Hostname: page-component-f554764f5-rvxtl Total loading time: 0 Render date: 2025-04-16T17:39:33.896Z Has data issue: false hasContentIssue false
  • English
  • Français

Meaning of life, representation of death, and their association with psychological distress

Published online by Cambridge University Press:  09 August 2017

Ines Testoni ,
Giulia Sansonetto ,
Lucia Ronconi ,
Maddalena Rodelli ,
Gloria Baracco  and
Luigi Grassi
Ines Testoni*
Affiliation:
Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padua, Padua, Italy
Giulia Sansonetto
Affiliation:
Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padua, Padua, Italy
Lucia Ronconi
Affiliation:
Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padua, Padua, Italy
Maddalena Rodelli
Affiliation:
Department of Philosophy, Sociology, Education, and Applied Psychology, University of Padua, Padua, Italy
Gloria Baracco
Affiliation:
Department of Health, Local Health Authorities 8, Asolo, Italy
Luigi Grassi*
Affiliation:
Department of Biomedical and Specialty Surgical Sciences, Institute of Psychiatry, University of Ferrara, Ferrara, Italy Hospital University Psychiatry Unit, Sant'Anna University Hospital and Local Health Trust, Ferrara, Italy
*
Address correspondence and reprint requests to: Luigi Grassi, Department of Biomedical Sciences, Institute of Psychiatry, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy. E-mail: [email protected] and Ines Testoni, Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padua, Piazza Capitaniato, 3, 35139 Padova, Italy E-mail: [email protected].
Address correspondence and reprint requests to: Luigi Grassi, Department of Biomedical Sciences, Institute of Psychiatry, University of Ferrara, Via Fossato di Mortara 64a, 44121 Ferrara, Italy. E-mail: [email protected] and Ines Testoni, Department of Philosophy, Sociology, Education and Applied Psychology (FISPPA), University of Padua, Piazza Capitaniato, 3, 35139 Padova, Italy E-mail: [email protected].
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

This paper presents a two-phase cross-sectional study aimed at examining the possible mitigating role of perceived meaning of life and representation of death on psychological distress, anxiety, and depression.

Method:

The first phase involved 219 healthy participants, while the second encompassed 30 cancer patients. Each participant completed the Personal Meaning Profile (PMP), the Testoni Death Representation Scale (TDRS), the Hospital Anxiety and Depression Scale (HADS), and the Distress Thermometer (DT). The primary analyses comprised (1) correlation analyses between the overall scores of each of the instruments and (2) path analysis to assess the indirect effect of the PMP on DT score through anxiety and depression as determined by the HADS.

Results:

The path analysis showed that the PMP was inversely correlated with depression and anxiety, which, in turn, mediated the effect on distress. Inverse correlations were found between several dimensions of the PMP, the DT, and the HADS–Anxiety and HADS–Depression subscales, in both healthy participants and cancer patients. Religious orientation (faith in God) was related to a stronger sense of meaning in life and the ontological representation of death as a passage, rather than annihilation.

Significance of Results:

Our findings support the hypothesis that participants who represent death as a passage and have a strong perception of the meaning of life tend to report lower levels of distress, anxiety, and depression. We recommend that perceived meaning of life and representation of death be more specifically examined in the cancer and palliative care settings.

Keywords

CancerMeaning of lifeOntological representation of deathAnxietyDepressionPsychological distress
Type
Original Article
Information
Palliative & Supportive Care , Volume 16 , Issue 5 , October 2018 , pp. 511 - 519
Copyright
Copyright © Cambridge University Press 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

