Skip to main content
Erschienen in: Supportive Care in Cancer 4/2011

01.04.2011 | Original Article

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

verfasst von: Sigrun Vehling, Claudia Lehmann, Karin Oechsle, Carsten Bokemeyer, Andreas Krüll, Uwe Koch, Anja Mehnert

Erschienen in: Supportive Care in Cancer | Ausgabe 4/2011

Einloggen, um Zugang zu erhalten

Abstract

Goal of work

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

Patients and methods

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

Results

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

Discussion

Findings confirm a global sense of meaning as an important protecting factor regarding the development of distress symptoms. Results suggest that different dimensions of meaning contribute to different dimensions of psychological well-being, as they refer to different existential problems. The need for and relevance of meaning-focused interventions in cancer patients is strengthened.
Literatur
1.
Zurück zum Zitat Adelbratt S, Strang P (2000) Death anxiety in brain tumour patients and their spouses. Palliat Med 14(6):499–507PubMedCrossRef Adelbratt S, Strang P (2000) Death anxiety in brain tumour patients and their spouses. Palliat Med 14(6):499–507PubMedCrossRef
2.
Zurück zum Zitat Boscaglia N, Clarke DM (2007) Sense of coherence as a protective factor for demoralisation in women with a recent diagnosis of gynaecological cancer. Psychooncology 16(3):189–195PubMedCrossRef Boscaglia N, Clarke DM (2007) Sense of coherence as a protective factor for demoralisation in women with a recent diagnosis of gynaecological cancer. Psychooncology 16(3):189–195PubMedCrossRef
3.
Zurück zum Zitat Breitbart W (2002) Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer 10(4):272–280PubMedCrossRef Breitbart W (2002) Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Support Care Cancer 10(4):272–280PubMedCrossRef
4.
Zurück zum Zitat Breitbart W, Gibson C, Poppito SR, Berg A (2004) Psychotherapeutic interventions at the end of life: a focus on meaning and spirituality. Can J Psychiatry 49(6):366–372PubMed Breitbart W, Gibson C, Poppito SR, Berg A (2004) Psychotherapeutic interventions at the end of life: a focus on meaning and spirituality. Can J Psychiatry 49(6):366–372PubMed
5.
Zurück zum Zitat Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, Nelson C, Tomarken A, Timm AK, Berg A, Jacobson C, Sorger B, Abbey J, Olden M (2009) Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology 19:21–28. doi:10.1002/pon.1556 Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, Nelson C, Tomarken A, Timm AK, Berg A, Jacobson C, Sorger B, Abbey J, Olden M (2009) Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology 19:21–28. doi:10.​1002/​pon.​1556
6.
Zurück zum Zitat Brennan J (2001) Adjustment to cancer—coping or personal transition? Psychooncology 10(1):1–18PubMedCrossRef Brennan J (2001) Adjustment to cancer—coping or personal transition? Psychooncology 10(1):1–18PubMedCrossRef
7.
Zurück zum Zitat Cella DF, Tross S (1987) Death anxiety in cancer survival: a preliminary cross-validation study. J Pers Assess 51(3):451–461PubMedCrossRef Cella DF, Tross S (1987) Death anxiety in cancer survival: a preliminary cross-validation study. J Pers Assess 51(3):451–461PubMedCrossRef
8.
Zurück zum Zitat Clarke DM, Kissane DW (2002) Demoralization: its phenomenology and importance. Aust N Z J Psychiatry 36(6):733–742PubMedCrossRef Clarke DM, Kissane DW (2002) Demoralization: its phenomenology and importance. Aust N Z J Psychiatry 36(6):733–742PubMedCrossRef
9.
Zurück zum Zitat Folkman S (1997) Positive psychological states and coping with severe stress. Soc Sci Med 45(8):1207–1221PubMedCrossRef Folkman S (1997) Positive psychological states and coping with severe stress. Soc Sci Med 45(8):1207–1221PubMedCrossRef
10.
Zurück zum Zitat Folkman S, Moskowitz JT (2000) Positive affect and the other side of coping. Am Psychol 55(6):647–654PubMedCrossRef Folkman S, Moskowitz JT (2000) Positive affect and the other side of coping. Am Psychol 55(6):647–654PubMedCrossRef
11.
Zurück zum Zitat Frankl VE (1984) Der leidende Mensch: Anthropologische Grundlagen der Psychotherapie, 2nd edn. Huber, Bern Frankl VE (1984) Der leidende Mensch: Anthropologische Grundlagen der Psychotherapie, 2nd edn. Huber, Bern
12.
Zurück zum Zitat Frankl VE (1991) Der Wille zum Sinn - Ausgewählte Vorträge über Logotherapie, 2nd edn. Piper, München Frankl VE (1991) Der Wille zum Sinn - Ausgewählte Vorträge über Logotherapie, 2nd edn. Piper, München
13.
Zurück zum Zitat Frankl VE (2005) Ärztliche Seelsorge. Grundlagen der Logotherapie und Existenzanalyse. Zehn Thesen über die Person, 11th edn. Deuticke, Wien Frankl VE (2005) Ärztliche Seelsorge. Grundlagen der Logotherapie und Existenzanalyse. Zehn Thesen über die Person, 11th edn. Deuticke, Wien
14.
Zurück zum Zitat Hermann C, Buss U, Snaith RP (1995) Hospital anxiety and depression scale – Deutsche version. Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Huber, Bern Hermann C, Buss U, Snaith RP (1995) Hospital anxiety and depression scale – Deutsche version. Ein Fragebogen zur Erfassung von Angst und Depressivität in der somatischen Medizin. Huber, Bern
15.
