Skip to main content

Meaningfulness protects from and crisis of meaning exacerbates general mental distress longitudinally



Reactions to the COVID-19 pandemic are diverse, and both mental distress and existential crises can arise. The identification of protective and exacerbating factors and their progress over time is therefore highly relevant. The current study examined longitudinal protective effects of meaningfulness and exacerbating effects of crisis of meaning on general mental distress.


N = 431 participants from Germany and Austria (mean age: 42 years) completed an online survey in both April/May (T1) and July/August 2020 (T2). After determining temporal stability or changes in meaningfulness, crisis of meaning, and general mental distress (PHQ-4), we examined whether (i) meaningfulness and (ii) crisis of meaning, measured at T1, incrementally predicted PHQ-4 at T2, beyond baseline levels of PHQ-4. We further tested (iii) a within-subject mediation of temporal changes in PHQ-4 by changes in crisis of meaning.


Meaningfulness prospectively predicted lower PHQ-4, and crisis of meaning predicted higher PHQ-4. From the first wave of the pandemic until a slowdown three months later, meaningfulness was stable, and crisis of meaning and PHQ-4 decreased. Changes in crisis of meaning mediated the changes in PHQ-4.


Meaningfulness appears to have a protective, and crisis of meaning an exacerbating effect on psychological distress, as shown here for the time of the first pandemic wave until three months later. Attention to existential experiences of meaningfulness and loss of meaning thus proves relevant to the clinical and public health context. Measures that support meaningfulness will help coping with crises of meaning, which in turn supports overcoming general mental distress.

Peer Review reports


In March 2020, the World Health Organization (WHO) declared the Coronavirus disease 2019 (COVID-19) to be a pandemic. The early phase of the pandemic was accompanied by increased levels of mental distress in the general population in Germany and Austria as in many other countries [1,2,3,4,5,6,7]. Several relevant resources were identified that appeared to serve as protective factors. Older age [8, 9] and male gender [10, 11] were associated with higher mental stability in terms of demographic characteristics. Supportive psychological characteristics were trust in the healthcare system [12, 13], psychological flexibility and acceptance of difficult experiences [14], self-esteem [15], resilience [16], and self-control [2, 17].

Beyond threatening mental health, large-scale crises also have the potential to shatter worldviews, jeopardize existential security, and trigger crises of meaning [18,19,20]. Several researchers have addressed existential experiences during the pandemic. Besides an intensified confrontation with one's mortality [21, 22], experiences of meaning – or its loss – are of crucial importance here. In times of crisis, meaningfulness is a resource that fundamentally determines whether a person sees their life as worth living and is therefore willing and motivated to actively overcome challenges and take responsibility for their health [20]. Various studies have shown that meaning in life was a protective factor during the pandemic [2, 23,24,25,26]. At the same time, it emerged that for quite a few people, the large-scale crisis was accompanied by a shaking of their worldview [27]. High levels of acute stress caused by the pandemic were linked to crises of meaning, which in turn predicted high levels of general mental distress [2]. The latter study also found that meaningfulness and crisis of meaning covaried with the pandemic-related restrictions in Germany and Austria. Meaningfulness was high and crisis of meaning low during the first lockdown, which met with very high approval from the population [28]. Meaningfulness was substantially lower and crisis of meaning higher for the second survey period covering the weeks immediately following the lockdown, a time characterized by insecurity, contradictions in the communication of public health measures, and regional differences regarding the measures in force.

This suggests that public health measures—or the way they are communicated and implemented—may have far-reaching consequences in the lives of individuals [29]. Furthermore, there is evidence that psychological distress occurred primarily at the beginning of the pandemic and decreased in the following months for the majority of respondents [30,31,32]. For some, however, stress levels either persisted or even increased [33, 34]. It is therefore a major research goal to identify not only resources that contribute to resilience, but also the risk factors that sustain or exacerbate mental distress. Since these are temporal processes, longitudinal data are of particular importance.

