Meaning of Life, Psychological Well-Being and Resilience in Iranian Students

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1 American Journal of Psychology and Behavioral Sciences 2017; 4(4): ISSN: (Print); ISSN: (Online) Meaning of Life, Psychological Well-Being and Resilience in Iranian Students Hamid Aghababaei Talkhouncheh 1, *, Sajjad Kamyarfar 1, Elham Foroozandeh 2 1 Department of Psychology, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran 2 Department of Psychology, Naein Branch, Islamic Azad University, Naein, Iran address Hamid.Aghababaei2@gmail.com (H. A. Talkhouncheh), sajjad.kamyarfar@yahoo.com (S. Kamyarfar), Elham_for@yahoo.com (E. Foroozandeh) * Corresponding author To cite this article Hamid Aghababaei Talkhouncheh, Sajjad Kamyarfar, Elham Foroozandeh. Meaning of Life, Psychological Well-Being and Resilience in Iranian Students. American Journal of Psychology and Behavioral Sciences. Vol. 4, No. 4, 2017, pp Received: April 14, 2017; Accepted: June 30, 2017; Published: August 15, 2017 Abstract This study aimed to investigate the relationship between meaning of life and psychological well-being and resilience of the high school students in Iran. The statistical population consisted of all 1000 high school students in Iran in the academic year , of whom 212 students (100 male and 112 female students) were selected using the multi-stage stratified random sampling method and Wong [1] Meaning in Life Questionnaire (MLQ), Ryff and Keyes [2] 18-items Psychological Well- Being scale, Connor-Davidson [3] Resilience Scale were administered to them. Pearson correlation coefficient and stepwise regression analysis were used for data analysis. The results showed that there is a significant positive relationship between the dimensions of the meaning of life (except intimacy) and psychological well-being (p 0.05) and resilience (p 0.05). Moreover, stepwise regression analysis showed that the dimensions of the meaning of life can predict the psychological wellbeing (p 0.05) and resilience (p 0.05). Results reveal that any change in the rate of meaning of life and its components result in change in the rate of psychological well-being in Iranian students. Keywords Meaning of Life, Psychological Well-Being, Resilience 1. Introduction Psychological theory has long distinguished between the presence of meaning in life and the search for meaning. Most research attention has been paid to the presence of meaning in life, which is dened as the sense made of, and signicance felt regarding, the nature of one s being and existence. Wong [1] states thatwith the development of the positive psychology, those features that give meaning to life have not taken into account by positivists psychologists. He also deals with the meaning as the basic construct of the positive psychology, since the positive emotion, psychological wellbeing, physical health, resilience, relationships, achievements, spirituality, and coping with anxiety are not fulfilled without it. It is likely that people cannot talk about the philosophy of their life, however, undoubtedly, all of them have their own philosophy. This philosophy is a combination of beliefs, values, practices and everything that gives meaning to the life. Psychological well-being is one of the basic components of the positivist psychology. It concurrently refers to the theory and measurement tool. According to Ryff [5] wellbeing is striving for perfection in order to realize one's potential. Resilience is one of the key variables in positivist psychology. Resilience that refers to the individual ability for mental biological balance in dangerous conditions, in fact, results from natural human adaptive responses and helps people to achieve successes and solve the problems when facing the serious threats [3]. Seligman [6] explains that nowadays, resilience is one of

2 21 Hamid Aghababaei Talkhouncheh et al.: Meaning of Life, Psychological Well-Being and Resilience in Iranian Students the most important research areas in psychology, in general and in positive psychology, in particular. Most of the people experiences hardships and resilience can be defined as the ability to accommodate and cope with the stresses and problems and it is essential for controlling the mental pressures and maintaining the optimal level of the well-being. Seligman et al [7] recommended to study the effect of finding meaning on a wide range of the variables related to the psychological well-being and mental strength. Wong [1] believes that exploration of the meaning systems in changing societies and various cultures is required in order to achieve a social ecological system for human flourishing. He also recommends to study the effect of finding the meaning on a variety of measures related to the psychological well-being and mental strength, because he believes that meaning is fundamental element of positive psychology and is inherent in positive emotion, psychological