Skip to main content Accessibility help

Posttraumatic growth and demoralization after cancer: The effects of patients' meaning-making

  • Yu-Chan Li (a1), Pei-Chen Yeh (a1) (a2), Hong-Wen Chen (a3), Yi-Fang Chang (a4), Shih-Hsuan Pi (a5) and Chun-Kai Fang (a1) (a6) (a7)...



It is common for patients to experience positive and negative psychological changes (e.g., posttraumatic growth or demoralization) after being diagnosed with cancer. Although demoralization and posttraumatic growth are both related to meaning-making, little attention has been paid to the associations among these concepts. The current study investigated the relationship between demoralization, posttraumatic growth, and meaning-making (focusing on sense-making and benefit-finding during the experience of illness) in cancer patients.


Some 200 cancer patients (with lung cancer, lymphoma, or leukemia) at the MacKay Memorial Hospital in New Taipei completed the Demoralization Scale–Mandarin Version (DS–MV), the Chinese Posttraumatic Growth Inventory (CPTGI), and a self-designed questionnaire for assessing sense-making and benefit-finding.


Demoralization was negatively correlated with posttraumatic growth, sense-making, benefit-finding, and time-since-diagnosis. Multiple regression analysis showed that meaning-making had different effects on demoralization and posttraumatic growth. The interactions of sense-making with either benefit-finding or time-since-diagnosis significantly predicted demoralization. Individuals with relatively higher sense-making and benefit-finding or shorter time-since-diagnosis experienced less demoralization.

Significance of Results:

The suffering of cancer may turn on the psychological process of demoralization, posttraumatic growth, and meaning-making in patients. Cancer patients who evidenced higher posttraumatic growth experienced less demoralization. Trying to identify positive changes in the experience of cancer may be a powerful way to increase posttraumatic growth. As time goes by, patients experienced less demoralization. Facilitating sense-making can have similar effects. Cancer patients with less benefit-finding experience higher demoralization, but sense-making buffers this effect.


Corresponding author

Address correspondence and reprint requests to: Chun-Kai Fang, 45 Mingsheng Road, MacKay Memorial Hospital Tamshui Branch, New Taipei, Taiwan. E-Mail:


Hide All
Aiken, L.S. & West, S.G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage Publications.
Barskova, T. & Oesterreich, R. (2009). Post-traumatic growth in people living with a serious medical condition and its relations to physical and mental health: A systematic review. Disability and Rehabilitation, 31(21), 17091733.
Brunet, J., McDonough, M.H., Hadd, V., et al. (2010). The Posttraumatic Growth Inventory: An examination of the factor structure and invariance among breast cancer survivors. Psycho-Oncology, 19(8), 830838.
Calhoun, L.G. & Tedeschi, R.G. (2001). Posttraumatic growth: The positive lessons of loss. In Meaning reconstruction and the experience of loss. Neimeyer, R.A. (ed.), pp. 157172. Washington, DC: American Psychological Association.
Chan, T.H.Y., Ho, R.T.H. & Chan, C.L.W. (2007). Developing an outcome measurement for meaning-making intervention with Chinese cancer patients. Psycho-Oncology, 16(9), 843850.
Clarke, D.M. & Kissane, D.W. (2002). Demoralization: Its phenomenology and importance. The Australian and New Zealand Journal of Psychiatry, 36(6), 733742.
Cockram, C.A., Doros, G. & de Figueiredo, J.M. (2009). Diagnosis and measurement of subjective incompetence: The clinical hallmark of demoralization. Psychotherapy and Psychosomatics, 78(6), 342345.
Cordova, M.J., Cunningham, L.L., Carlson, C.R., et al. (2001). Posttraumatic growth following breast cancer: A controlled comparison study. Health Psychology, 20(3), 176185.
Davis, C.G. (2001). The tormented and the transformed: Understanding responses to loss and trauma. In Meaning reconstruction and the experience of Loss. Neimeyer, R.A. (ed.), pp. 137155. Washington, DC: American Psychological Association.
Davis, C.G. (2008). Redefining goals and redefining self: A closer look at posttraumatic growth following loss. In Handbook of bereavement research and practice: Advances in theory and intervention. Stroebe, S. et al. (eds.), pp. 309325. Washington, DC: American Psychological Association.
Davis, C.G. & Nolen-Hoeksema, S. (2009). Making sense of loss, perceiving benefits, and posttraumatic growth. In Oxford handbook of positive psychology, 2nd ed. Lopez, S.J. & Snyder, C.R. (eds.), pp. 641649. New York: Oxford University Press.
Davis, C.G., Nolen-Hoeksema, S. & Larson, J. (1998). Making sense of loss and benefiting from the experience: Two construals of meaning. Journal of Personality and Social Psychology, 75(2), 561574.
Folkman, S. & Greer, S. (2000). Promoting psychological well-being in the face of serious illness: When theory, research, and practice inform each other. Psycho-Oncology, 9(1), 1119.
Grassi, L., Sabato, S., Rossi, E., et al. (2005). Use of the diagnostic criteria for psychosomatic research in oncology. Psychotherapy and Psychosomatics, 74(2), 100107.
Harvey, J.H. (2002). Perspectives on loss and trauma: Assaults on the self. Thousand Oaks, CA: Sage Publications.
Helgeson, V.S., Reynolds, K.A. & Tomich, P.L. (2006). A meta-analytic review of benefit-finding and growth. Journal of Consulting and Clinical Psychology, 74(5), 797816.
Ho, S.M., Chan, C.L. & Ho, R.T. (2004). Posttraumatic growth in Chinese cancer survivors. Psycho-Oncology, 13(6), 377389.
Holland, J.M., Currier, J.M. & Neimeyer, R.A. (2006). Meaning reconstruction in the first two years of bereavement: The role of sense-making and benefit-finding. Omega, 53(3), 175191.
Hung, H.C., Chen, H.W., Chang, Y.F., et al. (2010). Evaluation of the reliability and validity of the Mandarin version of the Demoralization Scale for cancer patients [in Chinese]. Journal of Internal Medicine of Taiwan, 21, 427435.
Jaarsma, T.A., Pool, G., Sanderman, R., et al. (2006). Psychometric properties of the Dutch version of the Posttraumatic Growth Inventory among cancer patients. Psycho-Oncology, 15(10), 911920.
Janoff-Bulman, R. (2004). Posttraumatic growth: Three explanatory models. Psychological Inquiry, 15(1), 3034.
Jim, H.S., Richardson, S.A., Golden-Kreutz, D.M., et al. (2006). Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychology, 25(6), 753761.
Kissane, D.W. (2004). The contribution of demoralization to end-of-life decision-making. The Hastings Center Report, 34(4), 2131.
Kissane, D.W., Clarke, D.M. & Street, A.F. (2001). Demoralization syndrome: A relevant psychiatric diagnosis for palliative care. Journal of Palliative Care, 17(1), 1221.
Kissane, D.W., Wein, S., Love, A., et al. (2004). The Demoralization Scale: A report of its development and preliminary validation. Journal of Palliative Care, 20(4), 269276.
Lee, C.Y., Fang, C.K., Yang, Y.C., et al. (2012). Demoralization syndrome among cancer outpatients in Taiwan. Supportive Care in Cancer, 20(10), 22592267.
Marchesi, C. & Maggini, C. (2007). Sociodemographic and clinical features associated with demoralization in medically ill inpatients. Social Psychiatry and Psychiatric Epidemiology, 42(10), 824829.
Mehnert, A., Vehling, S., Hocker, A., et al. (2011). Demoralization and depression in patients with advanced cancer: Validation of the German version of the Demoralization Scale. Journal of Pain and Symptom Management, 42(5), 768776.
Mermelstein, H.T. & Lesko, L. (1992). Depression in patients with cancer. Psycho-Oncology, 1(4), 199215.
Mitchell, A.J., Vahabzadeh, A. & Magruder, K. (2011). Screening for distress and depression in cancer settings: 10 lessons from 40 years of primary care research. Psycho-Oncology, 20(6), 572584.
Mols, F., Vingerhoets, A.J.J.M., Coebergh, J.W.W., et al. (2009). Well-being, posttraumatic growth and benefit-finding in long-term breast cancer survivors. Psychology & Health, 24(5), 583595.
Montgomery, C., Pocock, M., Titley, K., et al. (2002). Individual quality of life in patients with leukemia and lymphoma. Psycho-Oncology, 11(3), 239243.
Neimeyer, R.A. (2001). The language of loss: Grief therapy as a process of meaning reconstruction. In Meaning reconstruction & the experience of loss. Neimeyer, R.A. (ed.), pp. 261292. Washington, DC: American Psychological Association.
Neimeyer, R.A. (2004). Fostering posttraumatic growth: A narrative elaboration. Psychological Inquiry, 15(1), 5359.
Park, C.L. & Folkman, S. (1997). Meaning in the context of stress and coping. Review of General Psychology, 1(2), 115144.
Park, C.L., Edmondson, D., Fenster, J.R., et al. (2008). Meaning-making and psychological adjustment following cancer: The mediating roles of growth, life meaning, and restored just-world beliefs. Journal of Consulting and Clinical Psychology, 76(5), 863875.
Park, C.L., Chmielewski, J. & Blank, T.O. (2010). Post-traumatic growth: Finding positive meaning in cancer survivorship moderates the impact of intrusive thoughts on adjustment in younger adults. Psycho-Oncology, 19(11), 11391147.
Richardson, V.E. (2010). The dual process model of coping with bereavement: A decade later. Omega, 61(4), 269271.
Sawyer, A., Ayers, S. & Field, A.P. (2010). Posttraumatic growth and adjustment among individuals with cancer or HIV/AIDS: A meta-analysis. Clinical Psychology Review, 30(4), 436447.
Schroevers, M.J. & Teo, I. (2008). The report of posttraumatic growth in Malaysian cancer patients: Relationships with psychological distress and coping strategies. Psycho-Oncology, 17(12), 12391246.
Schroevers, M.J., Kraaij, V. & Garnefski, N. (2011). Cancer patients' experience of positive and negative changes due to the illness: Relationships with psychological well-being, coping, and goal reengagement. Psycho-Oncology, 20(2), 165172.
Sears, S.R., Stanton, A.L. & Danoff-Burg, S. (2003). The yellow brick road and the emerald city: Benefit-finding, positive reappraisal coping and posttraumatic growth in women with early-stage breast cancer. Health Psychology, 22(5), 487497.
Smith, S.K., Samsa, G., Ganz, P.A., et al. (2014). Is there a relationship between posttraumatic stress and growth after a lymphoma diagnosis? Psycho-Oncology, 23(3), 315321.
Stroebe, M. & Schut, H. (1999). The dual process model of coping with bereavement: Rationale and description. Death Studies, 23(3), 197224.
Stroebe, M.S. & Schut, H. (2001). Meaning-making in the dual process model of coping with bereavement. In Meaning reconstruction and the experience of loss. Neimeyer, R.A. (ed), pp. 5573. Washington, DC: American Psychological Association.
Stroebe, M.S. & Schut, H. (2010). The dual process model of coping with bereavement: A decade on. Omega, 61(4), 273289.
Tallman, B.A., Altmaier, E. & Garcia, C. (2007). Finding benefit from cancer. Journal of Counseling Psychology, 54(4), 481487.
Tallman, B., Shaw, K., Schultz, J., et al. (2010). Well-being and posttraumatic growth in unrelated donor marrow transplant survivors: A nine-year longitudinal study. Rehabilitation Psychology, 55(2), 204210.
Taylor, S.E. (1983). Adjustment to threatening events: A theory of cognitive adaptation. The American Psychologist, 38(11), 11611173.
Tedeschi, R.G. & Calhoun, L.G. (2004). Posttraumatic growth: Conceptual foundations and empirical evidence. Psychological Inquiry, 15(1), 118.
Thornton, A.A., Owen, J.E., Kernstine, K., et al. (2012). Predictors of finding benefit after lung cancer diagnosis. Psycho-Oncology, 21(4), 365373.
Vehling, S., Lehmann, C., Oechsle, K., et al. (2012). Is advanced cancer associated with demoralization and lower global meaning? The role of tumor stage and physical problems in explaining existential distress in cancer patients. Psycho-Oncology, 21(1), 5463.
Wijngaards-de Meij, L., Stroebe, M., Schut, H., et al. (2008). Parents grieving the loss of their child: Interdependence in coping. The British Journal of Clinical Psychology, 47(1), 3142.
Zoellner, T. & Maercker, A. (2006). Posttraumatic growth in clinical psychology: A critical review and introduction of a two component model. Clinical Psychology Review, 26(5), 626653. doi: 10.1016/j.cpr.2006.01.008.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed