2012. Vol.3, No.4, 337-345
Published Online April 2012 in SciRes (http://www.SciRP.org/journal/psych) http://dx.doi.org/10.4236/psych.2012.34048
Copyright © 2012 SciRes. 337
Meaning in Life, Psychological Well-Being and Depressive
Symptomatology: A Comparative Study
George Kleftaras, Evangelia Psarra
Department of Special Education, University of Thessaly, Volos, Greece
Received January 26th, 2012; revised February 24th, 2012; accepted March 27th, 2012
The purpose of the present study was to examine the relationship of meaning in life and its dimensions to
depression and general psychological health, as well as the differences concerning the meaning of life
among individuals with low, moderate and high depressive symptomatology. A sample of 401 newly re-
cruited young men for their national service in the navy, completed four questionnaires on meaning in life,
depressive symptomatology, psychological health and socio-demographic factors. Significant associations
were found between meaning in life and depressive symptoms. As expected, subjects with higher life
meaning were found to have lower depressive symptomatology, while subjects with higher depression
scores were found to have a lower sense of meaning in life. However, concerning the meaning in life di-
mensions, only the “contentedness with life” and the “goal achievement” significantly differentiated indi-
viduals of low, moderate and high depressive symptomatology. Furthermore, statistical significant corre-
lations were found between meaning in life and the four dimensions of general health. In the same vein,
the comparison between individuals with the lower and the higher meaning of life has shown that the two
groups differ significantly with regards to psychological health: those with higher meaning of life present
a better psychological health. Finally, being married or involved in a romantic relationship, as well as par-
ticipation in social activities are proven to be significant sources of meaning. These findings point to a
definite relationship of meaning in life with depression and psychological health. Implications for psy-
chotherapy and counselling are discussed.
Keywords: Meaning in Life; Depressive Symptomatology; Psychological Health
The primary motive of human behavior, according to Frankl’s
existential theory (1959) is the will to meaning or else a per-
son’s strive to find a reason for his/her limited and often “con-
fusing” existence. The meaning of life differs from person to
person and from moment to moment. Thus, it cannot be defined
in a general way. Human beings experience the meaning of life
when they correspond in time to the demands of the situation
they are in, when they discover and undertake their own unique
duty in life and when they allow themselves to experience or
believe in an ultimate meaning, which may refer to, among
others, the faith in God. The choice of a person to be dedicated
to a purpose outside of him/herself and to engage and contrib-
ute to the world are also emphasized. A person can discover
his/her personal meaning of life (Frankl, 1973) by: 1) his/her
creative values, which s/he experiences through goal achieve-
ment and what s/he contributes to life (e.g., work, creating a
home, defending of a belief etc.); 2) his experiental values,
which he experiences through anything good, beautiful or true
he takes from life (e.g., enjoy music or a landscape, making an
intimate relationship with another person) and 3) attitudinal
values, which he experiences through the attitude he holds in a
difficult situation or a situation which is inevitably accompa-
nied by suffering. This attitude is indicative of a person’s
deeper perception for life and the world.
Meaning of life is a vital element that gives coherence to the
person’s worldview and a critical factor for his/her psychologi-
cal and spiritual well-being. Frankl notes that life has meaning
under all circumstances and that it is psychologically damaging
when a person’s search for meaning is hindered. If someone
does not strive to find meaning in his/her life, then sooner or
later he will lose his psychological well-being (Frankl, 1967,
1969). Meaninglessness causes a situation called “existential
vacuum”. This state can be manifested with symptoms of
boredom, depression and/or aggressive behavior. Maddi (1967)
has been referred to this situation with the term “existential
neurosis”, which is differentiated by depression in that it is
more closely associated with apathy and less with depressive
In general, meaning of life has been positively associated
with physical/psychological health/well-being and psychopa-
thology and seems to serve as a mediator factor in psychology-
cal health (Chan, 2009; Fox & Leung, 2009; Halama & Dedova,
2007; Ho, Cheung, & Cheung, 2010; Holahan, Holahan, &
Suzuki, 2008; Owens, Steger, Whitesell, & Herrera, 2009) and
death acceptance/fear of death (Routledge & Juhl, 2010; Tho-
mpson, Noone, & Guarino, 2003). Additionally, people who
can find meaning in negative experiences, such as cancer
(Jaarsma, Pool, Ranchor, & Sanderman, 2007; Lethborg, Aranda,
Cox, & Kissane, 2007; Visser, Garssen, & Vingerhoets, 2010),
HIV (Lyon, 1997; Lyon & Younger, 2001) or the loss of a child
(Coyle, 1998), seem, after the incident, to cope better with the
situation, in comparison to those that cannot find meaning.
The concepts of meaning in life, psychological well-being
and depression are influenced by cultural factors. Culture in
G. KLEFTARAS ET AL.
mental health care is a multifaceted concept and it can be seen
as a dynamic process that links the past to the present and is
shaped in part by social, historical, and political forces. Culture
is more diverse than race or ethnicity and extends to other areas
that tend to receive different and less attention than that re-
ceived by the dominant culture, such as language, gender, class,
age, sexual orientation, and religion (Waite & Calamaro, 2009).
The cultural factors are important not only among eastern and
western societies but even for European multicultural society,
because despite the indisputable similarities, there are, also,
important and fundamental differences among the northern,
central and southern countries forming the European Union.
When examining depression within different European coun-
tries, culture may be integral to improve detection, intervention,
and recovery efforts for young men in different European coun-
tries, due to significant differences in social, political, financial,
historical, ethnic and cultural backgrounds and especially in
Greece, which seems to be in the midpoint between east and
west. An interesting study, for instance, based on data collected
in 14 nations in Europe (N = 3438 female and 2091 male stu-
dents; aged 17 - 30 years), has shown that soft or feminine na-
tions, in which both women and men are offered equal oppor-
tunities for the fulfillment of multiple social roles that are asso-
ciated with good self-rated health, would score significantly
lower on national depression levels than tough or masculine
societies in which such opportunities exist to a clearly lesser
extent (Arrindell, Steptoe, & Wardle, 2003).
