basis for possible prevention and psychotherapeutic interventions oriented toward demoralization and MiL constructs for suicidal patients with chronic pain.

CONCLUSIONS

The interest in exploring demoralization and MiL in chronic pain patients with SI arises from the common clinical observation that experiencing chronic pain often requires a revision of one's life goals and expectations. Hence, the impact of chronic pain is not limited to patients' biopsychosocial functioning, but it affects the existential domain as well. The major clinical implications in suicidal patients with chronic pain consist in trying to (1) delineate a more precise and individualized suicide risk profile, (2) improve detection and prevention strategies by investigating SI also in individuals who do not present with a clinically diagnosed depression, and (3) enhance the panel of interventions by broadening supportive or psychotherapeutic actions, taking into consideration the existential condition of a person who suffers and strives to deal with his or her suffering.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/24882.

Meaning in Life and Demoralization Constructs in Light of the Interpersonal Theory of Suicide: A Trans-Theoretical Hypothesis for a Cross-Sectional Study

Following V. Frankl's (in the 1950s) and J. Frank's (in the 1970s) historical definitions of the constructs Meaning in Life (MiL) and demoralization, there have been a multitude of studies which have described them from different theoretical perspectives. These constructs are closely linked, with the lack of MiL as one of the subconstructs underlying the definition of demoralization. Numerous studies have shown that MiL and demoralization affect suicidality, as protective and risk factors, respectively. The Interpersonal Theory of Suicide (IPTS) is a more recent framework conceptualized by T. Joiner (in the 2000s) to provide an additional possible reading key in the effort to better understand suicidality. By analogy to a previous study by E. Kleiman & J. Beaver (2013), examining MiL and demoralization in suicidality through a perspective of the IPTS framework can be of considerable interest. This study showed, in a cohort of undergraduate students, that MiL mediated the relationship between two variables associated with IPTS (perceived burdensomeness and thwarted belongingness) and suicidal ideation (SI). Taking into consideration future studies that these latter authors advocated, our aim is to verify this finding using a cross-sectional study. Differences in our approach would include a) studying a clinical population (suicidal patients attending an emergency department), b) analyzing relationships not only with SI but also with suicidal attempts (SA), and c) in consideration of the interconnection between MiL and demoralization, exploring also the possible role of demoralization as a mediator. The clinical implication lies in identifying multi-faceted targets that may be useful to mitigate suicidality risk in individuals, both in prevention and therapy intervention.

Testing the Effectiveness of a Salutogenic Model for Reducing Suicidal Tendencies in a Population of Elderly and Young Adults

Suicide is a leading cause of mortality worldwide, with the elderly having the highest suicide rates. This study tests the effectiveness of a salutogenic model in normative elderly people compared with young adults in protecting against risk behaviors and suicidal tendencies, based on two variables: locus of control and meaning in life (mediating variable between locus of control and suicidal tendency). Participants were 191 people aged 65 to 100 years and 200 young adults aged 18 to 28 years old. Participants completed questionnaires on locus of control and purpose in life and were assessed for suicidal tendencies. Findings reveal a negative effect of age on locus of control, purpose in life, and a negative correlation between purpose in life and internal locus of control and suicidal tendency. Purpose in life mediates between internal locus of control and suicidal tendency in both populations. The salutogenic model has significant implications and can be used to reduce suicidal tendencies.

Nurse's attunement to patient's meaning in life - a qualitative study of experiences of Dutch adults ageing in place

BACKGROUND

Meaning in life (MiL) is considered to be an important part of health and is associated with many positive outcomes in older adults, such as quality of life and longevity. As health promotors, nurses may take patients' MiL into account in the care process. There is a knowledge gap in terms of what constitutes good care in relation to older patients' MiL, and what the benefits may be for patients when nursing is attuned to this aspect. The purpose of this study was to explore the experiences of home nursing older adults in relation to nurses' attunement to MiL.

METHODS

Gadamerian hermeneutic phenomenological design with semi-structured interviews. Participants were 24 aged home nursing patients. A framework of care ethical evaluation was used in the analysis. Multiple dialogues enhanced understanding.

