A terror management perspective on the role of death-related anxiety in psychological dysfunction

Sympathy towards people infected with COVID-19 mediates relations between media use and death anxiety

The COVID-19 pandemic threatened mental health. This study examined the longitudinal associations among pandemic-related media use, sympathy for people infected with COVID-19 (PIWC), and death anxiety. 132 Chinese adults completed measures three times, one week apart during the initial phase of COVID. The results showed that media use, sympathy, and death anxiety decreased significantly over the first month of the outbreak. Pandemic-related media use predicted increased future sympathy for PIWC, and sympathy predicted increased future death anxiety. The study identified the short-term effects of media use on sympathy and death anxiety, and suggests that reduced media exposure may be beneficial.

The Association Between Depression and Death Anxiety Among Older Adults: Moderating Effect of Ego-Integrity

This study verifies the relationship between depression and death anxiety in older adults and the moderating effect of ego-integrity on this relationship. The survey was conducted with 236 participants aged 65 years and older through a combination of online and offline surveys. The final data were analyzed using the PROCESS macro for SPSS 2.16. The main findings of this study are as follows: First, depression in old age was positively related to anxiety about death. Second, the moderating effect of ego-integrity was observed on the relationship between depression and death anxiety. Third, on examining the moderating effect of each sub-variable of ego-integrity, the moderating effect of satisfaction with one's life was observed to be significant. Conversely, the moderating effect of attitude toward life and acceptance of old age was not significant. The results of this study are meaningful in examining the moderating effect of ego-integrity on the relationship between depression and death anxiety. Furthermore, the results of this study can provide basic data for the development and application of psychological intervention programs for older adults experiencing psychological problems due to depression and death anxiety in old age.

Development and validation of Believers' Death Anxiety Scale: integrating religious dimensions into death anxiety assessment

BACKGROUND AND OBJECTIVES

Death anxiety has traditionally been measured without considering religious beliefs related to death, such as afterlife, the grave, and punishment. The present study was aimed at developing and validating a new scale to address this limitation.

METHODS

The study was carried out in four phases and recruited a total of 2250 conveniently selected participants aged 18-59. Believers' Death Anxiety Scale (BDAS) was developed and validated according to the reputed standards for scale development and validation. Exploratory and confirmatory factor analyses were performed. The convergent validity was established by correlating BDAS with the Depression, Anxiety, and Stress Scale. Discriminant validity was established by correlating BDAS with the Satisfaction with Life Scale. Internal consistency and reliability were assessed through Cronbach's alpha, item-total, and item-scale correlations.

RESULTS

The BDAS consists of fifteen items distributed across five subscales: worry, terror, despair, avoidance, and thoughts. The BDAS exhibited a strong factor structure, with five distinct factors consistently exceeding acceptable factor loadings. Convergent validity was confirmed through positive correlations with depression, anxiety, and stress, while discriminant validity was demonstrated through a significant inverse correlation with life satisfaction. The scale demonstrated excellent internal consistency and reliability across all phases of testing.

CONCLUSION

The BDAS emerges as a valuable and innovative instrument for researchers and practitioners seeking to comprehensively assess death anxiety, considering the often-overlooked role of religious dimensions.

Of Love and Death: Death Anxiety, Attachment, and Suicide as Experienced by College Students

Drawing from the mental health crisis present on college campuses, we investigate the psychological processes associated with suicidal ideation among undergraduate students. Specifically, we used Terror Management Theory to investigate how individuals who have a history of suicidal ideation handle traditional death anxiety in coordination with Benjamin's theory underlying Interpersonal Reconstructive Therapy to explore specific attachment-based mechanisms that may allow for exceptions to the perceived meaning of death. Results show it was the fantasy of suicide itself, including its relevance in the lives of others, that was used to alleviate fear of death among the suicidal.

From dread to disorder: A meta-analysis of the impact of death anxiety on mental illness symptoms

Growing research suggests that death anxiety may be transdiagnostic, playing a key role in the development and symptomology of psychopathology. This meta-analysis examined the relationship between death anxiety and mental illness symptoms. In total, 104 papers were included, representing cross-sectional data from 99 studies (ntotal = 24,434), and experimental data from 11 studies (ntotal = 1372). Meta-analyses of cross-sectional studies indicated a moderate correlation (r = 0.397) between death anxiety and overall mental illness symptoms. The clinical nature of the group emerged as a significant moderator of this effect. In addition, the relationship between death anxiety and mental illness symptoms was larger for clinical samples (r = 0.580), and for anxiety-related symptoms (r = 0.506) than for depression. Additional meta-analyses of 11 mortality salience studies revealed that death reminders had an overall moderate impact on clinical symptoms (Hedge's g = 0.481). The relevance of the sample to the symptom being measured significantly predicted this relationship; that is, the effect was moderate-to-large (Hedge's g = 0.671) when excluding comparison subgroups for which the effect was not predicted by the authors. The clinical nature of the sample did not significantly moderate the effect. The experimental studies were generally of higher quality and lower risk of publication bias compared to cross-sectional studies. These findings support the strong transdiagnostic role of death anxiety across numerous disorders. Clinical implications include the potential need to treat death anxiety directly, to maximise long-term therapy benefits.

The Predictive Role of Personality Disorders and Personality Traits in Death Anxiety

The current study investigates the interplay between personality traits, personality disorders, and death anxiety in a sample of 2331 participants (49% males; 51% females) across two phases. The Death Anxiety Scale, the Psychosocial Personality Inventory, and the Personality Diagnostic Questionnaire were utilized. The findings revealed significant predictive relationships between personality disorders and death anxiety. Positive correlations were observed between death anxiety and nine personality disorders, including avoidant (r = .227), borderline (r = .123), dependent (r = .157), depressive (r = .098), histrionic (r = .074), narcissistic (r = .111), negativistic (r = .103), obsessive-compulsive (r = .126), and schizotypal (r = .078) personality disorders (p < .001). Death anxiety had significant inverse correlations with leadership (r = -.101) and spirituality (r = -.099) traits (p < .005). Avoidant personality disorder projected the highest prediction for death anxiety (β = .227; p = .000). Leadership as a personality trait demonstrated an outstanding ability to prevent death anxiety (β = -.101; p = .013). These findings make a unique contribution to the literature of death anxiety, personality disorders, and personality traits.

