Health and Quality of Life

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Meaning in life in the Federal Republic of Germany: results of
a representative survey with the Schedule for Meaning in Life
Evaluation (SMiLE
Martin ! Fegg"# Mechtild $ramer# %laudia &ausewein and Gian ' &orasio
(ddress: )nterdisciplinary %enter for *alliative Medicine# Ludwig+Ma,imilians+-niversity# Marchioninistrasse ./# 0.12. Munich#
Germany Email: Martin ! Fegg" + martin3fegg4de5 Mechtild $ramer + mechtild46ramer3gm,4de5 %laudia &ausewein +
claudia4bausewein3med4unimuenchen4de5 Gian ' &orasio + borasio3med4uni+muenchen4de
" %orresponding author
*ublished: 77 8ovember 7992
:ealth and ;uality of Life <utcomes 7992# /:/=
doi:.94..0>?.@22+2/7/+
/+/=
Ahis article is available from:
http:??www4hBlo4com?content?/?.?/= C 7992 Fegg et
al5 licensee &ioMed %entral Ltd4
Received: 70 (ugust 7992
(ccepted: 77 8ovember
7992
Ahis is an <pen (ccess article distributed under the terms of the %reative %ommons (ttribution License
(http:??creativecommons4org?licenses?by?749#
which permits unrestricted use# distribution# and reproduction in any medium# provided the original wor6 is properly cited4
(bstract
&ac6ground: Ahe construct Dmeaning+in+lifeD (MiL has recently raised the interest
of clinicians
wor6ing in psycho+oncology and end+of+life care and has become a topic of scientiEc
investigation4
'iFculties regarding the measurement of MiL are related to the various theoretical
and conceptual
approaches and its inter+individual variability4 Aherefore the DSchedule for
Meaning in Life
EvaluationD (SMiLE# an individualiGed instrument for the assessment of MiL# was
developed4 Ahe
aim of this study was to evaluate MiL in a representative sample of the German
population4
Methods: )n the SMiLE# the respondents Erst indicate a minimum of three and
ma,imum of seven areas which provide meaning to their life before rating their
current level of importance and satisfaction of each area4 )ndices of total
weighting ()oH# range 79+.99# total satisfaction ()oS# range 9+.99# and total
weighted satisfaction ()oHS# range 9+.99 are calculated4
Results: )n !uly 799/# .#99@ Germans were randomly selected and interviewed (inclusion rate#
0/41I4 1#/7. areas of MiL were listed and assigned to .1 a+posteriori categories4
Ahe mean )oS
was 0.4= J ./4.# the mean )oH was 0@4> J ..4=# and the mean )oHS was 074= J
.@404 )n youth (.>+
.= y?o# DfriendsD were most important for MiL# in young adulthood (79+7= y?o
DpartnershipD# in
middle adulthood (19+1= y?o Dwor6D# during retirement (>9+>= y?o DhealthD and
DaltruismD# and
in advanced age (29 y?o and more Dspirituality?religionD and Dnature
e,perience?animalsD4
%onclusion: Ahis study is a Erst nationwide survey on individual MiL in a
randomly selected# representative sample4 Ahe MiL areas of the age stages seem
to correspond with Eri6sonKs stages of psychosocial development4
&ac6ground
Ahe concept of Dmeaning+in+lifeD (MiL has recently
stim+
ulated the interest of clinicians and researchers
wor6ing in
psycho+oncology and end+of+life care4 Moadel et al4
L.M
surveyed cancer patients and assessed their most
impor+
tant needs: @9I of the patients indicated a need
for help
in discovering meaning in their life4 Meier et al4 L7M found
that @2I of the physicians who had granted at least
one
reBuest for assisted suicide cited the patientsK
Dloss of
meaning in their livesD as a reason for the reBuest4
Mean+
ing+%entered Group *sychotherapy was developed
to
Page 1 of 8
:ealth and ;uality of Life <utcomes 200! /"#$
help patients with advanced cancer to sustain or
enhance
a sense of meaning# peace and purpose in their lives
L1M4
Ahe (ustrian psychiatrist Nictor Fran6l L@M who had a
per+
sonal history as a survivor of the 8aGi
concentration camps# developed the so+called