As far as the role of meaning in life is concerned, protective effects have been confirmed in longitudinal studies among Chinese students [35, 36]. To our knowledge, studies in the general population and other countries are still pending, and implications of a lack of meaning have not been studied longitudinally at all. The present study thus aimed to examine the protective and exacerbating effects of meaning in life (meaningfulness and crisis of meaning) on general mental distress in a longitudinal design. Based on evidence that meaningfulness had not changed from the onset of the pandemic to three months later, but crisis of meaning and general mental distress had decreased [37], we first investigated whether meaningfulness prospectively predicted lower, and crisis of meaning higher general mental distress. To further gain insight into temporal change processes at the person level, we examined a within-subject mediation effect for crisis of meaning. Building on findings by Schnell & Krampe (2020) [2], we tested the following hypotheses: (i) Meaningfulness as measured during the first wave of the pandemic (T1) serves as a negative predictor of general mental distress as measured three months later (T2), beyond baseline levels of general mental distress (T1). (ii) Crisis of meaning as measured during the first wave of the pandemic (T1) serves as a positive predictor of general mental distress as measured three months later (T2), beyond baseline levels of general mental distress (T1). (iii) The slowdown of the pandemic was accompanied by changes in crisis of meaning, which in turn mediated the effect of time on general mental distress.


Procedure and participants

Online surveys were conducted during the first wave of the pandemic in April/May 2020 (T1) and in a period of relatively low incidence in July/August 2020 (T2). All T1 participants who had agreed to be contacted again were invited to participate in the follow-up study. Inclusion criteria at T1 were providing informed consent and a minimum age of 18 years; consent to repeat participation was not an inclusion criterion. Exclusion criteria were incomplete questionnaires and not affirming honest reporting. N = 1,568 participants completed the questionnaire at T1, N = 431 took part at T2. Evidence of biased attrition was found for education only: Participants at T2 were slightly more educated, odds ratio = 1.21 (standardized predictors). Among those who participated twice, thirty-four percent reported secondary or advanced education, 66% had a university degree. Sixty-six percent identified as women and 34% as men. The mean age was 42 (SD = 17; two missing values), ranging from 18 to 82 years. Fifty-three percent were resident in Germany, 41% in Austria, the remainder in Switzerland or Italy.


Two dimensions of meaning in life, meaningfulness and crisis of meaning, were assessed at T1 and T2 using the respective 5-item scales of the Sources of Meaning and Meaning in Life Questionnaire (SoMe; [38, 39]) with a six-point Likert scale (0–5). Cronbach's alphas were 0.81 and 0.83 for meaningfulness, and 0.92 and 0.94 for crisis of meaning. Also at T1 and T2, general mental distress was measured by the Patient Health Questionnaire-4 (PHQ-4) [40], a brief four-item measure of core symptoms of depression and anxiety (four-point Likert scale, 0–3). Cronbach's alphas were 0.84 and 0.83, respectively. While the original version of the SoMe [38, 39] was developed in German language, we employed a validated German translation of the PHQ-4 [41, 42].


Descriptive statistics including Cronbach’s alphas, means, standard deviations, and paired-sample t-tests were used to describe the sample and temporal changes. Gender, age, and education were examined as potential confounders. To test the hypotheses that meaningfulness protects from, and crisis of meaning exacerbates general mental distress three months later, we performed hierarchical linear regression analyses controlling for covariates and PHQ-4 at T1. The analyses were conducted separately for meaningfulness and crisis of meaning, as both are substantially correlated, but represent relatively independent dimensions [39, 43]. This is reflected in the fact that a decrease in meaningfulness is not necessarily associated with an increased crisis of meaning [44].

Moving on to the third hypothesis, we estimated a within-subject mediation model using MEMORE (Mediation and Moderation Analysis for Repeated Measures Designs) [45], version 2.1, model 1). Here, the mediator was the difference between measurements of crisis of meaning at T1 and T2. The outcome was the difference between measures of general mental distress at T1 and T2. The model thus tested if changes in the mediator (crisis of meaning) were associated with changes in mental distress (PHQ-4) from an early to a later phase of the pandemic. The grand mean-centered mean of the mediator pair was used as a covariate. We set bootstrapping at 5,000 samples and estimated percentile 95% confidence intervals.

We had planned to include all participants who responded to our invitation, aiming to collect the largest sample size possible. According to several scholars (e.g. [46]), this strategy might be preferable to power analyses with a focus on traditional null hypothesis significance testing. Since this information is after all frequently requested, we report the result of a post-hoc power analysis for hierarchical linear regression analyses: With the given sample size of N = 431 and an α = 0.05, the power to detect a small (f2 = 0.02) increase in R2 was sufficient at 0.83 ([G*Power [47]; version]).