well-being, physical health, resilience, relationships, achievement, spirituality, successful aging and overcoming the existential anxieties. It is noteworthy that with the development of the positive psychology and the importance of the factors that makes life worthy, meaning changed into one of the most important element of positive psychology [7]. Recently, Seligman [6] proposed a five-component model using the acronym PERMA: positive emotion, engagement, meaning, accomplishment, and relationship. This model encompasses both hedonic and eudaimonic well-being. Seligman s PERMA is an extension of his earlier conception of authentic happiness. However, the emphasis of PERMA is still happiness-oriented rather than meaning-oriented as differentiated by Wong [8]. In addition, Wong [9] believes that positivist psychology is based on the meaning and acknowledges that without integration of conceptual meaning in paradigms of human study, a comprehensive theory about human being cannot be achieved; he also provides evidences that increases the life meaning and mental well-being and reduces the mental disorders. The positive psychologists also stressed the need to consider the variable of meaning of life in positivist psychology. Therefore, this study deals with this issue and makes a relationship between the existential psychology and positivist psychology, it in order to show the significance of this problem. Wong [10] recommends that meaning as a subscales of the well-being and quality of life should be integrated in measurement tools, because studies indicated that positive emotions can give meaning to life and on the other hand, people who have meaningful life are more adaptive and show the higher well-being and satisfaction when facing the problems. King and Hix [11] presented some evidence on neglecting the concept of meaning in positive psychology; they believe that positive emotions significantly give meaning to life. They also offered convincing reasons that even in the absence of realistic reasons for finding the meaning of life, positive emotions play a causal role in people s experience of meaning of life. This means that when people feel fine they think that life is meaningful. Thus, the presence or absence of meaning in life largely dependent on their happiness or sadness rather than a meaningful life. They suppose that the meaning formed by emotions is transient and state that joy and happiness, no matter how high, reduces and therefore, they recommend studying the effects of cognitive dimensions of the potentials in meaningfulness of life. Klinger [12] states that the human brain cannot withstand purposeless life. According to him, finding the goal and positive emotions show that life has a purpose. So, in the absence of purpose or the lack of access to important objectives, sense of absurdity, depression and futility is dominant and in the absence of positive emotions, no adaptive meaning in life is shaped. Peterson and Park [13] idea is a good summary for the importance of meaning and meaningfulness In a positive psychology. They believe that although positive psychologists claim that their work domain goes beyond happiness, they usually confine to happiness and satisfaction with life variables and do not go further, so its absence can be clearly felt. Wong MLQ that is used in this study is based on these eclectic and integrated thinking theories and since according to Wong [1] exploration of the meaning systems in changing societies and various cultures is required in order to achieve a social ecological system for human flourishing. Many of the positivist psychologists such as Seligman et al. [7] emphasized that meaning should be considered as one of the most important element of positive psychology; therefore, this study aims to investigate the relationship between meaning of life and two key variables in positivist psychology. Review of literature shows the significance of the meaning of life in maintaining the physical and mental health, successful aging and death anxiety [1]. MQL questionnaire is firstly used in this study for the Iranian students. It seems that MQL questionnaire developed by Wong [1] is one of the few MLQ questionnaires in Iran that its psychometric properties have been reviewed and normalized and it is the first questionnaire with distinct components and dimensions. Other existing questionnaires merely indicate the rate of general meaning and surviving for exploration of the meaning in life and have no distinct subscales like Wong's questionnaire. To this end, this study focused on following objectives: H 1 : There is a significant relationship between the meaning of life and psychological well-being. H 2 : There is a significant relationship between the dimensions of meaning of life and resilience. H 3 : Dimensions of meaning of life can predict the psychological well-being. H 4 : Dimensions of meaning of life can predict the resilience.

