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The role of purpose in life in recovery from knee surgery

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Abstract

This study examined the role of a sense of purpose in life (PIL) in recovery from knee replacement surgery in 64 surgery patients. Each of the surgery patients had been diagnosed with severe osteoarthritis of the knee. Regression analyses were conducted predicting changes in health 6 months after surgery. When considered alone, PIL was related to less anxiety, depression, negative affect, functional disability, stiffness, and more positive affect. When optimism, pessimism, and emotionality were controlled, PIL was still related to less negative affect, depression, and anxiety, and more positive affect. The results suggest that PIL may be an important positive personal characteristic and target for interventions.
The Role of Purpose in Life in Recovery from Knee Surgery
Bruce W. Smith and Alex J. Zautra
This study examined the role of a sense of purpose in life (PIL) in recovery from knee
replacement surgery in 64 surgery patients. Each of the surgery patients had been di
-
agnosed with severe osteoarthritis of the knee. Regression analyses were conducted
predicting changes in health 6 months after surgery. When considered alone, PIL was
related to less anxiety, depression, negative affect, functional disability, stiffness, and
more positive affect. When optimism, pessimism, and emotionality were controlled,
PIL was still related to less negative affect, depression, and anxiety, and more positive
affect. The results suggest that PIL may be an important positive personal character
-
istic and target for interventions.
Key words: purpose in life, knee surgery, osteoarthritis.
The examination of the effects of positive personal
characteristics on health has received increasing atten
-
tion. Seligman (1999) has emphasized psychology’s
role in identifying these positive qualities and building
them through interventions. Several studies have ex-
amined the role of dispositional optimism and found
that it is often related to better mental or physical
health (Andersson, 1997). Other researchers have be-
gun to examine pathways by which positive affect may
improve coping with stress and enhance health
(Aspinwall, 1998; Fredrickson, 1998).
One of the positive characteristics that is frequently
mentioned but has received less attention than charac-
teristics such as optimism is a sense of meaning and
purpose in life. Viktor Frankl (1992) believed that a
sense of meaning and purpose was the distinguishing
feature between those who did and did not survive
World War II concentration camps. Wong and Fry
(1998) have asserted that “meaning seeking is a key to
unlocking the mysteries of optimal functioning at the
psychological, behavioral, and physiological levels”
(p. xxv).
Ryff and Singer (1998) have reviewed the philo
-
sophical and psychological literature regarding mean
-
ing and purpose in life. They tied it to research on sense
of coherence (Antonovsky, 1987) and personal mean
-
ing (Baumeister, 1991). Ryff and Keyes (1995, p.720)
have defined a sense of purpose in life simply as “the
belief that one’s life is purposeful and meaningful. In
-
dividuals possessing a sense of purpose in life have
goals in living, a sense that their lives have a direction,
and beliefs that give their lives a sense of meaning.
Scheier and Carver (2001) provided a conceptual
framework for understanding the significance of a
sense of purpose in life. They believe that both a sense
of purpose in life (PIL) and positive outcome expectan-
cies (POE; e.g., hope and optimism) are essential for
attaining valued goals. First, an individual must iden-
tify a goal or set of goals that are valued and worthy of
being sought. Valued goals provide the purpose in liv-
ing. Second, an individual must believe that it is possi-
ble to attain one’s valued goals and find a measure of
fulfillment in their sense of purpose in living. The hope
of attaining one’s goals enables one to stay engaged in
trying to attain them.
Within this framework, it is not difficult to see how
both PIL and POE may play important roles for indi
-
viduals facing challenges to their health and survival.
The sense of having valued goals (e.g., PIL) can pro
-
vide the motivation for maintaining mental and physi
-
cal health in the midst of adversity. The sense of being
able to attain valued goals (e.g., POE) makes it possi
-
ble to stay engaged and committed to reaching these
goals.
Despite the potential value of both PIL and POE,
surprisingly few studies have examined PIL or both
PIL and POE together. In addition, the few studies that
have included measures of PIL have examined only
cross-sectional relationships and only in relation to
mental health. In these studies, PIL has been related to
less neuroticism, negative affect, and depression and
more positive affect and life satisfaction (Addad, 1987;
Baum & Boxley, 1983; Ryff & Keyes, 1995). However,
PIL may be more a result than a cause of good mental
health, may be associated with it because of third vari
-
International Journal of Behavioral Medicine
2004, Vol. 11, No. 4, 197–202
Copyright © 2004 by
Lawrence Erlbaum Associates, Inc.
197
Bruce W. Smith, Department of Psychology, University of New
MexicoAlbuquerque,NewMexico,USA;AlexJ. Zautra, Department
of Psychology, Arizona State University, Tempe, Arizona, USA.
This research was supported by biomedical grants from the Ar
-
thritis Foundation, and the National Institute for Arthritis and Mus
-
cular-Skeletal Diseases, 5 RO1 AAR41687-03 (Alex J. Zautra, Prin
-
cipal Investigator).
Correspondence concerning this article should be addressed to
Bruce W. Smith, Department of Psychology, University of New
Mexico, Albuquerque, NM 87131. E-mail: XXXXX@XXXX.com
ables, or may merely indicate the absence of
neuroticism.