RESULTS

Patients did not expect nurses' regard for their MiL. They rather expected 'normal contact' and adequate physical care. Nurses showed that they were open to patients' MiL by being interested in the patient as a person and by being attentive to specific and hidden needs. Participants explained that the nurse's behaviour upon arrival set the tone: they knew immediately if there was room for MiL or not. All participants had positive and negative experiences with nurses' behaviour in relation to MiL. Valued nursing care included maintaining a long, kind and reciprocal relationship; doing what was needed; and skilled personalised care. Participants mentioned 'special ones': nurses who attuned to them in a special way and did more than expected. Benefits of care that was attuned to patients' MiL were: experiencing a cheerful moment, feeling secure, feeling like a valuable person and having a good day. Older adults also stressed that consideration for MiL helps identify what is important in healthcare.

CONCLUSION

Aged homecare patients value nurses' attunement to their MiL positively. Although patients regard MiL mostly as their own quest, nurses play a modest yet important role. Managers and educators should support nurses' investment in reciprocal nurse-patient relationships.

Suicide prevention from a public health perspective. What makes life meaningful? The opinion of some suicidal patients

BACKGROUND AND AIM OF THE WORK

Suicide is a worldwide phenomenon, with a relevant number of victims. Moreover, repercussions of suicidality-across its entire spectrum-involve not only the individual but also survivors and communities, in a profound and lasting way. As such, suicidality represents a crucial public mental health concern, in which risk/protection factors' study represent a key issue. However, research primarily focused on suicidality risk factors. This study, moving from Frankl's first observations on "Meaning in Life" (MiL) as protective against suicidality, aimed to identify the main themes that suicidal patients identified as MiL carriers, or potential carriers, in their existences.

METHODS

Qualitative study on 144 patients admitted to the Geneva University Hospital's emergency department for suicidal ideation (SI) and suicide attempt (SA).  Results: Interpersonal/affective relationships constituted the main theme (71.53%), with emphasis on family (39.80%), children/grandchildren (36.89%). Profession/education, intellectual/non-intellectual pleasures, and transcendental dimension also emerged.

CONCLUSIONS

These aspects could be considered among a public health agenda's points for suicide prevention programs taking into account also protective factors promotion/support, including community's mental health resources. Reconnecting to introduction's historical part, our findings are consistent with Frankl's observations. Even if exposed to "absurd" and reluctant to deliberate on this, he seems approach Camus conceptualization who, confronted to the necessity of predictable and conform to recognizable personal patterns transcending chaos for a sense-giving perspective, invited to imagine that a meaning, even a "non-absolute meaning", may lie in apparent smallest things and that Sisyphus can have "the possibility to revolt by trying to be happy".

Perceived Burdensomeness and the Wish for Hastened Death in Persons With Severe and Persistent Mental Illness

Background: In several European countries, medical assistance in dying (MAID) is no longer confined to persons with a terminal prognosis but is also available to those suffering from persistent and unbearable mental illness. To date, scholarly discourse on MAID in this population has been dominated by issues such as decision-making capacity, uncertainty as to when a disease is incurable, stigmatization, isolation, and loneliness. However, the issue of perceived burdensomeness has received little attention. Objective: The study explores the possible impact of perceived burdensomeness on requests for MAID among persons with severe and persistent mental illness (SPMI). Method: Using the method of ethical argumentation, we discuss the issue of access to MAID for persons with SPMI and perceived burdensomeness. Conclusion: Perceived burdensomeness may be a contributing factor in the wish for hastened death among persons with SPMI. MAID is ethically unsupportable if SPMI causes the individual to make an unrealistic assessment of burdensomeness, indicating a lack of decision-making capacity in the context of that request. However, the possibility that some individuals with SPMI may perceive burdensomeness does not mean that they should be routinely excluded from MAID. For SPMI patients with intact decision-making capacity who feel their life is not worth living, perceived burdensomeness as a component of this intolerable suffering is not a sufficient reason to deny access to MAID.