3 American Journal of Psychology and Behavioral Sciences 2017; 4(4): Materials and Method The current research design is descriptive and correlation type. The predictable variable is meaning of life dimension and criterion variables are psychological well-being and satisfaction with life. The statistical population includes all high school students of academic years in Iran and According to education system in Isfahan, Iran, there were around 1000 students. To select the subjects, first, Cochran formula was used and around 274 students were selected. This number was used as the enough number of participants because of the probable number of defaced data; around 210 people (140 boys and 150 girls) were selected through multistage stratified random sampling from triple Isafahan, Iran areas. Finally, 78 questionnaires out of 290 filled questionnaire were identified as defaced data and were removed from analysis process. The current research statistical analysis included 212 accurate and valid data, 100 boys and 112 girl students. Co ordinations have been set with school managers so, researchers visited the students in person in class and gave some explanations about how to fill up the questionnaire. Sex and school grade of the students were written at the end of the questionnaire, participants personal data was promised to be kept safe and secrete. Data was analyzed by SPSS 16 software. Assessment Tools Personal meaning profile (brief version) (Wong, 2012). Personal meaning profile or meaning of life questionnaire is a tool to assess people s perception from their meaning of their personal life [14]. This test includes 21 items and 7 subscales and for each subscales 3 items were considered. Responses were organized by 7 values scale from 1 (strongly agree) to 7 (strongly disagree). This questionnaire subscale scores were calculated through adding subscale item responses and sum of the responses of all item. For each subject the minimum score is 21 and maximum score is 147 [1]. Definition domains of this questionnaire are as follow: The persons tendency to be pioneer to do the task (to do the task initially) to accomplish achievements, the persons welcoming from onward challenges, stability in achieving goals, the quality of the person social relationships and the amount of the other people trust and interest to him, the quality of the persons close and romantic relationship (intimacy), persons religious tendency such as the amount of obedience from Gods commandments, praise of God, and believe in the possibility of making relationship with God (religion), the capability of spirituality admission and believe in the idea that human has a role and responsibility in an expanded context such as society or universe (Self- Transcendence), the persons capacity to accept weakness and satisfaction from strength (self acceptation) and believe in life justice and fair treatment of the others (fair treatment) [1]. The related subclasses and items in this questionnaire are as follow: Achievement: 5, 6, 16, relation: 7, 8, 13 religion: 4, 9, 18, Self-Transcendence: 1, 3, 17, self acceptance: 11, 15, 21, intimacy: 2, 12, 14, fair treatment: 10, 19, 20. According to Wong [1], internal consistency coefficient (alpha Chronbach) for subscales of this questionnaire is proper. Validity of test-retest with three weeks time gap, has verified all subscales reliability. Wong [1] Reported this questionnaire general alph Chronbach index (factor) as 0.93, he has also reported this index for the subscale as follow: Achievement (0.91), relations (0.81), religion (0.89), Self- Transcendence (0.84), self-acceptance (0.54), intimacy (0.78), fair treatment (0.74). The short form of the meaning of life questionnaire is translated in Persian by Rosatampour after cultural adaption with Iran in (2016). It has been translated again to English and got its designer, Dr. Paul T Wong, confirmation. Psychometrics features of this questionnaire has been surveyed in population of 545 students of Khorasgan Azad university and its standardization, validity and reliability has been reported as proper. He also calculated Cronbach`s Alpha index for the total score of this questionnaire (0.84) and for subscales as follow: Achievement (0.753), relations (0.802), religion (0.783), Self-Transcendence (0.733), selfacceptance (0.769) intimacy (0.733), fair treatment (0.870) [15]. In the present study, total Cvonbach`s alpha were equals to (0.870) and for subscales equals to Achievement (0.711), relations (0.702), religion (0.693), Self-Transcendence (0.754), self-acceptance (0.732), intimacy (0.656), fair treatment (0.732). Ryff and Keyes (1995) 18-items Psychological Well-Being Scale 18-item form of the psychological well-being questionnaire was used in this study with 18 items and six subscales and has three items in order to measure each subscale (It should be noted in this study, total score of psychological well-being is considered). Items are scored