Meaning in Life as A Mediator of Associations Between Self-Esteem and Psychological Adjustment Among Middle-Aged Women with Breast Cancer

Yıl 2023, Cilt: 43 Sayı: 1, 93 - 115, 08.05.2023

Cem Soylu , Zehra Uçanok

https://doi.org/10.26650/SP2022-1057478

Öz

A growing body of research has clearly demonstrated that meaning in life plays an important role in psychological adjustment in the face of highly stressful life events, such as a cancer diagnosis. This study primarily aims to explore the predictors of meaning in life and the mediating role of the two dimensions of meaning in life (presence of meaning, and search for meaning) on the association between self-esteem and psychological adjustment among middle-aged women diagnosed with breast cancer. In the present study, psychological well-beingand psychological distress have been used as indicators of psychological adjustment. The sample consisted of 125 women aged between 40 - 65 (Mage = 52.34, SD = 6.83). Participants completed a battery of self-report questionnaires including the Rosenberg Self-Esteem Scale, Psychological Well-Being Scale, Hospital Anxiety and Depression Scale, Meaning in Life Questionnaire, and Multidimensional Scale of Perceived Social Support. The findings revealed a negative significant relationship between the presence of meaning and the search for meaning. Multiple regression analyses revealed that perceived social support, age, perceived income level, and time since diagnosis positively predicted the presence of meaning and explained 30% of the total variance. On the other hand, perceived social support, age, and the time since diagnosis negatively predicted the search for meaning and explained 34% of the total variance. Moreover, the findings of mediation analysis showed that the presence of meaning in life partially mediates the association between self-esteem and psychological adjustment. In other words, although the predictors of the meaning in life are similar for both dimensions, it was shown that the mediating role of the presence of meaning was stronger than the search for meaning in the relationship between self-esteem and psychological adjustment. Hence, it can be concluded that high self-esteem contributes positively to psychological adjustment by increasing the presence of meaning in the life of middle-aged female cancer patients.

Anahtar Kelimeler

Breast cancer, self-esteem, psychological well-being, psychological distress, meaning in life, middle adulthood

Orta Yaş Dönemindeki Meme Kanseri Kadın Bireylerde Benlik Saygısı ve Psikolojik Uyum Arasındaki İlişkiler: Hayatın Anlamının Aracı Rolü

Öz

Giderek artan sayıda araştırma, hayatın anlamının kanser teşhisi gibi oldukça stresli yaşam olayları karşısında psikolojik uyum üzerinde önemli bir rol oynadığını açıkça göstermektedir. Araştırmanın temel amacı meme kanseri tanısı almış orta yaş dönemindeki kadınlarda hayatın anlamını yordayan faktörleri ve benlik saygısı ile psikolojik uyum arasındaki ilişkide hayatın anlamının boyutlarının (anlamın varlığı ve anlam arama) aracı rolünü incelemektir. Bu araştırmada psikolojik uyumun göstergeleri olarak psikolojik iyi oluş ve psikolojik sıkıntı kullanılmıştır. Araştırmanın örneklemini yaşları 40 ile 65 arasında değişen (Ort.yaş = 52.34, SS = 6.83) toplam 125 kadın oluşturmuştur. Katılımcılara Rosenberg Benlik Saygısı Ölçeği, Psikolojik İyi Oluş Ölçeği, Hastane Anksiyete ve Depresyon Ölçeği, Hayatın Anlamı Ölçeği ve Çok Boyutlu Algılanan Sosyal Destek Ölçeği’nden oluşan bir ölçek seti uygulanmıştır. Elde edilen bulgular, anlamın varlığı ile anlam arama arasında negatif yönde anlamlı bir ilişki ortaya koymuştur. Regresyon analizi sonuçları,sırasıyla algılanan sosyal destek, yaş, algılanan gelir düzeyi ve tanı süresinin anlamın varlığını pozitif yönde yordadığını ve toplam varyansın %30’unu açıkladığını ortaya koymuştur. Buna karşılık, anlam aramayı ise algılanan sosyal destek, yaş ve tanı süresi negatif yönde yordamakta ve toplam varyansın %34’ünü açıklamaktadır. Aracı rollere ilişkin analiz sonuçları ise benlik saygısı ile psikolojik uyum arasındaki ilişkide anlamın varlığının kısmi aracı role sahip olduğunu göstermiştir. Bir diğer ifade ile hayatın anlamının yordayıcıları her iki boyut için benzer olsa da, anlam aramaya göre anlamın varlığının aracı rolünün benlik saygısı ve psikolojik uyum arasındaki ilişkide daha güçlü olduğunu göstermiştir. Sonuç olarak, elde edilen bulgular çerçevesinde yüksek benlik saygısının orta yaş dönemindeki kadın kanser hastalarında anlamın varlığını artırarak psikolojik uyuma pozitif yönde katkı sağladığı söylenebilir.