Zurück zum Zitat Holland JC, Reznik I (2005) Pathways for psychosocial care of cancer survivors. Cancer 104(11):2624–2637PubMedCrossRef Holland JC, Reznik I (2005) Pathways for psychosocial care of cancer survivors. Cancer 104(11):2624–2637PubMedCrossRef
16.
Zurück zum Zitat Jim HS, Andersen BL (2007) Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. Br J Health Psychol 12(3):363–381PubMedCrossRef Jim HS, Andersen BL (2007) Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. Br J Health Psychol 12(3):363–381PubMedCrossRef
17.
Zurück zum Zitat Jim HS, Richardson SA, Golden-Kreutz DM, Andersen BL (2006) Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychol 25(6):753–761PubMedCrossRef Jim HS, Richardson SA, Golden-Kreutz DM, Andersen BL (2006) Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychol 25(6):753–761PubMedCrossRef
18.
Zurück zum Zitat Johnson-Vickberg SM, Duhamel KN, Smith MY, Manne SL, Winkel G, Papadopoulos EB, Redd WH (2001) Global meaning and psychological adjustment among survivors of bone marrow transplant. Psychooncology 10(1):29–39PubMedCrossRef Johnson-Vickberg SM, Duhamel KN, Smith MY, Manne SL, Winkel G, Papadopoulos EB, Redd WH (2001) Global meaning and psychological adjustment among survivors of bone marrow transplant. Psychooncology 10(1):29–39PubMedCrossRef
19.
Zurück zum Zitat Kissane DW, Bloch S, Smith GC, Miach P, Clarke DM, Ikin J, Love A, Ranieri N, McKenzie D (2003) Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Psychooncology 12(6):532–546PubMedCrossRef Kissane DW, Bloch S, Smith GC, Miach P, Clarke DM, Ikin J, Love A, Ranieri N, McKenzie D (2003) Cognitive-existential group psychotherapy for women with primary breast cancer: a randomised controlled trial. Psychooncology 12(6):532–546PubMedCrossRef
20.
Zurück zum Zitat Kissane DW, Clarke DM, Street AF (2001) Demoralization syndrome—a relevant psychiatric diagnosis for palliative care. J Palliat Care 17(1):12–21PubMed Kissane DW, Clarke DM, Street AF (2001) Demoralization syndrome—a relevant psychiatric diagnosis for palliative care. J Palliat Care 17(1):12–21PubMed
21.
Zurück zum Zitat Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM (2004) The Demoralization Scale: a report of its development and preliminary validation. J Palliat Care 20(4):269–276PubMed Kissane DW, Wein S, Love A, Lee XQ, Kee PL, Clarke DM (2004) The Demoralization Scale: a report of its development and preliminary validation. J Palliat Care 20(4):269–276PubMed
22.
Zurück zum Zitat Lee V (2008) The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning. Support Care Cancer 16(7):779–785PubMedCrossRef Lee V (2008) The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning. Support Care Cancer 16(7):779–785PubMedCrossRef
23.
Zurück zum Zitat Lee V, Cohen RS, Edgar L, Laizner AM, Gagnon AJ (2006) Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Soc Sci Med 62(12):3133–3145PubMedCrossRef Lee V, Cohen RS, Edgar L, Laizner AM, Gagnon AJ (2006) Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Soc Sci Med 62(12):3133–3145PubMedCrossRef
24.
Zurück zum Zitat Lethborg C, Aranda S, Cox S, Kissane DW (2007) To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliat Support Care 5(4):377–388PubMedCrossRef Lethborg C, Aranda S, Cox S, Kissane DW (2007) To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliat Support Care 5(4):377–388PubMedCrossRef
25.
Zurück zum Zitat Mehnert A (2008) Der Einfluss von religioeser und sinnbasierter Krankheitsverarbeitung auf Angst und Depressivitaet bei Brustkrebspatientinnen im Krankheitsverlauf. PIÖ 28(1):72–77 Mehnert A (2008) Der Einfluss von religioeser und sinnbasierter Krankheitsverarbeitung auf Angst und Depressivitaet bei Brustkrebspatientinnen im Krankheitsverlauf. PIÖ 28(1):72–77
26.
Zurück zum Zitat Mehnert A, Koch U (2008) Psychometric evaluation of the German version of the Life Attitude Profile—Revised (LAP-R) in prostate cancer patients. Palliat Support Care 6(2):119–124PubMedCrossRef Mehnert A, Koch U (2008) Psychometric evaluation of the German version of the Life Attitude Profile—Revised (LAP-R) in prostate cancer patients. Palliat Support Care 6(2):119–124PubMedCrossRef
27.
Zurück zum Zitat Mehnert A, Mueller D, Koch U (2007) Die Erfassung von sinnbasierten Bewaeltigungsstrategien und Lebenseinstellungen. Die deutsche Adaptation des Life Attitude Profile-Revised (LAP-R) an einer repraesentativen Stichprobe von Brustkrebspatientinnen. Z Klin Psychol Psychother 36(3):176–188CrossRef Mehnert A, Mueller D, Koch U (2007) Die Erfassung von sinnbasierten Bewaeltigungsstrategien und Lebenseinstellungen. Die deutsche Adaptation des Life Attitude Profile-Revised (LAP-R) an einer repraesentativen Stichprobe von Brustkrebspatientinnen. Z Klin Psychol Psychother 36(3):176–188CrossRef
28.
Zurück zum Zitat Mehnert A, Mueller D, Lehmann C, Koch U (2006) Die deutsche Version des NCCN Distress-Thermometers. Empirische Pruefung eines Screening-Instruments zur Erfassung psychosozialer Belastung bei Krebspatienten. ZPPP 54(3):213–223 Mehnert A, Mueller D, Lehmann C, Koch U (2006) Die deutsche Version des NCCN Distress-Thermometers. Empirische Pruefung eines Screening-Instruments zur Erfassung psychosozialer Belastung bei Krebspatienten. ZPPP 54(3):213–223
29.