Age is an important cultural factor, given that men in late
adolescence often experience a stressful time of transition as
they try to gain emotional independence. The ages between 18
and 25 years represent the final transition from childhood to
adulthood, encompassing the end of adolescence and the ach-
ievement of full adult status. In these critical years, people’s
perceptions about themselves and their world are shaped and
reshaped. Included in these perceptions are cultural values and
beliefs regarding health and mental health (Kendricks, An-
derson, & Moore, 2007). Research reports that 25% of young
adults, the highest incidence rate of any adult age group, ex-
perience a depressive episode by age 24 years (Kessler & Wal-
ters, 1998; Klerman, 1988; Klerman & Weissman, 1989). How-
ever, literature and research that examines psychological well-
being and especially depression among men has received rela-
tively little attention, in part, because the condition is often
associated with being a woman (Prior, 1999). Young men af-
fected by depression during this critical period are at increased
risk of substance abuse, impaired work and relationship func-
tion, and negative influences on the individual’s subsequent
development (Reinherz, Giaconia, Hauf, Wasserman, & Paradis,
2000). Moreover, fewer than 20% of young adults with depres-
sion, which has significant implications for suicide, receive
high-quality care (Young, Klap, Sherbourne, & Wells, 2001).
Undiagnosed depressed mood and associated suicidal risk
among youths have been greatest among young white men
(Centers for Disease Control and Prevention, 2000).
The studies that have investigated the relationship of mean-
ing in life with psychological well-being and depression are
relatively few, and in general they demonstrate significant
negative relationships among these variables. However, they
have been conducted in the United States of America and with
specific populations such as individuals with multiple sclerosis
(Hart, Fonareva, Merluzzi, & Mohr, 2005), HIV (Lyon &
Younger, 2001), cancer (Simonelli, Fowler, Maxwell, & An-
dersen, 2008), Schizophrenia (Stolovy, Lev-Wiesel, Adiel, &
Gelkopf, 2009), older adults (Westerhof et al., 2010) and col-
lege students (Mascaro & Rosen, 2005, 2008; Robak & Griffin,
2000). The need for further investigation of the relationship of
meaning in life with depression and psychological well-being in
other populations and in other sociocultural environments, such
as the European one and more specifically the one of Greece, is
necessary and becomes even more important, if we consider
that depression is closely connected with suicidal ideation and
mortality, which seem to be mediated by the concept of hope-
lessness. An intense feeling of depression may cause meaning-
lessness, which may in turn lead to suicidal ideation. The oppo-
site, however, may be more possible, in the sense that mean-
inglessness may affect twofold suicidal behavior in both an
indirect way, due to depression that may cause and in a direct
way, due to the fact that life and its difficulties seem meaning-
less (Fitzpatrick, 2009; Heisel & Flett, 2004; Kang, Shim, Jeon,
& Koh, 2009; Krause, 2009; Robak & Griffin, 2000; Yang,
Staps, & Hijmans, 2010).
The aim of the present study is to help to the better under-
standing of subjective well-being and depressive symptom-
matology of young men in Greece and mainly of their relation-
ships with meaning of life, which, according to the literature,
seems to play a critical role in psychological health. In general,
international studies regarding meaning of life, and its relation-
ship with psychological well-being and depression are rela-
tively few, especially in the population of young men, and
mainly conducted in North America, while in Greece the rele-
vant studies are non-existent, which rises caution as to the gen-
eralizability of their results to the specific sociocultural context
of Greece. In the light of the above, the present research study
aims at the evaluation of the subjective well-being and the se-
verity of depression in the population of newly recruited young
men for their national service in the Greek Army Navy, regard-
ing the general meaning of life they experience, which eventu-
ally determines their attitude towards the difficulties they face.
This population is considered vulnerable to both depressive
symptomatology, and sucidal behavior, due to stressors, which
these young men are going through during their first basic
military training in the Army Navy (abrupt separation from
family and friends for a month, change of their daily schedule
and adaptation to a new context with stricter rules) (Florkowski,
Gruszczynski, & Wawrzyniak, 2001; James, 1993).
Finally, the investigation of the relationships between meaning
of life and depressive symptomatology with socio-demographic
variables, such as age, having a brother/sister, educational level
and chiefly marital status and participation in cultural, athletic,
political or other activities, is of much interest. Especially, re-
garding marital status and participation in several activities, we
expect a significant positive relationship with meaning of life
and a negative one with depression, as they may potentially
serve as sources of meaning.
Subjects and Procedure
Τhe sample of the present study consisted of 401 newly re-
cruited men during their basic training in Army Navy, who
voluntarily participated in the present study, aged 18 - 30 years,
with a mean age of 24.5 years. The majority (82.8%) has either
a University degree or a degree from Technological Institute.
Copyright © 2012 SciRes.
G. KLEFTARAS ET AL.
The sample’s socio-demographic characteristics are illustrated
in Table 1.
The research took place at the Training Center of the Army
Navy in the island of Poros. Initially, subjects were informed
about the material, the duration of the whole procedure and the
anonymity of their participation and they were asked as to
whether or not they would like, voluntarily, to participate in the
study. Those who accepted, they were divided into two groups,
each of 250 individuals, in order to complete the questionnaires
of the study. Among the 464 completed questionnaires, only
401 were correctly filled.
In this study, except for the questions concerning the subjects’
demographic characteristics, three questionnaires were admin-
1) Questionnaire of Self Evaluated Depressive Symptoma-
tology (QD2). The QD2 is a 52-item self-report that taps a vari-
ety of the affective, cognitive and somatic symptoms of depress-
sion. The items are answered true or false. Higher scores indi-
cate more severe levels of depression. This questionnaire was
Socio-demographic characteristics of the sample (Ν = 401).
Ν Relative Frequencies (%)
18 - 20 23 5.8
21 - 24 159 39.9
25 - 28 202 50.8
29+ 14 3.5
Primary School 1 0.3
Junior High School/S.E.I.1 19 4.8
Senior High School 48 12.0
University 332 82.8
Single 194 48.5
Married 195 48.8
I have an affair 11 2.8
Order of birth
First 201 51.1
Second 145 36.9
Third 35 8.9
Fourth 7 1.8
Fifth+ 5 1.3
Participation in activities
Never 45 11.3
Sometimes 156 39.1
Often 156 39.1
Always 42 10.6
1Secondary Technological School.
constructed and validated by Pichot et al. (1984) in France. In
fact, QD2 derived from the content analysis of the items of the
four best known self report inventories exploring the symptoms
experienced by depressive patients: the Hopkins Symptoms
Check List, the French version of the Beck Depression Inven-
tory (BDI), the Depression Scale of the Minnesota Multiphasic
Personality Inventory (MMPI-D) and the Zung Self-Rating
Depression Scale (SDS).