Anahtar Kelimeler

Meme kanseri, benlik saygısı, psikolojik iyi oluş, psikolojik sıkıntı, hayatın anlamı, orta yetişkinlik dönemi

Kaynakça

• Aldwin, C. M., & Levenson, M.R. (2001). Stress, coping, and health at midlife: A developmental perspective. In M. E. Lachman (Eds.), Handbook of midlife development. John Wiley. google scholar
• Aydemir, O., Guvenir, T., Kuey, L., & Kultur, S. (1997). Validity and reliability of Turkish version of hospital anxiety and depression scale. Turkish Journal of Psychiatry, 8(4), 280-287. google scholar
• Baumeister, R. (1991). Meanings in life. Guilford Press. google scholar
• Boyraz, G., Lightsey, O. R., & Can, A. (2013). The Turkish version of the meaning in life questionnaire: Assessing the measurement invariance across Turkish and American adult samples. Journal of Personality Assessment, 95(4), 423-431. https://doi.org/10.1080/00223891.2013.765882 google scholar
• Brandao, T., Schulz, M. S., & Matos, P. M. (2017). Psychological adjustment after breast cancer: A systematic review of longitudinal studies. Psycho-Oncology, 26(7), 917-926. https://doi. org/10.1002/pon.4230 google scholar
• Cuhadaroglu, F. (1986). Self-esteem in adolescents [Unpublished doctoral dissertation]. Hacettepe University. google scholar
• Dacey, J. S., & Travers, J. F. (2002). Human development across life span. McGraw-Hill. google scholar
• Dezutter, J., Luyckx, K., & Wachholtz, A. (2015). Meaning in life in chronic pain patients over time: Associations with pain experience and psychological well-being. Journal of Behavioral Medicine, 38, 384-396. https://doi.org/10.1007/s10865-014-9614-1 google scholar
• Dirksen, S. R. (2000). Predicting well-being among breast cancer survivors. Journal of Advanced Nursing, 32(4), 937-943. https://doi.org/10.1046/j.1365-2648.2000.01559.x google scholar
• Eker, D., Arkar, H., & Yaldız, H. (2001). Factorial structure, validity, and reliability of revised form of the multidimensional scale of perceived social support. Turkish Journal ofPsychiatry, 12(1), 17-25. google scholar
• Erikson, E. H. (1968). Identity: Youth, and crisis. Norton. google scholar
• Faul, F., Erdfelder, E., Lang, A.-G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175-191. google scholar
• Frankl, V. (1963). Man’s search for meaning: An introduction to logotherapy (S. Budak, Trans.). Washington Square Press. google scholar
• Hayes, A. F. (2022). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (3rd ed.). Guilford Publications. google scholar
• Heijer, M., Seynaeve, C., Vanheusden, K., Duivenvoorden, H. J., Vos, J., Bartels, C., Menke-Pluymers, M. B. E., & Tibben, A. (2011). The contribution of self-esteem and self-concept in psychological distress in women at risk of hereditary breast cancer. Psycho-Oncology, 20(11), 1170-1175. https:// doi.org/10.1002/pon.1824 google scholar
• Hepper E. G. (2016). Self-esteem. In H. S. Friedman (Ed.) Encyclopedia of mental health (pp. 80-91). Academic Press. google scholar
• Hicks, J. A., & King, L. A. (2009). Meaning in life as a subjective judgment and lived experience. Social and Personality Psychology Compass, 3, 638-653. https://doi.org/10.1111/j.1751-9004.2009.00193.x google scholar
• Hicks, J. A., Schlegel, R. J., & King, L. A. (2010). Social threats, happiness, and the dynamics of meaning in life judgments. Personality and Social Psychology Bulletin, 36(10), 1305-1317. https:// doi.org/10.1177/0146167210381650 google scholar
• Imamoglu, E. O. (2004). Self-construal correlates of well-being. [Unpublished data]. google scholar
• Jadidi, A., & Ameri, F. (2022). Social support and meaning of life in women with breast cancer. Ethiopian Journal ofHealth Sciences, 32(4), 709. https://doi.org/ 10.4314/ejhs.v32i4.6 google scholar
• Jim, H. S., & Andersen, B. L. (2007). Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. British Journal ofHealth Psychology, 12(3), 363-381. https://doi.org/10.1348/135910706X128278 google scholar
• Joshanloo, M., & Daemi, F. (2015). Self-esteem mediates the relationship between spirituality and subjective well-being in Iran. International Journal of Psychology, 50(2), 115-120. https://doi. org/10.1002/ijop.12061. google scholar