Compassionate engagement of communities in support of palliative and end-of-life care: challenges in post-pandemic era

Over the years, humanity has faced various global crises of different kinds that have caused great suffering in the community, such as wars, slavery, torture or the Holocaust, but also climate change, economic crises, or sanitary disasters. The recent pandemic posed a barrier to palliative and End-of-Life (EoL) care, as the need for physical distance made it difficult to retain essential human interactions while minimizing the risk of viral transmission. During the COVID-19 pandemic, the robustness of supportive networks (i.e., family, friends, neighbors, and community members) determined whether someone experienced a calm death at home or an unnecessary hospital admission, labeled as an 'emergency'. In this vein, active establishment and strengthening of such networks are the foundation of compassionate community efforts. Firstly, providing both physical and emotional support to the entire network of caregivers enhances their ability to care for others and improves the overall experience of death, including the process of dying and the ensuing bereavement period. Furthermore, individuals can enhance their own physical and mental health by practicing compassion. The ability of networks to withstand and recover from physical and emotional challenges, while maintaining strong and supportive relationships among its members, depends on the health and overall well-being of those members. Therefore, we argue that active community participation and death education can strengthen a community's capacity to assist people facing death, dying, and bereavement.

Death perceptions, grief, and distress in Ultra-Orthodox Jews who witnessed the 2021 Meron disaster

On April 29, 2021, during an Ultra-Orthodox annual communal event in Meron, a crowd rush resulted in the deaths of 45 individuals. Experiencing such events may intensify death proximity (subjective nearness to death, SNtD) and death anxiety, and increase distress. Furthermore, the experience of grief following the trauma may disrupt defense mechanisms that reduce death-related anxieties. Thus, we examined the mediating role of death anxiety on the association between SNtD and distress, and the possible moderating role of grief experiences on this model. Ultra-Orthodox Israeli Jews who experienced the Meron disaster (N = 168) responded to scales assessing demographics, SNtD, death anxiety, and psychological distress. Death anxiety mediated the SNtD-distress link and grief was a significant moderator. Specifically, for individuals low in grief, the association between high death anxiety and increased distress was nullified. Findings are discussed from the perspective of Terror Management Theory.

Attachment styles and empathy in trainee nurses: the mediating and moderating roles of attitudes toward death

AIM

A growing body of evidence has shown that attachment styles and death attitudes have a significant impact on empathy. This study aimed to explore the precise role of death attitudes in the relationship between attachment styles and empathy levels among trainee nurses.

METHODS

A total of 626 Chinese trainee nurses with different attachment types were enrolled, and their attachment styles, death attitudes, and empathy levels were assessed using the Revised Adult Attachment Scale, the Death Attitude Profile-Revised, and the Jefferson Scale of Empathy-Healthy Professionals, and finally, data from 566 participants were included for statistical analysis.

RESULTS

We found that among trainee nurses with secure attachment type, fear of death, approach acceptance, escape acceptance, and neutral acceptance (-) mediated the relationships between attachment-related avoidance/anxiety and their overall empathy levels and all its dimensions; in the preoccupied type, only neutral acceptance (-) mediated the relationships between attachment-related avoidance and their overall empathy levels and compassionate care; and in the fearful type, only fear of death mediated the relationship between attachment-related avoidance and compassionate care. Furthermore, in the secure type, neutral acceptance attenuated the negative predictions of attachment-related avoidance on overall empathy level and perspective taking.

CONCLUSION

Attitudes toward death played different mediating and moderating roles in the relationship between attachment styles and empathy among trainee nurses with different attachment types. In addition to acculturated empathy-specific training, targeted education related to death for trainee nurses with different attachment types is needed to prevent their compassion fatigue.

The Psychopathological Predictors and Effects of Death Anxiety

Death anxiety has been linked to several psychopathological conditions. However, the causes, comorbidity, and differential diagnosis of death anxiety is unexplored. This paper stands out by identifying common predictors of death anxiety and exploring the potential of death anxiety as a predictor for other psychological conditions. The paper reports the findings of four consecutive studies that involved a total of 2291 conveniently selected participants including 861 men and 1430 women. We focused on clarifying both the predictors of death anxiety and the psychopathological consequences emerging from it. Our findings established depression, anxiety, stress, fear of aging, and reduced life satisfaction as predictors of death anxiety. Psychosocial illness, sleep disturbances, aggression, and daily hassles were established as the adverse outcomes of death anxiety. Fear of aging was the most significant predictor of death anxiety and daily hassles emerged as the most significant adverse consequence of death anxiety.

The Effect of Death Anxiety on Work Passion: Moderating Roles of Work Centrality and Work Connection

Fear of death is an emotional manifestation of the instinct for self-preservation. Any threat to our existence induces an anxiety response. Death anxiety can trigger obsessive-compulsive behaviours, such as an obsessive passion for work. Using a sample of 314 participants (68.2% female), with a mean age of 38.97 years (SD = 10.36), this study sought to observe the predictive effect of death anxiety on work passion, as well as the moderating effect of work-family centrality and connection on the relationship between anxiety and passion. The results revealed that death anxiety negatively affects harmonious passion, and positively affects obsessive passion. Work centrality did not moderate the influence of death anxiety on harmonious and obsessive passion. Nonetheless, work connection moderated the influence of death anxiety on harmonious passion. The negative influence of death anxiety on harmonious passion was greater in a group with high work connection than a group with low connection.

Rewriting the Story of Mid- and Late-Life Family Caregiving: Applying a Narrative Identity Framework

Family caregivers of older people with health needs often provide long-term, intensive support. Caregivers are, in turn, shaped by these caregiving experiences. According to the narrative identity framework, self-narratives from lived experiences influence self-beliefs and behaviors. We assert that family caregiving experiences, filtered through individuals' memory systems as self-narratives, provide substantial scaffolding for navigating novel challenges in late life. Self-narratives from caregiving can guide positive self-beliefs and behaviors, leading to constructive health-focused outcomes, but they also have the potential to guide negative self-beliefs or behaviors, causing adverse consequences for navigating late-life health. We advocate for incorporating the narrative identity framework into existing caregiving stress models and for new programs of research that examine central mechanisms by which caregiving self-narratives guide self-beliefs and behavioral outcomes. To provide a foundation for this research, we outline 3 domains in which caregiving self-narratives may substantially influence health-related outcomes. This article concludes with recommendations for supporting family caregivers moving forward, highlighting narrative therapy interventions as innovative options for reducing the negative consequences of maladaptive caregiving self-narratives.

The effect of gratitude on death anxiety is fully mediated by optimism in Lebanese adults following the 2023 earthquake

BACKGROUND

Exploring the levels of death anxiety and factors that can undermine its impact are crucial for the Lebanese nationals. Even though studies have shown various relationships between death anxiety and several factors, very few to no research has been done to show the relationship of death anxiety, gratitude and optimism. Therefore, the objectives of our study were to assess the mediating role of optimism in the association between gratitude and death anxiety, along with investigating the validity and reliability of the Arabic version of the Death Anxiety Scale.

METHODS

A one-time-point online survey was conducted among Arabic-speaking community adults from the general population of Lebanon (N = 601; mean age 29.91 ± 12.61; 62.7% females). The following scales were used: Scale of Death Anxiety, Optimism-Pessimism Short Scale-2, and Gratitude Questionnaire-Six-Item Form.

RESULTS

The results of the mediation analysis showed that optimism fully mediated the association between gratitude and death anxiety. Higher gratitude was significantly associated with more optimism; higher optimism was significantly associated with less death anxiety. Finally, higher gratitude was not directly associated with death anxiety.

CONCLUSION

Our study reveals the relationship between gratitude and death anxiety and the mediating role of optimism. Our results need to be confirmed in a longitudinal study, but point to the importance of assessing optimism in prevention and management of persons with death anxiety.

The Associations Between Death Anxiety, Supernatural Beliefs, Caring for Loved Ones and Attachments

Despite extensive efforts in a better understanding of associations between death anxiety and various factors, efforts studying the complex associations across those variables are still limited. This study was conducted to better understand the possible complexity between death anxiety and myriad of factors, by first extracting the most important features, and then assessing the complexity of variables by checking all pairwise interaction terms. We found most of associated factors of death anxiety are related to the concept of attachment or caring for loved ones. Ill-effect attachment with positive associations with death anxiety included factors such as attachment to the physical side of oneself, being alone before death, and the possibility of death being the end of us. On the other hand, supernatural conceptions of worldviews such as believing in God, believing that the soul is separate from body, and being religious buffer against the death anxiety.

Death anxiety and mental health: Requiem for a dreamer

Recently, there has been an increased interest in the role of death anxiety in a broad range of mental health disorders. It has been argued that the fear of death may be a transdiagnostic variable contributing to the development and maintenance of many chronic mental health problems. Further, it has been suggested that death anxiety may be responsible for relapse and the emergence of new disorders in patients that have received successful treatment for earlier conditions in their lives. Given this, the purpose of the present selective review is to: (1) explore contemporary theoretical accounts of the role of death anxiety in a broad range of human behaviours; (2) examine evidence for death anxiety as a key variable in mental health disorders; (3) examine evidence on the treatment of death anxiety in both non-clinical and clinical populations; (4) describe the limitations of the current literature, and; (5) provide a detailed description of the critical future directions for this field.

The mental health of China and Pakistan, mental health laws and COVID-19 mental health policies: a comparative review

Mental health is one of the major causes of disability worldwide, and mental health problems such as depression and anxiety are ranked among the top 25 leading causes of disease burden in the world. This burden is considerable over the lifetime of both men and women and in various settings and ages. This study aims to compare the mental health status of people in China and Pakistan and to highlight the mental health laws and policies during COVID-19 and afterwards. According to the literature on mental health, before the COVID-19 pandemic, mental health problems increased gradually, but during and after the COVID-19 pandemic, an abrupt surge occurred in mental health problems. To overcome mental health disorders, most (but not all) countries have mental health laws, but some countries ignore mental health disorders. China is one such country that has mental health laws and policies and, during the COVID-19 pandemic, China made beneficial and robust policies and laws, thereby succeeding in defeating the COVID-19 pandemic. The mortality rate and financial loss were also lower than in other countries. While Pakistan has mental health laws and general health policies, the law is only limited to paperwork and books. When it came to COVID-19, Pakistan did not make any specific laws to overcome the virus. Mental health problems are greater in Pakistan than in China, and China's mental health laws and policies are more robust and more widely implemented than those in Pakistan. We conclude that there are fewer mental health issues in China than in Pakistan both before and since the COVID-19 pandemic. China has strong mental health laws and these are robustly implemented, while the mental health law in Pakistan is not applied in practice.

Testing alternative models and predictive utility of the Death Anxiety Inventory-Revised: A COVID-19 related longitudinal population based study

The beginning of the COVID-19 pandemic had a profound effect on all aspects of daily life and triggered a swell of anxiety across the world. Some suggest this emotional response to the pandemic can be explained through death anxiety (DA), a transdiagnostic dimension associated with numerous psychological disorders. However, it remains unclear as to whether DA is a unidimensional or multidimensional construct. The primary aim of this study was to examine the underlying structure of the Death Anxiety Inventory-Revised (DAI-R; Tomás-Sábado et al., 2005) and assess its associations with mental health and demographic variables during the COVID-19 pandemic. To achieve these aims, we utilized data from Waves 1 (N = 2205: collected between March 23 and March 28, 2020) and 2 (N = 1406: collected between April 22 and May 1, 2020) of the COVID-19 Psychological Research Consortium (C19PRC), a multi-wave nationally representative study. Results showed that a 4-factor model provided the best fit to the data compared to a unidimensional and 4-factor second-order model. Further analyses showed that DA at Wave 1 was positively associated with somatic symptoms, paranoia, depression, anxiety, and traumatic stress symptoms at Wave 2, supporting previous research that suggests that the fear of death is predictive of psychopathology. Significantly, the factor labelled 'Thoughts about Death' at Wave 1 was the strongest predictor of the five main psychological variables at Wave 2, after statistically controlling for the other latent variables. These findings highlight the transdiagnostic nature of DA and support this important diagnostic construct becoming a measure of mental health more generally within the population. It is hoped that this research will shine a light on those suffering from DA and become a catalyst for increased therapeutic intervention, funding, and research in this area.

"My life became more meaningful": confronting one's own end of life and its effects on well-being-a qualitative study

Background

The perception of being closer to death can be experienced due to old age or life-limiting diseases, and can pose profound existential challenges. Actively confronting death-related issues and existential questions may increase psychosocial comfort and stimulate personal growth, whereas dysfunctional coping may lead to existential distress.

To date, research on individual and (semi-)professional approaches to confronting the own end of life and the effects on one’s well-being remain scarce. Therefore, the aim of this study was to explore individual strategies and wishes in order to derive ideas for appropriate support concepts.

