Psychological research on death attitudes: an overview and evaluation

Attitudes of Iranian nurses toward caring for dying patients

Objective:

To examine the attitudes of Iranian nurses toward caring for dying patients.

Methods:

Nurses' attitudes toward death and caring for dying patients were examined by using two types of questionnaires: the Death Attitude Profile–Revised (DAP-R) and Frommelt's Attitude towards Caring for Dying Patients (FATCOD), both with a demographic survey.

Results:

The results showed that most respondents are likely to view death as a natural part of life and also as a gateway to the afterlife. The majority reported that they are likely to provide care and emotional support for the people who are dying and their families, but they were unlikely to talk with them or even educate them about death. They had a tendency not to accept patients and their families as the authoritative decision makers or involve families in patient care. Nurses' personal views on death, as well as personal experiences, affected their attitudes toward care of the dying.

Significance of results:

Lack of education and experience, as well as cultural and professional limitations, may have contributed to the negative attitude toward some aspects of the care for people who are dying among the nurses surveyed. Creating a reflective narrative environment in which nurses can express their own feelings about death and dying seems to be a potentially effective approach to identify the factors influencing their interaction with the dying. Continuing education may be required for Iranian palliative care nurses in order to improve the patients quality of care at the end of life.

The Reliability and Validity of Revised Collett—Lester Fear of Death Scale (Version 3) in a Nigerian Population

The purpose of the study was to assess the reliability and validity of the Collett—Lester Fear of Death Scale in a Nigerian population. A cross-sectional survey was conducted among medical students using the Collett—Lester fear of death questionnaire, demographic variables were also obtained. A total of 175 students completed the questionnaire. Reliability score was good and convergent validity was also good. We concluded that the scale has good validity and reliability score among this population.

Love of life and death distress: two separate factors

The objectives of the current investigation were threefold: a) to explore the gender differences on love of life (a new construct in the well-being domain) and death distress (death anxiety, death depression, and death obsession); b) to explore the relationship between the scales of these constructs; and c) to examine the factorial structure of these scales. The sample was 245 volunteer Kuwaiti college students (53.5% women). Their mean age was 21.9 (SD = 2.3). They responded to the Love of Life Scale, the Death Anxiety Scale, the Arabic Scale of Death Anxiety, the Death Depression Scale-Revised, and the Death Obsession Scale. Gender differences on love of life were not significant. However, women had significantly higher mean scores for the four death distress scales than did their male counterparts. All the correlations between love of life and the death distress scales were not significant except one pertaining to love of life and death depression (negative) in women. Two oblique factors were extracted: death distress and love of life. It was concluded that these constructs represent two distinct and independent factors. Counselors and clinicians dealing with death distress would find that it is not associated with love of life.

Death awareness, maternal separation anxiety, and attachment style among first-time mothers--a terror management perspective

Two studies explored the interplay between death awareness, attachment style, and maternal separation anxiety among first-time mothers of infants aged 3-12 months. In Study 1 (N = 60), a higher accessibility of death-related thoughts was found following induction of thoughts about separation from the infant. In Study 2 (N = 100), a mortality salience induction led to higher maternal separation anxiety. Contrary to expectations, these findings were not moderated by mother's attachment style. The results are explained in terms of Terror Management Theory, and demonstrate its applicability to maternal emotions and cognitions.

The comparison of predictors of death obsession within two cultures

The objective of the study was to compare various predictors of death obsession (i.e., anxiety, optimism, pessimism), and self-ratings of religiosity, physical health, mental health, happiness, and satisfaction with life, among 2 samples of college students recruited from two different cultures: Kuwait (n = 271) and United Kingdom (n = 205). The findings suggest that anxiety, among both samples, pessimism among the Kuwait sample, and (un) happiness among the U.K. sample, might provide a good theoretical and empirical context with which to better understand the causes and consequences of death obsession.

Predictors of fear of death and self-mortality: an Atlantic Canadian perspective

This research was undertaken to explore gender, religiosity, perceived time-left-to-live and the interactions between these variables as predictors of fear of death in 144 Atlantic Canadian students using the Multidimensional Fear of Death Scale (MFODS). Predictions about cause, age, marital status, and place of death were also derived from the Do-It-Yourself-Death-Certificate and compared with actuarial data to determine accuracy. Results showed significant gender effects on 2 MFODS subscales, such that women demonstrated greater fear for significant others and fear of the dead. More religious participants expressed greater fear of the dead, fear of being destroyed, and fear of conscious death, whereas participants with lower religious conviction were more fearful of the unknown. In addition, significant interactions between the predictors on various subscales of the MFODS were observed. Finally, both men and women made inaccurate death-related predictions when compared to actuarial data but predicted differential causes of death.