The QD2 has 1) a good homogeneity (studied by computing
the phi [Φ] coefficient for each item: all coefficients were sig-
nificant to .01 level of significance except from two which were
significant to .05 level of significance); 2) a good reliability
(split-half method; Spearman-Brown formula) studied in four
groups of depressed (.93, N = 157), normal (.92, N = 89), or-
ganic (.95, N = 90) and psychiatric patients (.94, N = 145); 3) a
good concurrent validity according to three criteria: contrasts
between groups of depressed and non-depressed subjects (nor-
mal, organic and psychiatric patients), correlation with Zung
Questionnaire, correlation with the intensity of depression as
rated clinically; and 4) a satisfactory factorial structure. The
responses of a group of clinically depressed patients (N = 157)
to QD2 were subjected to factor analysis which revealed three
basic dimensions (factors), which correspond respectively to
the feelings of loss of general drive, to the depressive-pessi-
mistic mood, and to anxiety.
The QD2 was translated and adapted in Greek by a team of
three bilingual psychologists (Kleftaras & Tzonichaki, 2012).
The factorial structure of the Greek version of QD2, as studied
in both our sample and a population of young and elderly indi-
viduals (Kleftaras & Tzonichaki, 2010; Tzonichaki & Kleftaras,
1998), proved satisfactory and confirms the results of the rele-
vant studies in France (Kleftaras, 1991, 2000; Pichot et al.,
1984). The reliability coefficients of the Greek version of QD2,
as found in the present study are .92 (Cronbach’s a) and .91
2) Purpose in Life Test (PIL). Crumbaugh & Maholick’s PIL
test (1964, 1969) consists of 20 items, each rated on its own
separately labeled seven-point Likert scale and scores can range
from 20 to 140. This scale measures the degree to which a per-
son experiences a sense of meaning in his life, as defined by
Frankl’s existential theory. The higher an individual’s score on
PIL, the higher the sense of meaning of life experienced by the
According to relevant studies, PIL demonstrates a good reli-
ability and validity according to split-half (.87 - .92) and
test-retest method (.79 - .83) (Crumbaugh, 1968; Crumbaugh &
Maholick, 1964; Meier & Edwards, 1974; Reker & Cousins,
1979). PIL has also significant correlations with psychological
health, well-being and social attitudes (Chan, 2009; Halama &
Dedova, 2007; Ho et al., 2010; Holahan et al., 2008; Lethborg
et al., 2007; Jaarsma et al., 2007; Visser et al., 2010). Regarding
the factorial analysis of PIL test, some studies have concluded
that PIL test is a uni-dimensional scale (Garfield, 1973; Zei-
tchik, 2001), while others have found that the questionnaire
contains more than one dimensions (Chamberlain & Zika, 1988;
Harlow, Newcomb, & Bentler, 1986; Shek, 1992).
The PIL was translated, adapted into Greek and revised
through back-translations by a team of 3 bilingual psycholo-
gists. The reliability of the Greek version of PIL test, according
to Cronbach’s α (alpha) coefficient is .89, while the split half
method reaches a coefficient of .88. Finally, as it will be dis-
cussed next, its factorial structure, as studied in our sample, is
Copyright © 2012 SciRes. 339
G. KLEFTARAS ET AL.
Copyright © 2012 SciRes.
satisfying and confirms the results of relevant studies in other
countries (Kleftaras & Psarra, 2012, in press).
3) General Health Questionnaire (GHQ) (Goldberg & Hillier,
1979). The Greek version of GHQ, translated, adapted and vali-
dated in Greek by Garyfallos, Karastergiou and Adamopoulou
(1991), consists of 28 items, assessing four factors: 1) somatic
symptoms; 2) anxiety/sleep disturbances; 3) social dysfunction
and 4) symptoms of severe depression, mainly on a cognitive
level. Each factor can be assessed separately and the total score
is considered as an indicator of a person’s general psychologi-
cal health. The GHQ is a measure of current mental health, as it
asks whether the respondents have experienced a particular
symptom or behaviour recently. It is a self-administered ques-
tionnaire and each item is rated on a four-point scale (less than
usual, no more than usual, rather more than usual, or much
more than usual). The higher the score, the more severe the
GHQ has a very good split half reliability (r = .95), as well as
internal consistency and reliability with Cronbach’s α coeffi-
cients, ranging from .77 - .93 for its sub-scales (Goldberg &
Williams, 1988). Furthermore, regarding GHQ’s reliability, Gold-
berg and Williams (1988) report a variety of studies, in which
the GHQ scores have relatively high correlations with scales
assessing depression (Pearson r = .57 - .72), quality of life, life
satisfaction and psychosomatic symptoms, as well as structured
clinical interviews, assessing general psychopathology (r = .45
- .83). These associations render GHQ a reliable psychometric
instrument of the person’s psychological health (Goldberg &
In the series of statistical analyses, performed in order to in-
vestigate the hypotheses of this study, the total scores of the
participants in the questionnaires of depression and general
health were used, due to the fact that previous studies in Greece
have shown that the factorial structure and the reliability of
these questionnaires are satisfactory (Garyfallos et al., 1991;
Kleftaras & Tzonichaki, 2010; Kleftaras & Psarra, 2012, in
press; Tzonichaki & Kleftaras, 1998). However, regarding
meaning of life and its dimensions, the subjects’ scores in the
first principal component (general factor—principal component
analysis) were used for more precision, as well as their scores at
the four factors extracted from the factorial analysis after or-
thogonal Varimax rotations. Specifically, the Purpose in Life
Test has proven to be homogeneous and according to the “prin-
cipal component analysis” it is composed of a general factor (1st
principal component: eigenvalue = 7.9, explains 39.50% of the
total variance), which is defined as “general factor of meaning
of life”, while orthogonal Varimax rotations produced the ex-
pected factors: 1) “contentedness with life” (eigenvalue = 4.57,
accounting for 22.89% of the total variance); 2) “goal achieve-
ment” (eigenvalue = 4.04, accounting for 20.20% of total vari-
ance); 3) “freedom of choice” (eigenvalue = 1.36, accounting
for 6.83% of total variance) and d) “death” (eigenvalue = 1.13,
accounting for 5.66% of total variance) (Kleftaras & Psarra, in
Initially, the relationship of the concept of meaning of life
and its dimensions with depressive symptomatology was stud-
ied. The results indicate statistically significant negative corre-
lations between the level of an individual’s depressive symp-
tomatology and 1) the total meaning of life that he experiences
(r = –.55, p .0001); 2) contentedness with life that he feels (r
= –.46, p .0001); 3) the achievement of goals that he strives
for (r = –.31, p .0001) and 4) the freedom of choice that he
perceives to have (r = –.08, p .05). On the contrary, a statisti-
cally significant correlation between depressive symptomatol-
ogy and preoccupation with the concept of death (r = –.03, p
> .05) (Table 2), does not seem to exist.