logotherapy4 :e deEned DmeaningD as the
manifestation of values# which are based on (i
creativity (e4g4 wor6# deeds# dedication to causes#
(ii e,perience (e4g4 art# nature# humor# love#
relation+
ships# roles# and (iii attitude (oneKs attitude toward
suf+
fering and e,istential problems4
Ahe diOerent Buestionnaires developed so far to
assess
MiL L/+77M measure the intensity# but tend to
neglect the
content of the reported meanings# which vary from
person
to person and from situation to situation L71#7@M4
Since
measurement of MiL based on standardiGed models
and
pre+selected domains may not provide a fully
adeBuate
representation of this highly individual construct#
the
DSchedule for Meaning in Life EvaluationD (SMiLE#
based
on a methodology utiliGed in Buality of life
(;oL
research# has been developed L7/M4
)n ;oL assessment# researchers faced similar
problems# i4e4 how to measure a highly individual
concept# which is diFcult to operationaliGe from a
methodological point of view L7@M4 <K&oyle et al4
therefore developed the DSched+
ule for the Evaluation of )ndividual ;uality of
Life +
'irect HeightingD (SE);oL+'H# L7>#72M4 )n the
SE);oL+
'H# the respondent indicates domains of individual
;oL and rates their relative importance and
satisfaction with each domain4 Ahe SMiLE was
developed analogously to the SE);oL methodology
with the aim to provide an indi+
vidualiGed assessment of MiL L7/M4
<bPectives
Ahe obPective of this study was to evaluate individual
MiL in a representative sample of the German
population to gather data for future comparisons
with cancer and palli+
ative care patients4 More speciEcally# the study
aimed (i to evaluate and categoriGe individually
important MiL areas# and (ii to e,amine
diOerences between sociodemo+
graphic parameters and MiL4
Methods
Study design
(page number not for citation
purposes
http"%%&&&'h(lo'co)%content%#%1%#$
was not available or reBuested later completion4 (ll
/9 interviewers were well+e,perienced in telephone
inter+
views and received a written# standardiGed protocol of
the SMiLE method4 (ll German spea6ing individuals#
aged .> years and older# living in private households
eBuipped with a telephone# were eligible for the study4
Sociodemographic data consisted of age# gender#
marital
status# education# employment# household net
income#
residence# and federal state4 Ahe federal states were
classi+
Eed according to (%8ielsen L70M: . :amburg#
&remen#
Schleswig+:olstein# Lower Sa,ony5 7 8orth Rhine+
Hest+
phalia5 1a :esse# Rhineland+*alatinate# Saarland5
1b
&aden+Huerttemberg5 @ &avaria5 / &erlin5 >
Mec6len+
burg+Hestern *ommerania# &randenburg# Sa,ony+
(nhalt5
and 2 Ahuringia# Sa,ony4
Ahe Schedule for Meaning in Life Evaluation (SMiLE
Ahe SMiLE is an individualiGed measure of MiL which was
developed in accordance to the recommendations of
the
ScientiEc (dvisory %ommittee of the Medical
<utcomes
Arust L7=M4
Step . (area listing
Ahe respondents indicate a minimum of three and
ma,i+
mum of seven areas (n Q number of areas which
provide meaning to their life in their current situation4
Step 7 (weighting
Ahe importance of each area (w
.
444w
n
5 1 n 2 is
rated with a Eve+point adPectival scale# ranging from
. Dsome+
what importantD to / De,tremely importantD4
Step 1 (level of satisfaction
Ahe respondents rate their current level of
satisfaction
with each area (s
.
444s
n
5 with 1 n 2 on a seven+point
Li6+
ert scale# ranging from +1 Dvery unsatisEedD to R1
Dvery sat+
isEedD4
Ahe )nde, of Heighting ()oH indicates the mean
weighting of the MiL areas (range# 79+.99# with
higher
scores reSecting higher weights4 Since the scale
starts
with Dsomewhat importantD# the Soor is set to 79
instead
of 94
wges n
Ahe design of the study was cross+sectional4 )n !uly
799/#
a representative nationwide German sample was
inter+
)oH = 79 5 Hges
=
n

i =
.
w
i
viewed with assistance of Forsa# a German Social
Research
)nstitute4 Ahe survey consisted of computer assisted
tele+
phone interviews4 (ll telephone numbers#
comprising
published and unpublished numbers# were
randomly
selected4 Ao obtain a random sample# the member
of the
household who most recently had birthday was
as6ed to
participate4 (ppointments were made if the target
person
Ahe )nde, of Satisfaction ()oS indicates the mean satis+
faction or dissatisfaction with the individual MiL
areas
(range# 9+.99# with higher scores reSecting higher
satis+
faction4 Ao obtain a clear inde, varying from 9 to .99#
the
satisfaction ratings s
i
are recalculated (sK
i
4 DNery
unsatis+
EedD (s
i
Q +1 is set to sK
i
Q 9 and Dvery satisEedD (s
i
Q
R1 is
Page 2 of 8
:ealth and ;uality of Life <utcomes 200! /"#$
set to sK
i
Q .99 with the levels of .>42# 1141# /9#
>>42# and 0141 in between4
n
s Ti
)oS = i = .
http"%%&&&'h(lo'co)%content%#%1%#$
(ll p+values are &onferroni corrected4 'iOerences
were considered to be statistically signiEcant at p Q 4
9/4 Statisti+
cal tests were performed with the Statistical *ac6age
for Social Sciences (S*SS# version .1494
Results
n
)n the total SMiLE inde, ()nde, of Heighted
Satisfac+
tion# )oHS# the ratings for importance and
satisfaction are combined (range# 9+.99# with
higher scores reSecting higher MiL4
n
*articipation in the study
Ahe mean response rate in telephone surveys in
Germany
is around 2/I (Forsa# personal communication#
March
72# 799>4 .#99@ individuals were interviewed# .@0
partic+
ipants were e,cluded because they did not list the
reBuired
number of at least three areas of MiL4 )n total# 0/>
individ+
uals completed the interview (inclusion rate# 0/41I4
)oHS
=

i=
.
w
i
w
ges

sTi

RespondentKs characteristics
Aable . provides an overview of the respondentsK charac+
&efore completion of the SMiLE# participants are
as6ed to
rate their overall MiL satisfaction on a seven+point
Li6ert scale# ranging from +1 Dvery unsatisEedD to R1
Dvery satis+
EedD (MiLU8RS4
Ahe psychometric properties of the SMiLE were
evalu+
ated in a study L7/M with /== students of the Ludwig+
Ma,+
imilians+-niversity# Munich# and the Royal %ollege
of
Surgeons# 'ublin (response rate# =/4@I4 Mean )oH
was
0/42 J =4@# mean )oS was 2>42 J .@41# and mean
)oHS was
2242 J .@474 Aest+retest reliability of the )oHS was r
Q 9427
(p V 499.# with 0/4>I of all areas listed again after
a test+
retest period of seven days4 %onvergent validity was
eval+
uated with the *urpose in Life test L/M (r Q 94@0# p V
499.#
the Self+Aranscendence Scale L19M (r Q 941@# p V
99.# and
a general 8RS on MiL (r Q 94/1# p V 499.4 Ahe
psychomet+
rics of the SMiLE were reported according to the
recom+
mendations of the ScientiEc (dvisory %ommittee of
the
Medical <utcome Arust L7=M4
Statistical (nalysis
Multifactorial analyses of variance (F+test were
per+
formed for the outcome scores ()oS# )oH#
)oHS#
MiLU8RS to control for potential confounders4
)nde+
pendent variables included age# gender# marital
status#
education# employment# household net income#
resi+
dence# and federal states4 Ao identify diOerences
in the
li6elihood of listing a speciEc MiL area# parameter
estima+
tors (& of the multifactorial analyses of variance
and %hi+
SBuare tests were used4 <dds ratios (<Rs with
=/I con+
Edence intervals (%)s were calculated to describe
the rela+
tion between respondents with the most and
least
li6elihood of listing an area4
( posteriori binary cluster analyses (lin6age
between
groups# phi+@+point correlation were calculated to
facili+
tate the categoriGation of these MiL areas4
(page number not for citation
purposes
teristics4
)tem characteristics
)n total# 1#/7. areas of MiL were listed by the
respondents4 (ll open answers were transcribed and
assigned to 1= a+
posteriori MiL categories by two independent raters
(M!F# M$4 (fterwards# binary cluster analyses were
calculated to include areas with freBuencies 1I4 Ahe
results of the cluster analyses led to the following
thirteen categories that represent the diOerent MiL
areas:
.4 (ltruism (altruism# helping others# readiness to
help# volunteer wor64
74 (nimals?8ature (animals# fond of animals# nature#
nature+love# pets4
14 Family (children# family# grandchildren# parents#
rela+
tives# siblings4
@4 Financial Security (Enances# income# money#
property# prosperity4
/4 Friends?(cBuaintances (acBuaintances# friends#
neigh+
bors# human?social relations4
>4 :ealth (health# physical well+being4
24 :edonism (consumption# having fun# pleasure4
04 :ome?Garden (apartment# gardening# home#
housing4
=4 Leisure Aime (cinema# culture# drama# hobbies#
holi+
day# music# sport4
.94 <ccupation?Hor6 (Pob# occupation# professional
suc+
cess# wor6# wor6ing place4
..4 *artnership (love# marriage# partner# partnership4
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:ealth and ;uality of Life <utcomes 200! /"#$ http"%%&&&'h(lo'co)%content%#%1%#$
Aable .: RespondentsK characteristics (n Q 0/>4
n I
(ge .>+.= years /. /4=
79+7= years .7@ .@4/
19+1= years .>@ .=4.
