The presence of and search for meaning in life in comorbid depression and anxiety: A cross-sectional analysis from the Netherlands Study of Depression and Anxiety

Depression and anxiety often co-occur, leading to more severe symptoms and poorer treatment outcomes. Both are linked to low meaning in life (MiL), which consist of two inter-related but conceptually distinct dimensions: presence of MiL (P-MiL, perceiving life as meaningful) and search for MiL (S-MiL, seeking or enhancing meaning). This cross-sectional study examined MiL in comorbid anxiety and depression using both dimensional (level of symptoms) and categorical (clinical diagnosis) approaches. Participants (N = 1511; M_age = 56.35 years; 65% female) from the Netherlands Anxiety and Depression Study (NESDA) completed the Inventory of Depressive Symptomatology, Becks Anxiety Inventory, and Meaning in Life Questionnaire. A sub-set (n = 281) met diagnostic criteria for a single or comorbid depression and/or anxiety disorder, determined through CIDI interviews. Dimensional analyses showed lower P-MiL and higher S-MiL were associated with more (comorbid) symptoms of anxiety and depression, and vice versa (r_(P-MiL) = -.35, r_(S-MiL) = .12, ps < .001). However, neither MiL dimension was uniquely linked to the covariation of depression and anxiety symptoms. Depression symptoms were uniquely associated with P-MiL (β = -0.51, p < .001). Categorical analyses showed that participants with comorbid diagnoses reported lower P-MiL and higher S-MiL than those without a diagnosis or with a single (anxiety) disorder. In sum, comorbidity was linked to higher search and lower presence of MiL, but this relationship was mainly driven by depression symptoms. Addressing meaning in life as a modifiable factor may thus be a relevant approach for improving clinical outcomes in depression and comorbidity.