Moreover, in order to investigate how the concept of mean-
ing of life and especially its dimensions discriminate among the
individuals of different depressive symptomatology, the sample
was divided into three groups. The first group consists of 146
individuals with the lower depressive symptomatology (Μ
= .82, SD = .84), the second group of 118 individuals with the
higher depressive symptomatology (Μ = 17.95, SD = 7.43) and
finally the third group of 137 individuals with moderate levels
of depression (Μ = 5.60, SD = 1.92) compared to the other two
groups. According to Table 3, the means of these three groups
Pearson’s correlations between meaning of life and depressive symp-
Meaning of Life
Contentedness with life –.46****
Goal achievement –.31****
Freedom of choice –.08*
Total meaning of life –.55****
Note: *p .05, ****p .0001.
Comparison (One-Way ANOVA) of means (Μ) and standard deviations (SD) regarding meaning of life among persons with low, moderate and high
Lower (Ν = 146) Μ (SD) Moderate (Ν = 137) Μ (SD) Higher (Ν = 118) Μ (SD) F (d.f.)
Depression (total score) .82 (.84) 5.60 (1.92) 17.95 (7.43) 560.33 (2)****
Meaning of Life
Contentedness with life .39 (.66) .04 (.81) –.53 (1.27) 3.22 (2)****
Goal achievement .27 (.73) .06 (.83) –.40 (1.29) 16.75 (2)****
Freedom of choice .09 (.87) –.008 (.97) –.11 (1.16) 1.45 (2)
Death .12 (.87) –.09 (.98) –.04 (1.14) 1.78 (2)
Total meaning of life .48 (.60) .06 (.73) –.68 (1.24) 58.15 (2)****
ote: ****p .0001.
G. KLEFTARAS ET AL.
present statistically significant differences as to depressive sym-
ptomatology, because of the way they were selected (F[2, 398]
= 560.33, p < .0001 and p < .0001 for Scheffé criterion) and as
to the meaning of life (total score: F[2, 398] = 58.15, p < .0001
and p < .0001 for Scheffé criterion). More specifically, con-
cerning the dimensions of the meaning of life, only two of them
seem to differentiate, in a statistically significant way, individu-
als with lower, moderate and higher depressive symptomatology:
“contentedness with life” (F[2, 398] = 33.22, p < .0001 and p
< .001 for Scheffé criterion) and “goal achievement” (F[2, 398]
= 16.75, p < .0001 and p < .001 for Scheffé criterion).
However, in contrast with the previous correlations, the dif-
ferences among these three groups, except for “death”, are not
statistically significant even not with regards to “freedom of
choice”. In addition, Scheffé criterion, in the above analyses,
indicated that the differences of the means among the three
depression groups, studied in pairs, both regarding “conten-
tedness with life” and “goal achievement”, as well as “depress-
sion” and “total meaning of life”, are in all combinations statis-
tically significant. Specifically, when a group scores higher on
depression from another one, it presents, in comparison to that
group, a lower mean of meaning of life, considered both on the
total score as well as on each dimension separately.
Finally, it is of interest to consider the relationships of the
sample’s demographic characteristics with depression and mean-
ing of life. Specifically, depressive symptomatology displays
statistically significant negative correlations with age (Pearson r
= –.13, p < .01), order of an individual’s birth (Pearson r = –.13,
p < .01) and his/her participation in cultural, athletic, political
or other activities (Spearman’s rho = –.15, p < .001). An indi-
vidual’s sense of meaning of life is associated in a statistically
significant way with both his/her participation in various activi-
ties (Spearman’s rho = .26, p < .0001), and his/her mari-
tal-affective status: χ2(2, n = 400) = 8.39, p < .01. For example,
only 27.2% (56 individuals) of those who are married or in-
volved in a romantic affair are found in the group with the
lower meaning of life, while the respective percentage of un-
married or not in a romantic affair is of 40.7% (79 persons). In
the above analysis, for the computation of the χ2 criterion,
“meaning of life” was transformed from an ordinal into a cate-
gorical variable with three levels (1 = higher, 2 = moderate and
3 = lower).
Regarding the relationship between meaning of life and psy-
chological health, the results, as shown in Table 4, indicate a
negative moderate correlation between meaning of life and total
score in “G.H.Q.” (r = –.55, p .0001). That is, the higher the
meaning of life, the better the “general health”. Specifically,
concerning the factors of general psychological health, the fol-
lowing negative correlations have been found: 1) a moderate
correlation between meaning of life and the “somatic symp-
toms” factor (r = –.38, p .0001); consequently, the higher the
meaning of life, the less the somatic symptoms; 2) a moderate
correlation between meaning of life and the “anxiety/sleep dis-
turbances” factor (r = –.39, p .0001); therefore, the higher the
meaning of life, the less the anxiety; 3) a moderate correlation
between meaning of life and the “social dysfunction” factor (r =
–.32, p .0001); that is, the higher the meaning of life, the less
the social dysfunction and 4) a strong correlation between
meaning of life and the “severe depression” factor (r = –.63, p
.0001); that is, the higher the meaning of life, the lower the
In this sense, the comparison of the means concerning gen-
eral psychological health between individuals with the lower
and the higher meaning of life, based on their responses to the
“meaning of life scale” (Table 5), indicated that individuals
with the lower meaning of life showed a higher mean score on
“somatic symptoms” factor (Μ = 14.13), compared to individu-
als with the higher meaning of life (Μ = 11.06): t(195.22) =
6.00, p .0001. Additionally, subjects with the lower meaning
of life showed a higher mean score on “anxiety/sleep distur-
bances” factor (Μ = 12.54), than individuals with the higher
meaning of life (Μ = 9.82): t(173.34) = 5.84, p .0001. Indi-
viduals with the lower meaning of life also had a higher mean
score on “severe depression” factor (Μ = 10.56), than individu-
als with the higher meaning of life (Μ=7.42): t(111.21) = 7.34,
p .0001, and scored a higher mean (Μ = 15.34) when com-
pared to individuals with the higher meaning of life (Μ = 13.38)
on “social dysfunction” factor: t(214) = 4.30, p .0001. Fur-
thermore, individuals with the lower meaning of life showed a
higher mean score on “general psychological health” factor (Μ
= 52.49), than individuals with the higher meaning of life (Μ =
41.58): t(169.65) = 7.42, p .0001.
Correlations between meaning of life and general psychological health.
Meaning of Life
Somatic symptoms –.38****
Anxiety/sleep disturbances –.39****
Social dysfunction –.32****
Severe depression –.63****
General psychological health (Total) –.55****
Note: ****p .0001.