The primary purpose of this study was to examine
PIL as a prospective predictor of health in the context
of a stressor in which PIL might play an important role
and where POE was also assessed. Both positive and
negative outcome expectancies were assessed because
of evidence of their independence (Chang,
Maydeu-Olivares, & D’Zurilla, 1997). Participants
were older adults who had severe osteoarthritis of the
knee and elected to have total replacement surgery
(TKR). Osteoarthritis is the most common form of ar
-
thritis and joint replacement is a frequent alternative
for individuals with severe cases (Callahan, Drake,
Heck, & Dittus, 1994).
TKR was chosen because (a) it involves the common
expectation of improvement in physical health and (b)
the attainment and enjoyment of this health may depend
on having a sense of purpose in living. Because TKR al
-
ready provides a basis for hope that improvement in
physical health can occur, PIL might be expected to play
a critical role in providing the desire and motivation for
recovery and living a more satisfying life.
Emotional arousability was also assessed because it
is a central feature of neuroticism (Braithwaite, 1987)
and neuroticism has frequently been related to health
and symptom reports (Watson & Pennebaker, 1989).
Past studies have sometimes found that the relationship
between positive personal characteristics and health
disappears when neuroticism is controlled (Hart,
Hittner, & Paras, 1991; Smith, Pope, Rhodewalt, &
Poulton, 1989). Therefore, emotional arousability was
controlled to rule out the possibility that negative
affectivity might account for any relationship found
between PIL and health.
Changes in mental and physical health were exam
-
ined as indicators of recovery. Mental health measures
included indicators of both psychological distress
(e.g., negative affect, anxiety symptoms, depressive
symptoms) and psychological well-being (e.g., posi
-
tive affect). Physical health measures included were
those that are specifically relevant to individuals with
osteoarthritis on the knee (e.g., functional disability,
pain, stiffness).
The primary question addressed by this study was
whether PIL would predict recovery in the surgery
group, both alone and when controlling for outcome
expectancies and emotional arousability. It was ex
-
pected that PIL would be related to improved health
because it may provide the incentive to recover and live
a satisfying life. PIL might be important beyond out
-
come expectancies because it is important to actually
have valued goals as well as the belief that one can
reach them. Finally, it was expected that PIL would be
important beyond neuroticism because PIL is not just
the lack of negative affectivity but involves the belief
that there is a reason to live.
Methods
Participants
The sample consisted of 64 older adults who had se
-
vere osteoarthritis of the knee and elected to have total
knee replacement surgery (TKR). Originally, there
were 72 participants, but 8 left the study for various
reasons (postponed surgery = 3; request to be discon
-
tinued from the study = 3; out-of-state move = 1;
change to a nonparticipating surgeon = 1). The sample
was 52% women and the mean age was 67.2 (SD =
8.3). The mean level of education was 1 to 3 years of
college and 79% were married. The majority was
White (95%) and not employed (77%).
Procedure
Nurses in rheumatologists’ offices recruited pa
-
tients who had been diagnosed with osteoarthritis and
referred for TKR. Participants completed question
-
naires at two points in time: 2 weeks prior to surgery
(T1) and 6 months after surgery (T2). The question
-
naires at T1 included measures of PIL, other personal
characteristics, and of mental and physical health.
The questionnaires at T2 included the measures of
mental and physical health that had been adminis-
tered at T1.
Measures
Purpose in life. Purpose in life (PIL) was as-
sessed at T1 using a 14-item scale developed to mea
-
sure the belief that one’s life is purposeful and mean
-
ingful (Ryff & Keyes, 1995). The scale consists of
items such as “I have a sense of direction and purpose
in my life” and “I enjoy making plans for the future
and working to make them a reality. Cronbach’s α
was .83.
Optimism and pessimism. Optimism and pessi
-
mism were assessed at T1 using the Life Orientation
Test–Revised (LOT–R; Scheier, Carver, & Bridges,
1994). The LOT–R includes 3 items measuring opti
-
mism and 3 items measuring pessimism. Cronbach’s α
was .70 for optimism and .75 for pessimism.
Emotionality. Emotionality was assessed at T1
using the general emotionality subscale of the Scale
of Emotional Arousability (Braithwaite, 1987). The
emotionality subscale was designed to tap the emo
-
tionally labile facet of neuroticism. The items assess
the tendency to experience negative affect (e.g., “I
frequently get upset”). It consists of 6 items and
Cronbach’s α was .75.
198
SMITH AND ZAUTRA
Positive and negative affect. Positive and nega
-
tive affect were measured at T1 and T2 with the Posi
-
tive and Negative Affect Schedule (Watson, Clark, &
Tellegen, 1988). It consists of 10 positive affect items
and 10 negative affect items. Cronbach’s α was .88 for
positive affect and .89 for negative affect.
Mental health inventory. Anxiety and depres
-
sive symptoms were assessed at T1 and T2 using the
Mental Health Inventory (Veit & Ware, 1983). The
anxiety subscale consists of 10 items and the depres
-
sion subscale consists of 9 items. Cronbach’s α was .90
for anxiety and .90 for depression.
Western Ontario and McMaster University
Osteoarthritis Index (WOMAC). Functional dis
-
ability, pain, and stiffness due to osteoarthritis of the
knee was assessed at T1 and T2 by the WOMAC
(Bellamy, Buchanan, Goldsmith, Campbell, & Stitt,
1988). The WOMAC includes 17 items for functioning
disability, 5 items for pain, and 2 items for stiffness.
Cronbach’s α was .96 for functional disability, .88 for
pain, and .81 for stiffness.
Results
Table 1 displays the means and standard devia
-
tions for the personal characteristics and the health
measures before surgery (T1) and at 6 months follow
-
ing surgery (T2). Paired samples t tests were con
-
ducted to compare the health measures at T1 and T2.