based on six-point Likert Scale from (1) "strongly disagree" to (6) strongly agree" and a higher score indicates better psychological well-being. Out of all items, 10 were directly scored and 8 were indirectly scored and total scores of the items is calculated as the total score of psychological well-being. For each subject the minimum score is 18 and maximum one is 108 [16]. Furthermore, the correlation between short form of the Ryff's psychological well-being scale and original scale shows fluctuation from 0.70 to 0.89 [17]. Khanjani et al. [18] investigated the psychometric properties of the Ryff s psychological well-being questionnaire, 18-items form for a sample of 976 students. Internal consistency of this scale using Cronbach's alpha for the total scale of the score was In this study, Cronbach's alpha for the total scale score was Connor and Davidson Resilience Scale (2003) This questionnaire has 25 items that are scored based on a five point Likert scale between zero "strongly disagree" and four "strongly agree". The score of each subject is equal to the total score or the the sum of the obtained scores from the

4 23 Hamid Aghababaei Talkhouncheh et al.: Meaning of Life, Psychological Well-Being and Resilience in Iranian Students questions. For each subject, the minimum score is zero and the maximum one is 100 [3]. Besharat [19] reported the Cronbach's alpha coefficient as In this study, Cronbach's alpha coefficient for this scale is Due to the higher Cronbach's alpha coefficient obtained from the desirable criteria 0.7, it can be concluded that this scale in terms of consistency and inter-rater reliability is desirable. 3. Results 3.1. Mean, Standard Deviations and Correlations of Variables Table 1. The mean, standard deviation and inter-correlation between variables. In table 1 descriptive criteria (SD) and Metris correlation are the components of the presented research variables (To summarize, only significant correlation have been reported). Variables M SD self acceptance ** 0.22** 0.45** 0.30** 0.28** 0.24** 0.62** 0.117* 0.32 ** 2. Self-Transcendence ** ** 0.40** 0.30** 0.37** 0.17* 0.66** 0.26 ** 0.44 ** 3. relation ** 0.35** ** 0.24** 0.22** 0.31** 0.57** 0.35 ** 0.33 ** 4. fair treatment ** 0.40** 0.33** ** 0.17* 0.23** 0.68** 0.24 ** 0.32 ** 5. religion ** 0.30** 0.24** 0.40** * ** 0.18 ** 0.20 ** 6. Achievement ** 0.37** 0.22** 0.17* 0.15* ** 0.20 ** 0.53 ** 7. intimacy ** 0.17* 0.31** 0.23** ** * 8. Total score ** 0.66** 0.57** 0.68** 0.50** 0.49** 0.54** ** 0.50 ** 9. Psychological Welbeing * 0.26 ** 0.35 ** 0.24 ** 0.18 ** 0.20 ** ** ** 10. Resiliency * 0.26 ** 0.35 ** 0.24 ** 0.18 ** 0.20 ** ** 0.32 ** 1 p<0.01** p<0.05* As shown in Table 1, there is a positive and significant correlation between dimensions of meaning of life (except the intimacy) and psychological well-being (p 0.05). Thus, the first research hypothesis that states there is a significant relationship between the dimensions of meaning of life and psychological well-being was confirmed. As shown in Table 1, there is a positive and significant correlation between dimensions of meaning of life (except the intimacy) and resilience (p 0.05). Thus, the second research hypothesis that states there is a significant relationship between the dimensions of meaning of life and resilience was confirmed Regression Analysis to Predict Psychological Well-Being Regarding the third hypothesis, as it has shown in table 2, from 7 components of meaning of life, the components of relations and total score of meaning of life have been able to predict psychological well-beingscores (p 0.01). To summarize, the last steps of regression equation has only been reported. Table 2. Step by step regression analysis to predict psychological well-being based on meaning of life dimension. final step`s variables R R 2 adjusted R 2 SE F df1 df2 Sig. F Durbin-Watson Relations, total score of meaning of life Regression Equation to Predict Psychological Well-Being According to table 3 data, regression equation to predict psychological well-being scores based on meaning of life elements are as follows: meaning of life`s total score (0.1) + relations (0.65) + constant value (55.32) = psychological well-being score. Table 3. Standard and not standard indexes of psychological well-being prediction equation according to meaning of life dimensions. Variables added in the last step B SE βeta t Sig. (Constant) Relations Total score of meaning of life So according to the existed data, the research third hypothesis- meaning of lifedimension can predict psychological wellbeing is confirmed Predict Resiliency According to Meaning of Life Dimensions For the fourth research hypothesis, as shown in Table 4, it can be said that out of seven components of meaning of life, achievement, total score of the meaning of life, and self-transcendence could predict the resilience scores (p 0.01) (for brevity, only the last step of the regression equation has been reported).