• Kagitcibasi, C. (2005). Autonomy and relatedness in cultural context: Implications for self and family. Journal of Cross-Cultural Psychology, 36(4), 403-422. https://doi. org/10.1177/0022022105275959 google scholar
• Lai, X., Bao, Z., & Wang, Y., (2016). Meaning in life and depression among adolescents: The mediating effect of self-esteem. Psychological Research, 9(2), 28-34. google scholar
• Landmark, B. T., & Wahl, A. (2002). Living with newly diagnosed breast cancer: A qualitative study of 10 women with newly diagnosed breast cancer. Journal ofAdvanced Nursing, 40(1), 112-121. https://doi.org/10.1046/j.1365-2648.2002.02346.x google scholar
• Lethborg, C., Aranda, S., Cox, S., & Kissane, D. (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. Palliative & Supportive Care, 5(4), 377-388. https://doi.org/10.1017/ S1478951507000570 google scholar
• Liu, M., Li, R., & Xiao, H., (2012). Relationship between medical students’ sense of life meaning and depression. Journal of Shanxi Datong University, 28(6), 37-39. google scholar
• Mann, M. M., Hosman, C. M., Schaalma, H. P., & De Vries, N. K. (2004). Self-esteem in a broadspectrum approach for mental health promotion. Health Education Research, 19(4), 357-372. https://doi.org/10.1093/her/cyg041 google scholar
• Mitchell, A. J., Ferguson, D. W., Gill, J., Paul, J., & Symonds, P. (2013). Depression and anxiety in longterm cancer survivors compared with spouses and healthy controls: A systematic review and metaanalysis. The Lancet Oncology, 14(8), 721-732. https://doi.org/10.1016/S1470-2045(13)70244-4 google scholar
• Norton, S., Cosco, T., Doyle, F., Done, J., & Sacker, A. (2013). The Hospital Anxiety and Depression Scale: A meta confirmatory factor analysis. Journal of Psychosomatic Research, 74(1), 74-81. https://doi.org/10.1016/j.jpsychores.2012.10.010 google scholar
• Park, C. L. (2010). Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 257-301. https://doi.org/10.1037/a0018301 google scholar
• Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879-891. http://dx.doi.org/10.3758/BRM.40.3.879. google scholar
• Reker, G. T. (2005). Meaning in life of young, middle-aged, and older adults: Factorial validity, age, and gender invariance of the Personal Meaning Index (PMI). Personality and Individual Differences, 38(1), 71-85. https://doi.org/10.1016/j.paid.2004.03.010 google scholar
• Robins, R. W., & Trzesniewski, K. H. (2005). Self-esteem development across the lifespan. Current Directions in Psychological Science, 14(3), 158-162. https://doi.org/10.1111/j.0963-7214.2005.00353.x google scholar
• Robins, R. W., Trzesniewski, K. H., Tracy, J. L., Gosling, S. D., & Potter, J. (2002). Global selfesteem across the life span. Psychology and Aging, 17(3), 423-434. https://doi.org/10.1037/0882-7974.17.3.423 google scholar
• Rosenberg, M. (1965). Society and the adolescent self-Image. Princeton University Press. google scholar
• Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological well-being. Journal of Personality and Social Psychology, 57(6), 1069-1081. https://doi.org/10.1037/0022-3514.57.6.1069 google scholar
• Ryff, C. D., & Keyes, C. L. M. (1995). The structure of psychological well-being revisited. Journal of Personality and Social Psychology, 69(4), 719-727. https://doi.org/10.1037/0022-3514.69.4.719 google scholar
• Scheffold, K., Mehnert, A., Müller, V., Koch, U., Härter, M., & Vehling, S. (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. https://doi.org/10.1111/ecc.12152 google scholar
• Schroevers, M. J., Ranchor, A. V., & Sanderman, R. (2003). The role of social support and self-esteem in the presence and course of depressive symptoms: A comparison of cancer patients and individuals from the general population. Social Science & Medicine, 57, 375-385. https://doi.org/10.1016/ S0277-9536(02)00366-0 google scholar
• Scrignaro, M., Bianchi, E., Brunelli, C., Miccinesi, G., Ripamonti, C. I., Magrin, M. E., & Borreani, C. (2015). Seeking and experiencing meaning: Exploring the role of meaning in promoting mental adjustment and eudaimonic well-being in cancer patients. Palliative & Supportive Care, 13(3), 673-681. https://doi.org/10.1017/S1478951514000406. google scholar
• Sherman, A. C., & Simonton, S. (2012). Effects of personal meaning among patients in primary and specialized care: Associations with psychosocial and physical outcomes. Psychology and Health, 27(4), 475-490. https://doi.org/10.1080/08870446.2011.592983 google scholar