Methods

Twenty semi-structured interviews were conducted with people over the age of 80 (n = 11) and with a life-limiting disease (n = 10). The interviews were transcribed verbatim and independently coded by two researchers according to Braun and Clarke's thematic analysis approach.

Results

While the use of (semi-)professional approaches (e.g., therapeutic support) to confronting existential questions in the shape of one’s impending death was rare, individual coping strategies did have a positive impact on psychosocial comfort. There were hardly any significant differences between the participants aged 80 and over and those with a life-limiting disease in terms of individual coping strategies or how they approached the ends of their lives. Both groups reported that theoretical education, preparing for the ends of their lives (e.g., funerals), talking about death-related topics, reflecting on death-related topics, and contemplating death in a spiritual sense had positive effects on their assurance, self-determination and relief. The necessity of confrontation and a desire for low-threshold, accessible and flexible services to meet their existential and spiritual needs were highlighted.

Conclusions

There is both a desire and a need for the addressing of existential questions. Outside of private contexts, however, the participants possessed little awareness of support services that focused on confronting end-of-life issues, and rarely used such services. Efforts to raise awareness for psychosocial and spiritual needs should be implemented within the care system, together with low-threshold support concepts, in order to increase psychosocial well-being. More research evaluating individual approaches to confronting the own end of life are needed to better understand this determinant of well-being and its mechanisms of action.

Trial registration

www.germanctr.de, DRKS-ID: DRKS00020577.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00950-3.

OCD, death anxiety, and attachment: what's love got to do with it?

BACKGROUND

Death anxiety has been empirically implicated in obsessive compulsive disorder (OCD). Research has shown that secure attachments appear to protect against fear of death, and are also associated with reduced risk of mental illness. However, few studies have investigated the moderating effect of attachment style in the relationship between death anxiety and OCD.

AIMS

The present study sought to explore whether attachment style moderates the relationship between death anxiety and OCD symptoms among a treatment-seeking sample of individuals diagnosed with OCD.

METHOD

Following a structured diagnostic interview, a number of measures were administered to 48 participants. These included the Multidimensional Fear of Death Scale, Vancouver Obsessive Compulsive Inventory, and Experiences in Close Relationships-Revised.

RESULTS

As expected, death anxiety was a strong predictor of OCD severity, and other markers of psychopathology. However, contrary to hypotheses, neither anxious nor avoidant attachment style moderated the association between fear of death and OCD severity.

CONCLUSIONS

The current findings add further support to the role of death anxiety in OCD. Given the absence of a moderating effect of attachment between death fears and OCD severity, it is possible that this proposed buffer against death anxiety may potentially be insufficient in the presence of this disorder. Further research is needed to clarify whether attachment style may moderate the relationship between death anxiety and symptom severity in other disorders.

Meaning in life, psychological hardiness and death anxiety: individuals with or without generalized anxiety disorder (GAD)

Generalized anxiety disorder (GAD) is a widespread psychiatric disorder. According to the transdiagnostic approach, death anxiety can underpin predominantly somatic manifestations of GAD. Personal resilience factors such as a sense of a meaningful life, and psychological hardiness, which can protect people from developing clinical symptoms, may be lower in individuals with GAD. So far, there has been no study examining the role of meaning in life dimensions, death anxiety, and hardiness in individuals with GAD in Turkey. Thus, we aimed to investigate to what extent the GAD sample differs from the non-anxious control group in terms of death anxiety, meaning in life dimensions, and hardiness. Secondly, we examined how conceptually predicted death anxiety by meaning in life dimensions and hardiness regardless of diagnosis, age, and gender. Just before the spread of the Covid-19 pandemic, we could only recruit 38 individuals with GAD and 31 non-anxious control subjects. The Death Anxiety Scale, The Meaning in Life Questionnaire and the Psychological Hardiness Scale were administered to all the participants. The one-way MANOVA results with Bonferroni adjustment revealed that individuals with GAD significantly differed from the control group in every way. Hierarchical regression analysis displayed that the presence of meaning made the most significant contribution in predicting death anxiety. In conclusion, existential issues such as death anxiety, hardiness, and meaningful life can be emphasized for the treatment of GAD, and the presence of meaning is the most crucial antidote to avoid death anxiety in all individuals.

The existential dimension of the pandemic: Death attitudes, personal worldview, and coronavirus anxiety

A cross-sectional survey to investigate relationships between coronavirus anxiety, individual death attitudes, and personal worldview was conducted among 202 German-speaking adults in Central Europe. Results indicated that death anxiety significantly predicts coronavirus anxiety beyond sociodemographic variables. Women reported higher coronavirus anxiety than men. Against expectations, dimensions of personal worldview were hardly related to coronavirus anxiety. In contrast, we found evidence for a curvilinear relationship between religiosity as well as atheism and negative death attitudes. Our study contributes to recent discussions about death anxiety as a transdiagnostic factor in psychopathology and yields important implications for psychosocial support in the current pandemic.

The effects of confronting one's own end of life on older individuals and those with a life-threatening disease: A systematic literature review

BACKGROUND

Awareness of the impending end of one's life can pose profound existential challenges, thereby impairing well-being. Confronting one's own end of life may be an approach to meet the psychological needs and consequently enhance overall well-being. Different approaches of confrontation have been evaluated positively using measures of psychosocial comfort. To date, there exists no systematic overview on the different ways of confrontation (e.g. psychosocial or individual coping approaches).

AIM

To synthesize the existing knowledge on the effects of different approaches of confronting one's own end of life on older individuals and those with a life-threatening disease.

DESIGN

A systematic review of quantitative, qualitative, and mixed-methods full research reports was conducted. The retrieved studies were screened and appraised for methodological quality by two independent reviewers based on MMAT and CASP. The findings were synthesized narratively using the meta-summary technique by Sandelowski and Barroso.

DATA SOURCES

Medline, PsycINFO, and Web of Science were searched from inception to 12/2020.

RESULTS

N = 49 studies reported on different approaches of confronting one's own end of life, including psychosocial interventions, meaning-enhancing approaches, educational programs, and learning from lived experiences. The results suggest a clear trend toward beneficial effects on psychosocial comfort (e.g. anxiety, sense of meaning, well-being).

CONCLUSION

Low-threshold opportunities of confrontation have the potential to improve well-being and should be emphasized in practical implementation. The results can serve as a comprehensive basis for future research aiming to investigate the determinants of psychosocial comfort for people nearing the end of life.