@9+@= years .>. .040
/9+/= years ..= .@49
>9+>= years .72 .@40
29 years and above ..9 .74=
Gender Male @71 @=4@
Female @11 /94>
Marital status Single 7>= 1.4>
Married @70 /94.
'ivorced?Separated =9 .94/
Hidowed >2 240
Education Elementary school 79/ 7/4@
Secondary school 70> 1/4@
:igh school 1.2 1=47
<ccupational status Employed @1> /.49
-nemployed @79 @=49
:ousehold net income (per month === or less 07 .747
.4999 + .4=== 71.1@4@
74999 + 74=== ./=7142
14999 and more 7997=40
Residence Less than /4999 inhabitants .@0 .241
/4999 + =4=== .@=.24@
.94999 + @=4=== 7@.704.
/94999 + ==4=== >= 04.
.994999 and more 7@= 7=4.
.74 *sychological Hell+&eing (harmony# luc6# mental
sat+
isfaction?well+being4
.14 Spirituality?Religion (church# faith# God# !esus#
reli+
gion# spirituality4
Aable 7 shows weight and satisfaction of the listed
MiL areas4 )n median# @ areas of MiL were listed
by the
respondents (1 areas# @141I5 @ areas# 7242I5 /
areas# .@41I5 > areas# >4=I5 2 areas# 240I4
Ahe study subPects were most satisEed with
partnership
and spirituality and least satisEed with wor6 and
Enances4
:ealth# partnership# and family were rated as most
impor+
tant for MiL# home?garden and leisure time were
least
important4
)n multifactorial analyses of variance# signiEcant
inSu+
ences were found for age# gender# education#
household
(page number not for citation
purposes
net income# residence# and federal states4 8o signiEcant
inSuences were found for marital status and employment4
(ge
Ahe )oHS# )oS# and MiLU8RS were inSuenced by age (df
Q ># p
)oHS
Q 49.# p
)oS
Q 499># p
MiLU8RS
Q 499.4 Figure .#
7# 1 show the signiEcant eOects of age and gender
on these outcome scores4
)n the listed areas# diOerences were found for altruism
(p
Q 4997# animals?nature (p Q 491# friends (p V 4
99.#
health (p V 499.# partnership (p V 499.# spirituality
(p V
499.# and wor6 (p V 499.4 *ost+hoc tests showed
that
individuals aged .>+.= years were most li6ely to
list
friends (compared to 29# <R ..4># %) /47+7/4># 79+
1=
y?o individuals listed partner (compared to 29# <R
@40#
%) 74/+=47# 19+1= y?o wor6 (compared to 29# <R
7@4@#
%) ..4=+/74># >9+>= y?o health (compared to .>+.=#
<R
1047# %) /4.+70/47 and altruism (compared to 79+
7=#
Page + of 8
aesults of the multifactorial analysis with the eOects of age nigugreder on )oS aesults of the multifactorial analysis with the eOects of age nigugreder on )oHS
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purposes
:ealth and ;uality of Life <utcomes 200! /"#$ http"%%&&&'h(lo'co)%content%#%1%#$
Aable 7: (reas of MiL listed by the respondents (n Q 0/>4 )ncluded are number and percentage of the listings as well as mean and
standard deviation (S' of the importance and satisfaction ratings4
wi si
n I Mean J S' Mean J S'
Family 290 0742 @42 J 94> 741 J 94=
Hor6 @>1 /@4. 14= J 94= .4@ J .4>
Leisure time 1/9 @94= 14/ J .49 .4> J .4@
Friends 1@9 1=42 @41 J 940 747 J .49
:ealth 72> 1747 @40 J 94@ .40 J .4/
*artnership 711 7247 @42 J 94> 74@ J .4.
Finances .7@ .@4/ 14> J .4. .49 J .40
:ome?Garden 0. =4/ 14/ J .4. 749 J .4.
Spirituality 09 =4@ @4@ J 94= 74@ J 94=
(nimals?8ature 2= =47 @4. J 94= 741 J .49
:edonism @. @42 @47 J 94= .4= J .41
(ltruism 1= @4> 140 J 940 74. J 94=
Hell+&eing 12 @41 @4@ J 940 .40 J .41
<R .>4/# %) 74.+.7>42# and individuals aged 29
years
and above were most li6ely to list animals?nature
(com+
pared to .>+.=# <R /4@# %) .47+7@49 and
spirituality (compared to 19+1=# <R 242# %) 149+
.=4@4
Gender
Ahe )oHS# )oS# )oH# and MiLU8RS are inSuenced by
gen+
der (df Q .# p
)oHS
Q 4991# p
)oS
Q 499.# p
)oH
V 499.#
p
MiLU8RS
Q 4974 Males scored lower on all outcome
scores (&
)oHS
Q +14@# &
)oS
Q +140# &
)oH
Q +14=# &
MiLU8RS
Q
+14/4
Homen were more li6ely to list animals?nature (<R
74=# %) .40+@4=5 p V 499.# family (<R 149# %)
749+@4@5 p V 499.# and health (<R 741# %) .42+
14.5 p V 499.4
F .
Results of the multifactorial analysis with the
eOects of age and gender on )oHS4
Education
MiLU8RS was inSuenced by education (df Q 7# p Q 4
9974 )ndividuals with high school degree were more
satisEed than individuals with an elementary school
degree (& Q +
741 or a second school degree (& Q +/404
)n the listed areas# diOerences were found for
Enances (p
Q 491# health (p V 499.# leisure time (p Q 499@#
spiritual+
ity (p Q 497# and wor6 (p V 499.4 *ost+hoc tests
showed
that individuals with an elementary school degree
were
most li6ely to list Enances (compared to high school#
<R
74># %) .4/+@41# no inSuence of net income and
health
(compared to high school# <R 74># %) .40+1404
)ndividu+
als with high school degree were most li6ely to list
leisure
time (compared to elementary school# <R 741# %)
.4>+
F 7
Results of the multifactorial analysis with the eOects
of age and gender on )oS4
Page # of 8
aesults of the multifactorial analysis with the eOects of age nigugreder on MiLU8RS
(page number not for citation
purposes
:ealth and ;uality of Life <utcomes 200! /"#$
F 1
Results of the multifactorial analysis with the
eOects of age and gender on MiLU8RS4
141# spirituality (compared to elementary school#
<R .40# %) .49+141# and wor6 (compared to
elementary school# <R 749# %) .4@+74=4
:ousehold net income
MiLU8RS was inSuenced by household net income
(df Q
1# p Q 499@4 SubPects with the highest income
(W1#999
were most satisEed with their MiL compared to
respond+
ents with lower income (7#999+1#999: & Q +.4=5
.#999+
7#999 : & Q +14.5 V.#999 : & Q +=4=4
)n the listed areas# a diOerence was found for wor6
(p Q 49@4 ( post+hoc test showed that individuals
with the highest net income (W1#999 were
most li6ely to list wor6 (compared to V .#999#
<R .40# %) .49+1494
Residence
Ahe )oHS and )oS were inSuenced by residence (df
Q @# p
)oHS
Q 491# p
)oS
Q 4974 SubPects living in
rural areas
(V/#999 inhabitants were most satisEed (&
)oHS
Q
/49# &
)oS
Q /41# subPects from big cities were least
satisEed
(W.99#999: & Q 95 /+.9#999: &
)oHS
Q @4.# &
)oS
Q
@4.5 .9+
/9#999: &
)oHS
Q 740# &
)oS
Q 74=5 /9+.99#999: &
)oHS
Q 14@# &)oS
Q 1474
)n the listed areas# no signiEcant diOerences were found4
Federal states
MiLU8RS was inSuenced by federal states (df Q 7#
p V 499.: )nhabitants of the German South+Hest
(8ielsen 7# 1a# 1b# @5 & Q 241 were most
satisEed# followed by the German 8orth
(8ielsen .5 & Q @404 Ahe German East (8ielsen
/# ># 25 & Q 9 was least satisEed4
http"%%&&&'h(lo'co)%content%#%1%#$
)n the listed areas# a diOerence was found for
home?gar+
den (p Q 499@4 *ost+hoc tests showed that individuals
liv+
ing in the German East were more li6ely to list home?
garden (compared to South+Hest# <R 149# %) .40+/494
'iscussion
Ahis study is a Erst nationwide survey on MiL in a ran+
domly selected# representative general population with
a respondent+generated MiL instrument4
Ahe data presented here may be a useful basis for
compar+
isons in future studies with physically or mentally ill
patients# and also for the evaluation of meaning+
based
interventions recently developed in end+of+life care
L1M4
%ompared to the SE);oL+'H (measuring ;oL# the
SMiLE (measuring MiL has a simpler weighting proce+
dure (adPectival scale vs4 *ie+%hart+AechniBue4 )n a
previ+
ous study L7/M# university students were as6ed how
they
diOerentiate between ;oL and MiL: they stated that
MiL
was related for them to spirituality and self+
transcend+
ence# whereas ;oL reSected their current status of
subPec+
tive well+being4 Ahe DidiographicD approach in
both
instruments (SE);oL+'H# SMiLE responds to general
and philosophical arguments against
standardiGed
(DnomotheticD ;oL and MiL measurement: these
are
highly individual constructs which need a subPective
and
individualiGed approach L7@M4 :owever# statistical
com+
parisons are more diFcult with idiographic measures4
Ahirteen categories were found to represent 7#0/. of
1#/7. areas of MiL (0.49I listed by the
respondents4 :ealth# partnership# and family were
rated as most impor+
tant# home?garden and leisure time were least
important4 SubPects were most satisEed with
partnership and spiritu+
ality# and least satisEed with wor6 and Enances4
Ahe categories are similar to Endings of earlier studies4
Ahe
areas of Ebersole L1.M consist of activities# beliefs#
growths#
healths# life wor6# obtainings# pleasures#
relationships#
and services4 Re6er X Hong L17M found altruism#
meeting
basic needs (e4g4 food# shelter# safety# creative
wor6#
enduring values?ideals# legacy# leisure
activities?hobbies#
personal achievement# personal growth# personal
rela+
tionships# religion# social?political activism# and
tradi+
tions?culture4
Ahe well+6nown Dmidlife crisisD is reSected by the
Ending
that individuals aged @9+@= years were least satisEed
with
their MiL4 Ahe diOerent MiL areas in the age stages
seem to
correspond with Eri6sonKs last four stages in
psychosocial
development L11M4 )n youth (.>+.= years#
psychosocial
stage + D)dentity vs4 Role %onfusionD# friends are
most
important4 )n young adulthood (79+7= years#
psychoso+
cial stage + D)ntimacy and Solidarity vs4 )solationD#
part+
nership is getting more and more important4 )n
middle
Page , of 8
:ealth and ;uality of Life <utcomes 200! /"#$
adulthood (19+1= years# psychosocial stage +
DGenerativ+
ity vs4 Self+(bsorption and StagnationD# wor6 is
more
li6ely to be listed and the overall MiL is decreasing4
(fter
success in procreation and attainment of solid Pob
posi+
tions# health and altruism are becoming important
during
retirement (>9+>= years# psychosocial stage + DEgo
)nteg+
rity vs4 'espairD4 )n advanced age (29 years and
above#
psychosocial stage + DEgo )ntegrity vs4 'espairD#
spiritu+
ality?religion and e,perience of nature?animals are
getting
more and more important and support overall MiL
satis+
faction4
Ahe Eri6sonian approach is life+span oriented: all
stages are mar6ed by a speciEc conSict4 Ahe
individual has to learn to hold both e,tremes of the
life+stage challenges in tension with one another
L11M4 Future studies are neces+
sary to enhance empirical evidence of this model
and to improve the integration into life+span
oriented psycho+
logical interventions4
)n general# women were more satisEed with their MiL
and
listed more important areas4 Furthermore# they
focused
on animals?nature# family# and health4 Nalue
researchers
found that women emphasiGe e,pressive+communal
val+
ues (e4g4 creativity# nature e,perience# while men
empha+
siGe instrumental values (e4g4 Pob# achievement#
power
L1@M4
SubPects in rural areas and urban agglomerations
were more satisEed in MiL compared to subPects
living in urbaniGed areas or cities4 Ahis is supported
by the General Social Survey (GSS which found that