Power analysis for within-subject mediation designs is complex. According to Montoya (2021), within-subject designs typically require half the sample size of between-subject designs to detect indirect effects of the same size [48]. However, power is dependent on the correlations among repeated measurements, with a peak of power associated with a correlation of ρM = 0.75 among the mediators, but increasing power with increasing correlation of the outcome variables. Moreover, power seems to benefit from estimating the moderation parameter (the grand mean-centered mean of the mediator pair). Finally, Montoya concludes that in a within-subject design, between 100 and 200 participants suffice to achieve the statistical power of 0.80 for an indirect effect of 0.15 when using bootstrap confidence intervals, but to detect smaller effects, larger sample sizes are needed [48].


Table 1 shows descriptive statistics and paired-sample t-tests. Skewness and kurtosis values for all variables indicated near-normal data distribution ( <|2|, not shown; [49]).

Table 1 Descriptive statistics and paired sample t-tests

Measures at T1 and T2 were highly correlated (r = 0.61—0.76). Paired sample t-tests showed significant but small decreases in crisis of meaning (Cohen’s d with Hedges’ correction = 0.14) and general mental distress (Cohen’s d with Hedges’ correction = 0.13). Meaningfulness did not change over the course of the three months.

Table 2 displays scale intercorrelations and examines age, gender, and education as potential confounders.

Table 2 Correlations between scales, age, gender, and education

Age and education covaried with the dependent variable, general mental distress, at T2. In the following hierarchical linear regressions, they were thus included as covariates.

Examining longitudinal protective and exacerbating effects of meaningfulness and crisis of meaning on general mental distress

Table 3 shows two hierarchical regression analyses to longitudinally predict general mental distress. Models 1 and 2 are the same in both. For the first block, the results revealed a significant model (p = 0.002); age and education predicted approximately 3% of the variance in PHQ-4 at T2, with age the only significant predictor (β = -0.14, p = 0.004). The inclusion of PHQ-4 at T1 in the second block (β = 0.60, p < 0.001) led to a significant increase in the variance accounted for by the model (R2 change = 0.36, p < 0.001). Including meaningfulness in the third block (β = -0.10, p = 0.02) resulted in an additional increase in explained variance (R2 change = 0.008, p = 0.02). Including crisis of meaning in the third block of the second hierarchic regression analysis (β = 0.15, p = 0.002) also resulted in an additional increase in explained variance (R2 change = 0.014, p = 0.002).

Table 3 Two hierarchical regression analyses to longitudinally predict general mental distress (T2)

Figure 1 shows an overlay scatterplot with linear fit lines for the associations between meaningfulness (T1) and PHQ-4 (T2), and crisis of meaning (T1) and PHQ-4 (T2). Severe symptoms of depression and anxiety (values > 6 [40]) are mainly observed at low scores in meaningfulness and high scores in crisis of meaning. The cut-off score for moderate symptoms (> 4 [42]) is exceeded at values > 2.10 in crisis of meaning and values < 1.60 in meaningfulness. Low scores in meaningfulness are not associated with severe symptoms, but high scores in crisis of meaning are.

Fig. 1
figure 1

Overlay scatterplot with linear fit lines for the associations between (i) meaningfulness (T1) and PHQ-4 (T2), and (ii) crisis of meaning (T1) and PHQ-4 (T2). Note. X-axis = meaningfulness/crisis of meaning (T1). Y-axis: General mental distress (PHQ-4)(T2)

Examining a within-subject mediation effect of changes in crisis of meaning on changes in general mental distress

Utilising MEMORE [45], we tested the indirect effect of time on general mental distress through changes in crisis of meaning. Figure 2 displays the within-subject mediation model and corresponding regression coefficients for each pathway.