5 American Journal of Psychology and Behavioral Sciences 2017; 4(4): Table 4. Step by step regression analysis to predict resiliency according to meaning of life dimensions. final step`s variables R R 2 adjusted R 2 SE F df1 df2 Sig. F Achievement, Total score of meaning of life, Self-Transcendence Durbin- Watson In the final step, a regression equation with the predictor variables could explain 37.6% of the variance related to resilience (p 0.05) Predict the Score of Psychological Well-Being Using the Meaning of Life Scores As shown in Table 5, a regression equation to predict the score of psychological well-being can be obtained using the scores of the components of the meaning of life as follows: (Self-transcendence) (total score of meaning of life) (achievement) (constant) = standard score of resilience Table 5. Non-standard and standard coefficients of equation to predict resilience the basis of the meaning of life. Variables added in the last step B SE βeta t Sig. (Constant) Achievement Total score of meaning of life Self-Transcendence Thus, according to available data, the fourth research hypothesis that dimensions of meaning of life can predict psychological well-being was confirmed. 4. Discussion and Conclusion As shown in Table 1, there is a direct significant relationship between achievement, religion, selftranscendence, relationships, self-acceptance, fair behavior and the total score of the meaning of life and psychological well-being (p 0.05). Also, according to the results reported in Table 2 and Table 3, out of seven components of the meaning of life, relationships and total score of the meaning of life can predict psychological well-being (p 0.01) and regression equation with these predictors could clarify the 15% of the variance related to the psychological well-being (p 0.05). This finding is consistent with the findings of Jarsma et al. [20], Hope [21], Sims [22] and Rostampour [15]. The positive relationship between meaning of life and psychological well-being can be explained using thesims' theory [22]. In this theory, the meaning of life and well-being psychology are regarded as two of five important factors for maintaining mental health of the people. Other factors include personal growth, hardiness and positive relationships. In addition, Wong [10] has been well clarified the relationship between these two variables. He explained that when everything goes well, positive emotions are adequate for maintaining the well-being; however, where there is a problem, meaning gains more importance in maintaining the health indicators compared to the positive emotions, because one of the main functions of the meaning of life is to provide a ground for re-interpretation of the hardships and pains and changing the negative emotions into the positive ones in order to tolerate them. Wong [10] recommends that meaning as one of the subscales of well-being and quality of life should be integrated in measurement tools integration, because research has shown that that positive emotions can give meaning to life and on the other hand, people who have meaningful life are more adaptive and show the higher well-being and satisfaction when facing the problems. Moreover, purposiveness, relations with others and self-acceptance play a role in both theoretical foundations of meaning of life and psychological well-being. So, this relationship may be partially related to the theoretical similarities of these two concepts. Shemotkin and Sharira [23] state that mental well-being is required for a systematic process to manage the adverse conditions and considered meaning of lie as the requisite for regeneration processes required to interpret pain. Therefore, they used both existential psychological variables and positive psychological variables in their theory and emphasized on their interactive relationship. Seligman [6] clarified that assignment of adaptive meanings for the events and true interpretation leads to hope and well-being. Also, according to results presented in Table 1 Bilirubin, there is a significant direct relationship between achievement, religion, self-transcendence, relations, self-acceptance, fair behaviors and the total score of the meaning of life and resilience (p 0.05) and according to the results reported in Table 3 and Table 4, achievement, total score of the meaning of life and self-transcendence among the seven components of meaning of life can predict the scores of the resilience (p 0.05 ) and regression equation with these predictors could predict 37.6% of the variance related to resilience (p 0.05 ). These findings are consistent with those of Mascaro [24], Mascaro and Rosen [25], Wong [9] and Rostampour [15]. For explaining this finding, it can be said that according to Wong [9] resilience is the ability to overcome the hardships and achieve the flourishing and there are meaning aspects for

6 25 Hamid Aghababaei Talkhouncheh et al.: Meaning of Life, Psychological Well-Being and Resilience in Iranian Students it, too. Cognitive aspects including assignment of the adaptive meaning to the hardships and existential and spiritual aspects are one of the resilience dimensions in meaning-based studies, that Frankl [4] calls it tragic optimism that means the individual ability tomaintain optimism in tragic circumstances that necessitates the effective existential coping strategies and the ability to reconstruct the meaning using internal resources. He clarifies that when facing the adverse circumstances, that generally cannot be changed, only those who can internally solve the problem using the effective coping strategies are successful. It is natural that using the effective coping strategies depends on an internal semantic resources (consistent with Wong's theory, the relationship between religion and selftranscendence and resilience was confirmed in this study). In brief, resilience is a multifaceted issue and many factors are involved including meaning of life that its relationship with resilience was confirmed in this study. Meaning of life by creating the positive features such as self-efficacy and effective coping with stresses and problems focuses on the issue, and as Wong [1] states ability to accept problems, selftranscendence, religious beliefs and so on are the sources of meaning in life and bring about assertiveness and resilience for solving problems. Having a meaning and purpose in life gives the people the motivation to cope with the stress and the pain, even severe pain. Therefore, having a meaning and purpose in life shapes these features and increases the resilience of the people. Wong [9] emphasizes on the effect of meaning in creating and maintaining the resilience: What doesn't kill you, makes you stronger. He believes that meaning in life can help people to overcome hardships. In brief, one of the main features of the people than through which can explain why and how resilience is created is to look for the meaning in facing the seemingly unsolved problems or challenging situations. This can increase the perseverance and hardworking. It also helps people to recreate themselves and increase their progress during life. Acquiring meaning in life leads to the idea of self-mastery or life-mastery. References [1] Wong P T P. (Ed.) The human quest for meaning: Theories, research, and applications (2nd Edition). New York, NY: Routledge, 767 p. [2] Ryff C D, Keys C L The structure of psychological Well- being revisited. Jornal of personality and social psychology. 69: [3] Connor K M, Davidson J RT Development of a new resilience scale: The Connor-Davidson Resilience Scale (CD- RISC). Depression & Anxiety, 18: [4] 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, [5] Ryff C D Scales of psychological well-being. Journal of Personality and Social Psychology, 57: [6] Seligman M E Flourish. New York, NY: Free Press, 328 p. [7] Seligman M E P, Steen T, Park N, Peterson C Positive psychology progress: Empirical validation of interventions. American Psychologist, 60: [8] Wong, P. T. P Positive psychology 2.0: Towards a balanced interactive model of the good life. Canadian Psychology, 52 (2), Wong P T P. 2011c. The meaningful living project. Retrieved from [9] Wong P T P Meaning in life. In a. c. Michalos (Eds.), Encyclopedia of quality of life and well-being research. New york, NY: Springer. pp [10] King L, Hicks L Positive affect and the experience of meaning in life. Journal of Personality and Social Psychology, 90: [11] Klinger E The search for meaning in evolutionary perspective and its clinical implications. In P. T. P. Wong & P. S. Fry (Eds.), The human quest for meaning: A handbook of psychological research and clinical applications Mahwah, NJ: Erlbaum. pp [12] Peterson, C, Park N, Methodological issues in positive psychology and the assessment of character strengths. In A. D. Ong & M. van Dulmen (Eds.), Handbook of methods in positive psychology. New York, NY: Oxford University Press. pp [13] Wong, P T P The resource-congruence model of coping and the development of the Coping Schemas Inventory. In P. T. P. Wong & L. C. J. Wong (Eds.), Handbook of multicultural perspectives on stress and coping New York, NY: Springer, pp [14] Rostampour, R Surveing the psychometrics features of life meaning questionnaire and the relationship between life meaning and psychological well being, resiliency, satisfaction in life in students of khorasgan Azad university (Isfahan), master of science thesis, faculty of psychology and education of khorasgan Azad university (Isfahan). [15] Ryff C D, Singer B H Best news yet on the six-factor model of well-being. Social science Research, 35: [16] Ryff C, Singer B The role of purpose in life and personal growth in positive human health. In P. T. P. Wong & P. S. Fry (Eds.), T e human quest for meaning: A handbook of psychological research and clinical applications Mahwah, NJ: Erlbaum, pp [17] Khanjani, M., Shahidi, Sh., Fath Abadi, J., Mazaheri, M., Shokri A Factor structure and psychometric properties of the short (18 questions) Psychological well-being scale in male and female students. Thought And Behavior Quarterly, 32: [18] Besharat, M., Salehi, M., Shah Mohamadi, Kh., Nadali, H., Zebardast, A The relationship between exercise and mental health resilience and hard work with success in athletics. Contemporary Psychology, 3: [19] Jaarsma T A, Pool G, Ranchor A V, Sanderman R Th e concept and measurement of meaning in life in Dutch cancer patients. Psycho-Oncology, 16:

7 American Journal of Psychology and Behavioral Sciences 2017; 4(4): [20] Hope N L When caring hurts: The signif cance of personal meaning for wellbeing in the presence of secondary traumatic stress (master s thesis). Trinity Western University, Langley, BC, Canada. [21] Simms S M Making lemonade out of life s lemons: Factors of mental health and wellbeing (Phd thesis). Trinity Western University, Langley, BC, Canada. [23] Mascaro N The development, construct valid ity, and clinical utility of the Spiritual Meaning Scale. Personality and Individual Diferences, 37: [24] Mascaro N, Rosen D H Existential meaning s role in the enhancement of hope and prevention of depressive symptoms. Journal of Personality, 73: [22] Shmotkin D, Shrira, A Happiness and suf ering in the life story: An inquiry into conf icting expectations concerning the association of perceived past with present subjective wellbeing in old age. Journal of Happiness Studies, 24:

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