Beyond the Physical: Meaning of Life and Stress Coping Strategies with Broken Heart Syndrome

Beyond the Physical: Meaning of Life and Stress Coping Strategies with Broken Heart Syndrome | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Beyond the Physical: Meaning of Life and Stress Coping Strategies with Broken Heart Syndrome Nesreen Khaled Hosny, Nayera Mohamed Shousha, Ali Mohamed Ali This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7406684/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 10 Nov, 2025 Read the published version in Scientific Reports → Version 1 posted 19 You are reading this latest preprint version Abstract Background Broken heart syndrome (BHS), also known as Takotsubo cardiomyopathy (TTC), is a temporary cardiac condition triggered by acute stress, with emotional or physical events often acting as precipitating factors. This study examines the psychosocial aspects of TTC by exploring meaning in life, the perceived impact of stress, perceived social support, and stress-coping strategies among TTC patients and healthy individuals. Methods A cross-sectional method was employed. Eighty participants (40 TTC patients, age: M = 39.92, SD = 13.30, and 40 matched healthy participants, Age: M = 31.50, SD = 10.71) were assessed. Results TTC patients scored significantly lower on measures of meaning in life and practical coping, while they scored higher on wishful thinking and the perceived negative impact of stress. Both practical and wishful coping strategies were positively correlated with meaning in life, and this relationship was not moderated by the perceived impact of stress and social support. Conclusions These findings underscore the importance of enhancing life meaning and individuals’ perception of stressful events to improve resilience and coping mechanisms in individuals with TTC. Health sciences/Cardiology Health sciences/Diseases Health sciences/Health care Biological sciences/Psychology Social science/Psychology Broken heart syndrome Takotsubo cardiomyopathy Egypt coping strategies social support Introduction Stress-induced cardiomyopathy, Tako-tsubo cardiomyopathy (TTC) or transient left ventricular ballooning syndrome, also known as broken heart syndrome, is a clinical condition that is frequently triggered by a stressful event that activates the sympathetic nervous system (SNS) and leads to a surge of catecholamines [ 1 – 2 – 3 ]. This syndrome develops in the absence of any significant coronary artery disease (CAD) and is characterized by a sudden onset of intense emotional and/or physical symptoms [ 3 ]. TTC may serve as a paradigm to understand the pathological basis of the mind‒heart relationship, as exemplified by the increased risk of heart and cardiovascular disorders, including coronary heart disease, that are observed in persons with psychiatric disorders such as depression and anxiety [ 2 ]. Consequently, recent research has suggested that psychological aspects may contribute to the pathophysiology of TTC [ 1 – 3 – 4 – 2 ]. Accordingly, treating TTC requires an interdisciplinary approach that integrates the management of heart failure and psychiatric disorders [ 2 ]. In most patients, the clinical presentation is indistinguishable from that of acute coronary syndrome, typically presenting with chest pain and dyspnoea. Sympathetic overactivity is another known feature of TTC. Additionally, the suppression of negative emotions, such as those arising from stressful situations, is linked to heightened sympathetic and cardiovascular responses [ 3 – 5 – 6 ]. As previously mentioned, the TTC can be triggered by stressful events. Stress adversely impacts both physiological and mental health, manifesting as worry, anxiety, irritability, fatigue, metabolic imbalances, and compromised immunity [ 7 ]. Therefore, individuals who experienced stressful situations, combined with their difficulty in expressing emotions and tendency to somatise, may have been more vulnerable to developing TCM. However, somatization often occurs when individuals experience internal or external stressors that are perceived as a threat and overwhelm their coping strategies. In such cases, their bodies respond to psychological threats as if they were physiological threats [ 3 ]. On the other hand, Majumdar & Ray [ 7 ] stated that stress is an inherent part of human life. It can add challenges and opportunities, motivating people toward their goals and making their experiences more exciting and activities more engaging. Hence, individuals who have meaning in their lives show a greater ability to cope with stressful life situations. In contrast, those who lose their purpose for living may experience deterioration in their physical and mental well-being. Therefore, meaning in life is considered a buffer against stress [ 8 ]. The meaning in life empowers individuals to act and make conscious choices regarding their life goals, thereby enhancing their ability to cope with stressful situations. A person’s response to a stressful situation primarily depends on how they perceive the situation and the coping strategy they employ [ 9 ]. Also, many researchers have related a person's meaning in life to several psychological processes that may contribute to heart risk; because they either (1) find stressors easier to handle or react less readily or (2) are less likely to resort to unhealthy coping strategies, people who have a stronger sense of purpose in life may be less likely to suffer from cardiotoxic stress [ 10 ]. Accordingly, the importance of meaning is not limited to only human functioning but also survival [ 11 ]. Furthermore, a review of the literature revealed an absence of research specifically examining meaning in life among people with broken heart syndrome. To this end, the current study aims to examine the differences between people with broken heart syndrome and healthy people in terms of their perceptions of stressful situations, meaning in life, and coping strategies, and the relationships between meaning in life and coping strategies moderated by perceived stress and perceived social support among people who are diagnosed with TTC. Accordingly, the hypotheses can be formulated as follows: H1: TTC patients differ in their perceptions of stressful situations, meaning in life, and coping strategies compared with healthy people. H2: Perceived impact of stress and perceived social support act as moderators of the relationship between meaning in life and coping strategies among TTC patients. Methods Sample and Data Collection Eighty volunteers participated in the current study (as shown in Table 1 ). According to their health condition and the diagnosis made by a cardiologist, the participants were divided into two groups: (1) participants with TTC (n = 40; age: M = 39.92, SD = 13.30; 22 = M/18 = F). (2) Healthy Participants HP (n = 54 Age: M = 31.50, SD = 10.71; =16 M/24 = F). At admission, the authors carefully assessed each patient’s medical history, identifying any recent stressful events that might have triggered their symptoms. The study followed APA ethical standards for treating human experimental volunteers; each participant provided written consent. The research was approved by the ethical committee of the Faculty of Arts, Benha University, Egypt, and the administrative approval from the director of Al Mabara Hospital for Health Insurance - El Zagazig, Egypt. Table 1 Sociodemographic characteristics Variables TTC HP SEX , n (%) Female Male 18 (45) 22(55) 24 (60) 16 (40) Age , M (SD) 39.92 (13.30) 31.50 (10.71) Marital status , n (%) Married Single Divorced 23 (57.5) 13 (32.5) 4 (10) 10(25) 29(72.5) 1(2.5) Educational level , n (%) High school Undergraduate Graduate 22(55) 15(37.5) 3(7.5) 8 (20) 21 (52.5) 11 (27.5) Source of support , n (%) Yes No 30(75) 10 (25) 32 (80) 8 (20) Perceived stress (%) 1. Perceived as no negative effects 2. Mild effects 3. Moderate effects 4. Sever effects 0 0 24 (60) 16 (40) 7 (17.5) 10 (25) 14 (35) 9 (22.5) Life Stressful events , n (%) 1. Death 2. Emotional separation 3. Domestic violence 4. Bad news 5. Exposed to accidents, surgeries, rape, thieve 6. Financial problems 7. Constant stress 8. Triggering memories 9. Unidentified 8(20) 1(2.5) 0 4(10) 7(17.5) 1(2.5) 19(47.5) 0 0 21 (52.5) 19 (47.5) 20(50) 25 (62.5) 26 (65) 13 (32.5) 29 (72.5) 20(50) 19 (47.5) TTC = Takotsubo cardiomyopathy patients; HP = Healthy people Inclusion and Exclusion Criteria For patients with TTC, according to Prasad et al [ 12 ] the inclusion criteria were (1) acute onset of symptoms; (2) the absence of obstructive coronary disease or angiographic evidence of acute plaque rupture; (3) new ECG abnormalities (ST-segment elevation