Zurück zum Zitat Park CL, Edmondson D, Fenster JR, Blank TO (2008) Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs. J Consult Clin Psychol 76(5):863–875PubMedCrossRef Park CL, Edmondson D, Fenster JR, Blank TO (2008) Meaning making and psychological adjustment following cancer: the mediating roles of growth, life meaning, and restored just-world beliefs. J Consult Clin Psychol 76(5):863–875PubMedCrossRef
30.
Zurück zum Zitat Park CL, Folkman S (1997) Meaning in the context of stress and coping. Rev Gen Psychol 1(2):115–144CrossRef Park CL, Folkman S (1997) Meaning in the context of stress and coping. Rev Gen Psychol 1(2):115–144CrossRef
31.
Zurück zum Zitat Reker GT (1992) Manual of the life attitude profile-revised (LAP-R). Student Psychologists Press, Trent University, Peterborough Reker GT (1992) Manual of the life attitude profile-revised (LAP-R). Student Psychologists Press, Trent University, Peterborough
32.
Zurück zum Zitat Reker GT (1997) Personal meaning, optimism, and choice: existential predictors of depression in community and institutional elderly. Gerontologist 37(6):709–716PubMed Reker GT (1997) Personal meaning, optimism, and choice: existential predictors of depression in community and institutional elderly. Gerontologist 37(6):709–716PubMed
33.
Zurück zum Zitat Reker GT (2000) Theoretical perspective, dimensions, and measurement of existential meaning. In: Reker GT, Chamberlain K (eds) Exploring existential meaning. Optimizing human development across the life span. Sage, Thousand Oaks, pp 39–55 Reker GT (2000) Theoretical perspective, dimensions, and measurement of existential meaning. In: Reker GT, Chamberlain K (eds) Exploring existential meaning. Optimizing human development across the life span. Sage, Thousand Oaks, pp 39–55
34.
Zurück zum Zitat Reker GT (2007) The search for meaning in life following traumatic brain injury: conceptual, measurement, and application issues. Paper presented at the State of the Science Conference for the RRTC on Community Integration of Persons with Traumatic Brain Injury, Arlington, Virginia Reker GT (2007) The search for meaning in life following traumatic brain injury: conceptual, measurement, and application issues. Paper presented at the State of the Science Conference for the RRTC on Community Integration of Persons with Traumatic Brain Injury, Arlington, Virginia
35.
Zurück zum Zitat Sigal JJ, Ouimet MC, Margolese R, Panarello L, Stibernik V, Bescec S (2008) How patients with less-advanced and more-advanced cancer deal with three death-related fears: an exploratory study. J Psychosoc Oncol 26(1):53–68PubMedCrossRef Sigal JJ, Ouimet MC, Margolese R, Panarello L, Stibernik V, Bescec S (2008) How patients with less-advanced and more-advanced cancer deal with three death-related fears: an exploratory study. J Psychosoc Oncol 26(1):53–68PubMedCrossRef
36.
Zurück zum Zitat Simonelli LE, Fowler J, Maxwell GL, Andersen BL (2008) Physical sequelae and depressive symptoms in gynecologic cancer survivors: meaning in life as a mediator. Ann Behav Med 35(3):275–284PubMedCrossRef Simonelli LE, Fowler J, Maxwell GL, Andersen BL (2008) Physical sequelae and depressive symptoms in gynecologic cancer survivors: meaning in life as a mediator. Ann Behav Med 35(3):275–284PubMedCrossRef
37.
Zurück zum Zitat Vickberg SM, Bovbjerg DH, Duhamel KN, Currie V, Redd WH (2000) Intrusive thoughts and psychological distress among breast cancer survivors: global meaning as a possible protective factor. Behav Med 25(4):152–160PubMedCrossRef Vickberg SM, Bovbjerg DH, Duhamel KN, Currie V, Redd WH (2000) Intrusive thoughts and psychological distress among breast cancer survivors: global meaning as a possible protective factor. Behav Med 25(4):152–160PubMedCrossRef
38.
Zurück zum Zitat Westman B, Bergenmar M, Andersson L (2006) Life, illness and death—existential reflections of a Swedish sample of patients who have undergone curative treatment for breast or prostatic cancer. Eur J Oncol Nurs 10(3):169–176PubMedCrossRef Westman B, Bergenmar M, Andersson L (2006) Life, illness and death—existential reflections of a Swedish sample of patients who have undergone curative treatment for breast or prostatic cancer. Eur J Oncol Nurs 10(3):169–176PubMedCrossRef
39.
Zurück zum Zitat White CA (2004) Meaning and its measurement in psychosocial oncology. Psychooncology 13(7):468–481PubMedCrossRef White CA (2004) Meaning and its measurement in psychosocial oncology. Psychooncology 13(7):468–481PubMedCrossRef
40.
Zurück zum Zitat Xuereb MC, Dunlop R (2003) The experience of leukaemia and bone marrow transplant: searching for meaning and agency. Psychooncology 12(5):397–409PubMedCrossRef Xuereb MC, Dunlop R (2003) The experience of leukaemia and bone marrow transplant: searching for meaning and agency. Psychooncology 12(5):397–409PubMedCrossRef
Metadaten
Titel
Global meaning and meaning-related life attitudes: exploring their role in predicting depression, anxiety, and demoralization in cancer patients
verfasst von
Sigrun Vehling
Claudia Lehmann
Karin Oechsle
Carsten Bokemeyer
Andreas Krüll
Uwe Koch
Anja Mehnert
Publikationsdatum
01.04.2011
Verlag
Springer-Verlag
Erschienen in
Supportive Care in Cancer / Ausgabe 4/2011
Print ISSN: 0941-4355
Elektronische ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-010-0845-6