Relationships between individual characteristics and occupational possibilities for young adults with visual impairments

Individuals with disabilities highlight the importance of having career options, as these people are more likely to have narrowed occupational possibilities and to be employed in part-time and contingent jobs. This study explores (a) the range of occupational possibilities that according to Holland’s Self- Directed Search (SDS) Questionnaire most closely resemble the personality types of 55 young adults with visual impairments, b) the impact of individual characteristics on occupational possibilities, and c) the differences between sighted adults and adults with visual impairments regarding the SDS Questionnaire scores for the six personality types (Realistic, Investigative, Artistic, Social, Enterprising, Conventional). The research instrument was the SDS Questionnaire of Holland. The study results showed that the occupational possibilities for young adults with visual impairments relate mostly to social occupations. Individual characteristics also were found to be significant predictors of individual types according to the SDS Questionnaire. In addition, differences emerged from the comparison between adults with visual impairments and sighted adults in regard to the six personality types identified by Holland, based on the normative data. The study revealed that individual characteristics of young adults with visual impairments play an important role in their occupational possibilities.

Gratitude and Suicidal Ideation in Undergraduates in Taiwan: The Mediating Role of Self-Esteem and Meaning in Life

This study examined both the mediation effects of self-esteem and meaning in life for the relationship between gratitude and suicidal ideation in late adolescence. A total of 276 Taiwanese university students completed measures of gratitude, self-esteem, meaning in life, and suicidal ideation. Path analyses indicated that self-esteem and meaning in life acted as full mediators of the association between gratitude and suicidal ideation. The identified model also revealed a significant path from gratitude through self-esteem and meaning in life to suicidal ideation. A multigroup analysis found that the paths did not differ by genders. Implications for future research and limitations of the present findings are discussed.

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

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

The Meaning of a Visual Arts Program for Older Adults in Complex Residential Care

Cette étude qualitative explore les expériences vécues par des personnes âgées participant dans un programme d’arts visuels créatifs dans un établissement de soins de Victoria (Colombie-Britannique). Une approche par enquête narrative a été utilisée dans le cadre d’entretiens en personne menés avec dix résidents et trois membres du personnel du programme. Les activités du programme et l’exposition artistique qui y était associée ont aussi fait l’objet d’une observation systématique. Les résultats démontrent que le programme a stimulé le sentiment de communauté des participants et augmenté leur estime d’eux-mêmes, en tant qu’artistes. Une exposition artistique publique dans un centre communautaire a permis de souligner la valeur de leur production artistique et a conféré un sens et un but à leur implication dans le programme. Les résultats démontrent l’importance des programmes artistiques stimulant la créativité chez la population âgée. Ils illustrent aussi que les personnes vivant en institution peuvent prendre conscience des multiples dimensions de leur personnalité à travers l’expression artistique. Cette étude souligne la pertinence d’accroître l’accès à des programmes artistiques pour les individus vivant en établissements de soins.

Experimentally-enhanced perceptions of meaning confer resilience to the interpersonal adversity implicated in suicide risk

BACKGROUND AND OBJECTIVES

The interpersonal theory of suicide proposes that perceived burdensomeness and thwarted belongingness (PB-TB) are proximal causes of suicidal desire. Here we test whether experimentally induced perceptions of meaningfulness can confer resilience against interpersonal adversity and enhance persistence, the erosion of which is a potential antecedent to suicide risk.

METHODS

Undergraduate university students (N = 93) were randomly allocated to complete a team task under conditions of high or low task-extrinsic meaning and high or low PB-TB. Participants in the high task-extrinsic meaning condition were given the opportunity to donate to a charity as part of their experimental participation, whereas those in the low task-extrinsic meaning condition were not.

RESULTS

Consistent with the buffering hypothesis that suicide resilience is active only when adversity is heightened, participants in the high task-extrinsic meaning condition who reported higher levels of perceived meaningfulness displayed greater willingness to persist in the face of experimentally-induced high PB and TB compared to those in the low task-extrinsic meaning condition and those in conditions where the interpersonal adversity was not induced (low PB and TB).

LIMITATIONS

The meaning induction was effective only in a subset of participants. The dual induction of PB and TB also precludes inferences about their independent causal effects on willingness to persist.

CONCLUSIONS

Meaning-making interventions may attenuate the impact of proximal interpersonal antecedents of suicidal desire. Enhancing resilience in this manner can potentially improve the efficacy of prevention efforts beyond the direct amelioration of suicide risk factors.

Attitudes towards end-of-life decisions in case of long-term care dependency: a survey among the older population in Austria

BACKGROUND

Research on attitudes towards end-of-life decisions (ELDs) contextually most often refers to the very end of life, that is, to situations of terminally ill patients or severe pain, but it is rarely applied to the broader context of long-term care dependency in old age.

METHODS

In a representative survey among older Austrians (50+, n=968), respondents were asked about their approval of assisted suicide and euthanasia (EUT) when requested by an older, severely care-dependent person. The influence of sociodemographics, care-related experiences and expectations, religiosity, trust, locus of control and concerns regarding constrictions of old age on the approval of both these ELDs was assessed through logistic regression analyses.

RESULTS

42% and 34% of the respondents approved assisted suicide and EUT, respectively, in case of care dependency. Non-religious individuals, less trusting respondents and those concerned about constrictions associated with old age were more likely to approve both these ELDs.

CONCLUSIONS

Widespread concerns regarding long-term care dependency in old age should be addressed in information campaigns, and public discourse about ELDs should pay more attention to situations of long-term care dependency.

Suicide Risk, Meaning in Life, and Need for Life Respect in Adults and Elderly Among Public Hospital Outpatients in South Korea: A Cross-Sectional Survey

The purpose of this study was to identify the differences in suicide risk, meaning in life, and need for life respect among three age groups (young adults, the middle aged, and the elderly) of 540 public hospital outpatients in South Korea. This was a cross-sectional study. Among these 3 age groups, we observed significant differences in suicide risk, meaning in life, and need for life respect according to education level, marital status, living arrangements, type of disease, gender, and monthly income. These findings might contribute to the prevention of suicide in the future and the implementation of better community-based nursing care.

Meaning in life of older persons: An integrative literature review

Background:

Meaning in life of older persons is related to well-being, health, quality of life, and “good life.” However, the topic is scarcely covered in nursing literature.

Objective:

The aim of this integrative review for nurses is to synthesize knowledge from scholarly literature to provide insight into how older persons find meaning in life, what are influencing circumstances, and what are their sources of meaning. The review serves as a starting point for including meaning in life of older persons as a major concern for nurses in their role as health promoters.

Method:

An integrative review was performed including empirical research literature and texts on theoretical perspectives.

Ethical consideration:

Researches agree with ethical codes for research of universities in the Netherlands. For literature reviews no additional procedures are necessary according to Dutch law.

Findings:

A total of 44 heterogeneous texts were included in this review. Finding meaning in life is challenging for older persons. Older persons find meaning through a developmental process, by creating and discovering. Meaning in life is found in connection with self and others. Health, living together, high socio-economic status, social relations, activities, and religion are associated with experiencing meaning in later life. The main source of meaning in life of older persons is human relationships. Other sources of meaning in life vary by age and culture.

Discussion:

The review provides insight into meaning in life of older persons. There are several gaps in knowledge: literature is culturally biased, research on discovery of meaning and daily meaning is limited, and research from a nursing perspective is lacking. In practice, nurses have many opportunities to attune to meaning in life of patients. Further development of competence and training are needed.

Conclusion:

Older persons find meaning in life through different processes. Meaning in life is associated with the circumstances old persons live in. Human relationship is the major source of meaning. The knowledge from this review is a necessary knowledge base for nurses to include meaning in life of older patients in care. Further research is needed to explore the role of nurses.