Older Adults Who Experience Their Lives to Be Completed and No Longer Worth Living: A Systematic Mini-Review Into Used Terminology, Definitions, and Interpretations

In the Netherlands and in Belgium, a political debate emerged regarding the possibility of euthanasia and assisted suicide (EAS) for older adults who experience their lives as completed and no longer worth living, despite being relatively healthy. This mini-review aimed to (1) present an overview of the terms used to denote this phenomenon as well as their definitions and to (2) explore how the underlying experiences are interpreted by the study authors. A systematic search was performed in Web of Science, MEDLINE, PsycINFO, and CINAHL, yielding 35 articles meeting the selection criteria. We selected empirical, English-language articles published in peer-reviewed journals. Participants had to have a first-person experience of the phenomenon or be assessed for it, or have a third-person experience of the phenomenon. Results show that the terms tiredness of life (ToL) and weariness of life (WoL) were used most frequently, also in the broader literature on suicidal expressions across the life span. Many studies mentioned operational definitions or synonyms rather than theoretical definitions. Moreover, inside the EAS debate, the term ToL was more common, its definition incorporated death wishes, and it was regularly framed existentially. Outside of this debate, the phenomenon was generally considered as a part of suicidal ideation distinct from death wishes, and its experience was often associated with underlying psychopathology. We discuss the need to establish consensus definitions and conclude that only a multidimensional view may be suitable to capture the complex nature of the phenomenon.

Manifesting hope in despair: Exploring prosocial behavioural outcomes of COVID-19

The novel coronavirus (COVID-19) outbreak has resulted into global devastation. This study attempts to explore the positive phenomenal impact of perceived pandemic anxiety resulting in prosocial behaviour (PB) through the mechanisms of self-awareness and spiritual transformation using terror management theory (TMT). The study also examines the moderating impact of conscious state expansion (CSE) on the self-awareness and spiritual transformation relationship, and the impact of this moderation effect is further tested separately on two gender groups. The data (N = 573) for the study were collected from the Punjab state of India during the ascending phase of outbreak. The results of PLS-SEM analysis reveal the significant influence of variables under study on prosocial behavioural outcomes. Taking insights from the findings of the study it becomes clear that during dreadful situations, when people experience the possibility of loss of life, their self-awareness level increases, which in turn results in their spiritual transformation. Such mechanism is observed more in the people possessing higher spiritual consciousness. The study concludes by recognising the positive role played by spiritual transformation (ST) in the evolution of the attributes of care and compassion for others, resulting in positive social consequences. The discussion, implications, limitations, and future directions are presented and discussed.

Death Anxiety and Related Factors in Schizophrenia Patients: Controlled Study

The aim of the study was to investigate the level of death anxiety and related sociodemographic and clinical variables in schizophrenia patients. One hundred and ninety schizophrenia patients and 110 healthy controls were included the study. Death anxiety measured with Templer Death Anxiety Scale (TDAS). The patients were also evaluated with scales in terms of depression, anxiety, obsessive-compulsive symptoms, and suicide. The death anxiety level in patients with schizophrenia was significantly higher than the healthy controls. The severity of depressive and psychotic symptoms were related to the level of death anxiety. Patients with schizophrenia may need more protection and psychosocial interventions about death related themes.

Mental Health of Chinese People During the COVID-19 Pandemic: Associations With Infection Severity of Region of Residence and Filial Piety

This study aims to investigate mental health among Chinese people living in areas with differing levels of infection severity during the COVID-19 outbreak. It also assesses the association between reciprocal and authoritarian filial piety and mental health in times of crises. A sample of 1,201 Chinese participants was surveyed between April and June 2020. Wuhan city (where 23.4% of participants resided), Hubei province outside Wuhan (13.4% of participants), and elsewhere in China (63.1% of participants) were categorized into high, moderate, and low infection severity areas, respectively. The Depression, Anxiety, and Stress Scale’s severity cut-points were used to categorize participants. In the overall sample, 20.9, 34.2, and 29.0% of the participants showed elevated (mild to extremely severe) levels of stress, anxiety, and depression. Those in the highest infection severity group were significantly more likely to be categorized as having elevated levels of stress, anxiety, and depression. General linear modeling was performed on a composite mental distress variable (taking into account stress, anxiety, and depression scores). This model indicated that, even after adjusting for group differences in age, gender, education, and filial piety, the high infection severity group displayed more mental distress than the low infection severity groups. The model also found reciprocal filial piety to have a negative association with mental distress. Conversely, authoritarian filial piety was found to be unrelated to mental distress when controlling for the other variables in the model. No evidence was found for an interaction between either authoritarian or reciprocal filial piety and infection severity, which suggests that the negative association observed between reciprocal filial piety and mental distress was relatively consistent across the three infection severity groups. The findings suggest that future public health programs may integrate the promotion of filial piety as a strategy to help Chinese people maintain good mental health in the face of pandemic crises.

Religious Struggle and Life Satisfaction Among Adult Christians: Self-esteem as a Mediator

The religious dimension of life represents an important source of human strength, meaning, and coping for many people. However, the religious life is not always "smooth and easy" and can be associated with weak personal adjustment, poorer psychological well-being, and lower satisfaction. Yet, besides the direct relationship between these variables, some researchers postulate the existence of an indirect association that has not been fully explained by various psychosocial mediators. The aim of the present study was to verify whether self-esteem could be a potential mediator between religious strain and life satisfaction. The sample consisted of 607 adult Christians (49.6% women) aged between 18 and 79. We used the Religious Comfort and Strain Scale, the Satisfaction with Life Scale, and the Rosenberg Self-Esteem Scale. Consistent with our hypotheses, life satisfaction positively correlated with religious comfort and was negatively associated with fear/guilt, negative emotions toward God, and negative social interactions surrounding religion. The same pattern of results was shown in the case of self-esteem. Moreover, the outcomes obtained from bootstrap sampling (5000) with a 95% confidence interval indicated a significant role of self-esteem as a mediator in all of the relationships between: (1) religious comfort and life satisfaction; (2) fear/guilt and life satisfaction; (3) negative emotions toward God and life satisfaction; and (4) negative social interactions surrounding religion and life satisfaction.