Weitere Artikel der Ausgabe 4/2011

Supportive Care in Cancer 4/2011 Zur Ausgabe

Adjuvante Immuntherapie verlängert Leben bei RCC

25.04.2024 Nierenkarzinom Nachrichten

Nun gibt es auch Resultate zum Gesamtüberleben: Eine adjuvante Pembrolizumab-Therapie konnte in einer Phase-3-Studie das Leben von Menschen mit Nierenzellkarzinom deutlich verlängern. Die Sterberate war im Vergleich zu Placebo um 38% geringer.

Alectinib verbessert krankheitsfreies Überleben bei ALK-positivem NSCLC

25.04.2024 NSCLC Nachrichten

Das Risiko für Rezidiv oder Tod von Patienten und Patientinnen mit reseziertem ALK-positivem NSCLC ist unter einer adjuvanten Therapie mit dem Tyrosinkinase-Inhibitor Alectinib signifikant geringer als unter platinbasierter Chemotherapie.

Bei Senioren mit Prostatakarzinom auf Anämie achten!

24.04.2024 DGIM 2024 Nachrichten

Patienten, die zur Behandlung ihres Prostatakarzinoms eine Androgendeprivationstherapie erhalten, entwickeln nicht selten eine Anämie. Wer ältere Patienten internistisch mitbetreut, sollte auf diese Nebenwirkung achten.

ICI-Therapie in der Schwangerschaft wird gut toleriert

Müssen sich Schwangere einer Krebstherapie unterziehen, rufen Immuncheckpointinhibitoren offenbar nicht mehr unerwünschte Wirkungen hervor als andere Mittel gegen Krebs.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.