Fig. 2
figure 2

Within-subject mediation model for the effect of time on changes in general mental distress through changes in crisis of meaning. Note. The superscript + indicates grand mean-centered. T1 = Time 1, first wave of the pandemic in spring 2020. T2 = Time 2, three months later in summer 2020

The results showed that the total effect of time on PHQ-4 was significant (c = -0.316 [-0.542, -0.090], t(430) = -2.75, p = 0.006), meaning that general mental distress decreased in the period from the onset of the pandemic to a time of less infections and lowered restrictions, three months later. With time, also crisis of meaning decreased significantly (a = -0.12 [-0.211, -0.037], t(430) = -2.80, p = 0.005). The changes in crisis of meaning, in turn, were positively related to the changes in PHQ-4 scores (b = 1.11 [0.885, 1.332], t(428) = 9.76, p < 0.001). As hypothesized, there was a significant indirect effect of time on PHQ-4 through changes in crisis of meaning (ab = -0.14 [-0.254, -0.039], ps (partially standardized indirect effect) = -0.06, proportion of the total effect due to the indirect effect = 44%. This indicates that improvements with regard to crisis of meaning accounted for a substantial proportion of improvement in general mental distress.


The question of whether or not we perceive our lives as meaningful has profound implications for how we relate to ourselves and our environment [20]. The evaluation of life as meaningful determines whether we see life as worth living at all and are thus motivated to invest in constructive interaction with the environment—even if this should be challenging [50]. Apart from this activating and motivating function which has been replicated by several studies (e.g. [51, 52],), meaningfulness also has a protective function: It impacts how people cope with stress or pain [53, 54]. A crisis of meaning, on the other hand, is a state of severe existential insecurity. People who suffer from not seeing meaning in their lives do not have access to personal resources such as hope, self-efficacy, or resilience; instead, depression, anxiety, negative mood and pessimism prevail [43, 55,56,57]. Despite the overlap with clinical symptoms, crises of meaning cannot be explained by these alone. Thus, most respondents who suffer from depression also tend to report high scores in crisis of meaning—but the reverse is true to a much lesser extent [58]. A crisis of meaning further proved to be a significant predictor of suicidality when controlling for depression [58], which demonstrates that the prevalence of crises of meaning in the population should be seriously monitored.

The present study looked at both the protective effect of meaningfulness and the risk to mental health associated with crisis of meaning. Its primary aim was to understand effects over time. The results confirmed our hypothesis that people who reported higher levels of meaningfulness at the beginning of the pandemic suffered from less general mental distress three months later. The bivariate prospective correlation exhibited a negative effect of medium size; when additionally controlling for age, education and general mental distress at the first measurement point, the incremental predictive value of meaningfulness was still significant. Our study is thus in line with recent research that showed a risk-protective effect of meaning in life [35, 36]. Testing the second hypothesis confirmed a reverse effect: Individuals who reported higher crisis of meaning scores at the beginning of the pandemic suffered more general mental distress three months later—even when controlling for demographic covariates and baseline PHQ-4 score. Here, a high level of crisis of meaning predicted more severe symptoms of depression and anxiety than a low level of meaningfulness. This confirms earlier findings [44] that the mere absence of meaning does not necessarily imply suffering and stress. Above all, it is the suffering from a meaningless life that leads to further symptoms.

The third hypothesis tested in the present study focused on the changes that occurred during the first months of the pandemic. Using paired-sample tests, meaningfulness was found to be stable across the two measurement points—replicating previous evidence of its stability [39, 59]. A sense of meaning in life is thus not easily shaken, apparently not even by the occurrence of a pandemic—at least as far as the first months of the emergence of the coronavirus disease are concerned. The extent of crisis of meaning measured during the first wave of infection, on the other hand, declined slightly in the following three months. This was also true for general mental distress. The third hypothesis therefore referred to these two characteristics. Based on the assumption that crises of meaning can lead to psychological distress, we tested whether their decrease would also predict the decrease in symptoms of distress. The corresponding indirect effect proved to be significant. The proportion of the total effect attributable to the indirect effect was substantial at 44%. This suggests that existential concerns should not be disregarded in clinical and public health contexts. It seems feasible to prevent mental distress and support mental health by addressing a crisis of meaning, e.g. through counselling or therapy.

The outcomes of the present study are in line with the general scientific evidence. Considering the overall responses to the pandemic, the majority seems to be resilient, whereas some experience it as a critical interruption of the continuity of their life [60]. According to our and other published [30,31,32] data, this might be a short-term crisis, as both scores in crisis of meaning and general mental distress decreased after the onset of the pandemic. Nevertheless, elevated scores of crisis of meaning during the first wave of the pandemic predicted higher general mental distress three months later. This suggests that a significant minority questions social or personal priorities [27] and enters into a crisis of meaning [2]. Although such crises are typically accompanied by psychological suffering [55,56,57] and even suicidality [58], they also have a considerable constructive potential: A more authentic approach to life, based on a more realistic—and thus more stable – worldview, seems to come into effect when crises are genuinely confronted [61, 62].