and/or T-wave inversion) or modest elevation in cardiac troponin; (4) transient hypokinesis, akinesis, or dyskinesis in the left ventricular mid segments with or without apical involvement; regional wall motion abnormalities that extend beyond a single epicardial vascular distribution; and frequently, but not always, a stressful trigger; and (5) the absence of pheochromocytoma and myocarditis. A cardiologist at Al Mabara Hospital for Health Insurance, El Zagazig, Egypt, recruited the participants. For healthy participants, the inclusion criteria were (1) the absence of any heart disease in their clinical history and (2) an age close to that of the group of patients. To control for possible confounding variables that could influence the study, for all participants, the general inclusion criteria were as follows: (1) absence of severe chronic medical conditions (e.g., cancer, autoimmune diseases); (2) absence of neurological (e.g., epilepsy) and psychiatric diseases (e.g., schizophrenia, bipolar disorder, major depressive disorder) or diagnosis of dementia or other cognitive impairments. Instruments The Meaning in Life Questionnaire (MLQ) was developed by Steger et al [ 13 ]. It consists of a 10-item measure of two subscales of meaning in life, the presence of meaning, which refers to the subjective experience of feeling that one's life is meaningful and purposeful. People who have high levels of meaning report feeling a sense of purpose and value in their lives (e.g., My life has a clear sense of purpose, I understand my life’s meaning). The search for meaning refers to the process of seeking out meaning and purpose in life. Individuals with high levels of search for meaning are characterized as curious, open-minded, and actively engaged in their personal growth (e.g., I am always looking to find my life’s purpose, I am seeking a purpose or mission for my life). The participants had to indicate what makes their lives feel important to them on a 7-point Likert scale (1: Absolutely Untrue, 7: Absolutely True). The Ways of Coping Questionnaire (WCQ-R) was developed by Lazarus & Folkman [ 14 ]. It involves two ways of coping subscales: practical coping , which involves coping directly with a stressful situation to change it (e.g., I draw on my past experiences, I try to analyse the situation to understand it better), and selfish thinking , which involves attempting to cope with one’s emotions about a stressful situation rather than attempting to change the stressful situation itself (e.g., I daydream or imagine a better time or place than the one I am in, I wish that could change what has happened). The items are rated on a four-point Likert scale (1 = not used, 4 = used a great deal). Sociodemographic Participants were also asked about various sociodemographic variables, including stressful situations they had recently experienced and their perceived negative impact on their lives, sex, age, educational level, marital status, and perceived social support. Two bilingual individuals translated the questionnaires from English to Arabic via the back-translation procedure. A committee of three native professional translators then evaluated the agreement between the English and Arabic forms. Table 2 provides the reliability coefficients of the abovementioned measures. Table 2 Reliability coefficients of variables Variable Cronbach’s alpha TTC HP The Meaning in Life Questionnaire (MLQ) 0.877 0.741 Presence of Meaning 0.712 0.784 Search for Meaning 0.903 0.846 Practical Coping 0.592 0.743 Wishful Thinking 0.451 0.700 Notably, all the Cronbach’s alpha coefficients were rationally high. Results To test the first hypothesis, namely, that TTC patients differ in their perceptions of stressful situations, meaning in life, and coping strategies compared with healthy people, a t-test for independent samples was used, as shown in Table 3 . Table 3 T-test TTC and HP groups on the MLQ subscales, coping strategies, and perceived stress Variables TTC (n = 40) HP(n = 40) t (df) P Cohen's d M SD M SD The Meaning in Life Questionnaire (MLQ) 28.60 6.25 40.22 5.43 -8.878 (78) 0.001 5.855 Presence of Meaning 13.67 3.04 19.25 3.76 -7.290 (78) 0.001 3.419 Search for Meaning 14.92 3.90 20.97 3.75 -7.066 (78) 0.001 3.829 Practical Coping 21.22 3.11 23.22 3.48 3.893 (78) 0.001 3.389 Wishful Thinking 23.45 3.90 20.50 4.11 -2.703 (78) 0.008 3.087 Perceived impact of stress 8.650 0.863 6.400 2.63 5.142 (78) 0.001 1.956 As shown in Table 3 , the results revealed significant differences between the groups in all the variables (p < .05). Specifically, the TTC group reported significantly lower scores for the presence of meaning (t (78) = -7.290, p < .001, d = 3.419), search for meaning (t (78) = -7.066, p < .001, d = 3.829), and practical coping (t (78) = 3.893, p < .001, d = 3.389) than did the HP group. Additionally, the TTC group reported significantly higher scores on Wishful Thinking (t (78) = -2.703, p = .008, d = 3.087) and Perceived Impact of Stress (t (78) = 5.142, p < .001, d = 1.956) than did the HP group. Thus, the following hypothesis was reached. To test the second hypothesis, hierarchical multiple regression was used to examine the perceived impact of stress and perceived social support as moderators of the relationship between meaning in life and coping strategies among TTC patients. As shown in Tables 4 and 5 : Table 4 Moderation analysis of practical coping strategies by meaning in life, the perceived impact of stress, and perceived social support among patients Models Coefficient Standard Error t value p value F P Adjusted R² MLQ 0.166 0.071 2.331 0.025 4.909 0.006 0.231 PIS -1.369 0.509 -2.690 0.011 MLQ*PIS 0.235 0.49 0.535 0.596 MLQ 0.195 0.074 2.640 0.012 3.403 0.028 0.156 PSS 1.362 1.065 1.279 0.209 MLQ*PSS 0.576 0.486 1.186 0.243 MLQ = The Meaning in Life Questionnaire, PIS = Perceived impact of stress, PSS = Perceived social support, Dependent variable: practical coping As shown in Table 4 , the MLQ has a significant positive relationship with practical coping strategies. This suggests that individuals with a greater sense of meaning in life are more likely to engage in practical coping strategies. However, PIS has a significant negative relationship with practical coping strategies (p = 0.011). This finding indicates that individuals who perceive stress to have a greater negative impact on their lives are less likely to use practical coping strategies. The interaction effect on a person’s meaning in life and the perceived impact of stress are not significant (p = 0.596). Additionally, the interaction term between meaning in life and perceived social support was not significant (p = 0.243). These findings indicate that the relationship between the MLQ score and practical coping strategies is not moderated by perceived social support or the perceived impact of stress. Table 5 Moderation analysis of wishful coping strategies by meaning in life, the perceived impact of stress, and perceived social support Models coefficient Standard Error t value p value F P Adjusted R² MLQ 0.139 0.062 2.232 0.032 1.673 0.190 0.049 PIS 0.170 0.446 0.380 0.706 MLQ*PIS -0.158 0.385 -0.410 0.685 MLQ 0.127 0.062 2.057 0.047 1.849 0.156 0.061 PSS -0.614 0.886 -0.693 0.493 MLQ*PSS 0.260 0.404 0.643 0.525 Dependent variable: Wishful coping As shown in Table 5 , the MLQ score has a significant positive relationship with wishful coping strategies (p = 0.032 and p = 0.047). This suggests that individuals with a greater sense of meaning in life are more likely to engage in wishful coping strategies. PIS and PSS have a nonsignificant relationship with wishful coping strategies (PSS: p = 0.706, PSS: p = 0.493). The interaction term between MLQ and PIS was not significant (p = 0.685). Additionally, the interaction term between the MLQ score and PSS score was not significant (p = 0.525). These findings indicate that the relationship between the MLQ score and wishful coping strategies is not moderated by perceived social support or the perceived impact of stress. Discussion The current study aimed to examine the relationships between meaning in life and coping strategies (practical and wishful coping) moderated by perceived stress and social support among TTC patients and the differences between people with broken heart syndrome and healthy people in terms of their perceptions of stress, meaning in life, and coping strategies. The results revealed that the TTC group presented a significantly lower presence of meaning, search for meaning, and practical coping than did the healthy comparison group. Conversely, the TTC group reported significantly higher levels of wishful thinking and perceived impact of stress