Using polytomous item response models to assess death anxiety

BACKGROUND

: The study of human attitudes toward death has given rise to a substantial body of empirical research. Psychometric instruments have been developed to measure fear of death, or death anxiety, and its psychological consequences in people who continually come into contact with stimuli related to mortality.

OBJECTIVES

: To analyze the 20-item Death Anxiety Inventory (DAI) within the framework of item response theory (IRT) and using the generalized partial credit model.

METHODS

: The sample comprised 154 men and 550 women and was drawn from nurses, doctors, industrial workers, teachers, undergraduates, and retired persons. Subjects completed the DAI, a self-administered, Likert-type questionnaire of 20 items, each with six response options.

RESULTS

: The DAI showed a relatively adequate fit to the generalized partial credit model. Thus, 4 of the 20 items presented a poor fit to the model. The analysis of item information and test information functions revealed that the 20-item test was appropriate for differentiating subjects with medium or high levels of death anxiety. The test information function was higher in this range of scores, indicating greater precision in the estimate of death anxiety for these subjects.

DISCUSSION

: The generalized partial credit model can be used to obtain detailed information about a clinical test and its items, and there are advantages to this approach when working with polytomous tests.

Spanish adaptation of the Collett-Lester Fear of Death Scale

The Collett-Lester Fear of Death Scale (CL-FODS) consists of 4 subscales: Death of Self, Dying of Self, Death of Others, and Dying of Others. The aim of this study was to develop a Spanish version of the CL-FODS and to explore its psychometric properties. The revised version of the scale was translated into Spanish from English. Then, the back translation technique was carried out. A sample of 281 Spanish nursing students and professionals responded to the Spanish CL-FODS, along with 2 instruments assessing death anxiety and general anxiety. Good internal consistency and satisfactory test-retest reliability of the 4 subscales of the Spanish CL-FODS were achieved. Its correlations with death anxiety were higher than that with general anxiety, supporting its discriminant validity. The principal component analysis forced to 4 components provided a distribution of loadings that is more coherent with the theoretical formulation of the 4 components than those obtained in previous studies. These results justify the use of the CL-FODS in Spanish-speaking health care professionals for the purpose of assessing attitudes toward death and dying in self and others.

Preparedness for the Death of a Loved One and Mental Health in Bereaved Caregivers of Patients with Dementia: Findings from the REACH Study

BACKGROUND

Although it has been suggested that family and friends who are prepared for the death of a loved one have less distress, the relationship between preparedness and bereavement mental health is inconclusive.

OBJECTIVES

To determine the relationship between preparedness for the death and mental health in bereaved caregivers of dementia patients and explore predictors of preparedness.

DESIGN

A prospective study of family caregivers of persons with dementia. Standardized assessment instruments and structured questions were used to collect data at study entry and at 6, 12, and 18 months. Multiple caregiving-related variables were collected. Bereaved caregivers reported whether they were "not at all" prepared or prepared for the death of their loved one.

SUBJECTS

Two hundred twenty-two bereaved caregivers

RESULTS

Twenty-three percent of caregivers were not prepared for the death. These caregivers had more depression, anxiety, and complicated grief symptoms. Black caregivers, caregivers with less education, those with less income, and those with more depressive symptoms prior to the death were more likely to perceive themselves as "not at all" prepared. In contrast, the amount of pain the care recipient was in prior to death was positively associated with preparedness.

CONCLUSIONS

Despite providing high-intensity care, often for years, many bereaved caregivers perceived themselves as unprepared for the death. These caregivers had more depression, anxiety, and complicated grief symptoms. Future work should be directed to confirming these findings and determining how best to intervene with high-risk caregivers.