REFERENCES

Applebaum, A.J., Kulikowski, J.R. & Breitbart, W. (2015). Meaning-centered psychotherapy for cancer caregivers (MCP–C): Rationale and overview. Palliative & Supportive Care, 13(6), 1631–1641.Google Scholar
Ardelt, M. (2003). Effects of religion and purpose in life on elders' subjective well-being and attitudes toward death. Journal of Religious Gerontology, 14(4), 55–77. Available from http://users.clas.ufl.edu/ardelt/Effects%20of%20Religion%20and%20Purpose%20in%20Life.pdf.Google Scholar
Brady, M.J., Peterman, A.H., Fitchett, G., et al. (1999). A case for including spirituality in quality of life measurement in oncology. Psycho-Oncology, 8(5), 417–428.Google Scholar
Breitbart, W. (2002). Spirituality and meaning in supportive care: Spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Supportive Care in Cancer, 10(4), 272–280.Google Scholar
Breitbart, W., Rosenfeld, B., Pessin, H., et al. (2015). Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology, 33(7), 749–754.Google Scholar
Burke, B.L., Martens, A. & Faucher, E.H. (2010). Two decades of terror management theory: A meta-analysis of mortality salience research. Personality and Social Psychology Review, 14(2), 155–195.Google Scholar
Canada, A.L., Murphy, P.E., Fitchett, G., et al. (2008). A 3-factor model for the FACIT–Sp. Psycho-Oncology, 17(9), 908–916.Google Scholar
Caruso, R., Nanni, M.G., Riba, M., Sabato, S., Mitchell, A.J., Croce, E., Grassi, L. (2017). Depressive spectrum disorders in cancer: prevalence, risk factors and screening for depression: a critical review. Acta Oncologica, 56(2), 146–155.Google Scholar
Costantini, M., Musso, M., Viterbori, P., et al. (1999). Detecting psychological distress in cancer patients: Validity of the Italian version of the Hospital Anxiety and Depression Scale. Supportive Care in Cancer, 7(3), 121–127.Google Scholar
Dechesne, M., Pyszczynski, T., Arndt, J., et al. (2003). Literal and symbolic immortality: The effect of evidence of literal immortality on self-esteem striving in response to mortality salience. Journal of Personality and Social Psychology, 84(4), 722–737.Google Scholar
Donovan, K.A., Grassi, L., McGinty, H.L., et al. (2013). Validation of the Distress Thermometer worldwide: State of the science. Psycho-Oncology, 23(3), 241–250.Google Scholar
Fillion, L., Duval, S., Dumont, S., et al. (2009). Impact of a meaning-centered intervention on job satisfaction and on quality of life among palliative care nurses. Psycho-Oncology, 18(12), 1300–1310.Google Scholar
Grassi, L., Sabato, S., Rossi, E., et al. (2009). Affective syndromes and their screening in cancer patients with early and stable disease: Italian ICD–10 data and performance of the Distress Thermometer from the Southern European Psycho-Oncology Study (SEPOS). Journal of Affective Disorders, 114(1–3), 193–199.Google Scholar
Grassi, L., Johansen, C., Annunziata, M.A., et al. (2013). Screening for distress in cancer patients: A multicenter, nationwide study in Italy. Cancer, 119(9), 1714–1721.Google Scholar
Greenberg, J., Solomon, S. & Pyszczynski, T. (1997). Terror management theory of self-esteem and cultural worldviews: Empirical assessments and conceptual refinements. Advances in Experimental Social Psychology, 29, 61–139.Google Scholar
Jaarsma, T.A., Pool, G., Ranchor, A.V., et al. (2007). The concept and measurement of meaning in life in Dutch cancer patients. Psycho-Oncology, 16(3), 241–248.Google Scholar
Jacobsen, P.B. (2007). Screening for psychological distress in cancer patients: Challenges and opportunities. Journal of Clinical Oncology, 25(29), 4526–4527.Google Scholar
Jöreskog, K.G. & Sörbom, D. (1996). LISREL 8: User's Reference Guide. Chicago: Scientific Software International.Google Scholar
Kissane, D.W., Clarke, D.M. & Street, A.F. (2001). Demoralization syndrome: A relevant psychiatric diagnosis for palliative care. Journal of Palliative Care, 17(1), 12–21.Google Scholar
Krause, N. (2003). Religious meaning and subjective well-being in late life. The Journals of Gerontology Series B, Psychological Sciences and Social Sciences, 58(3), S160–S170.Google Scholar
Lambert, A.J., Eadeh, F.R., Peak, S.A., et al. (2014). Toward a greater understanding of the emotional dynamics of the mortality salience manipulation: Revisiting the “affect-free” claim of terror management research. Journal of Personality and Social Psychology, 106(5), 655–678.Google Scholar
Martens, A., Burke, B.L., Schimel, J., et al. (2011). Same but different: Meta-analytically examining the uniqueness of mortality salience effects. European Journal of Social Psychology, 41(1), 6–10.Google Scholar
MacDonald, M.J., Wong, P.T.P. & Gingras, D.T. (2012). Meaning-in-life measures and development of a brief version of the Personal Meaning Profile. In The Human Quest for Meaning: Theories, Research, and Applications, 2nd ed. Wong, P.T.P. (ed.), pp. 357–382). New York: Routledge. Available from http://www.drpaulwong.com/documents/HQM2-chapter17.pdf.Google Scholar
McClain, C.S., Rosenfeld, B. & Breitbart, W. (2003). Effect of spiritual well-being on end-of-life despair in terminally ill cancer patients. Lancet, 361(9369), 1603–1607.Google Scholar
Mitchell, A.J., Chan, M., Bhatti, H., et al. (2011). Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative care settings: A meta-analysis of 94 interview-based studies. The Lancet. Oncology, 12(2), 160–174.Google Scholar
NCCN (National Comprehensive Cancer Network) (2017). Distress Management, Version 1.2017. Fort Washington, PA: National Comprehensive Cancer Network. Available from https://www.ncn.org.Google Scholar
Puchalski, C.M. (2012). Spirituality in the cancer trajectory. Annals of Oncology, 23(Suppl. 3), 49–55.Google Scholar
Pyszczynski, T., Greenberg, J. & Solomon, S. (2005). The machine in the ghost: A dual process model of defense against conscious and unconscious death-related thought. In Social Motivation: Conscious and Unconscious Processes. Forgas, J., Williams, K.D. & Laham, S.M. (eds.), pp. 40–54. New York: Cambridge University Press.Google Scholar
Robak, R.W. & Griffin, P.W. (2000). Purpose in life: What is its relationship to happiness, depression, and grieving? North American Journal of Psychology, 2, 113–119.Google Scholar
Rohánszky, M., Konkolÿ Thege, B. & Bodoky, G. (2011). Cancer survivors—quality of life in Hungarian cancer patients: A retrospective study [in Hungarian]. Magyar Onkologia, 55(3), 193–198.Google Scholar
Ronconi, L., Testoni, I. & Zamperini, A. (2009). Validation of the Italian version of the Reasons for Living Inventory. Testing, Psychometrics, Methodology in Applied Psychology, 16(3), 151–159. Available from http://www.tpmap.org/wp-content/uploads/2014/11/16.3.4.pdf.Google Scholar
Rosenfeld, B., Saracino, R., Tobias, K., et al. (2016). Adapting meaning-centered psychotherapy for the palliative care setting: Results of a pilot study. Palliative Medicine, 31(2), 140–146.Google Scholar
Roth, A.J., Kornblith, A.B., Batel-Copel, L., et al. (1998). Rapid screening for psychological distress in men with prostate carcinoma. Cancer, 82(10), 1904–1908.Google Scholar
Rutjens, B.T. & Loseman, A. (2010). The society-supporting self: System justification and cultural worldview defense as different forms of self-regulation. Group Processes & Intergroup Relations, 13(2), 241–250.Google Scholar
Salsman, J.M., Pustejovsky, J.E., Jim, H.S., et al. (2015). A meta-analytic approach to examining the correlation between religion/spirituality and mental health in cancer. Cancer, 121(21), 3769–3778.Google Scholar
Scheffold, K., Mehnert, A., Müller, V., et al. (2014). Sources of meaning in cancer patients: Influences on global meaning, anxiety and depression in a longitudinal study. European Journal of Cancer Care, 23(4), 472–480.Google Scholar
Schnell, T. (2010). Existential indifference: Another quality of meaning in life. Journal of Humanistic Psychology, 50(3), 351–373.Google Scholar
Schreiber, J.A. & Brockopp, D.Y. (2012). Twenty-five years later—what do we know about religion/spirituality and psychological wellbeing among breast cancer survivors? A systematic review. Journal of Cancer Survivorship, 6(1), 82–94.Google Scholar
Schreiber, J.B., Nora, A., Stage, F.K., et al. (2006). Reporting structural equation modeling and confirmatory factor analysis results: A review. The Journal of Educational Research, 99(6), 323–337.Google Scholar