than did the HP group. This result aligns with a study conducted by Casagrande et al. [ 15 ], which revealed that stressful events are perceived differently by patients with TTC than by healthy individuals, as they tend to perceive life events more negatively. Similarly, Smeijers et al [ 16 ] reported that perceived stress levels were higher in TTCs than in healthy controls. Furthermore, a noteworthy prevalence of TTS has been documented in patients who have a history of psychopathological illnesses (such as depression and anxiety), which are frequently linked to emotional dysregulation and a distorted perception of life and environmental events [ 15 ]. Accordingly, these results assume that an individual's perception and emotional response to triggering events may be more significant determinants of TTC onset than the actual nature of the triggering event itself. Additionally, the findings showed that meaning in life has a significant positive relationship with both practical and wishful coping strategies and that there is a significant negative relationship between the perceived impact of stress and practical coping strategies. These findings are consistent with a growing body of research indicating that a sense of purpose and meaning in life, a key component of psychological well-being, may act as a buffer against the negative consequences of stress; individuals with a stronger sense of purpose tend to perceive stressors as less threatening, show reduced reactivity to stressors, and demonstrate improved resilience in recovering from stressful events through adaptive coping strategies. This, in turn, may contribute to a decrease in the potential for cardiotoxic stress [ 10 – 17 – 18 – 19 ]. This result can be explained by the fact that stressful life events are strongly linked to negative health outcomes, which can be characterized by epidemiological, psychological, and biological traditions, where life events unfold throughout an individual's lifespan, accumulate over time, and significantly affect their well-being, health, and behaviours. Consequently, effectively coping with life events perceived as threats is crucial for preventing potential human illnesses [ 20 ]. The biopsychosocial model posits that the interplay of biological, psychological, and social factors influences health outcomes. Stressful life events, when perceived as threats, trigger physiological and psychological reactions that can negatively impact health. Biologically, chronic stress can dysregulate hormone levels and compromise immune function [ 21 ]. Psychologically, coping strategies and resilience play crucial roles in mitigating the effects of stress [ 14 ]. Social support networks also influence stress perception and management, impacting long-term well-being [ 22 ]. Therefore, effective coping mechanisms are essential for minimizing the detrimental impact of life stressors, which is consistent with the biopsychosocial perspective. As Lazarus and Folkman [ 14 ] distinguished between problem-focused and emotion-focused coping responses to stressors, problem-focused coping involves attempting to address the source of stress directly, such as through proactive problem solving. In contrast, emotion-focused coping focuses on managing the emotional distress associated with the stressor, such as through techniques to regulate negative emotions. Thus, patients who lack the resources to effectively employ appraisal-focused or problem-focused coping strategies. This included the inability to reframe their perspective on the situation, develop and implement effective problem-solving strategies, or acquire the required skills to address the underlying cause of their distress [ 2 – 23 ]. However, despite extensive research on the relationship between coping and the perception of life events, limited knowledge exists regarding the specific coping mechanisms employed by patients with heart disease [ 20 ]. However, the findings did not reveal a moderating effect of perceived stress and perceived social support on the relationship between the meaning of life and coping strategies. This result may be explained by the inconsistent findings in previous research regarding the extent to which meaning in life is associated with psychological stress [ 17 – 19 ]. This may also be due to the unique experiences of individuals with broken heart syndrome, where the intensity of perceived distress could overshadow the potential positive effects of meaning in life. Research indicates that individuals facing high levels of perceived stress may experience a diminished capacity to use positive meaning as a coping resource (Park, 2010). Furthermore, individuals with broken heart syndrome may experience stress exceeding the protective capacity of meaning in life, potentially due to multiple concurrent stressors [ 25 ]. Consequently, the usual buffering role of meaning in life may be less effective in the face of such extreme emotional distress due to the overwhelming psychological or physiological impact. The findings can also be interpreted in light of several demographic and conceptual factors. A meta-analysis of 108 articles encompassing 76,892 participants revealed that the relationships among the meaning of life, psychological stress, and coping strategies are influenced by a variety of demographic and conceptual factors. The study revealed that variations in culture, region, age, and other variables contributed to inconsistent results across studies [ 11 ]. When these findings are evaluated, it is important to consider some of the study's limitations. The gender disparity inside the patient group is the primary constraint of this study—the male sample in the current study was larger than the female sample, making its findings tentative. This is based on what clinical studies have reported: a higher rate of diagnosis of broken heart syndrome in women than in men [ 26 – 27 – 28 ], with the need to address various age groups. To allow for intriguing interpretations, future research should consider balancing the groups according to gender and age, for example, which could be used to examine the functions of certain psychological elements. Another possible limitation of this study is the difficulty in obtaining a sample of patients due to the uncommon diagnosis of the syndrome, especially in Arab environments. This was evident from the absence of any studies that addressed the syndrome concerning the psychological aspect, whether studies in Arabic or English, which is in light of the researchers’ knowledge, as the interest in the research heritage was in the physical symptoms and pathology from the medical perspective of the syndrome, rather than the psychological symptoms. Conclusion This study offers valuable insights into the psychological dynamics of Takotsubo cardiomyopathy (TTC), commonly referred to as broken heart syndrome (BHS). The findings highlight significant differences between TTC patients and healthy individuals in their perceptions of life meaning, coping strategies, and stress levels. TTC patients reported lower levels of life meaning and practical coping abilities while exhibiting higher levels of wishful thinking and perceived stress. The results emphasize the crucial role of psychological resilience and a sense of purpose in managing stress and its physiological effects. Although a significant relationship was identified between life meaning and coping strategies, the anticipated moderating effects of perceived stress and social support were not observed. These findings underscore the complex interplay between psychological and physiological factors in the TTC, suggesting the necessity of an integrated treatment approach. Interventions designed to enhance life meaning and promote adaptive coping mechanisms may significantly improve patient outcomes. Further research is needed to examine these relationships in larger, more diverse populations, with consideration of cultural and demographic variables. Abbreviations TCC Tako-Tsubo Cardiomyopathy SNS Sympathetic Nervous System CAD Coronary Artery Disease BHS Broken Heart Syndrome Declarations Author contributions Nesreen contributed to the literature review and discussion; Nayera to data analysis, reporting, and manuscript revision, and served as corresponding author; and Ali to data collection and administrative processes. Funding The authors have not received any financial support. Data availability The data sets used and/or analysed during the current study are available from the corresponding author on reasonable request. Ethics approval and consent to participate Each participant provided written informed consent. Also, they have the right to withdraw from the interview at any time. Additionally, institutional review board approval was obtained from the Ethics Committee of the Faculty of Arts, Benha University, Egypt, and administrative approval was obtained from the Director of Al Mabara Hospital for Health Insurance, El Zagazig, Egypt. Consent for publication Not applicable. Conflict of interest The authors declare no relevant financial or non-financial interests. Acknowledgment The authors acknowledge that the participants in the current study were beneficial, and their cooperation is greatly appreciated. Furthermore, Ali Mohamed Ali Abd Rabou, who works as an Assistant Professor of Clinical Psychology at Benha University, Egypt, for his assistance in the Data collection phase. Declaration of generative AI in scientific writing The authors declare that AI tools were used solely to support the writing and editing process, as well as to assist in searching for relevant references. References Del Pace, S. et al. 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This syndrome develops in the absence of any significant coronary artery disease (CAD) and is characterized by a sudden onset of intense emotional and/or physical symptoms [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. TTC may serve as a paradigm to understand the pathological basis of the mind‒heart relationship, as exemplified by the increased risk of heart and cardiovascular disorders, including coronary heart disease, that are observed in persons with psychiatric disorders such as depression and anxiety [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Consequently, recent research has suggested that psychological aspects may contribute to the pathophysiology of TTC [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Accordingly, treating TTC requires an interdisciplinary approach that integrates the management of heart failure and psychiatric disorders [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In most patients, the clinical presentation is indistinguishable from that of acute coronary syndrome, typically presenting with chest pain and dyspnoea. Sympathetic overactivity is another known feature of TTC. Additionally, the suppression of negative emotions, such as those arising from stressful situations, is linked to heightened sympathetic and cardiovascular responses [\u003cspan additionalcitationids=\"CR4\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eAs previously mentioned, the TTC can be triggered by stressful events. Stress adversely impacts both physiological and mental health, manifesting as worry, anxiety, irritability, fatigue, metabolic imbalances, and compromised immunity [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Therefore, individuals who experienced stressful situations, combined with their difficulty in expressing emotions and tendency to somatise, may have been more vulnerable to developing TCM. However, somatization often occurs when individuals experience internal or external stressors that are perceived as a threat and overwhelm their coping strategies. In such cases, their bodies respond to psychological threats as if they were physiological threats [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eOn the other hand, Majumdar \u0026amp; Ray [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] stated that stress is an inherent part of human life. It can add challenges and opportunities, motivating people toward their goals and making their experiences more exciting and activities more engaging. Hence, individuals who have meaning in their lives show a greater ability to cope with stressful life situations. In contrast, those who lose their purpose for living may experience deterioration in their physical and mental well-being. Therefore, meaning in life is considered a buffer against stress [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The meaning in life empowers individuals to act and make conscious choices regarding their life goals, thereby enhancing their ability to cope with stressful situations. A person\u0026rsquo;s response to a stressful situation primarily depends on how they perceive the situation and the coping strategy they employ [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Also, many researchers have related a person's meaning in life to several psychological processes that may contribute to heart risk; because they either (1) find stressors easier to handle or react less readily or (2) are less likely to resort to unhealthy coping strategies, people who have a stronger sense of purpose in life may be less likely to suffer from cardiotoxic stress [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Accordingly, the importance of meaning is not limited to only human functioning but also survival [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Furthermore, a review of the literature revealed an absence of research specifically examining meaning in life among people with broken heart syndrome. To this end, the current study aims to examine the differences between people with broken heart syndrome and healthy people in terms of their perceptions of stressful situations, meaning in life, and coping strategies, and the relationships between meaning in life and coping strategies moderated by perceived stress and perceived social support among people who are diagnosed with TTC. Accordingly, the hypotheses can be formulated as follows:\u003c/p\u003e\u003cp\u003eH1: TTC patients differ in their perceptions of stressful situations, meaning in life, and coping strategies compared with healthy people.\u003c/p\u003e\u003cp\u003eH2: Perceived impact of stress and perceived social support act as moderators of the relationship between meaning in life and coping strategies among TTC patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n\u003ch2\u003eSample and Data Collection\u003c/h2\u003e\n\u003cp\u003eEighty volunteers participated in the current study (as shown in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e). According to their health condition and the diagnosis made by a cardiologist, the participants were divided into two groups: (1) participants with TTC (n\u0026thinsp;=\u0026thinsp;40; age: M\u0026thinsp;=\u0026thinsp;39.92, SD\u0026thinsp;=\u0026thinsp;13.30; 22\u0026thinsp;=\u0026thinsp;M/18\u0026thinsp;=\u0026thinsp;F). (2) Healthy Participants HP (n\u0026thinsp;=\u0026thinsp;54 Age: M\u0026thinsp;=\u0026thinsp;31.50, SD\u0026thinsp;=\u0026thinsp;10.71; =16 M/24\u0026thinsp;=\u0026thinsp;F). At admission, the authors carefully assessed each patient\u0026rsquo;s medical history, identifying any recent stressful events that might have triggered their symptoms. The study followed APA ethical standards for treating human experimental volunteers; each participant provided written consent. The research was approved by the ethical committee of the Faculty of Arts, Benha University, Egypt, and the administrative approval from the director of Al Mabara Hospital for Health Insurance - El Zagazig, Egypt.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab1\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eSociodemographic characteristics\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eVariables\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eTTC\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003eHP\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSEX\u003c/strong\u003e, n (%)\u003c/p\u003e\n\u003cp\u003eFemale\u003c/p\u003e\n\u003cp\u003eMale\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e18 (45)\u003c/p\u003e\n\u003cp\u003e22(55)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e24 (60)\u003c/p\u003e\n\u003cp\u003e16 (40)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge\u003c/strong\u003e, M (SD)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e39.92 (13.30)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e31.50 (10.71)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e, n (%)\u003c/p\u003e\n\u003cp\u003eMarried\u003c/p\u003e\n\u003cp\u003eSingle\u003c/p\u003e\n\u003cp\u003eDivorced\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e23 (57.5)\u003c/p\u003e\n\u003cp\u003e13 (32.5)\u003c/p\u003e\n\u003cp\u003e4 (10)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e10(25)\u003c/p\u003e\n\u003cp\u003e29(72.5)\u003c/p\u003e\n\u003cp\u003e1(2.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e, n (%)\u003c/p\u003e\n\u003cp\u003eHigh school\u003c/p\u003e\n\u003cp\u003eUndergraduate\u003c/p\u003e\n\u003cp\u003eGraduate\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e22(55)\u003c/p\u003e\n\u003cp\u003e15(37.5)\u003c/p\u003e\n\u003cp\u003e3(7.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e8 (20)\u003c/p\u003e\n\u003cp\u003e21 (52.5)\u003c/p\u003e\n\u003cp\u003e11 (27.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eSource of support\u003c/strong\u003e, n (%)\u003c/p\u003e\n\u003cp\u003eYes\u003c/p\u003e\n\u003cp\u003eNo\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e30(75)\u003c/p\u003e\n\u003cp\u003e10 (25)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e32 (80)\u003c/p\u003e\n\u003cp\u003e8 (20)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived stress\u003c/strong\u003e (%)\u003c/p\u003e\n\u003cp\u003e1. Perceived as no negative effects\u003c/p\u003e\n\u003cp\u003e2. Mild effects\u003c/p\u003e\n\u003cp\u003e3. Moderate effects\u003c/p\u003e\n\u003cp\u003e4. Sever effects\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e24 (60)\u003c/p\u003e\n\u003cp\u003e16 (40)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e7 (17.5)\u003c/p\u003e\n\u003cp\u003e10 (25)\u003c/p\u003e\n\u003cp\u003e14 (35)\u003c/p\u003e\n\u003cp\u003e9 (22.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u003cstrong\u003eLife Stressful events\u003c/strong\u003e, n (%)\u003c/p\u003e\n\u003cp\u003e1. Death\u003c/p\u003e\n\u003cp\u003e2. Emotional separation\u003c/p\u003e\n\u003cp\u003e3. Domestic violence\u003c/p\u003e\n\u003cp\u003e4. Bad news\u003c/p\u003e\n\u003cp\u003e5. Exposed to accidents, surgeries, rape, thieve\u003c/p\u003e\n\u003cp\u003e6. Financial problems\u003c/p\u003e\n\u003cp\u003e7. Constant stress\u003c/p\u003e\n\u003cp\u003e8. Triggering memories\u003c/p\u003e\n\u003cp\u003e9. Unidentified\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e8(20)\u003c/p\u003e\n\u003cp\u003e1(2.5)\u003c/p\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e4(10)\u003c/p\u003e\n\u003cp\u003e7(17.5)\u003c/p\u003e\n\u003cp\u003e1(2.5)\u003c/p\u003e\n\u003cp\u003e19(47.5)\u003c/p\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003cp\u003e0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e21 (52.5)\u003c/p\u003e\n\u003cp\u003e19 (47.5)\u003c/p\u003e\n\u003cp\u003e20(50)\u003c/p\u003e\n\u003cp\u003e25 (62.5)\u003c/p\u003e\n\u003cp\u003e26 (65)\u003c/p\u003e\n\u003cp\u003e13 (32.5)\u003c/p\u003e\n\u003cp\u003e29 (72.5)\u003c/p\u003e\n\u003cp\u003e20(50)\u003c/p\u003e\n\u003cp\u003e19 (47.5)\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eTTC\u0026thinsp;=\u0026thinsp;Takotsubo cardiomyopathy patients; HP\u0026thinsp;=\u0026thinsp;Healthy people\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cp\u003eFor patients with TTC, according to Prasad et al [\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e] the inclusion criteria were (1) acute onset of symptoms; (2) the absence of obstructive coronary disease or angiographic evidence of acute plaque rupture; (3) new ECG abnormalities (ST-segment elevation and/or T-wave inversion) or modest elevation in cardiac troponin; (4) transient hypokinesis, akinesis, or dyskinesis in the left ventricular mid segments with or without apical involvement; regional wall motion abnormalities that extend beyond a single epicardial vascular distribution; and frequently, but not always, a stressful trigger; and (5) the absence of pheochromocytoma and myocarditis. A cardiologist at Al Mabara Hospital for Health Insurance, El Zagazig, Egypt, recruited the participants. For healthy participants, the inclusion criteria were (1) the absence of any heart disease in their clinical history and (2) an age close to that of the group of patients. To control for possible confounding variables that could influence the study, for all participants, the general inclusion criteria were as follows: (1) absence of severe chronic medical conditions (e.g., cancer, autoimmune diseases); (2) absence of neurological (e.g., epilepsy) and psychiatric diseases (e.g., schizophrenia, bipolar disorder, major depressive disorder) or diagnosis of dementia or other cognitive impairments.\u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003e\u003cem\u003eThe Meaning in Life Questionnaire (MLQ)\u003c/em\u003e was developed by Steger et al [\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e]. It consists of a 10-item measure of two subscales of meaning in life, the presence of meaning, which refers to the subjective experience of feeling that one's life is meaningful and purposeful. People who have high levels of meaning report feeling a sense of purpose and value in their lives (e.g., My life has a clear sense of purpose, I understand my life\u0026rsquo;s meaning). The search for meaning refers to the process of seeking out meaning and purpose in life. Individuals with high levels of search for meaning are characterized as curious, open-minded, and actively engaged in their personal growth (e.g., I am always looking to find my life\u0026rsquo;s purpose, I am seeking a purpose or mission for my life). The participants had to indicate what makes their lives feel important to them on a 7-point Likert scale (1: Absolutely Untrue, 7: Absolutely True).\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eThe Ways of Coping Questionnaire (WCQ-R)\u003c/em\u003e was developed by Lazarus \u0026amp; Folkman [\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e]. It involves two ways of coping subscales: \u003cem\u003epractical coping\u003c/em\u003e, which involves coping directly with a stressful situation to change it (e.g., I draw on my past experiences, I try to analyse the situation to understand it better), and \u003cem\u003eselfish thinking\u003c/em\u003e, which involves attempting to cope with one\u0026rsquo;s emotions about a stressful situation rather than attempting to change the stressful situation itself (e.g., I daydream or imagine a better time or place than the one I am in, I wish that could change what has happened). The items are rated on a four-point Likert scale (1\u0026thinsp;=\u0026thinsp;not used, 4\u0026thinsp;=\u0026thinsp;used a great deal).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSociodemographic\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants were also asked about various sociodemographic variables, including stressful situations they had recently experienced and their perceived negative impact on their lives, sex, age, educational level, marital status, and perceived social support. Two bilingual individuals translated the questionnaires from English to Arabic via the back-translation procedure. A committee of three native professional translators then evaluated the agreement between the English and Arabic forms. Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e provides the reliability coefficients of the abovementioned measures.\u0026nbsp;\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\n\u003ctable id=\"Tab2\" border=\"1\"\u003e\u003ccaption\u003e\n\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n\u003cdiv class=\"CaptionContent\"\u003e\n\u003cp\u003eReliability coefficients of variables\u003c/p\u003e\n\u003c/div\u003e\n\u003c/caption\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth rowspan=\"2\" align=\"left\"\u003e\n\u003cp\u003eVariable\u003c/p\u003e\n\u003c/th\u003e\n\u003cth colspan=\"2\" align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eCronbach\u0026rsquo;s alpha\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eTTC\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003cth align=\"left\"\u003e\n\u003cp\u003e\u003cem\u003eHP\u003c/em\u003e\u003c/p\u003e\n\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eThe Meaning in Life Questionnaire (MLQ)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.877\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.741\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePresence of Meaning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.712\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.784\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eSearch for Meaning\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.903\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.846\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003ePractical Coping\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.592\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.743\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd align=\"left\"\u003e\n\u003cp\u003eWishful Thinking\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.451\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd align=\"char\" char=\".\"\u003e\n\u003cp\u003e0.700\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNotably, all the Cronbach\u0026rsquo;s alpha coefficients were rationally high.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eTo test the first hypothesis, namely, that TTC patients differ in their perceptions of stressful situations, meaning in life, and coping strategies compared with healthy people, a t-test for independent samples was used, as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eT-test TTC and HP groups on the MLQ subscales, coping strategies, and perceived stress\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e\u003cp\u003e\u003cem\u003eTTC (n\u0026thinsp;=\u0026thinsp;40)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e\u003cem\u003eHP(n\u0026thinsp;=\u0026thinsp;40)\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003et (df)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCohen's d\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThe Meaning in Life Questionnaire (MLQ)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e28.60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e40.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e5.43\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-8.878 (78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e5.855\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePresence of Meaning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e13.67\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.04\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e19.25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-7.290 (78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.419\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSearch for Meaning\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e14.92\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.97\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-7.066 (78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.829\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePractical Coping\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23.22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.48\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.893 (78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.389\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eWishful Thinking\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e23.45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.90\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e20.50\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e-2.703 (78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.008\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e3.087\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePerceived impact of stress\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e8.650\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.863\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6.400\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.63\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e5.142 (78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e\u003cp\u003e0.001\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\"\u003e\u003cp\u003e1.956\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the results revealed significant differences between the groups in all the variables (p\u0026thinsp;\u0026lt;\u0026thinsp;.05). Specifically, the TTC group reported significantly lower scores for the presence of meaning (t (78) = -7.290, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, d\u0026thinsp;=\u0026thinsp;3.419), search for meaning (t (78) = -7.066, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, d\u0026thinsp;=\u0026thinsp;3.829), and practical coping (t (78)\u0026thinsp;=\u0026thinsp;3.893, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, d\u0026thinsp;=\u0026thinsp;3.389) than did the HP group. Additionally, the TTC group reported significantly higher scores on Wishful Thinking (t (78) = -2.703, p\u0026thinsp;=\u0026thinsp;.008, d\u0026thinsp;=\u0026thinsp;3.087) and Perceived Impact of Stress (t (78)\u0026thinsp;=\u0026thinsp;5.142, p\u0026thinsp;\u0026lt;\u0026thinsp;.001, d\u0026thinsp;=\u0026thinsp;1.956) than did the HP group. Thus, the following hypothesis was reached.\u003c/p\u003e\u003cp\u003eTo test the second hypothesis, hierarchical multiple regression was used to examine the perceived impact of stress and perceived social support as moderators of the relationship between meaning in life and coping strategies among TTC patients. As shown in Tables\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e and \u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e:\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eModeration analysis of practical coping strategies by meaning in life, the perceived impact of stress, and perceived social support among patients\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModels\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eAdjusted R\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.071\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.331\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.025\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e4.909\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.006\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.231\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-1.369\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.509\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-2.690\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.011\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLQ*PIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.235\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.535\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.596\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.074\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.640\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.012\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e3.403\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e1.362\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.065\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.279\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.209\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLQ*PSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.576\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.486\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.186\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.243\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eMLQ\u0026thinsp;=\u0026thinsp;The Meaning in Life Questionnaire, PIS\u0026thinsp;=\u0026thinsp;Perceived impact of stress, PSS\u0026thinsp;=\u0026thinsp;Perceived social support, Dependent variable: practical coping\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, the MLQ has a significant positive relationship with practical coping strategies. This suggests that individuals with a greater sense of meaning in life are more likely to engage in practical coping strategies. However, PIS has a significant negative relationship with practical coping strategies (p\u0026thinsp;=\u0026thinsp;0.011). This finding indicates that individuals who perceive stress to have a greater negative impact on their lives are less likely to use practical coping strategies. The interaction effect on a person\u0026rsquo;s meaning in life and the perceived impact of stress are not significant (p\u0026thinsp;=\u0026thinsp;0.596). Additionally, the interaction term between meaning in life and perceived social support was not significant (p\u0026thinsp;=\u0026thinsp;0.243). These findings indicate that the relationship between the MLQ score and practical coping strategies is not moderated by perceived social support or the perceived impact of stress.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eModeration analysis of wishful coping strategies by meaning in life, the perceived impact of stress, and perceived social support\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"8\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModels\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003ecoefficient\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandard Error\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003et value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eF\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eP\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eAdjusted R\u0026sup2;\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.139\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.032\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.673\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.170\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.446\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.380\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.706\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLQ*PIS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.385\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.410\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.685\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLQ\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.062\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2.057\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.047\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e1.849\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.156\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c8\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003e0.061\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e-0.614\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.886\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e-0.693\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.493\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMLQ*PSS\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.260\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.404\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.643\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.525\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"8\"\u003eDependent variable: Wishful coping\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, the MLQ score has a significant positive relationship with wishful coping strategies (p\u0026thinsp;=\u0026thinsp;0.032 and p\u0026thinsp;=\u0026thinsp;0.047). This suggests that individuals with a greater sense of meaning in life are more likely to engage in wishful coping strategies. PIS and PSS have a nonsignificant relationship with wishful coping strategies (PSS: p\u0026thinsp;=\u0026thinsp;0.706, PSS: p\u0026thinsp;=\u0026thinsp;0.493). The interaction term between MLQ and PIS was not significant (p\u0026thinsp;=\u0026thinsp;0.685). Additionally, the interaction term between the MLQ score and PSS score was not significant (p\u0026thinsp;=\u0026thinsp;0.525). These findings indicate that the relationship between the MLQ score and wishful coping strategies is not moderated by perceived social support or the perceived impact of stress.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe current study aimed to examine the relationships between meaning in life and coping strategies (practical and wishful coping) moderated by perceived stress and social support among TTC patients and the differences between people with broken heart syndrome and healthy people in terms of their perceptions of stress, meaning in life, and coping strategies. The results revealed that the TTC group presented a significantly lower presence of meaning, search for meaning, and practical coping than did the healthy comparison group. Conversely, the TTC group reported significantly higher levels of wishful thinking and perceived impact of stress than did the HP group. This result aligns with a study conducted by Casagrande et al. [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], which revealed that stressful events are perceived differently by patients with TTC than by healthy individuals, as they tend to perceive life events more negatively. Similarly, Smeijers et al [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] reported that perceived stress levels were higher in TTCs than in healthy controls. Furthermore, a noteworthy prevalence of TTS has been documented in patients who have a history of psychopathological illnesses (such as depression and anxiety), which are frequently linked to emotional dysregulation and a distorted perception of life and environmental events [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Accordingly, these results assume that an individual's perception and emotional response to triggering events may be more significant determinants of TTC onset than the actual nature of the triggering event itself.\u003c/p\u003e\u003cp\u003eAdditionally, the findings showed that meaning in life has a significant positive relationship with both practical and wishful coping strategies and that there is a significant negative relationship between the perceived impact of stress and practical coping strategies. These findings are consistent with a growing body of research indicating that a sense of purpose and meaning in life, a key component of psychological well-being, may act as a buffer against the negative consequences of stress; individuals with a stronger sense of purpose tend to perceive stressors as less threatening, show reduced reactivity to stressors, and demonstrate improved resilience in recovering from stressful events through adaptive coping strategies. This, in turn, may contribute to a decrease in the potential for cardiotoxic stress [\u003cspan additionalcitationids=\"CR11 CR12 CR13 CR14 CR15 CR16\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This result can be explained by the fact that stressful life events are strongly linked to negative health outcomes, which can be characterized by epidemiological, psychological, and biological traditions, where life events unfold throughout an individual's lifespan, accumulate over time, and significantly affect their well-being, health, and behaviours. Consequently, effectively coping with life events perceived as threats is crucial for preventing potential human illnesses [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The biopsychosocial model posits that the interplay of biological, psychological, and social factors influences health outcomes. Stressful life events, when perceived as threats, trigger physiological and psychological reactions that can negatively impact health. Biologically, chronic stress can dysregulate hormone levels and compromise immune function [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Psychologically, coping strategies and resilience play crucial roles in mitigating the effects of stress [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Social support networks also influence stress perception and management, impacting long-term well-being [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Therefore, effective coping mechanisms are essential for minimizing the detrimental impact of life stressors, which is consistent with the biopsychosocial perspective.\u003c/p\u003e\u003cp\u003eAs Lazarus and Folkman [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] distinguished between problem-focused and emotion-focused coping responses to stressors, problem-focused coping involves attempting to address the source of stress directly, such as through proactive problem solving. In contrast, emotion-focused coping focuses on managing the emotional distress associated with the stressor, such as through techniques to regulate negative emotions. Thus, patients who lack the resources to effectively employ appraisal-focused or problem-focused coping strategies. This included the inability to reframe their perspective on the situation, develop and implement effective problem-solving strategies, or acquire the required skills to address the underlying cause of their distress [\u003cspan additionalcitationids=\"CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10 CR11 CR12 CR13 CR14 CR15 CR16 CR17 CR18 CR19 CR20 CR21 CR22\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, despite extensive research on the relationship between coping and the perception of life events, limited knowledge exists regarding the specific coping mechanisms employed by patients with heart disease [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. However, the findings did not reveal a moderating effect of perceived stress and perceived social support on the relationship between the meaning of life and coping strategies. This result may be explained by the inconsistent findings in previous research regarding the extent to which meaning in life is associated with psychological stress [\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. This may also be due to the unique experiences of individuals with broken heart syndrome, where the intensity of perceived distress could overshadow the potential positive effects of meaning in life. Research indicates that individuals facing high levels of perceived stress may experience a diminished capacity to use positive meaning as a coping resource (Park, 2010). Furthermore, individuals with broken heart syndrome may experience stress exceeding the protective capacity of meaning in life, potentially due to multiple concurrent stressors [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Consequently, the usual buffering role of meaning in life may be less effective in the face of such extreme emotional distress due to the overwhelming psychological or physiological impact. The findings can also be interpreted in light of several demographic and conceptual factors. A meta-analysis of 108 articles encompassing 76,892 participants revealed that the relationships among the meaning of life, psychological stress, and coping strategies are influenced by a variety of demographic and conceptual factors. The study revealed that variations in culture, region, age, and other variables contributed to inconsistent results across studies [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eWhen these findings are evaluated, it is important to consider some of the study's limitations. The gender disparity inside the patient group is the primary constraint of this study\u0026mdash;the male sample in the current study was larger than the female sample, making its findings tentative. This is based on what clinical studies have reported: a higher rate of diagnosis of broken heart syndrome in women than in men [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e], with the need to address various age groups. To allow for intriguing interpretations, future research should consider balancing the groups according to gender and age, for example, which could be used to examine the functions of certain psychological elements.\u003c/p\u003e\u003cp\u003eAnother possible limitation of this study is the difficulty in obtaining a sample of patients due to the uncommon diagnosis of the syndrome, especially in Arab environments. This was evident from the absence of any studies that addressed the syndrome concerning the psychological aspect, whether studies in Arabic or English, which is in light of the researchers\u0026rsquo; knowledge, as the interest in the research heritage was in the physical symptoms and pathology from the medical perspective of the syndrome, rather than the psychological symptoms.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study offers valuable insights into the psychological dynamics of Takotsubo cardiomyopathy (TTC), commonly referred to as broken heart syndrome (BHS). The findings highlight significant differences between TTC patients and healthy individuals in their perceptions of life meaning, coping strategies, and stress levels. TTC patients reported lower levels of life meaning and practical coping abilities while exhibiting higher levels of wishful thinking and perceived stress. The results emphasize the crucial role of psychological resilience and a sense of purpose in managing stress and its physiological effects. Although a significant relationship was identified between life meaning and coping strategies, the anticipated moderating effects of perceived stress and social support were not observed. These findings underscore the complex interplay between psychological and physiological factors in the TTC, suggesting the necessity of an integrated treatment approach. Interventions designed to enhance life meaning and promote adaptive coping mechanisms may significantly improve patient outcomes. Further research is needed to examine these relationships in larger, more diverse populations, with consideration of cultural and demographic variables.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eTCC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTako-Tsubo Cardiomyopathy\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eSNS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eSympathetic Nervous System\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eCAD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eCoronary Artery Disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u003cb\u003eBHS\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBroken Heart Syndrome\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNesreen contributed to the literature review and discussion; Nayera to data analysis, reporting, and manuscript revision, and served as corresponding author; and Ali to data collection and administrative processes.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors have not received any financial support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEach participant provided written informed consent. Also, they have the right to withdraw from the interview at any time. Additionally, institutional review board approval was obtained from the Ethics Committee of the Faculty of Arts, Benha University, Egypt, and administrative approval was obtained from the Director of Al Mabara Hospital for Health Insurance,\u0026nbsp;El Zagazig, Egypt.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare no relevant financial or non-financial interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors acknowledge that the participants in the current study were beneficial, and their cooperation is greatly appreciated. Furthermore,\u0026nbsp;Ali Mohamed Ali Abd Rabou, who works as an Assistant Professor of Clinical Psychology at Benha University, Egypt,\u0026nbsp;for his assistance in the Data collection phase.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of generative AI in scientific writing\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that AI tools were used solely to support the writing and editing process, as well as to assist in searching for relevant references.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eDel Pace, S. et al. Anxiety trait in patients with stress-induced cardiomyopathy: a case-control study. \u003cem\u003eClin. Res. 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Comparison and Outcome Analysis of Patients with Takotsubo Cardiomyopathy Triggered by Emotional Stress or Physical Stress. \u003cem\u003ePsychol. Clin. Settings\u003c/em\u003e. \u003cb\u003e8\u003c/b\u003e, 1\u0026ndash;6 (2017).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLooi, J. et al. \u003cem\u003eA comparison of the clinical features and outcomes of Takotsubo syndrome across metropolitan hospitals in New Zealand\u003c/em\u003e13373\u0026ndash;82 (NZMJ, 2020). 1520\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nzma.org.nz/journal/133-1520/4096\u003c/span\u003e\u003cspan address=\"https://www.nzma.org.nz/journal/133-1520/4096\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLopez- Pais, J. et al. Differences Between Takotsubo and the Working Diagnosis of Myocardial Infarction with Nonobstructive Coronary Arteries. \u003cem\u003eFront. Cardiovasc. Med.\u003c/em\u003e \u003cb\u003e9\u003c/b\u003e, 1\u0026ndash;8. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fcvm.2022.858718\u003c/span\u003e\u003cspan address=\"10.3389/fcvm.2022.858718\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2022).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Broken heart syndrome, Takotsubo cardiomyopathy, Egypt, coping strategies, social support","lastPublishedDoi":"10.21203/rs.3.rs-7406684/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7406684/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBroken heart syndrome (BHS), also known as Takotsubo cardiomyopathy (TTC), is a temporary cardiac condition triggered by acute stress, with emotional or physical events often acting as precipitating factors. This study examines the psychosocial aspects of TTC by exploring meaning in life, the perceived impact of stress, perceived social support, and stress-coping strategies among TTC patients and healthy individuals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional method was employed. Eighty participants (40 TTC patients, age: M = 39.92, SD = 13.30, and 40 matched healthy participants, Age: M = 31.50, SD = 10.71) were assessed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTTC patients scored significantly lower on measures of meaning in life and practical coping, while they scored higher on wishful thinking and the perceived negative impact of stress. Both practical and wishful coping strategies were positively correlated with meaning in life, and this relationship was not moderated by the perceived impact of stress and social support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThese findings underscore the importance of enhancing life meaning and individuals’ perception of stressful events to improve resilience and coping mechanisms in individuals with TTC.\u003c/p\u003e","manuscriptTitle":"Beyond the Physical: Meaning of Life and Stress Coping Strategies with Broken Heart Syndrome","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-15 12:32:07","doi":"10.21203/rs.3.rs-7406684/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision 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