Death ideation in older adults: psychological symptoms of depression, thwarted belongingness, and perceived burdensomeness

Death ideation is commonly reported by older adults in the United States; however, the factors contributing to death ideation in older adults are not fully understood. Depressive symptoms, as well as components of the interpersonal theory of suicide, perceived burden, and thwarted belonging may contribute to death ideation.

OBJECTIVES

The purpose of this study was to investigate the moderating relationship of the psychological symptoms of depression on the relation between perceived burdensomeness and death ideation, and thwarted belongingness and death ideation.

METHOD

A sample of 151 older adults completed questionnaires assessing numerous covariates, as well as perceived burdensomeness, thwarted belongingness, death ideation, and the psychological symptoms of depression.

RESULTS

The results of this study indicated that the proposed moderating relationship was supported for the relationship between perceived burdensomeness and death ideation, but was not supported for the relationship between thwarted belongingness and death ideation when covariates (loneliness and hopelessness) were controlled.

CONCLUSION

This suggests that the psychological symptoms of depression are significantly associated with death ideation in older adults experiencing feelings of perceived burdensomeness. Additionally, the findings suggest that loneliness and hopelessness are also important factors to consider when assessing death ideation in older adults.

Does Recognition of Meaning in Life Confer Resiliency to Suicide Ideation Among Community-Residing Older Adults? A Longitudinal Investigation

OBJECTIVE

To test a theoretical model of the onset and/or exacerbation of late-life suicide ideation, incorporating consideration of risk, resiliency, and precipitating factors.

DESIGN

A longitudinal study investigating whether recognition of meaning in life (MIL) at baseline confers resiliency to the onset and/or exacerbation of suicide ideation over a 6- to 22-month period of follow-up, controlling for baseline depression, self-rated health, and physical functioning, and for frequency and intensity of intervening daily hassles.

SETTING

Mental health research offices in an urban academic health sciences center.

PARTICIPANTS

173 community-residing older adults (mean: 73.9 years, SD: 6.1 years, range: 65-93 years) recruited from health, wellness, and interest programs, and from newspaper ads and flyers posted in London, Ontario, a mid-sized Canadian city. A total of 126 (73%) completed follow-up assessments.

MEASUREMENTS

Participants completed a demographics form, a cognitive screen, and measures of suicide ideation and of risk (depressive symptom severity, self-rated health problems, and physical functioning) and potential resiliency (recognition of MIL) factors at baseline and follow-up assessment points, and a measure of intervening daily hassles.

RESULTS

MIL at baseline was negatively associated with the onset and/or exacerbation of suicide ideation over time, controlling for risk factors and intervening precipitating factors. The extent and relative significance of this finding differed with the manner in which MIL and suicide ideation were operationalized.

CONCLUSIONS

Study findings add to a growing body of knowledge suggesting that MIL may play an important role in promoting mental health and well-being and potentially conferring resiliency to contemplations of suicide in later life.

Spirituality attenuates the association between depression symptom severity and meaning in life

OBJECTIVES

This cross-sectional study examined whether spirituality moderates the association between depression symptom severity and meaning in life among treatment-seeking adults.

METHOD

Participants were 55 adults (≥60 years of age) newly seeking outpatient mental health treatment for mood, anxiety, or adjustment disorders. Self-report questionnaires measured depression symptom severity (Patient Health Questionnaire-9), spirituality (Spirituality Transcendence Index), and meaning in life (Geriatric Suicide Ideation Scale-Meaning in Life subscale).

RESULTS

Results indicated a significant interaction between spirituality and depression symptom severity on meaning in life scores (β = .26, p = .02). A significant negative association between depression symptom severity and meaning in life was observed at lower but not the highest levels of spirituality.

CONCLUSION

In the presence of elevated depressive symptomatology, those participants who reported high levels of spirituality reported comparable levels of meaning in life to those without elevated depressive symptomatology. Assessment of older adult patients' spirituality can reveal ways that spiritual beliefs and practices can be can be incorporated into therapy to enhance meaning in life.