Strengths and limitations

This study's strengths include a longitudinal design with a substantial sample size and the employment of validated measures to assess two dimensions of meaning in life and general mental distress. Its major limitation is the fact that the sample is not representative. We did not use random sampling, and women and more educated participants were over-represented. This was considered in the analyses by including education as a covariate, but not gender, as it was not related to the outcome variable, general mental distress. Second, there was a slightly greater risk of dropout amongst individuals with lower education. However, this effect was small, and since the study focused on within-subject changes, we assume that attrition did not lead to any relevant bias. Finally, we cannot draw robust conclusions about causality. Studies with two-wave designs reduce the chance of bias due to common methods [63], but studies with more than two waves will allow for higher fidelity of conclusions about the proposed indirect effect [64].


Summarising the results indicates that existential questions should be taken seriously and targeted in times of large-scale crises—both in counselling and therapy and concerning public health measures. Public health guidelines can have a tangible impact on the four pillars of meaningfulness—significance, purpose, coherence, and belonging [20] through the design of the measures taken, their communication, and implementation [29]. Our data show that enabling citizens to maintain meaning in their lives even under challenging conditions is an effective preventive measure against the emergence of mental health problems. Elevated levels of a crisis of meaning, on the other hand, prospectively increased the likelihood of experiencing symptoms of depression and anxiety, while coping with them also proved beneficial for the progression of general mental distress.

Availability of data and materials

The dataset generated and analysed during the current study is not publicly available because participants did not agree for their data to be shared publicly, but it is available from the corresponding author on reasonable request.


  1. Mækelæ MJ, Reggev N, Dutra N, Tamayo RM, Silva-Sobrinho RA, Klevjer K, Pfuhl G. Perceived efficacy of COVID-19 restrictions, reactions and their impact on mental health during the early phase of the outbreak in six countries. Royal Soc Open Sci. 2020;7(8): 200644.

    Article  CAS  Google Scholar 

  2. Schnell T, Krampe H. Meaning in life and self-control buffer stress in times of COVID-19: moderating and mediating effects with regard to mental distress. Front Psychiatry. 2020;11: 582352.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Arora T, Grey I, Östlundh L, Lam KBH, Omar OM, Arnone D. The prevalence of psychological consequences of COVID-19: a systematic review and meta-analysis of observational studies. J Health Psychol. 2020:1–20.

  4. Bueno-Notivol J, Gracia-García P, Olaya B, Lasheras I, López-Antón R, Santabárbara J. Prevalence of depression during the COVID-19 outbreak: a meta-analysis of community-based studies. Int J Clin Health Psychol. 2021;21(1):100196.

    Article  PubMed  Google Scholar 

  5. Luo M, Guo L, Yu M, Jiang W, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis. Psychiatry Res. 2020;291:113190.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. COVID-19 Mental Disorders Collaborators. Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic.Lancet. 2021.

  7. TMGH-Global COVID-19 Collaborative. Psychological impacts and post-traumatic stress disorder among people under COVID-19 quarantine and isolation: a global survey. Int J Environ Res Public Health. 2021;18(11):5719.

    Article  Google Scholar 

  8. Knepple Carney A, Graf AS, Hudson G, Wilson E. Age moderates perceived COVID-19 disruption on well-being. Gerontologist. 2021;61(1):30–5.

    Article  PubMed  Google Scholar 

  9. Cleofas JV, Rocha ICN. Demographic, gadget and internet profiles as determinants of disease and consequence related COVID-19 anxiety among Filipino college students. Educ Inf Technol. 2021;26(6):6771–86.

    Article  Google Scholar 

  10. Magson NR, Freeman JYA, Rapee RM, Richardson CE, Oar EL, Fardouly J. Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic. J Youth Adolesc. 2021;50(1):44–57.

    Article  PubMed  Google Scholar 

  11. TMGH-Global COVID-19 Collaborative. Perceived stress of quarantine and isolation during COVID-19 pandemic: A global survey. Front Psychiatry. 2021;12.

  12. Harris SM, Sandal GM. COVID-19 and psychological distress in Norway: The role of trust in the healthcare system. Scand J Public Health. 2021;49(1):96–103.