Comparison of means (Μ) and standard deviations (SD) between persons with the lower and the higher meaning of life as to general psychological
Lower meaning (Ν = 99) Μ (SD)Higher meaning (Ν = 117) Μ (SD)
Somatic symptoms 14.13 (3.98) 11.06 (3.44) 6.00****
Anxiety/Sleep disturbances 12.54 (3.87) 9.82 (2.76) 5.84****
Social dysfunction 15.34 (3.68) 13.38 (3.03) 4.30****
Severe depression 10.56 (4.12) 7.42 (1.16) 7.33****
General psychological health (total) 94.03 (12.35) 129.41 (8.52) 7.42****
Note: ****p .0001.
Copyright © 2012 SciRes. 341
G. KLEFTARAS ET AL.
One of the aims of the present study was to explore the rela-
tionship between meaning of life and depression in young men
in the sociocultural context of Greece. Our assumption regard-
ing the relationship between these two variables was confirmed
and showed that the higher the meaning of life of a person, the
less the depressive symptomatology he/she manifests. In the
same sense, the comparison between individuals with lower,
medium and higher depressive symptomatology, indicated, as
expected, that meaning of life is an important discriminative
factor among them, in the sense that when a group has a higher
level of depression than another one, it presents in comparison
a lower mean score in meaning of life. Subsequently, the higher
a person’s sense of meaning of life, the less possible is for
him/her to develop depressive symptomatology; a finding
which is in accordance with the existing literature (Hart et al.,
2005; Lyon & Younger, 2001; Mascaro & Rosen, 2005, 2008;
Robak & Griffin, 2000; Simonelli et al., 2008; Stolovy et al.,
2009; Westerhof et al., 2010).
Another important issue of this study that has not yet been
investigated sufficiently in the international literature, concerns
the dimensions of meaning of life and how they are associated
with depressive symptomatology. According to the results, it
seems clear, that in fact only meaning emanated from “content-
edness with life” and “goal achievement” differentiates the
subjects of our sample as to their depressive symptomatology.
On the contrary, meaning associated with “freedom of choice”,
as well as preoccupation with “death”, its meaning and the way
an individual gives meaning to life do not seem to be associated
with depressive symptomatology. These negative results as to
“freedom of choice” and “death” are explained, eventually, by
the fact that our sample consists of persons of a relative young
age (18 - 30 years old), in a particular period of their life, where
the event that literally prevails is their obligatory military ser-
vice in the navy, which is unquestionable and many might
agree with this. Because of their young age, and although
they are aware, eventually they haven’t yet realized, considered
and estimated in depth concepts like “freedom of choice” and
“death”, or the consequences that these concepts may have.
However, this is even truer for the concept of death, the realiza-
tion of which, as well as the search for meaning of life in death,
are not included, developmentally, among the issues that usu-
ally preoccupy young people of post adolescence or early
It is worthwhile to mention the relationship of depressive
symptomatology with age and order of birth. Specifically, the
higher a person’s age and order of birth the lower his/her de-
pressive symptomatology. As to age, our findings concur with
other studies that constantly indicate that young people belong
to the population with the highest risk for developing depres-
sive symptomatology. This may be due to the fact that young
people experience high levels of social pressure and stress,
because during this period of age (18 to 30 years old) they are
socially expected to develop successfully in almost all impor-
tant domains of their life (personal, social, sentimental, voca-
tional, financial) (Brown, Ahmed, Gary, & Milburn, 1995;
Jorm, 2000; Lu, 1995). As to the relationship between depres-
sion and order of birth, it has repeatedly been suggested that the
first-born children are overcharged, due to the difference in the
way their parents treat them, because of luck of prior parental
experience, the greater attention they receive as well as the
greater parental expectations and demands (Herrera, 2001;
Herrera, Zajonc, & Wieczorkowska, 2003; Saroglou & Fiasse,
2003; Whiteman, McHale, & Crouter, 2003).
Finally, a finding of special interest is the significant associa-
tion between the increase of a person’s participation in several
social, political, athletic and cultural activities and the reduction
of depressive symptomatology and mainly the increase of
meaning of life. The relationship between activities and mean-
ing of life constitutes, probably, the intermediate link, which
allows a better and probably a more complete, interpretation of
the repeatedly ascertained relationship between activities (plea-
sant or not) and depression (Kleftaras, 2000; Logsdon & Teri,
1997; Meeks & Depp, 2002). In other words, a person’s in-
volvment in any kind of activities, seems to be an important
source of meaning, which exactly for that reason (increased
sense of meaning) may, eventually, lead to reduced depressive
symptomatology. The significant relationship between a person’s
marital status and meaning of life that he/she experiences can
also be explained in the same way. Being married or in a ro-
mantic affair seems to be an important source of support and
meaning. This interpretation, though, as to both marital status
and participation in activities should be investigated systemati-
cally in future studies.
Regarding the relationship between meaning of life and psy-
chological well-being/health in newly recruited young men for
their national service in the Greek navy, our initial hypothesis
was confirmed. Specifically, a statistically significant negative
relationship has been found between meaning of life and gen-
eral psychological health, somatic symptoms, anxiety and sleep
disturbances, social dysfunction and severe depression. In other
words, the higher an individual’s meaning of life, the better
his/her psychological health, sense of personal health level,
social functioning and the lower his/her anxiety, sleep distur-
bances and depressive symptoms. In addition, the comparison
of the mean scores between individuals with higher and lower
meaning of life, indicated, as expected, that the individuals with
higher meaning of life differ significantly in all the above fac-
tors, when compared with those of lower meaning in life,
showing much better scores in their general psychological
In this sense, it is not surprising that individuals with higher
meaning of life differed significantly from those with lower
meaning of life, with regards to depression as measured by
General Health Questionnaire. In other words, it seems that
individuals experiencing a more intense sense of meaning in
their life, in contrast with those with lower meaning of life,
have a positive perception for their personal health level, they
experience lower anxiety and sleep disturbances, they are more
socially functional and they have a better psychological health,
as reflected by the definite lower depressive symptomatology
they mention. Therefore, meaning of life is significantly as-
sociated with general psychological health.
The conclusions of the present study are limited by the fact
that women are not included in the sample, but only young men
in the context of their military service in the Navy, who volun-
teered to participate in this study and who do not present clini-
cally diagnosed depression. Moreover, the population of newly
recruited men, at that particular period of their life, may differ
from the rest of the population of young people. Their shared
experience—i.e., training in Army Navy—may tend to incline
them to a more or less shared view on meaning of life; a fact
that does not allow to consider these two populations as identi-
Copyright © 2012 SciRes.