Views on ageing: a lifespan perspective

Views on ageing (VoA) have special relevance for the ageing process by influencing health, well-being, and longevity. Although VoA form early in life, so far, most research has concentrated on how VoA affect later middle-aged and older adults. In this theoretical article, we argue that a lifespan approach is needed in order to more fully understand the origins of VoA, how they change over ontogenetic time, and how they shape development across the full breadth of the lifespan. We begin by explicitly linking VoA to fundamental principles of lifespan development. We review existing theories of VoA and discuss their respective contributions and limitations. We then outline a lifespan approach to VoA that integrates existing theories and addresses some of their limitations. We elaborate on three core propositions of a lifespan approach to VoA: (1) VoA develop as the result of a dynamic, ongoing, and complex interaction between biological-evolutionary, psychological, and social-contextual factors; however, the relative importance of different sources changes across the lifespan; (2) VoA impact development across the whole lifespan; however, different outcomes, mechanisms, and time frames need to be considered in order to describe and understand their effects; and (3) VoA are multidimensional, multidirectional, and multifunctional throughout life, but their complexity, meaning, and adaptivity change across the lifespan. We conclude with recommendations for future lifespan research on VoA.

Preliminary evidence of the effectiveness of acceptance and commitment therapy for death anxiety in Iranian clients diagnosed with obsessive-compulsive disorder

The authors investigated the effectiveness of acceptance and commitment therapy (ACT) for the treatment of death anxiety and obsessive-compulsive disorder (OCD) with eight adult women in Iran. The ACT protocol was conducted in weekly solo sessions with each participant for 8 weeks (45 minutes each). The results were analyzed by visual analysis method and improvement percentage. ACT resulted in a 60%-80% decrease in death anxiety and a 51%-60% decrease in obsessive-compulsive symptoms, thereby indicating promise for ACT as a treatment for OCD and death anxiety.

A quarantined lodging stay: The buffering effect of service quality

How do guests feel during their stay at quarantine lodging? This study draws on terror management theory and social exclusion theory to synthesize a model that highlights guests' perceptions about their experience under enforced isolation. The model articulates guests' feeling of anxiety and loneliness, whereas quality of service presents warmth and care that activates an anxiety buffer mechanism that mitigates the effect of anxiety. In turn guests' level of anxiety is further explained by an interaction between their health status and the length of stay. Results point to a conduit for studying the dark side of hospitality, opening up research avenues that could help assess broader social behavioral changes during the global pandemic, while offering operators revelations for lodging management during a crisis.

Constructing a hero–victim identity through reminiscing: a phenomenological study on rural Chinese elders

Reminiscing contributes to the formulation of identity in later adulthood through integrating individuals’ recomposed past, perceived present and envisioned future. Aiming to understand rural Chinese elders’ identity construction through reminiscing, we conducted semi-structured interviews with 20 elders living in ShiGo, a village located in the south-west of China. Data analysis suggests the rural elders in this study constructed a hero–victim identity through telling stories about the hardships they went through and the sacrifices they made. The participants narrated suffering from lack of basic living needs in the past, in particular before the 1980s while they were involved in turmoil brought on by wars and national movements, from destructive relationships, from making sacrifices for the country and their families, and from adapting to challenges brought on by the hardships. The rural elders shared life experiences with other villagers in daily life through bitter-sweet telling and wanted their suffering and sacrifices to be witnessed. Witnessing connects suffering, sacrifice, hero and victim into a self-enforcing system that helps the elders maintain interdependence and defence against existential concerns like death anxiety. A hero–victim dialectic model was presented to capture the self-enforcing attribute of the hero–victim identity. Findings of this study could be used to make sense of rural ageing in China and benefit clinical professionals working with rural Chinese elders.

Social Support Moderates the Relationship Between Death Anxiety and Psychological Distress Among Israeli Nurses

Based on the stress-buffering model, the current study sought to examine the moderating role of perceived social support in the association between death anxiety and psychological distress among nurses. Select variables found in previous studies to correlate with psychological distress served in the current study as covariates to control for their relationship with psychological distress among nurses. These include gender, years of professional experience, self-rated health, self-efficacy, and self-defined burnout. Structured questionnaires were administered to a sample of 795 professionally active nurses in Israel. Psychological distress was assessed by the 6-item Kessler Psychological Distress Scale (K6), death anxiety was assessed by a single item scale designed by Abdel-Khalek, and perceived social support was assessed by the Multidimensional Scale of Perceived Social Support (MSPSS). The research findings show that higher levels of death anxiety were associated with higher levels of psychological distress only among nurses with lower levels of perceived social support. The study indicates that in order to reduce the level of distress experienced by nurses it is important to take action to reduce their death anxiety and enhance their social support mechanisms.

Psychological Predictors of Mortality Awareness: Time Perspective, Contentment With Age and Paternal Antipathy and Neglect

Much research has focused upon the association between mortality awareness and mental ill-health. In this study we attempt to explore positive as well as negative psychological concomitants of mortality awareness. 170 participants were recruited in an online questionnaire study, measuring seven independent variables - marginalisation, childhood adversity, rebelliousness, time perspective, attitudes toward age and stage of life, health attitudes and demographics - and five dependent variables, specifically mortality legacy, mortality fearfulness, mortality acceptance, mortality disempowerment and mortality disengagement. Several significant bivariate associations were found. Follow-up regression analysis observed combined effects of variables accounting for 28% of variance in mortality legacy, 27% for mortality fearfulness, 13% for mortality acceptance, 42% for mortality disempowerment and 25% for mortality disengagement. Time perspective, contentment with age, and paternal antipathy and neglect were the most notable independent predictors. It was concluded that attitudes towards health, stage of life and childhood experiences significantly predict mortality awareness.

Age is not just a number: age awareness, subjective nearness-to-death, self-esteem, and depressive symptoms among older adults

Objectives: Humans often hold structured generalizations about themselves, which include attributes of qualities or characteristics they consider as important to their personal self-definitions. In this regard, holding one's age as an important defining personal category (high age awareness) was demonstrated to be connected with increased distress in older adults. However, little is known about the manner by which this connection is affected by individuals' perceptions regarding how close they are to their death on the one hand, and their personal resources on the other hand. Accordingly, the current research examined whether the connection between age awareness and depressive symptoms is mediated by subjective nearness-to-death, and whether this mediation is moderated by self-esteem.Method: A convenience sample of 386 older adults was collected using an online panel survey (age range 60-97, M = 71.62, SD = 6.88). Participants were requested to fill out scales assessing age awareness, subjective nearness-to-death, self-esteem, and depressive symptoms, as well as various sociodemographic scales.Results: Age awareness was associated with increased subjective nearness-to-death and depressive symptoms. In line with the hypotheses, subjective nearness-to-death mediated the age awareness-depressive symptoms connection, and this mediation was moderated by self-esteem.Conclusion: Age awareness is an important concept in old age, and is connected with increased depressive symptoms. We discuss this issue in line with Terror Management Theory, and emphasize the relevance of personal resources, such as feeling far from death and holding a positive view of oneself, in this regard.

Specific Phobias: Maintaining Control in the Face of Chaotic Threats

Introduction: Drawing on existential psychology we examine the possibility that specific phobias can serve a psychological function. Specifically, we propose that phobic objects allow individuals to focalize anxieties about haphazard existential threats into a more manageable form, reducing perceptions of risk and bolstering control.

Method: We tested this by assessing perceived control among participants with varying levels of spider fear who were reminded of chaotic hazards (or not) and exposed to spiders images (or not).

Results: Study 1 (N = 940) found that among those high in spider fear, salient uncontrollable threats (vs. controllable threats or uncontrollable non-threats) reduced feelings of control unless participants were exposed to their phobic object. Similarly, exposure to spider (vs. non-spider) images bolstered perceived control in the face of salient hazards, but only for those high in spider fear. A second preregistered study (N = 1349) found that the palliative effects of focusing on a phobic object were partially explained by a decreased concern with haphazard harms.

Discussion: This supports the premise that phobic objects help to maintain control by narrowing the source of disordered risks, creating a more controllable conception of reality.

Anxiety Buffer Disruption: Self-Evaluation, Death Anxiety, and Stressor Appraisals Among Low and High Posttraumatic Stress Symptom Samples

Objective: Research driven by terror management theory suggests sociocultural anxiety-buffer systems typically protect against existential anxiety, whereas anxiety buffer disruption theory suggests traumatic experiences may disrupt that process.

Method: Following posttraumatic stress (PTS) symptom screening (n = 4097), individuals with low (n = 149) and high (n = 120) PTS engaged in either negative or positive self-evaluations, then reported death anxiety and appraised life's stressors as negative/threatening or positive/challenging.

Results: When low PTS participants contemplated their worst (vs. best) selves, they experienced moderately heightened death anxiety yet appraised life's stressors as more positive/challenging than harmful/threatening, reflecting effective existential anxiety buffers. However, high PTS participants reported high death anxiety in both the best-self and worst-self conditions—indicating anxiety buffer disruption—and the worst-self (vs. best self) prompt increased their appraisal of life's stresses as a harmful threat and decreased appraisal as positive/challenging opportunities for growth and well-being.

Discussion: Theoretical and clinical implications are discussed.

Towards an Anxiety-Buffer Disruption Approach to Depression: Attachment Anxiety and Worldview Threat Heighten Death-Thought Accessibility and Depression-Related Feelings

Introduction: In two studies, we tested an anxiety-buffer disruption approach to depression, examining the effects of attachment insecurities, worldview threat, and death concerns on depression-related feelings.

Method: In both studies, Israeli undergraduates reported on their attachment insecurities (anxiety, avoidance), were exposed to a worldview threat or a no-threat condition, and then rated their current level of depression-related feelings.

Results: In Study 1 (N = 124), we also measured death-thought accessibility and found that a worldview threat (versus no-threat) heightened death-thought accessibility and depression feelings only among participants scoring relatively high on attachment anxiety, and that death-thought accessibility mediated the effects of worldview threat and attachment anxiety on feelings of depression. In Study 2 (N = 240), we randomly assigned participants to a mortality salience or a control condition and found that heightened death concerns caused more depression only when a worldview threat was present and participants' attachment anxiety was high.

Discussion: The roles that disruption of anxiety buffering systems and death-related concerns play in depression were discussed.

Does Posttraumatic Growth Buffer the Association Between Death Anxiety and Quality of Life Among People living with HIV/AIDS?

People living with HIV (PLWH) may experience death anxiety (DA), which can be detrimental to quality of life. Posttraumatic growth (PTG), however, is antithetical to DA, with its positive attributes at odds with negative psychosocial outcomes. Previous research has not examined the buffering effect of PTG on the association between DA and quality of life. Therefore, in addition to the direct effects of DA and PTG on health-related quality of life (HRQoL), we investigated the moderating role of PTG on the relationship between DA and HRQoL among people living with HIV/AIDS (PLWH) in Nigeria. Using cross-sectional design and availability sampling method, we selected 201 outpatients (men, n = 63, 31.3%, women, n = 138, 68.7%, mean age = 40.1, SD = 10.5) managed for HIV/AIDS in a Nigerian tertiary healthcare institution. Death Anxiety Inventory-Revised, Posttraumatic Growth Inventory-Short Form, and Patient-Reported Outcome Quality of Life-HIV were used to access DA, PTG and HRQoL, respectively. Results showed that while adjusting for socio-demographic factors (age, gender, time since diagnosis and educational status), DA was associated with physical health, mental health and social relationships domains of HRQoL as well as overall HRQoL. In contrast, PTG did not evidence significant association with HRQoL dimensions and overall HRQoL. The moderation effect of PTG on the association between DA and HRQoL was not supported. Independent of PTG, alleviating DA may be an important target in terms of therapeutic intervention towards improving quality life of PLWH.

Embedding existential psychology within psychedelic science: reduced death anxiety as a mediator of the therapeutic effects of psychedelics

Psychedelic therapies can engender enduring improvements in psychological well-being. However, relatively little is known about the psychological mechanisms through which the salutary effects of psychedelics emerge. Through integrating extant research on psychedelics with contemporary existential psychology, we present a novel hypothesis that reduced death anxiety may be a key mechanism underpinning the therapeutic effects of psychedelics. In developing this hypothesis, we also provide a complementary review of mechanisms through which psychedelics may reduce death anxiety. We conclude that an awareness of the role of death anxiety in psychopathology has the potential to guide future research into psychedelic therapies.

A systematic review of the psychometric properties of death anxiety self-report measures

Recent research suggests that the transdiagnostic construct of death anxiety may be a basic fear underlying a range of anxiety disorders. Although the investigation of death anxiety in clinical populations is relatively recent, the death anxiety literature as a whole has a longer history evidenced by the number of instruments developed to measure this construct. This systematic review aimed to evaluate the evidence supporting the psychometric properties of self-report death anxiety measures. Relevant studies were identified via a systematic search of four electronic databases in addition to reference list searches. Two independent reviewers evaluated relevant studies using the established Terwee et al. quality appraisal tool. Of the 1831 studies identified, 89 met inclusion criteria. These studies investigated the psychometric properties of 21 self-report scales of death anxiety as well as six subscales. No measure was found to possess evidence of adequacy on all evaluated quality criteria. The Templer Death Anxiety Scale, Concerns about Dying Instrument and Death Concern Scale were found to possess the most evidence supporting their validity and reliability. Overall findings suggest that additional research is needed to establish the psychometric adequacy of death anxiety instruments, especially given increased utilization of these measures in both clinical and research settings.

Generativity and other buffers of death awareness in first responders

Background and Objectives: Anxiety buffer disruption theory (ABDT) predicts that posttraumatic stress reactions occur when buffers of awareness of death, such as meaning in life, self-esteem, and social intimacy, fail to suppress overwhelming death-anxiety. In this study, we hypothesized that generativity may also serve as an effective buffer of awareness of death and posttraumatic stress disorder (PTSD).Design: The present study investigated the presence of anxiety buffering disruption in first responders with a spectrum of posttraumatic stress via a mediation path model of self-report measures of PTSD symptoms, anxiety buffer variables, and death-thought accessibility.Methods: To investigate the role of anxiety buffering in PTSD, a sample of 986 first responders completed self-report measures of PTSD symptoms and anxiety buffer variables in randomized order, and a death-thought accessibility measure following random assignment to mortality salience (n = 290) or control (n = 302) conditioning.Results and Conclusion: Results of structural equation modeling indicated PTSD symptoms have a small relation to increased awareness of death whereas anxiety buffering variables did not mediate the relation between PTSD symptoms and awareness of death. Nonetheless, generativity and meaning in life, self-esteem, and social support were significant predictors of lower levels of PTSD.

To grieve or not to grieve (online)? Interactions with deceased Facebook friends

Besides seeking social support, connecting with bereaved others, and maintaining relationships with the deceased, bereaved Facebook users may express their grief on Facebook to reduce their death anxiety. Notably, research has not yet explored the psychological outcomes of expressing grief on Facebook. This study undertook quantitative analysis of survey data from an initial community sample of 409 bereaved Facebook users (77.8% survey completion rate, n = 312; M_age = 34.46, SD = 12.38; 90% women) to ascertain whether expressions of grief on Facebook had negative psychological outcomes, and whether terror management theory (TMT) provided an appropriate lens for understanding Facebook grief expressions (FBGE). The aims of this study were three-fold: to clarify rates at which Facebook profiles of deceased users are deactivated, memorialized, unchanged, or managed; frequency and types of FBGE; and prevalence of/visitation to commemorative groups. Results-though insufficient to support TMT as an explanatory theoretical framework for FBGE-indicated that individuals who participated in FBGE reported higher anxiety and stress compared to bereaved individuals who did not express their grief on Facebook. Results provide a useful starting point for future research regarding online grieving behaviors and psychological wellbeing.

Anxiety Buffer Disruption: Relationship Threat, Death Anxiety, and Coping Appraisals Among Low and High Posttraumatic Stress Symptom Samples

Objective: Prior work suggests that people function effectively in the world, in part, by relying on sociocultural anxiety-buffer systems to protect against death anxiety. However, traumatic experiences may overwhelm and disrupt those systems, and this work tests whether posttraumatic stress symptoms reflect a vulnerability to death anxiety and risk of coping failure.

Method: Following posttraumatic stress screening (n = 4129), individuals with low (n = 187) and high (n = 186) posttraumatic stress symptoms engaged in either an anxiety-buffer stressor task (contemplating relationship problems) or control task. Participants subsequently reported death anxiety and made coping appraisals.

Results: Results supported four key hypotheses. Among individuals with low posttraumatic stress: (1) death anxiety was low under control conditions but moderately increased after contemplating relationship problems; and (2) perceived coping ability remained high in both conditions. However, among those with high posttraumatic stress: (3) death anxiety was exceptionally high in both the relationship problems prime and the control conditions—indicating anxiety buffer disruption; and (4) perceived coping ability was low in the control condition, and even lower after contemplating relationship problems.

Conclusions: These findings support the hypotheses and make novel contributions, in that prior research on the existential implications of PTSD have not considered that anxiety buffer disruption may be associated with failure to cope with new challenges after traumatic experiences. Future research should determine whether therapies can improve the core dimensions of functional worldviews, a sense of meaning and self-esteem, and whether such improvements result in improvements to perceived coping abilities.

The Utility of a Positive Body Image Among Community-Dwelling Older Adults Who Perceive Death to Be Near and Fear It

Physical changes are an inevitable part of the aging process. However, research has demonstrated inconclusive findings with regard to body image among older adults. This study attempts to clarify the utility of body image among this age-group, by adopting the framework of terror management theory. It is suggested that a positive body image may moderate the connection between two types of death concerns and psychological distress: subjective nearness-to-death and death anxiety. A convenience sample of 386 community-dwelling older adults, aged 60-97, filled scales measuring subjective nearness-to-death, positive body image, psychological distress, and death anxiety. A significant negative association was found between a positive body image and distress. Moreover, positive body image moderated the connection between distress and both subjective nearness-to-death and death anxiety. Thus, holding a positive image of the body seems to be an important resource for older adults when death is perceived to be near.

Death anxiety and its association with hypochondriasis and medically unexplained symptoms: A systematic review

OBJECTIVE

To systematically review of the available literature to (1) examine the association between death anxiety and hypochondriasis and (2) examine the association between death anxiety and medically unexplained symptoms (MUS).

METHODS

A systematic literature search was conducted in Embase, PsycINFO, Pubmed and Ovid databases and reference lists of selected articles. Articles were included when the research population concerned people with hypochondriasis and/or MUS in who death anxiety was assessed by a validated research method. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted relevant characteristics and data. The data were descriptively analysed.

RESULTS

Of the 1087 references identified in the search, six studies on the association between death anxiety and hypochondriasis and three studies on the association between death anxiety and MUS met inclusion criteria. All studies found a positive association of death anxiety with hypochondriasis and/or MUS. The design of all studies was cross-sectional and the overall quality of the studies was low. The influence of age or sex on these associations was not analysed in any of the studies. Given the diversity in setting, population, study design, and methods used, a meta-analysis was not possible.

CONCLUSION

All studies found a positive association of death anxiety with hypochondriasis and/or MUS. Acknowledging that death anxiety may play a prominent role in hypochondriasis/MUS populations, future research should address (potentially modifiable) determinants of death anxiety in these populations.