rural residents had signiEcantly higher levels of
family life satisfaction and community satisfaction
L1/M4
)nhabitants of the aYuent German South+Hest
(&aden+
Huerttemberg# &avaria# :esse?Rhineland+
*alatinate?Saar+
land# and 8orth Rhine+Hestphalia were most
satisEed
with their overall MiL4 <ther surveys have also
found that
residents of Hest Germany were more satisEed in
almost
all life domains with the diOerences to East
Germany
becoming smaller L1>M4 Ahe D*erspe6tive
'eutschlandD
L12M# an online survey of public opinion with more
than
/.9#999 participants# found that &avaria and
&aden+
Huerttemberg had the highest satisfaction scores
in Ger+
many but East GermanyKs satisfaction is rising4
Limitations
Ahe advantage of surveys using telephone
interviews is the cost+eOectiveness and high
response rate but the precision depends on the
training of the interviewers4 Ahe research institute
was well+e,perienced and all interviewers
received a written# standardiGed protocol of the
SMiLE method4 8evertheless# face+to+face
interviews would have increased the surveyKs
validity4
(page number not for citation
purposes
http"%%&&&'h(lo'co)%content%#%1%#$
Ahe respondent generated listings were assigned to a+
pos+
teriori categories4 )t is possible that not all listings
were
identiEed correctly4 Sometimes it was diFcult to
diOeren+
tiate between nature vs4 garden and spirituality vs4
psycho+
logical well+being4 (dditionally# assessment of
individual
meanings of the listed areas is limited in telephone
inter+
views4 For e,ample# many respondents list DfamilyD as
a
cue label# but it can have various meanings for the
individ+
ual: feeling secure# ta6ing care of the children# loving
and
being loved# or pleasure in social activities of the
family4
For further understanding# it will be necessary to
obtain
in+depth descriptions of what is meant by the cue
labels#
e4g4 using Bualitative research designs L71M4
%onclusion
Ahis study investigated MiL in a representative survey
of
the German population with an individualiGed assess+
ment tool# the Schedule for Meaning in Life
Evaluation
(SMiLE4 )n the open answers# .1 MiL categories were
found4 Multifactorial analyses of variance showed
signiE+
cant inSuences of sociodemographic parameters on
the
listed areas and the outcome scores of the SMiLE4 Ahe
li6e+
lihood of MiL areas listed during the age stages of this
sur+
vey seem to correspond with Eri6sonKs phases of
the
psychosocial development4
Many e,isting MiL Buestionnaires are based on the
theo+
retical bac6ground of the researchers L10M4 (n
advantage of the SMiLE is to be a non+theoretically
driven assess+
ment tool4 Ahe subPects themselves nominate areas
which are important to their individual MiL4 Since a
consensus in the deEnition of MiL is still missing L1=M#
an attempt to deEne MiL for the individualiGed
approach may read as follows (paraphrasing <K&oyle
L7@M: DMeaning in life is what the individual says it isD4
(bbreviations
)oH )nde, of Heighting
)oS )nde, of Satisfaction
)oHS )nde, of Heighted Satisfaction
MiL Meaning in Life
MiLU8RS 8umeric Rating Scale on MiL
satisfaction n numbers of MiL areas listed
;oL ;uality of Life
s .444sn satisfaction with each MiL area
SE);oL Schedule for the Evaluation of )ndividual
;uality of Life
Page of 8
:ealth and ;uality of Life <utcomes 200! /"#$
SMiLE Schedule for Meaning in Life
Evaluation
w
.
444w
n
weighting?importance of each MiL
are
%ompeting interests
Ahe author(s declare that they have no competing
inter+
ests4
(uthorsK contributions
MF designed the study# analyGed the data#
interpreted the results and wrote the manuscript4
M$# %& and G'& were involved in the planning of
the design# the interpretation of the results and
the writing of the manuscript4 (ll authors read
and approved the Enal manuscript4
(c6nowledgements
Ahe authors are grateful to 'r4 :elmut $uechenhoO#
professor of statistics at the Ludwig+Ma,imilians+-niversity
Munich# for his advice and to Robin Grewal for his helpful
comments4
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purposes