G. KLEFTARAS ET AL.
cal (equivalent), even if the age criterion is respected. Therefore,
the results cannot be generalized to the general population or to
a sample manifesting clinically diagnosed depression. Although
this sample cannot be considered as representative of the wider
population of young people, it may though be considered far
representative of the general population of the newly recruited
men for military service in the Navy. Consequently, further
studies with various and more representative populations and
especially with clinical samples, would lead to better and more
reliable data. Additionally, we should mention that the meas-
ures used at the present study, though adapted in Greek and
with good reliability and factorial structure, still, they haven’t
been standardized in Greece. Furthermore, they are all self-
reports and consequently the effects of “social desirability”
cannot be ruled out.
An additional limitation of this study is the correlational na-
ture of the results. The undoubted relationships between the
variables, though ascertained, don’t allow “cause and effect”
conclusions, regarding the relationship between depression and
meaning of life. Although the dominant view, to which we sub-
scribe, is that the concept of meaning of life affects psycho-
logical well-being in general and especially depression, how-
ever, it is also possible that a person’s depressive symptoma-
tology may affect his/her perception of what is meaningful and
how much. The data of this study are not sufficient for answer-
ing this question, which still remains open for future investiga-
Despite the abovementioned limitations, we consider that the
results of the present study are important, as they confirm the
relationship between meaning of life and depression. This fact
renders imperative the need for a revisal of the often suggested
view, that meaning of life is nothing more than a philosophical
concept, which may be overlooked in the context of psycho-
therapeutic process (Debats, 1996; Rufflin, 1984). It is also
important, if reconfirmed by other studies, that among meaning
of life dimensions, those of great importance in eliciting de-
pressive symptomatology (at least in young men) seem to be
“contentedness with life” and “goal achievement”. Conse-
quently, these two dimensions in combination with the situation
of marriage (or the existence of a romantic relationship) and
participation in several social, political, athletic and cultural
activities, as sources of meaning, should be considered and
utilized when coping therapeutically with depressive sympto-
The relationship between meaning of life and depression is a
complex one and many other issues concerning meaning of life
should also be investigated in future studies. As seen previously,
it is interesting and useful in psychotherapeutic terms to inves-
tigate which are the personal sources of meaning, how they are
created and how they can be cultivated. A person can find
meaning of life from many and different sources. The fact,
however that some of them may promote psychological health,
while others may foster the development of psychopathology
and more specifically depressive symptomatology, renders
necessary and essential an in depth study of their effects.
Another important issue for research is how and through
which mechanism meaning of life comes to influence the psy-
chological health and more specifically depressive symptoma-
tology. According to some studies meaning of life seems to
have a direct influence on health, psychological adjustment and
well-being (Chou, 2000; Compton, 2000; Desormeaux, 2000;
Labelle et al., 2001; Moomal, 1999; Smith & Zautra, 2004;
Thompson, Coker, & Krause, 2003), while according to others
it acts as a mediator (Harlow, Newcomb, & Bentler, 1986;
Heisel & Flett, 2004; Newcomb & Harlow, 1986). Finally, an
issue that comes up and hasn’t yet been understood is why
some people tend to seek for meaning, especially in difficult
situations, while others do not. It is possible that some tem-
perament characteristics or personality traits predispose some
persons for meaning seeking, which, however, have not been
Our hypotheses regarding the relationship between meaning
of life and general psychological health were confirmed. It
would be interesting for future studies in the field of psy-
chological health to consider the way that existential theory
interprets and explains human behavior, as it seems a very
promising theoretical approach, mainly in regard to the under-
standing and coping with depressive symptomatology. More-
over, it is of interest to study the concept of meaning of life in
relation to psychopathology and its comparison with respective
data in general population as well as a more systematic investi-
gation of meaning of life regarding specific personality traits
and personal values.
Arrindell, W. A., Steptoe, A. A., & Wardle, J. J. (2003). Higher levels
of state depression in masculine than in feminine nations. Behaviour
Research and Therapy, 41, 809-817.
Brown, D. R., Ahmed, F., Gary, L. E., & Milburn, N. G. (1995). Major
depression in a community sample of African Americans. American
Journal of Psychiatry, 152, 373-378.
Centers for Disease Control and Prevention (CDC) (2000). National
center for injury prevention and control. URL (last checked 1 Febru-
ary 2008). http://www.cdc.gov/ncipc/pub-res/youthsui.htm
Chamberlain, K., & Zika, S. (1988). Measuring meaning in life: An
examination of three scales. Personality and Individual Differences,
9, 589-596. doi:10.1016/0191-8869(88)90157-2
Chan, D. W. (2009). Orientations to happiness and subjective well-
being among Chinese prospective and in-service teachers in Hong
Kong. Educational Psychology, 29, 139-151.
Chou, K.-L. (2000). Intimacy and psychosocial adjustment in Hong
Kong Chinese adolescents. Journal of Genetic Psychology, 161, 141-
Compton, W. C. (2000). Meaningfulness as a mediator of subjective
well-being. Psychological Reports, 87, 156-160.
Coyle, B. (1998). Restoring meaning and purpose after the death of a
child: A qualitative psychological study. Dissertation Abstracts In-
ternational: Section B: The Sciences & Engineering, 59, 1363.
Crumbaugh, J. C. (1968). Cross-validation of Purpose in Life Test based
on Frankl’s concepts. Journal of Individual Psychology, 24, 74-81.
Crumbaugh, J. C., & Maholick, L. T. (1964). An experimental study in
existentialism: The psychometric approach to Frankl’s concept of
noogenic neurosis. Journal of Clinical Psychology, 20, 589-596.
Crumbaugh, J. C., & Maholick, L. T. (1969). Manual of instructions for
the Purpose-in-Life-Test. Munster: Psychometric Affiliates.
Debats, D. L. (1996). Meaning in life: Clinical relevance and predictive
power. British Journal of Clinical Psychology, 35, 503-516.
Desormeaux, L. (2000). Meaning: Relationship to coping mechanisms
and well-being. Dissertation Abstracts International: Section B: The
Sciences & Engineering, 61, 3274.
Fitzpatrick, J. J. (2009). Preventing suicide: Developing meaning in life.
Archives of Psychiatric Nursing, 23, 275-276.
Florkowski, A., Gruszczynski, W., & Wawrzyniak, Z. (2001). Evalua-
tion of psychopathological factors and origins of suicides committed
Copyright © 2012 SciRes. 343
G. KLEFTARAS ET AL.
by soldiers. Military Medicine, 166, 44-47.
James, F. A. P., & Leung, N. (2009). Existential well-being in younger
and older people with anorexia nervosa—A preliminary investigation.
European Eating Disorders Review, 17, 24-30.
Frankl, V. (1959). Man’s search for meaning. London: Hodder &
Frankl, V. (1967). Psychotherapy and existentialism: Selected papers
on logotherapy. New York: Simon and Schuster.
Frankl, V. (1969). The will to meaning: Foundations and applications
of logotherapy. New York: Meridian.
Frankl, V. (1973). The doctor and the soul. From psychotherapy to
logotherapy. New York: Random House.
Garfield, C. A. (1973). A psychometric and clinical investigation of
Frankl’s concept of existential vacuum and of anomia. Psychiatry, 36,
Garyfalos, G., Karastergiou, I., & Adamopoulou, M. (1991). Greek
version of the General Health Questionnaire: Accuracy of translation
and validity. Acta Psychiatrica Scandinavica, 84, 371-378.
Goldberg, D. P., & Hillier, V. F. (1979). A scaled version of the Gen-
eral health Questionnaire. Psychological Medicine, 9, 139-145.
Goldberg, D. P., & Williams, E. (1988). A user’s guide to the G.H.Q.
Halama, P., & Dedova, M. (2007). Meaning in life and hope as predic-
tors of positive mental health: Do they explain residual variance not
predicted by personality traits? Studia Psychologica, 49, 191-200.
Harlow, L. L., Newcomb, M. D., & Bentler, P. M. (1986). Depression,
self-derogation, substance use, and suicide ideation: Lack of purpose
in life as a mediational factor. Journal of Clinical Psychology, 42,
Hart, S., Fonareva, I., Merluzzi, N., & Mohr, D. C. (2005). Treatment
for depression and its relationship to improvement in quality of life
and psychological well-being in multiple sclerosis patients. Quality
of Life Research, 14, 695-703. doi:10.1007/s11136-004-1364-z
Heisel, M. J., & Flett, G. L. (2004). Purpose in life, satisfaction with
life, and suicide ideation in a clinical sample. Journal of Psychopa-
thology & Behavioral Assessment, 26, 127-135.
Herrera, N. C. (2001). Birth rank and personality: Beliefs and their
consequences. Dissertation Abstracts International: Section B: The
Sciences & Engineering, 61, 5054.
Herrera, N. C., Zajonc, R. B., & Wieczorkowska, G. (2003). Beliefs
about birth rank and their reflection in reality. Journal of Personality
& Social Psychology, 85, 142-150. doi:10.1037/0022-35126.96.36.199
Ho, M. Y., Cheung, F. M., & Cheung, S. F. (2010). The role of mean-
ing in life and optimism in promoting well-being. Personality and
Individual Differences, 48, 658-663.
Holahan, C. K., Holahan, C. J., & Suzuki, R. (2008). Purposiveness,
physical activity, and perceived health in cardiac patients. Disability
and Rehabilitation, 30, 1772-1778.
Jaarsma, T. A., Pool, G., Ranchor, A. V., & Sanderman, R. (2007). The
concept and measurement of meaning in life in Dutch cancer patients.
Psycho-Oncology, 16, 241-248. doi:10.1002/pon.1056
James, A. (1993). Evolution des conduites suicidaires dans les armées
en France. Psychologie Médicale, 25, 325-327.
Jorm, A. F. (2000). Does old age reduce the risk of anxiety and depres-
sion? A review of epidemiological studies across the adult life span.
Psychological Medicine, 30, 11-22.
Kang, K. A., Shim, J. S., Jeon, D. G., & Koh, M. S. (2009). The effects
of logotherapy on meaning in life and quality of life of late adoles-
cents with terminal cancer. Journal of Korean Academy of Nursing,
39, 759-768. doi:10.4040/jkan.2009.39.6.759
Kendricks, L., Anderson, N., & Moore, B. (2007). Perceptions of de-
pression among young African American men. Family and Commu-
nity Health, 30, 63-73.
Kessler, R., & Walters, E. (1998). Epidemiology of DSM-III-R major
depression and minor depression among adolescents and young
adults in the National Comorbidity Survey. Depression Anxiety, 7,
Kleftaras, G. (2000). Interpersonal problem-solving of means-ends
thinking, frequency and strength of pleasant and unpleasant activities
and symptoms of depression in French older adults. Physical and
Occupational Therapy in Geriatrics, 17, 43-63.
Kleftaras, G., & Tzonichaki, I. (2010). Perceived locus of control and
depression among Greek young and older adults. Review of Counsel-
ling and Guidance, 91-92, 33-46.
Kleftaras, G., & Tzonichaki, Ι. (2012). Questionnaire d’auto-evaluation
de la symptomatologie dépressive [in Greek]. In Α. Stalikas, S.
Triliva, & P. Roussi (Eds.), The psychometric tools in Greece. Ath-
ens: Ellinika Grammata.
Kleftaras, G., & Psarra, Ε. (2012). Purpose in life test [in Greek]. In Α.
Stalikas, S. Triliva, & P. Roussi (Eds.), The psychometric tools in
Greece. Athens: Ellinika Grammata.
Kleftaras, G., & Psarra, Ε. (in press). Meaning in life: Scale’s facto-rial
structure and psychological well-being [in Greek]. Review of Coun-
selling and Guidance.
Klerman, G. (1988). The current age of youthful melancholia. Evidence
for increase in depression among adolescents and young adults. Brit-
ish Journal of Psychiatry, 152, 4-14. doi:10.1192/bjp.152.1.4
Klerman, G., & Weissman, M. (1989). Increasing rates of depression.
Journal of the American Medical Association, 262, 2229-2235.
Krause, N. (2009). Meaning in life and mortality. Journals of Geron-
tology: Series B: Psychological Sciences and Social sciences, 64,
Labelle, R., Alain, M., Bastin, E., Bouffard, L., Dube, M., & Lapierre,
S. (2001). Well-being and psychological stress: Toward a hierarchi-
cal, cognitive-affective model in mental health. Revue Quebecoise de
Psychologie, 22, 71-87.
Lethborg, C, Aranda, S., Cox, S., & Kissane, D. (2007). To what extent
does meaning mediate adaptation to cancer? The relationship be-
tween physical suffering, meaning in life, and connection to others in
adjustment to cancer. Palliative & Supportive Care, 5, 377-388.
Logsdon, R. G., & Teri, L. (1997). The pleasant events schedule-AD:
Psychometric properties and relationship to depression and cognition
in Alzheimer’s disease patients. Gerontologist, 37, 40-45.
Lu, L. (1995). Life events, social support, and depression among Tai-
wanese female. Journal of Social Psychology, 135, 185-190.