There was a significant decrease in functional disabil
-
ity, t(63) = –10.26, p < .001; stiffness, t(63) = –8.12,
p < .001; pain, t(63) = –11.44, p < .001; and negative
affect, t(63) = –3.74, p < .001; and an increase in pos
-
itive affect, t(63) = 3.45, p < .01.
Table 2 displays the correlations between the per
-
sonal characteristics and health measures at T1. PIL
was positively related to optimism and negatively re
-
lated to pessimism and emotionality. As for the health
measures, PIL was significantly related (ps < .05) to
more positive affect and less anxiety, depression, and
negative affect. Although the correlations between PIL
and these mental health measures were substantial,
r(62) = .317–.585, they were not strong enough to sug
-
gest multicollinearity problems (Tabachnick & Fidell,
1996).
199
PURPOSE IN LIFE AND KNEE SURGERY
Table 1. Means and Standard Deviations of Personal Characteristics and Health Measures at Baseline and 6 Months
Baseline 6 Months
MSDMSDScale Range
Purpose in life 5.09 .67 1–6
Optimism 3.11 .62 0–4
Pessimism .86 .80 0–4
Emotionality 2.70 .79 1–5
Anxiety 2.26 .84 2.12 .83 1–6
Depression 1.70 .74 1.74 .89 1–6
Negative affect 1.91 .76 1.59 .78 1–5
Positive affect 3.22 .74 3.55 .89 1–5
Functional disability 2.19 .63 1.12 .77 0–4
Pain 2.15 .67 .87 .75 0–4
Stiffness 2.40 .93 1.39 .86 0–4
Note. N = 64.
Table 2. Correlations Between Personal Characteristics and Baseline Health Measures at Baseline
1234567891011
1. Purpose in life
2. Optimism .437
***
3. Pessimism –.585
***
–.382
***
4. Emotionality –.300
**
–.306
**
.311
**
5. Anxiety –.425
***
–.265
**
.409
***
.572
***
6. Depression –.464
***
–.268
**
.456
***
.456
***
.796
***
7. Negative affect –.317
**
–.162 .212
*
.392
***
.611
***
.692
***
8. Positive affect .379
***
.175 –.165 –.222
*
–.233
*
–.188 –.240
*
9. Functional disability –.125 –.261
**
.031 .068 .290
**
.319
**
.477
***
–.307
**
10. Pain –.081 .108 –.044 .159 .290
**
.295
**
.430
***
–.312
**
.790
***
11. Stiffness –.060 .176 –.040 .107 .151 .234
*
.343
***
–.274
**
.638
***
.580
***
Note. N = 64.
*
p < .10.
**
p < .05.
***
p < .01.
Table 3 displays the partial correlations between the
personal characteristics and health measures at 6
months partialling out the corresponding T1 health
measure. PIL was significantly related to less anxiety,
depression, negative affect, functional disability, stiff
-
ness, and more positive affect at 6 months. Of the other
personal characteristics, pessimism was related to
more negative affect, functional disability, and stiff
-
ness, emotionality was related to more anxiety and less
positive affect, and optimism was related to less nega
-
tive affect.
The hypotheses regarding the relationship between
PIL and improvements in mental and physical health
were tested using regression analyses predicting the
T2 health outcomes controlling for the corresponding
T1 outcomes. For each analysis, PIL was first entered
as the sole predictor and then entered with optimism,
pessimism, and emotionality. In addition, sex and ed
-
ucation level were controlled because they were the
demographic variables that were related to the per
-
sonal characteristics or health measures. Women re
-
ported more positive affect, r(31) = .299, p < .05;
functional disability, r(31) = .416, p < .01; pain, r(31)
= .315, p < .05; and stiffness, r(31) = .388, p < .01.
Education was related to less functional disability,
r(62) = –.269, p < .01; and pain, r(62) = –.367, p <
.01. Age was not related to the personality character-
istics or health measures.
Table 4 displays the results for the regression analy-
ses for the mental health outcomes. When entered
alone, PIL was related to an increase in positive affect
and a decrease in anxiety, depression, and negative af
-
fect. When entered with optimism, pessimism, and
emotionality, PIL was still related to an increase in pos
-
itive affect and a decrease in anxiety, depression, and
negative affect. Thus, PIL explained a significant vari
-
ance beyond the other personal characteristics. The ad
-
justed R
2
for PIL was 2.3% for anxiety, 7.9% for de
-
pression, 14.3% for negative affect, and 12.0% for
positive affect.
Table 5 displays the results for the regression analy
-
ses for the physical health outcomes. When entered
alone, PIL was related to a decrease in functional dis
-
ability and a decrease in stiffness. However, when en
-
tered with optimism, pessimism, and emotionality, PIL
was no longer related to any of the physical health out
-
comes. Thus, PIL did not make a contribution to physi
-
cal health beyond the other personal characteristics. In
-
deed, when considered together, none of the personal
characteristics were related to any of the physical
health measures.
Finally, because the optimism and pessimism mea
-
sures were originally designed to be a part of the
same scale, the analyses using optimism and pessi-
mism were repeated substituting the combined scores
of the two scales combined into one score (pessimism
items were coded negatively). The results showed
that there were no differences in whether PIL was a
significant predictor of outcomes or in the direction
of the predictions.
200
SMITH AND ZAUTRA
Table 3. Partial Correlations Between Personal Characteristics and Change in Health Measures
Anxiety Depression Negative Affect Positive Affect Functional Disability Pain Stiffness
Purpose in life –.347
***
–.393
***
–.627
***
.422
***
–.288
**
–.093 –.308
**
Optimism –.210
*
–.112 –.303
**
.107 –.135 –.021 –.164
Pessimism .235
*
.137 .463
***
–.172 .356
***
.155 .289
**
Emotionality .334
***
.206 .207 –.292
**
.246
*
.129 .180
Note. N = 64. The corresponding health measure at T1 was partialled out for each partial correlation coefficient.
*
p < .10.
**
p < .05.
***
p < .01.
Table 4. Standardized Beta Weights for Purpose in Life and Other Personal Characteristics Predicting Mental Health
Outcomes at Six Months
Anxiety Depression Negative Affect Positive Affect
β tpβ tpβ tpβ tp
Simple regression
a
Purpose in life –.254 –2.64 .011 –.330 –3.16 .003 –.573 –6.23 < .000 .407 3.64 .001
Multiple regression
b
Optimism –.020 –.21 .838 .050 .49 .630 –.039 –.38 .705 –.096 –.82 .416
Pessimism .027 .25 .806 –.080 –.67 .504 .099 .84 .405 .159 1.19 .239
Emotionality .265 2.40 .020 .165 1.45 .154 .034 .30 .766 –.243 –2.07 .043
Purpose in life –.238 –2.04 .046 –.398 –3.11 .003 –.521 –4.10 < .000 .486 3.37 .001
Note. N = 64. Sex and education level were controlled in all analyses. The corresponding pre-surgery health measure was controlled in all
analyses.
a
Purpose in life was the sole predictor.
b
Purpose in life was entered with optimism, pessimism, and emotionality.
Discussion
The results indicate that PIL played an important
role in recovery for individuals electing to have TKR.
When considered alone, PIL was related to improved
mental and physical health. Even when controlling for
optimism, pessimism, and emotionality, PIL was still
related to improved mental health.
These findings make several contributions to our
understanding of PIL. First, PIL was a prospective pre-
dictor of improvement in mental and physical health
when entered alone and mental health when control-
ling for other personal characteristics. Past studies
have examined the concurrent relationship between
PIL and health or used PIL as a dependent variable
(Addad, 1987; Ryff & Keyes, 1995). This study dem
-
onstrates that PIL may be related to positive changes in
health over time.
Second, the effects of PIL on improved mental
health were not accounted for by negative affectivity.
Controlling for emotionality did not completely erase
the effects of PIL as they have on occasion with other
negative characteristics (Hart et al., 1991; Smith et al.,
1989). The implication is that PIL is more than just the
absence of negative affectivity. Whereas having a
sense of purpose in living may result in less negative
affect, and vice versa, they are not merely opposite
ends of the same continuum.
Third, the effects of PIL on all four mental health
outcomes held when controlling for both optimism and
pessimism. PIL appears to represent a unique positive
personal feature and plays an important role beyond
that of outcome expectancies. While POE may be nec
-
essary to be engaged in one’s valued goals, there may
first have to be the sense that one has valued goals and a
purpose for living. TKR may have provided hope and
the expectation for improved physical functioning.
However, the opportunity for improved functioning
may not have resulted in improved emotional health
unless there was a sense of purpose in life to help moti
-
vate recovery.
Future research may do well to examine the role of
both PIL and POE to learn more about how they may
complement each other and when one may be more im
-
portant than the other. It appears that the recent empha-
sis on positive personal characteristics needs to encom-
pass both the ability to identify value goals (e.g.,
finding a purpose in life) and the belief that these goals
can be reached. It is possible that while modern behav-
ioral science has concentrated on engendering hope,
confidence, and optimism as a means, it has neglected
the need to first identify and foster valued goals as an
end.
This study has several limitations. First, it was
based on a relatively small sample. Thus, this should be
considered a preliminary study requiring replication
with a larger sample. Second, the mental and physical
health measures were self-report and not obtained
through interviews or clinician assessments. Third, it
would have been useful to acquire more information
about differences in the surgery procedure between
participants and on compliance to recovery regimens.
Each of these could have also helped to account for dif
-
ferences in health outcomes. Examining compliance
could be particularly instructive because it may be a
partial mediator of the beneficial effects of PIL.
Despite these limitations, this study strongly sug
-
gested that PIL is an important positive personal char
-
acteristic and that it has implications for individuals
facing challenges that present opportunities for better
health. While some positive characteristics may be dif
-
ficult to alter, there is evidence that interventions can
increase PIL. For example, logotherapy was developed
by Frankl (1992) and has been shown to increase the
sense of meaning and purpose in living. The findings
of this study suggest that interventions that enhance
PIL may help individuals successfully meet health
challenges and live a more fulfilling and satisfying life.
201
PURPOSE IN LIFE AND KNEE SURGERY
Table 5. Standardized Beta Weights for Purpose in Life and Other Personal Characteristics Predicting Physical Health
Outcomes at Six Months
Functional Pain Stiffness
β tpβ tpβ tp
Simple regression
a
Purpose in life –.297 –2.42 .018 –.131 –1.02 .310 –.279 –2.33 .023
Multiple regression
b
Optimism .103 .70 .488 .104 .70 .485 .002 .01 .989
Pessimism .254 1.61 .113 .092 .55 .586 .148 .94 .354
Emotionality .196 1.35 .182 .211 1.37 .176 .083 .57 .568
Purpose in life –.118 –.73 .468 –.056 .32 .747 –.166 –1.06 .319
Note. N = 64. Sex and education level were controlled in all analyses. The corresponding pre-surgery health measure was controlled in all
analyses.
a
Purpose in life was the sole predictor.
b
Purpose in life was entered with optimism, pessimism, and emotionality.
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... In the general chronic pain literature, evidence suggests that peer support may buffer against the negative effects of pain on functional disability, emotional regulation capacities, and identity formation [18]. In contrast, optimism [19], having a sense of purpose [20,21], actively coping with symptoms [22], and pain acceptance [22][23][24][25] are associated with less disease burden and improved functioning in adults with chronic pain [21,25]. The complex and debilitating nature of JFM underscores the need to better understand the specific processes that predict poorer longterm outcomes among these individuals, those which promote resilience and improved functioning over time. ...
... In the general chronic pain literature, evidence suggests that peer support may buffer against the negative effects of pain on functional disability, emotional regulation capacities, and identity formation [18]. In contrast, optimism [19], having a sense of purpose [20,21], actively coping with symptoms [22], and pain acceptance [22][23][24][25] are associated with less disease burden and improved functioning in adults with chronic pain [21,25]. The complex and debilitating nature of JFM underscores the need to better understand the specific processes that predict poorer longterm outcomes among these individuals, those which promote resilience and improved functioning over time. ...
... In contrast, participants who learned to cope effectively reported a refusal to allow FM symptoms to hold them back from achieving goals, an embracing of optimism, and a rejection of their JFM diagnosis as a core feature of their identity. This resilience factor captures the extent to which an individual believes their life has direction [20,21]. Benefit-finding and gaining positive perspectives appears to facilitate healthy coping with chronic conditions [38]. ...
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Background Juvenile-onset Fibromyalgia (JFM) is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, sleep difficulties, mood concerns, and other associated symptoms. Although diagnosed in childhood, JFM often persists into adulthood can result in continued physical, social, and psychological impairment. The purpose of this qualitative study was to identify themes of risk and resilience for long-term outcomes among young adults diagnosed with JFM in childhood. Methods The sample included 13 young adults (ages 26–34) who had been diagnosed with JFM in adolescence. Focus groups were used to elicit qualitative information about living with JFM and perceived challenges and buffering factors impacting their adjustment. Results The majority of participants (80%, N = 12) continued to meet criteria for fibromyalgia (FM). An iterative, thematic analysis revealed themes of resilience (e.g., greater acceptance, re-setting expectations, active coping, addressing mental health) and risk (e.g., lack of information, stigma, isolation, negative healthcare experiences). Conclusion Results suggest the need for longer follow-up of youth with JFM as they transition to adulthood with multidisciplinary care and more attention to education about JFM and associated symptoms such as fatigue, as well as ongoing support for coping and mental health needs. A holistic approach to care during the transition years could be beneficial to minimize impact of JFM on long-term functioning.
... Also, in other studies, patients with lower baseline MCS had less improvement in functional scores postoperatively. 2,27) Among our patients, baseline physical and mental health (PCS and MCS) were correlated strongly and directly with postoperative PCS, MCS, KOOS, and their improvement (p < 0.01), which means patients with higher baseline mental and physical scores had greater improvement. Baseline KOOS only had significant direct relationship with postoperative KOOS. ...
... p = 0.017), which is in contrast with Smith and Zautra's findings. 27) Among many factors that significantly affect the outcome of TKA, the only independent predictor of physical, mental, and functional outcome was depression (OHI score). ...
Article
Background: Precise assessment of preoperative mental health and psychological determinants may be useful in identifying patients at risk for poor postoperative outcomes of total knee arthroplasty (TKA). The aim of this study was to investigate the influence of psychological status and physical and mental health on the outcome of patients undergoing TKA. Methods: Fifty-two patients undergoing unilateral TKA were assessed preoperatively with Oxford Happiness Inventory, Eysenck Personality Inventory, 12-item short form health survey (SF-12), and Knee Injury and Osteoarthritis Outcome Score (KOOS) for evaluating depression, personality traits, physical and mental health, and function, respectively. At 1 year after surgery, health-related quality of life (HRQL) and function were assessed using the SF-12 and KOOS. Results: HRQL and function of all personality traits increased significantly after TKA, without significant difference among them. Extroversion and neuroticism did not have significant correlation with subjective well-being, HRQL, and function before and after surgery. Subjective well-being and the baseline physical and mental health scores were correlated strongly and directly with postoperative physical component summary, mental component summary, and KOOS scores and their improvement. Among many factors that significantly affected the outcomes of TKA, the only independent predictor of physical, mental, and functional outcome was depression. Conclusions: Outcomes of surgery were not significantly different among diverse personality traits. Patients with less depressive symptoms and higher baseline mental and physical scores had significantly greater improvement in HRQL after surgery. The only independent factor affecting the physical, mental, and functional outcome was depression.
... Nowadays, conceptually, it is distinguished into two interrelated but distinct dimensions; the presence of meaning (experiencing the meaning) and the search for meaning (seeking more meaning in life). Recent empirical studies have shown that the presence of meaning, which is regarded as a trait-like and relatively stable resource (Steger & Kashdan, 2007), was an indicator for promoting and maintaining physical health, based on neuroendocrine, immunological, and cardiovascular markers (Bower et al., 1998;Krause, 2004;O'Connor & Vallerand, 1998;Smith & Zautra, 2004), as well as mental health in terms of greater happiness and life satisfaction, less depression, distress, anxiety, and loneliness (Ishida & Okada, 2006;Shiah et al., 2015;Steger & Frazier, 2005;Steger & Kashdan, 2007), and reductions in substance abuse (Nicholson et al., 1994) and smoking (Steger et al., 2009a, b). On the other hand, search for meaning correlates with ill-being indicators (Schulenberg et al., 2011;Steger & Park, 2012;Steger et al., 2008a, b). ...
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Generalized anxiety disorder (GAD) is a widespread psychiatric disorder. According to the transdiagnostic approach, death anxiety can underpin predominantly somatic manifestations of GAD. Personal resilience factors such as a sense of a meaningful life, and psychological hardiness, which can protect people from developing clinical symptoms, may be lower in individuals with GAD. So far, there has been no study examining the role of meaning in life dimensions, death anxiety, and hardiness in individuals with GAD in Turkey. Thus, we aimed to investigate to what extent the GAD sample differs from the non-anxious control group in terms of death anxiety, meaning in life dimensions, and hardiness. Secondly, we examined how conceptually predicted death anxiety by meaning in life dimensions and hardiness regardless of diagnosis, age, and gender. Just before the spread of the Covid-19 pandemic, we could only recruit 38 individuals with GAD and 31 non-anxious control subjects. The Death Anxiety Scale, The Meaning in Life Questionnaire, and the Psychological Hardiness Scale were administered to all the participants. The one-way MANOVA results with Bonferroni adjustment revealed that individuals with GAD significantly differed from the control group in every way. Hierarchical regression analysis displayed that the presence of meaning made the most significant contribution in predicting death anxiety. In conclusion, existential issues such as death anxiety, hardiness, and meaningful life can be emphasized for the treatment of GAD, and the presence of meaning is the most crucial antidote to avoid death anxiety in all individuals.
... Individuals that express a stronger belief that their lives have purpose exhibit a higher tolerance to pain on both cold pressor and heat-based induction procedures (60). Furthermore, patients that have scored higher on a purpose in life scale have demonstrated faster recovery times after total knee arthroplasty (TKA) (61). Pain acceptance is a general willingness to experience pain and its associated cognitive and emotional consequences as a means of fostering a greater sense of personal engagement and well-being by not relying on www.painphysicianjournal.com ...
Article
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Background: The role of psychological factors influencing chronic pain has been well documented. This review includes a historical perspective and current examination of the literature on psychological and behavioral health characteristics and their influence on chronic pain. Objectives: To identify psychological and behavioral health factors involved with chronic pain, as well as the challenges and opportunities of integrating multidisciplinary care into a pain management practice. Study design: Narrative review of peer-reviewed literature examining psychological and behavioral health factors associated with poor clinical outcomes with an emphasis on orthopedics. Methods: The Medline database was reviewed to identify peer-reviewed research that discussed psychological and behavioral health factors relevant to pain management or orthopedics. Results: The evidence provided suggests that these constructs should receive strong consideration when managing chronic pain. The incorporation of such factors may improve patient care and clinical outcomes and reduce total health care costs. Limitations: This narrative review is not systematic in nature, but rather focused on the impacts on orthopedics and pain management. Conclusions: Psychological and behavioral health factors should be an integral component of a pain management practice as there is substantial overlap between depression and anxiety with chronic pain. Positive affect, such as resilience, may act as a buffer and confer some protection against the sequelae of chronic pain. There is evidence that psychological screeners offer further insight into the patient condition and would contribute to the treatment plan. The novel role of a behavioral health navigator in a pain management clinic is worthy of further exploration as it has proved beneficial in other chronic health conditions.
... Specifically, a sense of meaning in life has the potential to offset the harmful effects of stress on the physical, social and emotional health of older adults (Krause, 2007). For instance, Smith and Zautra (2004) investigated the role of a sense of purpose and meaning in health-related outcomes for 64 older adults who had recently had knee replacement surgery in the United States of America (USA). Results indicated that purpose and meaning in life were related to lower rates of anxiety, depression, negative affect, functional disability, stiffness, and increased positive affect. ...
Article
Objectives: The aim of the current study was to investigate meaning-making in 57 older predominantly female adults (M = 72.68) required to temporarily cease attending a university-affiliated integrated care clinic in Australia with a focus on exercise and well-being due to COVID-19 restrictions, specifically regarding consequential grief, loss, hopelessness, and loss of purpose. Methods: Quantitative and qualitative data were collected by telephone interviews and an online survey. Results: Results indicated that most participants valued attending the Clinic, and experienced a number of physical, social and emotional benefits from attending, including a sense of meaning. Specifically, some participants developed social connections, learned to cope more effectively with mental health conditions, and regained strength following stressful or traumatic events through their attendance at the clinic. Conclusions: Throughout the pandemic, most participants retained their resilience and continued to derive meaning from various sources, including their families, careers, interests, and attitude toward life. Clinical implications: Older adults may experience enhanced physical, emotional and social health from engaging in community-based programs focused on exercise and overall wellness. Furthermore, meaning-making has the potential to buffer the harmful effects of stress and traumatic events on the physical, emotional and social health of older adults.
... 18 In contrast, optimism 19 , having a sense of purpose 20,21 , actively coping with symptoms 23 , and pain acceptance [22][23][24][25] are associated with less disease burden and improved functioning in adults with chronic pain. 21,25 The complex and debilitating nature of JFM underscores the need to better understand the speci c processes that predict poorer long-term outcomes among these individuals, those which promote resilience and improved functioning over time. ...
Preprint
Full-text available
Background. Juvenile-onset Fibromyalgia (JFM) is a chronic pain condition characterized by widespread musculoskeletal pain, fatigue, sleep difficulties, mood concerns, and other associated symptoms. Although diagnosed in childhood, JFM often persists into adulthood can result in continued physical, social, and psychological impairment. The purpose of this qualitative study was to identify themes of risk and resilience for long-term outcomes among young adults diagnosed with JFM in childhood. Methods. The sample included 13 young adults (ages 26-34) who had been diagnosed with JFM in adolescence. Focus groups were used to elicit qualitative information about living with JFM and perceived challenges and buffering factors impacting their adjustment. Results. The majority of participants (80%, N=12) continued to meet criteria for fibromyalgia (FM). An iterative, thematic analysis revealed themes of resilience (e.g., greater acceptance, re-setting expectations, active coping, addressing mental health) and risk (e.g., lack of information, stigma, isolation, negative healthcare experiences). Conclusion. Results suggest the need for longer follow-up of youth with JFM as they transition to adulthood with multidisciplinary care and more attention to education about JFM and associated symptoms such as fatigue, as well as ongoing support for coping and mental health needs. A holistic approach to care during the transition years could be beneficial to minimize impact of JFM on long-term functioning.
... Although those who reported searching for meaning did not appear to experience better health outcomes, those who said they found and experienced meaning enjoyed a range of health benefits. Examples of these include faster recovery from knee surgery (Smith & Zautra, 2004); lower risk of disability in old age (Krause & Hayward, 2012); greater odds of survival in myocardial infarction (Koizumi et al., 2008); better immune functioning (Holt-Lunstad et al., 2011); and better subjective health and health-related quality of life (HRQOL; Park et al., 2008). Individuals with a greater sense of meaning and purpose, also tended to engage in more health-promoting behaviours (such as exercising [Holahan et al., 2008], refraining from smoking [Konkoly, Thege, et al., 2010], etc.), which may partially explain the mechanisms for the relationship between meaning and health outcomes. ...
Chapter
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Recently, the concept of ikigai has attracted international scholarly attention. Originally, researchers have focused on its impact on longevity; however, contemporary approaches to ikigai include career guidance, wellbeing training and clinical practice. That said, much of the existing literature on ikigai has relied on anecdotal episodes, without a clear focus on scientific or clinical literature. In this chapter, we (a) define ikigai, (b) explore the health benefits of ikigai regarding its impact on both physical health and mental health, and (c) discuss how to enhance ikigai and future research, based on scientific findings. Ikigai—originally identified in difficult life experiences among leprosy patients—is defined as an experiential, everyday life phenomena that relates to a reason for your being. Based on a number of meta-analyses and longitudinal studies, evidence suggests a protective benefit and positive correlation between ikigai and better physical health, and an inverse relationship with all-cause mortality. Psychologically, ikigai may be important in developing one's sense of self-understanding, goal attainability, and problem-solving skills. Interventions such as life crafting are deemed helpful to enhance ikigai, although further research (e.g., cross-culture, longitudinal) needs to be conducted to further support the utility of this construct. Our findings can help healthcare workers and researchers to further advance the science of this experiential wellbeing construct.
... Previous studies, including our own 6-month findings in this patient cohort, reported no significant association of optimism with pain or function after TKA. However, these studies examined the effects of optimism only up to 6 months after surgery (1,33,34). The greatest gains in pain and function after TKA occur mostly within the first 3 to 6 months after surgery. ...
Article
Full-text available
Objective: To evaluate the association of preoperative psychosocial and demographic factors with total knee arthroplasty (TKA) outcomes and satisfaction in patients with osteoarthritis (OA) of the knee at 24 months after surgery. Methods: A prospective cohort study of patients undergoing TKA was conducted. Outcome measures included: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Short Form 36 (SF-36) scores at baseline and 24 months after surgery, and patient satisfaction with TKA at 24 months. Linear regression models were performed to evaluate the association of preoperative psychosocial determinants (ie, Medical Outcome Study Social Support Scale; Depression, Anxiety, and Stress Scale; Brief COPE inventory, The Life Orientation Test-Revised; Multidimensional Health Locus of Control; and Arthritis Self-Efficacy Scale) on outcomes. Results: We included 178 patients. Increasing WOMAC pain scores at 24 months were associated with increasing age and body mass index (BMI); low tangible social support and low optimism were associated with higher levels of pain (R2 = 0.15). A decrease in WOMAC function scores was also associated with older age and higher BMI; low tangible support, increased stress, and low optimism were also associated with worse function (R2 = 0.22). When evaluating quality of life, lower SF-36 physical functioning scores at 24 months were associated with age, high BMI, and comorbidity (R2 = 0.34). Lower SF-36 mental functioning scores were associated with depression and low optimism (R2 = 0.38). Having a dysfunctional style of coping was associated with lower satisfaction with surgery after 24 months (adjusted R2 = 0.12). Conclusion: Psychosocial factors, such as tangible support, depression, dysfunctional coping, and optimism, were associated with pain, function, and satisfaction 2 years after TKA. Perioperative programs identifying and addressing psychosocial problems may result in improvements in pain and function after TKA.
... Several studies have found that optimism predicts subjective wellbeing, life satisfaction, and perceived health (Chang & Sanna, 2001;Diener, Oishi, & Lucas, 2003;Eid & Diener, 2004;Mäkikangas & Kinnunen, 2003). It also correlates with a variety of health outcomes across populations, including less reported pain, lower risk of heart disease, fewer physical symptoms, and better physical and psychological functioning in patients with a variety of medical conditions (Affleck et al., 2001;Carver et al., 1993;Costello et al., 2002;Fournier, Ridder, & Bensing, 2002a, 2002bHarper et al., 2007;Mahler & Kulik, 2000;Ridder, Fournier, & Bensing, 2004;Smith & Zautra, 2004). Optimism has been linked to functioning and health both directly (as noted above) and indirectly (for example, through self-esteem) (Chang & Sanna, 2001;Symister & Friend, 2003). ...
Article
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This capstone project analyzes potential opportunities for integration between the fields of positive psychology and art therapy in the treatment of trauma. The experience of trauma is widespread: between 60-89% of people will likely experience at least one traumatic event during their lifetime (Kilpatrick, Resnick, & Acierno, 2009; Mills et al., 2011; Resnick et al., 1993). Extensive research on trauma over the past few decades has been essential to more deeply understand trauma and recovery. Still, traumatized persons deserve the opportunity to not just survive, but flourish. After reviewing valuable historical information on both fields, four related positive psychology constructs of meaning, posttraumatic growth, optimism, and hope are discussed and practical opportunities for integration are considered. Current and well-researched interventions in positive psychology are reviewed, and a call to action is made to develop a growth-based trauma-informed art therapy approach.
Chapter
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A sense of meaning is widely considered to be a central human concern, and it is closely intertwined with religion and spirituality. Meaning in life is a highly desirable quality in and of itself, and it is also associated with many aspects of physical, spiritual, and mental well-being. In this chapter, we introduce the Multidimensional Existential Meaning Scale (MEMS), which is designed to capture three dimensions of meaning. Differing from the intent of several existing unidimensional measures of existential meaning, we assert that meaning in life reflects three distinct aspects—comprehension (a sense that one’s life and the world are understandable and coherent), purpose (a sense that one has valuable goals that one is working towards), and mattering (a sense that one’s existence is of significance in the world). We describe three recent studies in which we systematically developed and tested this new measure of existential meaning. Results of these studies indicate that the MEMS has good psychometric properties and that conceptualizing and measuring comprehension, purpose, and mattering separately is advantageous over using an aggregated single “meaning in life” score. We discuss cross-cultural issues in meaning in life assessment and describe how the MEMS may be useful in examining cultural aspects of meaning and spirituality. We conclude that studying meaning in life as three distinct dimensions advances the science of meaning in life research and enhances clinical applications.
Article
Emotional processes influence a wide range of mental and physical systems, which makes them difficult to understand from a single perspective. In this special issue of the Review of General Psychology, contributing authors present 4 articles that draw from several areas within psychology in the service of understanding a topic relevant to emotion. In this overview, the authors argue that the long neglect of the scientific study of complex processes such as emotion might be linked, in part, to the fractionation of the field into specialized subdisciplines. Just as emotions were of central concern in the early years of psychology (which was a generalist's era), as psychology moves toward more integration in the late 20th century broad phenomena such as emotions are once again central interests. The 4 articles of this special issue are briefly reviewed as exemplars of an integrated approach to understanding emotional phenomena.
Article
This introduction to the two-part special issue reviews recent evidence that suggests that positive mood may play a beneficial, multifaceted, and flexible role in self-regulatory processes that cannot be explained by most current theories. First, under some conditions positive mood seems to facilitate careful processing of goal-relevant information, even negative information. Second, the relation of positive mood to cognition and behavior seems to be strongly moderated by goal-relevant features of the task context. Three frameworks (mood as input, processing advantages conferred by positive mood, and mood as resource) that may account for these facilitating effects of positive mood on self-regulation are discussed.
Article
Antonovsky (1987) has proposed that the Sense of Coherence (SOC) scale assesses a personality-related “stress-resistance resource” that comprises the belief that life is comprehensible, manageable, and meaningful. To date, most of the research on the SOC scale has been conducted in Israel. One finding that appears to be particularly robust, at least among Israeli adolescents, is an inverse association between SOC total scale scores and trait anxiety. The first purpose of the present study, which examines American college students, is to attempt to provide some external validity evidence for the Israeli research linking SOC and anxiety. The present study also attempts to refine previous research by examining whether anxiety is differentially related to the comprehensibility, manageability, and meaningfulness SOC subscales. In addition, this study seeks to extend previous research by examining whether individuals scoring high on SOC would perceive social support to be more readily available than individuals scoring low on SOC. Finally, the present investigation provides preliminary reliability and validity data for the short form version of the SOC scale. Results showed that SOC total scores were strongly negatively correlated with levels of trait anxiety. The relative strength of the correlations of anxiety to the various SOC subscales could not be assessed accurately because the SOC subscales were unreliable. Other results showed SOC scores were unrelated to the perceived availability of four different types of social support. These data support the generalizability of Israeli research suggesting that individuals scoring high on SOC enjoy better mental health than their lower scoring counterparts. In addition, results showing that SOC is independent of socially based stress-resistance resources suggest the SOC scale has discriminant validity. Finally, the present results support the validity of the shortened version of the SOC scale, but suggest that use of short form subscale scores may be problematic.