    Article  PubMed  Google Scholar 

  13. Olagoke AA, Olagoke OO, Hughes AM. Psychological pathways linking public trust during the coronavirus pandemic to mental and physical well-being. Front Psychol. 2020;11(3139).

  14. Smith BM, Twohy AJ, Smith GS. Psychological inflexibility and intolerance of uncertainty moderate the relationship between social isolation and mental health outcomes during COVID-19. J Contextual Behav Sci. 2020;18:162–74.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Zhao X, Lan M, Li H, Yang J. Perceived stress and sleep quality among the non-diseased general public in China during the 2019 coronavirus disease: a moderated mediation model. Sleep Med. 2021;77:339–45.

    Article  PubMed  Google Scholar 

  16. Du C, Zan MCH, Cho MJ, Fenton JI, Hsiao PY, Hsiao R, Keaver L, Lai CC, Lee H, Ludy MJ, Shen W, Swee WCS, Thrivikraman J, Tseng KW, Tseng WC, Tucker RM. Increased resilience weakens the relationship between perceived stress and anxiety on sleep quality: A moderated mediation analysis of higher education students from 7 countries. Clocks Sleep. 2020;2(3):334–53.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Li J-B, Yang A, Dou K, Cheung RYM. Self-control moderates the association between perceived severity of coronavirus disease 2019 (COVID-19) and mental health problems among the Chinese public. Int J Environ Res Public Health. 2020;17(13):4820.

    Article  CAS  PubMed Central  Google Scholar 

  18. Danbolt LJ, Stifoss-Hanssen H. Ritual and recovery: Traditions in disaster ritualizing. Dialog. 2017;56(4):352–60.

    Article  Google Scholar 

  19. Janoff-Bulman R. Shattered assumptions. New York: Simon and Schuster; 2010.

    Google Scholar 

  20. Schnell T. The psychology of meaning in life. New York, Abingdon: Routledge; 2021.

    Google Scholar 

  21. Lee SA, Jobe MC, Mathis AA, Gibbons JA. Incremental validity of coronaphobia: Coronavirus anxiety explains depression, generalized anxiety, and death anxiety. J Anxiety Disord. 2020;74:102268.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Spitzenstätter D, Schnell T. The existential dimension of the pandemic: Death attitudes, personal worldview, and coronavirus anxiety. Death Stud. 2022;6(5):1031–41.

  23. Arslan G, Allen KA. Exploring the association between coronavirus stress, meaning in life, psychological flexibility, and subjective well-being. Psychol Health Med. 2021:1–12. Advance online publication.

  24. Ashraf F, Zareen G, Nusrat A, Arif A, Griffiths MD. Correlates of psychological distress among Pakistani adults during the COVID-19 outbreak: Parallel and serial mediation analyses. Front Psychol. 2021;12(825).

  25. Humphrey A, Vari O. Meaning matters: Self-perceived meaning in life, Its predictors and psychological stressors associated with the COVID-19 pandemic. Behav Sci. 2021;11(4):50.

    Article  Google Scholar 

  26. Trzebiński J, Cabański M, Czarnecka JZ. Reaction to the COVID-19 pandemic: The influence of meaning in life, life satisfaction, and assumptions on world orderliness and positivity. J Loss Trauma. 2020;25(6–7):544–57.

    Article  Google Scholar 

  27. Venuleo C, Marinaci T, Gennaro A, Palmieri A. The meaning of living in the time of COVID-19. A large sample narrative inquiry. Front Psychol. 2020;11:577077.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Bundesamt für Risikobewertung (2020 May 26). BfR-Corona-Monitor vom 26. Mai 2020. Accessed 19 Oct 2021.

  29. Christensen T, Lægreid P. The coronavirus crisis—crisis communication, meaning-making, and reputation management. Int Public Manag J. 2020;23(5):713–29.

    Article  Google Scholar 

  30. Fancourt D, Steptoe A, Bu F. Trajectories of anxiety and depressive symptoms during enforced isolation due to COVID-19 in England: a longitudinal observational study. Lancet Psychiatry. 2021;8(2):141–9.

    Article  PubMed  Google Scholar 

  31. Robinson E, Sutin AR, Daly M, Jones A. A systematic review and meta-analysis of longitudinal cohort studies comparing mental health before versus during the COVID-19 pandemic in 2020. J Affect Disord. 2022;296:567–76.

