Meaning in life influence how psychological stress, death anxiety and suicide behavior impact on resilience in people living with cancer in South Africa

BACKGROUND: Cancer is a life-threatening health condition that, beyond its physical consequences, can lead to multiple coping challenges including psychological stress (PS), death anxiety and suicide behavior, which often, significantly, impact patients' resilience abilities. Meaning in life is a personal psychological resource that may protect people against the impact of psychosocial vulnerabilities on mental health outcome. This study examined the role of meaning in life in the relationship between PS, death anxiety, suicide behavior and resilience. METHODS: A cross-sectional study was conducted among 238 cancer patients (122 (51.3%) females, M age = 42.55; SD = 11.95) selected from a healthcare institution in South Africa. Participants were diagnosed with either prostate cancer 57 (23.9%), colon cancer 29 (12.2%), liver cancer 37 (15.5%), gastric cancer 22 (9.2%), breast cancer 79 (33.2%), or other kinds of cancer 14 (5.9%). Validated tools were used: The Resilience Scale (RS); Presence of Meaning in Life Subscale of Meaning in Life Questionnaire (MLQ); Impact of Event Scale (IES); Death Anxiety Inventory-Revised (DAI-R) and Suicidal Behaviors Questionnaire-Revised (SBQ-R). Moderation hypotheses were tested via Hayes PROCESS Macro Model 1 in SPSS vs. 31. RESULTS: Findings revealed that meaning in life moderates the relationship between PS and resilience such that PS was associated with lower levels of resilience at low and average levels of meaning in life but not at high levels of meaning in life. Meaning in life moderated the association between death anxiety and resilience such that death anxiety resulted to lower levels of resilience only among patients with low but not among those with average and high levels of meaning in life. This same pattern of findings was observed when we examined whether meaning in life moderates the relationship between suicide behavior and resilience. CONCLUSION: The findings have revealed that higher sense of meaning in life moderates the negative psychological impacts of PS, death anxiety and suicide behavior on resilience. Targeted interventions that enhance a sense of meaning in life and addresses PS, death anxiety, and suicide behavior are essential for fostering resilience and adaptive coping with cancer disease.