• Sherman, A. C., Simonton, S., Latif, U., & Bracy, L. (2010). Effects of global meaning and illnessspecific meaning on health outcomes among breast cancer patients. Journal of Behavioral Medicine, 33(5), 364-377. https://doi.org/10.1007/s10865-010-9267-7 google scholar
• Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological Bulletin, 139(1), 213-240. https://doi.org/10.1037/a0028931 google scholar
• Steger, M. F., Frazier, P., Oishi, S., & Kaler, M. (2006). The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Journal of Counseling Psychology, 53(1), 80-93. https:// doi.org/10.1037/0022-0167.53.1.80 google scholar
• Steger, M. F., Kashdan, T. B., Sullivan, B. A., & Lorentz, D. (2008a). Understanding the search for meaning in life: Personality, cognitive style, and the dynamic between seeking and experiencing meaning. Journal of Personality, 76(2), 199-228. https://doi.org/10.1111/j.1467-6494.2007.00484.x google scholar
• Steger, M. F., Kawabata, Y., Shimai, S., & Otake, K. (2008b). The meaningful life in Japan and the United States: Levels and correlates of meaning in life. Journal of Research in Personality, 42(3), 660-678. https://doi.org/10.1016/j.jrp.2007.09.003 google scholar
• Steger, M. F., Oishi, S., & Kashdan, T. B. (2009). Meaning in life across the life span: Levels and correlates of meaning in life from emerging adulthood to older adulthood. The Journal of Positive Psychology, 4(1), 43-52. https://doi.org/10.1080/17439760802303127 google scholar
• Steger, M. F., Oishi, S., & Kesebir, S. (2011). Is a life without meaning satisfying? The moderating role of the search for meaning in satisfaction with life judgments. The Journal of Positive Psychology, 6(3), 173-180. https://doi.org/10.1080/17439760.2011.569171 google scholar
• Tabachnick, B. G., & Fidell, L. S. (2013). Using multivariate statistics (6th ed.). Pearson Education. google scholar
• Tomas-Sabado, J., Villavicencio-Chavez, C., Monforte-Royo, C., Guerrero-Torrelles, M., Fegg, M. J., & Balaguer, A. (2015). What gives meaning in life to patients with advanced cancer? A comparison between Spanish, German, and Swiss patients. Journal of Pain and Symptom Management, 50(6), 861-866. https://doi.org/10.1016/j.jpainsymman.2015.06.015 google scholar
• Toothman, E. L., & Barrett, A. E. (2011). Mapping midlife: An examination of social factors shaping conceptions of the timing of middle age. Advances in Life Course Research, 16(3), 99-111. https:// doi.org/10.1016/j.alcr.2011.08.003 google scholar
• Tsai, P. L., Kuo, T. T., Ku, C. H., Liao, G. S., Lin, C. K., & Pan, H. H. (2021). Self-Esteem as a predictor of mental adjustment in patients with breast cancer. International Journal of Environmental Research and Public Health, 18(23), 12588. https://doi.org/10.3390/ijerph182312588 google scholar
• Williams, K., Jackson, S. E., Beeken, R. J., Steptoe, A., & Wardle, J. (2016). The impact of a cancer diagnosis on health and well-being: A prospective, population-based study. Psycho-Oncology, 25 (6), 626-632. https://doi.org/10.1002/pon.3998 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. https:// doi.org/10.1002/pon.3798 google scholar
• Yarar, O. F. (2015) Autotelic personality: Links with flow propensity, personal strengths, and psychopathology (Unpublished doctoral dissertation). Middle East Technical University. google scholar
• Yektatalab, S., & Ghanbari, E. (2020). The relationship between anxiety and self-esteem in women suffering from breast cancer. Journal of Mid-Life Health, 11(3), 126-132. google scholar
• Yeniceri, Z. (2013). Impact of self orientations on well-being during adulthood: The mediating roles meaning in life, attitudes towards death and religious outlook [ Unpublished doctoral dissertation]. Middle East Technical University. google scholar
• Zigmond, A. S., & Snaith, R. P. (1983). The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica, 67(6), 361-370. https://doi.org/10.1111/j.1600-0447.1983.tb09716.x google scholar
• Zimet, G. D., Dahlem, N. W., Zimet, S. G., & Farley, G. K. (1988). The multidimensional scale of perceived social support. Journal of Personality Assessment, 52(1), 30-41. https://doi.org/10.1207/ s15327752jpa5201_2 google scholar