Lyon, D. E. (1997). A causal model of the effects of existential well-
being on the relationship between severity of human immunodefi-
ciency virus (HIV) disease and depression. Dissertation Abstracts
International: Section B: The Sciences & Engineering, 58, 1214.
Lyon, D. E., & Younger, J. B. (2001). Purpose in life and depressive
symptoms in persons living with HIV Disease. Journal of Nursing
Scholarship, 33, 129-133. doi:10.1111/j.1547-5069.2001.00129.x
Maddi, S. R. (1967). The existential neurosis. Journal of Abnormal
Psychology, 72, 311-325. doi:10.1037/h0020103
Mascaro, N., & Rosen, D. H. (2005). Existential meaning’s role in the
enhancement of hope and prevention of depressive symptoms. Jour-
nal of Personality, 73, 985-1013.
Mascaro, N., & Rosen, D. H. (2008). Assessment of existential mean-
ing and its longitudinal relations with depressive symptoms. Journal
of Social and Clinical Psychology, 27, 576-599.
Meeks, S., & Depp, C. A. (2002). Pleasant events-based behavioral
interventions for depression in nursing residents: A conceptual and
empirical foundation. Clinical Gerontologist, 25, 125-148.
Copyright © 2012 SciRes.
G. KLEFTARAS ET AL.
Copyright © 2012 SciRes. 345
Meier, A., & Edwards, H. (1974). Purpose in life test: Age and sex
differences. Journal of Clinical Psychology, 30, 384-386.
Moomal, Z. (1999). The relationship between meaning in life and men-
tal well-being. South African Journal of Psychology, 29, 36-41.
Newcomb, M. D., & Harlow, L. L. (1986). Life events and substance
use among adolescents: Mediating effects of perceived loss of con-
trol and meaninglessness in life. Journal of Personality and Social
Psychology, 51, 564-577. doi:10.1037/0022-35188.8.131.524
Owens, G. P., Steger, M. F., Whitesell, A. A., & Herrera, C. J. (2009).
Posttraumatic stress disorder, guilt, depression, and meaning in life
among military veterans. Journal of Traumatic Stress, 22, 654-657.
Pichot, P., Boyer, P., Pull, C. B., Rein, W., Simon, M., & Thibault, A.
(1984). Un questionnaire d’auto-évaluation de la symptomatologie
dépressive, le questionnaire QD2, I. Construction, structure factorielle
et propriétés métrologiques. Revue de Psychologie Appliquée, 34,
Prior, P. M. (1999). Gender and mental health. Basingstoke and Lon-
don: Macmillan Press.
Reinherz, H., Giaconia, R., Hauf, A., Wasserman, M., & Paradis, A.
(2000). General and specific childhood risk factors for depression
and drug disorders by early adulthood. Journal of the American
Academy of Child Adolescent Psychiatry, 39, 223-231.
Reker, G. T., & Cousins, J. B. (1979). Factor structure, construct valid-
ity and reliability of the Seeking of Noetic Goals (SONG) and Pur-
pose in Life (PIL) Tests. Journal of Clinical Psychology, 35, 85-91.
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.
Routledge, C., & Juhl, J. (2010). When death thoughts lead to death
fears: Mortality salience increases death anxiety for individuals who
lack meaning in life. Cognition and Emotion, 24, 848-854.
Rufflin, J. E. (1984). The anxiety of meaninglessness. Journal of Coun-
seling and Development, 63, 40-42.
Saroglou, V., & Fiasse, L. (2003). Birth order, personality, and religion:
A study among young adults from a three-sibling family. Personality
& Individual Differences, 35, 19-29.
Shek, D. T. L. (1992). Meaning in life and psychological well-being:
An empirical study using the Chinese version of the Purpose in Life
Questionnaire. The Journal of Genetic Psychology, 153, 185-200.
Simonelli, L. A., Fowler, J., Maxwell, G. L., & Andersen, B. L. (2008).
Physical sequelae and depressive symptoms in gynecologic cancer
survivors: Meaning in life as a mediator. Annals of Behavioral Medi-
cine, 35, 275-284. doi:10.1007/s12160-008-9029-8
Smith, B. W., & Zautra, A. J. (2004). The role of purpose in life in
recovery from knee surgery. International Journal of Behavioral
Medicine, 11, 197-202. doi:10.1207/s15327558ijbm1104_2
Stolovy, T., Lev-Wiesel, R., Adiel, D., & Gelkopf, M. (2009). The
meaning in life for hospitalized patients with schizophrenia. Journal
of Nervous and Mental Disease, 197, 133-135.
Thompson, E. H. Jr., Noone, M. E., & Guarino, A. B. (2003). Widows’
spiritual journeys: Do they quest? [special issue]. Journal of Reli-
gious Gerontology, 14, 119-138. doi:10.1300/J078v14n02_03
Thompson, N. J., Coker, J., & Krause, J. S. (2003). Purpose in life as a
mediator of adjustment after spinal cord injury. Rehabilitation
Psychology, 48, 100-108. doi:10.1037/0090-55184.108.40.206
Tzonichaki, I., & Kleftaras, G. (1998). Etude comparative entre sujets
jeunes et âgés, concernant la dépression et le “lieu de contrôle”.
Journal d’Ergothérapie, 20, 49-55.
Visser, A., Garssen, B., & Vingerhoets, A. (2010). Spirituality and
well-being in cancer patients: A review. Psycho-Oncology, 19, 565-
Waite, R., & Calamaro, C. (2009). Cultural competency—Culture and
depression: A case example of a young african american man. Per-
spectives in Psychiatric Care, 45, 232-238.
Westerhof, G. J., Bohlmeijer, E. T., Van Beljouw, I. M. J., & Margriet,
A. (2010). Improvement in personal meaning mediates the effects of
a life review intervention on depressive symptoms in a randomized
controlled trial. Gerontologist, 50, 541-549.
Whiteman, S. D., McHale, S. M., & Crouter, A. C. (2003). What par-
ents learn from experience: The first child as a first draft? Journal of
Marriage & Family, 65, 608-621.
Yang, W., Staps, T., & Hijmans, E. (2010). Existential crisis and the
awareness of dying: The role of meaning and spirituality. Omega-
Journal of Death and Dying, 61, 53-69. doi:10.2190/OM.61.1.c
Young, A., Klap, R., Sherbourne, C., & Wells, K. (2001). The quality
of care for depressive and anxiety disorders in the United States. Ar-
chives of General Psychiatry, 58, 55-61.
Zeitchik, G. (2001). The construct validity of the purpose in life test:
Quantifying Victor Frankl’s “Will to Meaning”. Dissertation Ab-
stracts International: Section B: The Sciences & Engineering, 61,