Sherman, A.C., Merluzzi, T.V., Pustejovsky, J.E., et al. (2015). A meta-analytic review of religious or spiritual involvement and social health among cancer patients. Cancer, 121(21), 3779–3788.Google Scholar
Simonelli, L.E., Siegel, S.D. & Duffy, N.M. (2016). Fear of cancer recurrence: A theoretical review and its relevance for clinical presentation and management. Psycho-Oncology. doi: 10.1002/pon.4168. Epub ahead of print.Google Scholar
Steger, M.F., Frazier, P., Oishi, S., et al. (2006). The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53(1), 80–93. Available from http://www.michaelfsteger.com/wp-content/uploads/2012/08/Steger-Frazier-Oishi-Kaler-JCP-2006.pdf.Google Scholar
Taylor, E.J. (2006). Prevalence and associated factors of spiritual needs among patients with cancer and family caregivers. Oncology Nursing Forum, 33(4), 729–735.Google Scholar
Testoni, I., Ancona, D. & Ronconi, L. (2015). The ontological representation of death: A scale to measure the idea of annihilation versus passage. Omega, 71(1), 60–81.Google Scholar
Testoni, I., Visintin, E.P., Capozza, D., et al. (2016 a). The implicit image of God: God as reality and psychological well-being. Journal for the Scientific Study of Religion, 55(1), 174–184.Google Scholar
Testoni, I., Falletti, S., Visintin, E.P., et al. (2016 b). Volunteering in palliative care: Religiosity, explicit representations of death and implicit representations of God between dehumanization and burnout [Il volontariato nelle cure palliative: Religiosità, rappresentazioni esplicite della morte e implicite di Dio tra deumanizzazione e burnout] [in Italian]. Psicologia della Salute, 2, 27–42.Google Scholar
Vandenbroucke, J.P., von Elm, E., Altman, D.G., et al. (2014). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration. Epidemiology, 18(6), 805–835.Google Scholar
van der Spek, N., van Uden-Kraan, C.F., Vos, J., et al. (2014). Meaning-centered group psychotherapy in cancer survivors: A feasibility study. Psycho-Oncology, 23(7), 827–831.Google Scholar
Visser, A., Garssen, B. & Vingerhoets, A. (2010). Spirituality and wellbeing in cancer patients: A review. Psycho-Oncology, 19(6), 565–572.Google Scholar
Vos, J. (2015). Meaning and existential givens in the lives of cancer patients: A philosophical perspective on psycho-oncology. Palliative & Supportive Care, 13(4), 885–900.Google Scholar
Westerhof, G.J., Bohlmeijer, E. & Valenkamp, M.W. (2004). In search of meaning: A reminiscence program for older persons. Educational Gerontology, 30(9), 751–766.Google Scholar
Winger, J.G., Adams, R.N. & Mosher, C.E. (2016). Relations of meaning in life and sense of coherence to distress in cancer patients: A meta-analysis. Psycho-Oncology, 25(1), 2–10.Google Scholar
Woll, M.L., Hinshaw, D.B. & Pawlik, T.M. (2008). Spirituality and religion in the care of surgical oncology patients with life-threatening or advanced illnesses. Annals of Surgical Oncology, 15(11), 3048–3057.Google Scholar
Wong, P.T.P. (1998). Implicit theories of meaningful life and the development of the personal meaning profile. In The Human Quest for Meaning: A Handbook of Psychological Research and Clinical Applications. Wong, P.T.P. & Fry, P.S. (eds.), pp. 111–140. Mahwah, NJ: Lawrence Erlbaum.Google Scholar
Wong, P.T.P. (2010). Meaning therapy: An integrative and positive existential psychotherapy. Journal of Contemporary Psychotherapy, 40(2), 85–99.Google Scholar
Wong, P.T.P. (2012). The Human Quest for Meaning: Theories, Research, and Applications, 2nd ed. New York: Routledge.Google Scholar
Wong, P.T.P. & Fry, P.S. (1998). The Human Quest for Meaning: A Handbook of Psychological Research and Clinical Applications. Mahwah, NJ: Lawrence Erlbaum.Google Scholar
Zigmond, A.S. & Snaith, R.P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67(6), 361–370.Google Scholar
Supplementary material: File

Testoni supplementary material S1

Appendix

Download Testoni supplementary material S1(File)
File 18.6 KB
Supplementary material: File

Testoni supplementary material S2

Appendix

Download Testoni supplementary material S2(File)
File 92.5 KB