    Article  CAS  PubMed  Google Scholar 

  32. Sønderskov KM, Dinesen PT, Santini ZI, Østergaard SD. Increased psychological well-being after the apex of the COVID-19 pandemic. Acta Neuropsychiatr. 2020;32(5):277–9.

    Article  CAS  PubMed  Google Scholar 

  33. Hyland P, Vallières F, Daly M, Butter S, Bentall RP, Fox R, Karatzias T, MacLachlan M, McBride O, Murphy J, Murphy D, Spikol E, Shevlin M. Trajectories of change in internalizing symptoms during the COVID-19 pandemic: A longitudinal population-based study. J Affect Disord. 2021;295:1024–31.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. McPherson KE, McAloney-Kocaman K, McGlinchey E, Faeth P, Armour C. Longitudinal analysis of the UK COVID-19 Psychological Wellbeing Study: Trajectories of anxiety, depression and COVID-19-related stress symptomology. Psychiatry Res. 2021;304: 114138.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Yang Z, Ji LJ, Yang Y, Wang Y, Zhu L, Cai H. Meaning making helps cope with COVID-19: A longitudinal study. Pers Indiv Differ. 2021;174:110670.

    Article  Google Scholar 

  36. Yu Y, Yu Y, Lin Y. Cross-lagged analysis of the interplay between meaning in life and positive mental health during the COVID-19 epidemic. Asian J Psychiatr. 2020;54:102278.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Schnell T, Spitzenstätter D, Krampe H. Compliance with COVID-19 public health guidelines: an attitude-behaviour gap bridged by personal concern and distance to conspiracy ideation. Psychol Health. 2021;Advance online publication:1–22.

  38. Schnell T, Becker P. Der Fragebogen zu Lebensbedeutungen und Lebenssinn (LeBe). Göttingen: Hogrefe; 2007.

    Google Scholar 

  39. Schnell T. An empirical approach to existential psychology: Meaning in life operationalized. In: Kreitler S, Urbanek T, editors. Conceptions of meaning New York: Nova Science. 2014. p. 173–94.

    Google Scholar 

  40. Kroenke K, Spitzer RL, Williams JB, Monahan PO, Loewe B. An ultra-brief screening scale for anxiety and depression: The PHQ–4. Psychosomatics. 2009;50(6):613–21.

    PubMed  Google Scholar 

  41. Loewe B, Wahl I, Rose M, Spitzer C, Glaesmer H, Wingenfeld K, Schneider A, Braehler E. A 4-item measure for depression and anxiety: Validation and standardization of the Patient Health Questionnaire-4 (PHQ-4) in the general population. J Affect Disord. 2010;122:86–95.

    Article  Google Scholar 

  42. Kerper L, Spies C, Tillinger J, Wegscheider K, Salz A-L, Weiß-Gerlach E, Neumann T, Krampe H. Screening for depression, anxiety and general psychological distress in preoperative surgical patients: A psychometric analysis of the Patient Health Questionnaire 4 (PHQ-4). Clinical Health Promotion. 2014;4(1):5–14.

    Article  Google Scholar 

  43. Damásio BF, Koller SH, Schnell T. Sources of meaning and Meaning in Life Questionnaire (SoMe): Psychometric properties and sociodemographic findings in a large Brazilian sample. Acta Invest Psicol. 2013;3(3):1205–27.

    Article  Google Scholar 

  44. Schnell T. Existential indifference: another quality of meaning in life. J Humanist Psychol. 2010;50(3):351–73.

    Article  Google Scholar 

  45. Montoya AK, Hayes AF. Two-condition within-participant statistical mediation analysis: A path-analytic framework. Psychol Methods. 2017;22(1):6–27.

    Article  PubMed  Google Scholar 

  46. Cribbie R, Beribisky N, Alter U. A multi-faceted mess: A review of statistical power analysis in psychology journal articles. PsyArXiv October 21. 2021.

  47. Faul F, Erdfelder E, Lang A-G, Buchner A. G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods. 2007;39(2):175–91.

    Article  PubMed  Google Scholar 

  48. Montoya AK. Selecting a within- or between-subject design for mediation: Validity, causality, and statistical power. PsyArXiv July 19 2021.

  49. George D, Mallery P. IBM SPSS Statistics 23 step by step: A simple guide and reference (14th ed.). New York: Routledge; 2016.

  50. Antonovsky A. Health, stress and coping. San Franciso: Jossey-Bass; 1979.

    Google Scholar 

  51. Holahan CK, Holahan CJ, Suzuki R. Purposiveness, physical activity, and perceived health in cardiac patients. Disabil Rehabil. 2008;30(23):1772–8.

    Article  PubMed  Google Scholar 

  52. Kim ES, Strecher VJ, Ryff CD. Purpose in life and use of preventive health care services. PNAS. 2014;111(46):16331–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Boyle PA, Buchman AS, Wilson RS, Yu L, Schneider JA, Bennett DA. Effect of purpose in life on the relation between Alzheimer disease pathologic changes on cognitive function in advanced age. Arch Gen Psychiatry. 2012;69(5):499–505.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Winger JG, Adams RN, Mosher CE. Relations of meaning in life and sense of coherence to distress in cancer patients: a meta-analysis. Psychooncology. 2016;25(1):2–10.

    Article  PubMed  Google Scholar 

  55. Pedersen HF, Birkeland MH, Jensen JS, Schnell T, Hvidt NC, Sorensen T, la Cour P. What brings meaning to life in a highly secular society? A study on sources of meaning among Danes. Scand J Psychol. 2018;59(6):678–90.

    Article  PubMed  Google Scholar 

  56. Schnell T. The Sources of Meaning and Meaning in Life Questionnaire (SoMe): relations to demographics and well-being. J Posit Psychol. 2009;4(3):483–99.

    Article  Google Scholar 

  57. Sørensen T, la Cour P, Danbolt LJ, Stifoss-Hanssen H, Lien L, DeMarinis V, Pedersen HF, Schnell T. The Sources of Meaning and Meaning in Life Questionnaire in the Norwegian context: Relations to mental health, quality of life, and self-efficacy. Int J Psychol Rel. 2019;29(1):32–45.

    Article  Google Scholar 

  58. Schnell T, Gerstner R, Krampe H. Crisis of meaning predicts suicidality in youth independently of depression. Crisis. 2018;39(4):294–303.

    Article  PubMed  Google Scholar 

  59. Vötter B, Schnell T. Cross-lagged analyses between life meaning, self-compassion, and subjective well-being among gifted adults. Mindfulness. 2019;10(7):1294–303.

    Article  Google Scholar 

  60. Saunders R, Buckman JEJ, Fonagy P, Fancourt D. Understanding different trajectories of mental health across the general population during the COVID-19 pandemic. Psychol Med. 2021:1–9.

  61. Schnell T. Einlassen, Zulassen, Loslassen: Über ein konstruktives Leidensverständnis. Z Palliativmed. 2018;19(05):249–55.

    Article  Google Scholar 

  62. Calhoun LG, Tedeschi RG. Handbook of posttraumatic growth: Research and practice. London: Routledge; 2014.

    Book  Google Scholar 

  63. Podsakoff PM, MacKenzie SB, Lee JY, Podsakoff NP. Common method biases in behavioral research: a critical review of the literature and recommended remedies. J Appl Psychol. 2003;88(5):879–903.

    Article  PubMed  Google Scholar 

  64. Cole DA, Maxwell SE. Testing mediational models with longitudinal data: questions and tips in the use of structural equation modeling. J Abnorm Psychol. 2003;112(4):558–77.

    Article  PubMed  Google Scholar 

Download references


The authors did not receive support from any organization for the submitted work.

Author information

Authors and Affiliations



TS and HK collected, analyzed, and interpreted the data. TS conceptualized the study and wrote the manuscript. HK revised the manuscript. Both authors read and approved the submitted version of the manuscript.

Corresponding author

Correspondence to Tatjana Schnell.

Ethics declarations

Ethics approval and consent to participate

Ethical approval was issued by the Review Board (Psychology) of the University of Innsbruck. The procedures used in this study adhere to the tenets of the Declaration of Helsinki and its later amendments. Informed consent was obtained from all individual participants included in the study.

Consent for publication

Not applicable.

Competing interests

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schnell, T., Krampe, H. Meaningfulness protects from and crisis of meaning exacerbates general mental distress longitudinally. BMC Psychiatry 22, 285 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: