Mediating Role of Perceived Stress in the Relationship between Facing Existential Issues and Symptoms of Depression and Anxiety
,
Abstract
Objective: This study aimed at investigating the mediating role of perceived stress in anticipation of anxiety and depression on facing the ultimate concerns (death, loneliness, freedom, and meaningfulness).
Method: A total of 389 students from Ferdowsi University of Mashhad participated in this study in 2017-18. The participants were selected using random sampling. The data were collected using the subscales of anxiety and depression in depression, anxiety, stress scale (DASS), Death Anxiety Scale (DAS), the third edition of Loneliness Scale UCLA (UCLA-LS), the subscale of meaning in life in Meaningfulness of Life Questionnaire (MLQ), responsibility scale of California Psychological Inventory (CPI), and the Perceived Stress Scale (PSS). Then, they were evaluated using Pearson correlation and path analysis.
Results: The correlation between the symptoms of anxiety and depression, and death anxiety and loneliness was direct and significant with the perceived stress. The relationship between the perceived stress with meaningfulness of life and responsibility was significantly inverse. The analysis of the data path showed that the component dealing with existence (loneliness and death anxiety) predicted 20% of anxiety symptoms through perceived stress in the model that was fitted well with research data.
Conclusion: According to the findings, it can be concluded that the relationship between dealing with ultimate concerns and anxiety symptoms was not linear. Dealing with ultimate concerns affects the anxiety symptoms through the perceived stress. Therefore, attention to the perceived stress management to promote health and prevent anxiety disorders is important.
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2. Motevalian S. Amin Esmaeili M. Hajebi M. Hefazi A. Rad Goudarzi R. Rahimi Monaghar A. Sharifi V. Thirty-first Annual Congress of Iranian Psychiatric Association. 2014; Tehran, Oct, Milad Hospital.
3. Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull. 2015;141(1):176-212.
4. Bishop SJ, Gagne C. Anxiety, depression, and decision making: a computational perspective. Annu Rev Neurosci. 2018;41:371-88.
5. Craske MG, Wolitzky-Taylor KB, Mineka S, Zinbarg R, Waters AM, Vrshek-Schallhorn S, et al. Elevated responding to safe conditions as a specific risk factor for anxiety versus depressive disorders: evidence from a longitudinal investigation. J Abnorm Psychol. 2012;121(2):315.
6. McElroy E, Fearon P, Belsky J, Fonagy P, Patalay P. Networks of Depression and Anxiety Symptoms Across Development. J Am Acad Child Adolesc Psychiatry. 2018;57(12):964-73.
7. Zafirides P, Markman KD, Proulx T, Lindberg MJ. Psychotherapy and the restoration of meaning: Existential philosophy in clinical practice: American Psychological Association; 2013.
8. Walsh SJ. Yalom, Irvin. Existential Psychotherapy. New York, Basic Books, 1980. JSTOR; 1981.
9. Schneider KJ, editor. Existential-integrative psychotherapy: Guideposts to the core of practice. Routledge; 2011 Apr 27.
10. Becker E. The denial of death, New York (The Free Press) 1973.
11. Boss M. Existential foundations of medicine & psychology. 1977.
12. Ozanne AO, Graneheim UH, Strang S. Finding meaning despite anxiety over life and death in amyotrophic lateral sclerosis patients. Journal of clinical nursing. 2013 Aug;22(15-16):2141-9.
13. Coulehan J. Suffering, hope, and healing. InHandbook of pain and palliative care 2018 (pp. 739-753). Springer, Cham.
14. Fava M, Rush AJ. Current status of augmentation and combination treatments for major depressive disorder: a literature review and a proposal for a novel approach to improve practice. Psychotherapy and psychosomatics. 2006;75(3):139-53.
15. Stålsett G, Gude T, Rønnestad MH, Monsen JT. Existential dynamic therapy (“VITA”) for treatment-resistant depression with Cluster C disorder: matched comparison to treatment as usual. Psychother Res. 2012;22(5):579-91.
16. Lazarus RS. Psychological stress and the coping process, 1966.
17. Yew SH, Lim KM, Haw YX, Gan SK. The association between perceived stress, life satisfaction, optimism, and physical health in the Singapore Asian context. Asian Journal of Humanities and Social Sciences (AJHSS). 2015;3(1):56-66.
18. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983:385-96.
19. Pereira-Morales AJ, Adan A, Forero DA. Perceived stress as a mediator of the relationship between neuroticism and depression and anxiety symptoms. Current Psychology. 2019;38(1):66-74.
20. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013.
21. Ruscio AM, Gentes EL, Jones JD, Hallion LS, Coleman ES, Swendsen J. Rumination predicts heightened responding to stressful life events in major depressive disorder and generalized anxiety disorder. J Abnorm Psychol. 2015;124(1):17-26.
22. Siddaway AP, Taylor PJ, Wood AM, Schulz J. A meta-analysis of perceptions of defeat and entrapment in depression, anxiety problems, posttraumatic stress disorder, and suicidality. Journal of affective disorders. 2015;184:149-59.
23. Ventegodt S, Kandel I, Neikrug S, Merrick J. Clinical holistic medicine: the existential crisis--life crisis, stress, and burnout. ScientificWorldJournal. 2005;5:300-12.
24. Pines AM. Burnout: An existential perspective. Professional burnout: Routledge; 2017. p. 33-51.
25. Ekedahl M, Wengström Y. Nurses in cancer care—stress when encountering existential issues. Eur J Oncol Nurs. 2007;11(3):228-37.
26. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological assessment. 1998;10(2):176.
27. Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970;30(3):607-10.
28. Besharat MA. Evaluating the Depression Anxiety Stress Scale (DASS-21) in clinical samples and the general population. Research report, Tehran University. 2005.
29. Daza P, Novy DM, Stanley MA, Averill P. The depression anxiety stress scale-21: Spanish translation and validation with a Hispanic sample. Journal of Psychopathology and Behavioral Assessment. 2002;24(3):195-205.
30. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy. 1995;33(3):335-43.
31. Norton PJ. Depression Anxiety and Stress Scales (DASS-21): Psychometric analysis across four racial groups. Anxiety Stress Coping. 2007;20(3):253-65.
32. Templer DI. The construction and validation of a death anxiety scale. J Gen Psychol. 1970;82(2):165-77.
33. Rajabi Gh, Bohrani M. Factor analysis of Death Anxiety Scale questions. Journal of Psychology. 2002; 4(20), 331-45.
34. Tavakoli MA, Ahmadzadeh B. Investigation of Validity and Reliability of Templer Death Anxiety Scale. Thought & Behavior in Clinical Psychology. 2011; 6(21), 72-80.
35. Russell DW. UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure. J Pers Assess. 1996;66(1):20-40.
36. Bohayraei H, Deavar A, Ahadi H. Loneliness Scale Standardization, third edition (UCLA) in the community of students in Tehran. Applied Psychology. 2010;1:6-18.
37. Steger MF, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire: Assessing the presence of and search for meaning in life. J Couns Psychol. 2006;53(1):80.
38. Eshtad E. Study the effectiveness of cognitive group therapy on subjective well-being. Thesis Master of Clinical Psychology, Tehran Psychiatric Institute. 2009.
39. Groth-Marnat G. Handbook of psycholgical assessment: for clinical psychologists, counselors and psychiatrists. Pasha-Sharifi H, Nikkhoo M,(Persian translators). Tehran: Roshd Press; 2008.
40. Gough HG. California psychological inventory: Administrator's guide: Consulting Psychologists Press; 1987.
41. Atef-Vahid MK, Nasr-Esfahani M, Fethullah P, Shojaei, M. Standardization of the California Psychological Inventory. Journal of Psychiatry and Clinical Psychology. 2005;11:371-8.
42. Pasha Gh, Goudarzian M. The relationship between identity styles and moral development of students' personal responsibility. New findings in Psychology. 2008;2:87-99.
43. Safai m, Shokri A. Stress Assessment in cancer patients, the validity of the Perceived Stress Scale factor in Iran. Psychiatric Nursing. 2014;2:13-22.
44. Sharf RS. Theories of psychotherapy & counseling: Concepts and cases: Cengage Learning; 2015.
45. Thoits PA. Self, identity, stress, and mental health. Handbook of the sociology of mental health: Springer; 2013. p. 357-77.
46. Mascaro N, Rosen DH. The role of existential meaning as a buffer against stress. Journal of Humanistic Psychology. 2006;46(2):168-90.
2. Motevalian S. Amin Esmaeili M. Hajebi M. Hefazi A. Rad Goudarzi R. Rahimi Monaghar A. Sharifi V. Thirty-first Annual Congress of Iranian Psychiatric Association. 2014; Tehran, Oct, Milad Hospital.
3. Leventhal AM, Zvolensky MJ. Anxiety, depression, and cigarette smoking: a transdiagnostic vulnerability framework to understanding emotion-smoking comorbidity. Psychol Bull. 2015;141(1):176-212.
4. Bishop SJ, Gagne C. Anxiety, depression, and decision making: a computational perspective. Annu Rev Neurosci. 2018;41:371-88.
5. Craske MG, Wolitzky-Taylor KB, Mineka S, Zinbarg R, Waters AM, Vrshek-Schallhorn S, et al. Elevated responding to safe conditions as a specific risk factor for anxiety versus depressive disorders: evidence from a longitudinal investigation. J Abnorm Psychol. 2012;121(2):315.
6. McElroy E, Fearon P, Belsky J, Fonagy P, Patalay P. Networks of Depression and Anxiety Symptoms Across Development. J Am Acad Child Adolesc Psychiatry. 2018;57(12):964-73.
7. Zafirides P, Markman KD, Proulx T, Lindberg MJ. Psychotherapy and the restoration of meaning: Existential philosophy in clinical practice: American Psychological Association; 2013.
8. Walsh SJ. Yalom, Irvin. Existential Psychotherapy. New York, Basic Books, 1980. JSTOR; 1981.
9. Schneider KJ, editor. Existential-integrative psychotherapy: Guideposts to the core of practice. Routledge; 2011 Apr 27.
10. Becker E. The denial of death, New York (The Free Press) 1973.
11. Boss M. Existential foundations of medicine & psychology. 1977.
12. Ozanne AO, Graneheim UH, Strang S. Finding meaning despite anxiety over life and death in amyotrophic lateral sclerosis patients. Journal of clinical nursing. 2013 Aug;22(15-16):2141-9.
13. Coulehan J. Suffering, hope, and healing. InHandbook of pain and palliative care 2018 (pp. 739-753). Springer, Cham.
14. Fava M, Rush AJ. Current status of augmentation and combination treatments for major depressive disorder: a literature review and a proposal for a novel approach to improve practice. Psychotherapy and psychosomatics. 2006;75(3):139-53.
15. Stålsett G, Gude T, Rønnestad MH, Monsen JT. Existential dynamic therapy (“VITA”) for treatment-resistant depression with Cluster C disorder: matched comparison to treatment as usual. Psychother Res. 2012;22(5):579-91.
16. Lazarus RS. Psychological stress and the coping process, 1966.
17. Yew SH, Lim KM, Haw YX, Gan SK. The association between perceived stress, life satisfaction, optimism, and physical health in the Singapore Asian context. Asian Journal of Humanities and Social Sciences (AJHSS). 2015;3(1):56-66.
18. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983:385-96.
19. Pereira-Morales AJ, Adan A, Forero DA. Perceived stress as a mediator of the relationship between neuroticism and depression and anxiety symptoms. Current Psychology. 2019;38(1):66-74.
20. Association AP. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Pub; 2013.
21. Ruscio AM, Gentes EL, Jones JD, Hallion LS, Coleman ES, Swendsen J. Rumination predicts heightened responding to stressful life events in major depressive disorder and generalized anxiety disorder. J Abnorm Psychol. 2015;124(1):17-26.
22. Siddaway AP, Taylor PJ, Wood AM, Schulz J. A meta-analysis of perceptions of defeat and entrapment in depression, anxiety problems, posttraumatic stress disorder, and suicidality. Journal of affective disorders. 2015;184:149-59.
23. Ventegodt S, Kandel I, Neikrug S, Merrick J. Clinical holistic medicine: the existential crisis--life crisis, stress, and burnout. ScientificWorldJournal. 2005;5:300-12.
24. Pines AM. Burnout: An existential perspective. Professional burnout: Routledge; 2017. p. 33-51.
25. Ekedahl M, Wengström Y. Nurses in cancer care—stress when encountering existential issues. Eur J Oncol Nurs. 2007;11(3):228-37.
26. Antony MM, Bieling PJ, Cox BJ, Enns MW, Swinson RP. Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological assessment. 1998;10(2):176.
27. Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas. 1970;30(3):607-10.
28. Besharat MA. Evaluating the Depression Anxiety Stress Scale (DASS-21) in clinical samples and the general population. Research report, Tehran University. 2005.
29. Daza P, Novy DM, Stanley MA, Averill P. The depression anxiety stress scale-21: Spanish translation and validation with a Hispanic sample. Journal of Psychopathology and Behavioral Assessment. 2002;24(3):195-205.
30. Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour research and therapy. 1995;33(3):335-43.
31. Norton PJ. Depression Anxiety and Stress Scales (DASS-21): Psychometric analysis across four racial groups. Anxiety Stress Coping. 2007;20(3):253-65.
32. Templer DI. The construction and validation of a death anxiety scale. J Gen Psychol. 1970;82(2):165-77.
33. Rajabi Gh, Bohrani M. Factor analysis of Death Anxiety Scale questions. Journal of Psychology. 2002; 4(20), 331-45.
34. Tavakoli MA, Ahmadzadeh B. Investigation of Validity and Reliability of Templer Death Anxiety Scale. Thought & Behavior in Clinical Psychology. 2011; 6(21), 72-80.
35. Russell DW. UCLA Loneliness Scale (Version 3): Reliability, validity, and factor structure. J Pers Assess. 1996;66(1):20-40.
36. Bohayraei H, Deavar A, Ahadi H. Loneliness Scale Standardization, third edition (UCLA) in the community of students in Tehran. Applied Psychology. 2010;1:6-18.
37. Steger MF, Frazier P, Oishi S, Kaler M. The meaning in life questionnaire: Assessing the presence of and search for meaning in life. J Couns Psychol. 2006;53(1):80.
38. Eshtad E. Study the effectiveness of cognitive group therapy on subjective well-being. Thesis Master of Clinical Psychology, Tehran Psychiatric Institute. 2009.
39. Groth-Marnat G. Handbook of psycholgical assessment: for clinical psychologists, counselors and psychiatrists. Pasha-Sharifi H, Nikkhoo M,(Persian translators). Tehran: Roshd Press; 2008.
40. Gough HG. California psychological inventory: Administrator's guide: Consulting Psychologists Press; 1987.
41. Atef-Vahid MK, Nasr-Esfahani M, Fethullah P, Shojaei, M. Standardization of the California Psychological Inventory. Journal of Psychiatry and Clinical Psychology. 2005;11:371-8.
42. Pasha Gh, Goudarzian M. The relationship between identity styles and moral development of students' personal responsibility. New findings in Psychology. 2008;2:87-99.
43. Safai m, Shokri A. Stress Assessment in cancer patients, the validity of the Perceived Stress Scale factor in Iran. Psychiatric Nursing. 2014;2:13-22.
44. Sharf RS. Theories of psychotherapy & counseling: Concepts and cases: Cengage Learning; 2015.
45. Thoits PA. Self, identity, stress, and mental health. Handbook of the sociology of mental health: Springer; 2013. p. 357-77.
46. Mascaro N, Rosen DH. The role of existential meaning as a buffer against stress. Journal of Humanistic Psychology. 2006;46(2):168-90.
| Files | ||
| Issue | Vol 15 No 1 (2020) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijps.v15i1.2442 | |
| Keywords | ||
| Anxiety Symptoms Depression Symptoms Death Freedom Loneliness Meaningfulness Perceived Stress | ||
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How to Cite
1.
Besharart M-A, Khadem H, Zarei V, Momtaz A. Mediating Role of Perceived Stress in the Relationship between Facing Existential Issues and Symptoms of Depression and Anxiety. Iran J Psychiatry. 2020;15(1):80-87.