The interpersonal needs questionnaire with a shortened response scale for oral administration with older adults

OBJECTIVES

The purpose of this paper is to examine the psychometric properties and construct validity of the interpersonal needs questionnaire (INQ) using a modified three-point response scale for oral administration with older adults.

METHODS

In-home interviews were conducted with 269 participants aged 60 and older who were completing an eligibility interview for a randomized control trial. The INQ was administered orally, as were measures of social support, death and suicide ideation, and meaning in life.

RESULTS

A confirmatory factor analysis demonstrated acceptable fit, with all of the items loading significantly onto the associated latent variable of thwarted belongingness or perceived burdensomeness. Construct validity of the measure was supported through an examination of discriminant validity using constructs hypothesized by the interpersonal theory of suicide to be related to the measured constructs, including social support and social integration for thwarted belongingness, social worth and death ideation for perceived burdensomeness, and meaning in life and suicide ideation for both.

CONCLUSION

The INQ yields reliable and valid scores of thwarted belongingness and burdensomeness when administered orally using a shortened response scale with older adults. These results help establish the measure as a valuable and practical tool for use in the field of late-life suicide prevention.

Too Much to Bear: Psychometric Evidence Supporting the Perceived Burdensomeness Scale

BACKGROUND

People who feel they have become a burden on others may become susceptible to suicidal ideation. When people no longer feel capable or productive, they may assume that friends and family members would be better off without them.

AIM

The present study was designed to assess preliminary psychometric properties of a new measure, the Perceived Burdensomeness (PBS) Scale.

METHOD

Depressed psychiatric patients (N = 173) were recruited from a veterans affairs medical center. Patients were assessed with a structured diagnostic interview and self-report measures assessing perceived burdensomeness, depression severity, hopelessness, and suicidal ideation.

RESULTS

The present study supported preliminary evidence of reliability and concurrent validity of the PBS. Additionally, perceived burdensomeness was significantly associated with higher levels of hopelessness and suicidal ideation.

CONCLUSION

It is hoped that with the aid of the PBS clinicians may be able to intervene more specifically in the treatment of suicidality.

Adapting interpersonal psychotherapy for older adults at risk for suicide

OBJECTIVE

To pilot a psychological intervention adapted for older adults at risk for suicide.

DESIGN

A focused, uncontrolled, pre-to-post-treatment psychotherapy trial. All eligible participants were offered the study intervention.

SETTING

Outpatient mental health care provided in the psychiatry department of an academic medical center in a mid-sized Canadian city.

PARTICIPANTS

Seventeen English-speaking adults 60 years or older, at risk for suicide by virtue of current suicide ideation, death ideation, and/or recent self-injury.

INTERVENTION

A 16-session course of Interpersonal Psychotherapy (IPT) adapted for older adults at risk for suicide who were receiving medication and/or other standard psychiatric treatment for underlying mood disorders.

MEASUREMENTS

Participants completed a demographics form, screens for cognitive impairment and alcohol misuse, a semi-structured diagnostic interview, and measures of primary (suicide ideation and death ideation) and secondary study outcomes (depressive symptom severity, social adjustment and support, psychological well-being), and psychotherapy process measures.

RESULTS

Participants experienced significant reductions in suicide ideation, death ideation, and depressive symptom severity, and significant improvement in perceived meaning in life, social adjustment, perceived social support, and other psychological well-being variables.

CONCLUSIONS

Study participants experienced enhanced psychological well-being and reduced symptoms of depression and suicide ideation over the course of IPT adapted for older adults at risk for suicide. Larger, controlled trials are needed to further evaluate the impact of this novel intervention and to test methods for translating and integrating focused interventions into standard clinical care with at-risk older adults.

Does the Experience of Interpersonal Predictors of Suicidal Desire Predict Positive Attitudes Toward Physician Assisted Suicide?

The current study examined the relationship between Physician Assisted Suicide (PAS) attitudes and interpersonal risk factors of suicidal desire as outlined by the interpersonal-psychological theory of suicidal behavior (Joiner, 2005). It was hypothesized that both thwarted belongingness and perceived burdensomeness would be positively related to PAS acceptance. Results indicated that thwarted belongingness and perceived burdensomeness predicted significance of favorable attitudes toward PAS in a college sample. Results suggest that attitudes toward PAS may be influenced by the experience of thwarted belongingness and perceived burdensomeness and provide a clear rationale for the study of these variables in populations more apt to consider hastened death. Future work regarding the application of the interpersonal-psychological theory of suicidal behavior in hastened death research is discussed.

Well-being of elderly stroke survivors in Chinese communities: mediating effects of meaning in life

OBJECTIVES

This study aims to examine the role of meaning in life as a mediator for the relationship of physical functioning, social support, and optimism with well-being among elderly Chinese stroke survivors.

METHOD

A cross-sectional study was conducted on 214 community-dwelling older stroke survivors (128 men and 86 women), ranging from 60 to 88 years. The physical functioning, social support, optimism, meaning in life, and subjective well-being of the participants were measured.

RESULTS

Structural equation modeling revealed that meaning in life fully mediates the relationship of physical functioning, social support, and optimism with subjective well-being.

CONCLUSION

This study examines the role of meaning in life in stroke experience from an existential perspective. The modifiable features of meaning in life may offer an intervening angle for improving the well-being of elderly stroke survivors.

A meaningful life is worth living: meaning in life as a suicide resiliency factor

Given the high rate of suicide worldwide, it is imperative to find factors that can confer resiliency to suicide. The goal of the present study was to examine the search for and the presence of meaning in life as possible resilience factors. We hypothesized that the presence of, but not the search for, meaning in life would predict decreased suicidal ideation over an eight-week time period and decreased lifetime odds of a suicide attempt. We also examined a subsidiary hypothesis that the presence of, but not the search for, meaning in life would mediate the relationship between the two variables associated with the interpersonal psychological theory of suicide (i.e., perceived burdensomeness and thwarted belongingness) and suicidal ideation. Our results were generally in support of our hypothesis: presence of meaning in life predicted decreased suicidal ideation over time and lower lifetime odds of a suicide attempt. Surprisingly, search for meaning in life also predicted decreased suicidal ideation over time. Finally, the search for, but not presence of, meaning in life mediated the relationship between the interpersonal psychological theory variables and suicidal ideation. These findings suggest that interventions that target meaning in life may be useful to attenuate suicide risk in individuals.

Meaning-in-life in nursing-home patients: a correlate with physical and emotional symptoms

AIMS AND OBJECTIVES

To investigate the prevalence of physical and emotional symptoms and the associations between symptoms and meaning-in-life in a cognitively intact nursing-home population.

BACKGROUND

Meaning has been found to be a strong individual predictor of successful ageing and life satisfaction as well as an important psychological variable that promotes well-being. Meaning serves as a mediating variable in both psychological and physical health.

DESIGN AND METHODS

The study employed a cross-sectional design. Data were collected in 2008 and 2009 using the QLQ-C15-PAL quality-of-life questionnaire, the purpose-in-life test and the Hospital Anxiety and Depression Scale. A total of 250 cognitively intact nursing-home patients who met the inclusion criteria were approached and 202 attended.

RESULTS

The prevalence of symptoms was fairly high, with fatigue (57%), pain (49%), constipation (43%) and dyspnoea (41%) as the most frequent physical symptoms, while 30% were depressed and 12% had anxiety. Significant correlations between meaning-in-life and symptom severity were displayed.

CONCLUSIONS

The level of symptom severity among cognitively intact nursing-home patients is high, requiring highly competent staff nurses. Meaning-in-life might be an important resource in relation to a patient's physical and emotional health and global well-being.

RELEVANCE TO CLINICAL PRACTICE

Facilitating patients' meaning-in-life might help reducing symptom severity and fostering quality of life in cognitively intact nursing-home patients. However, advancing staff nurses' competence in palliative care, symptom management and nurse-patient interaction is important for care quality and quality if life in nursing homes.