Religiosity and death distress in Arabic college students

The purpose of the present study was to explore the relationship between religiosity and death distress (death anxiety, death depression, and death obsession) among a sample (N = 570) of Egyptian women nursing undergraduates, mainly Muslims. Their ages ranged from 17 to 25. The correlations between religiosity and both death anxiety and death depression were significant and negative, whereas the correlation between religiosity and death obsession was not. Significant, positive and high correlations were found between the different scales of death distress. Factor analysis of all the correlations yielded a single, salient, and bipolar factor labeled 'death distress versus religiosity.' It was argued that different situational variables may have had influenced the conceptual relationship between religiosity and death distress, including the young ages of the present sample.

Reducing the risk of burnout in end-of-life care settings: the role of daily spiritual experiences and training

OBJECTIVE

Individuals in the helping professions are subject to unique stressors that may lead to burnout, and research has shown that those who work with dying or bereaved individuals might be particularly at-risk. This study explores how factors such as spirituality and level of training might buffer the stress of working with terminally ill clients and their families.

METHOD

A total of 80 medical and mental health practitioners attending palliative care seminars were surveyed, with each completing validated measures of daily spiritual experiences and caregiver burnout, as well as assessments of demographic factors, their general education and training experiences specific to working in end-of-life care and bereavement settings.

RESULTS

Findings indicate that daily spiritual experiences might mitigate physical, cognitive, and emotional forms of burnout in the workplace. In addition, a negative correlation was found between the amount of end-of-life training received and burnout in the physical and cognitive domains. However, training was not related to professionals' level of emotional exhaustion.

SIGNIFICANCE OF THE RESEARCH

Results reinforce a growing literature on the salutary effects of spirituality, and underscore its relevance as one possible form of constructive coping for professionals attending to the needs of the dying and bereaved. The study carries further implications for how the stresses of such work might be ameliorated by enhanced training efforts, as well as creative facilitation of diverse spiritual expressions (e.g., inclusive forms of ritual recognition of loss) in the workplace.

Death obsession in Palestinians

The authors explored death obsession level and correlates among a sample (N = 601) of Palestinians living in the city of Beit Jala, the village of Al-Khader, and the Aida refugee camp in the Bethlehem area. They live in war conditions; the houses of half of them have been demolished. The Death Obsession Scale (DOS) was administered. Its alpha reliability was .92, denoting high internal consistency. Among women, it yielded 1 factor, (General Death Obsession), whereas among men it yielded 3 factors: Death Rumination, Death Dominance, and Death Idea Repetition. Palestinian men and women attained significantly lower DOS mean scores than participants from 4 Arab countries: Egypt, Kuwait, Syria, and Lebanon in 7 out of 8 comparisons. However, Palestinian women had significantly higher DOS mean score than their Spanish, American and British counterparts, whereas Palestinian men had significantly higher mean DOS score than Spanish peers. The low DOS scores of Palestinians, in proportion to other Arab samples, may reflect their adaptation to strife and violence.

Satisfaction with life and death distress

A convenient sample of 568 Egyptian female nursing undergraduates (M age = 19.5 yr., SD = 1.6) was recruited. Their scores on the Satisfaction with Life Scale were correlated with scores on the Death Anxiety Scale, Arabic Scale of Death Anxiety, Death Depression Scale-Revised, and the Death Obsession Scale. Pearson correlations were significant but small [-.15, -.18, -.14 (p < .01) and -.08 (ns), respectively], indicating their predictive and practical value is negligible.

Death anxiety in clinical and non-clinical groups

The Arabic Scale of Death Anxiety (ASDA) was administered, individually, to 7 groups (N = 765) of Egyptian normal participants (non-clinical), anxiety disorder patients, and patients suffering from schizophrenia (males and females), and addicts (males only). They were generally matched as groups according to age, occupation, and education. The female and male anxiety disorder patients means were, respectively, significantly higher than the means of the other 5 groups on the ASDA, while male schizophrenics attained the lowest mean score in proportion to all the other 6 groups, including the non-clinical 2 groups. All female groups have higher mean scores than their male counterparts.

Death anxiety and personal growth in adolescents experiencing the death of a grandparent

Relationships between bereavement following the death of a grandparent and adolescent death anxiety levels were examined using Hogan's Inventory of Bereavement and the revised Death Anxiety Scale within private schools. Of the 226 adolescent respondents (aged 11-18) who completed questionnaires, 124 had experienced the death of a grandparent. The regression model indicated that grief due to bereavement was found to be significantly associated with death anxiety. The factors of personal growth, gender, time since death, and numbers of deaths experienced were not found to be significant predictors within the model. The findings encourage further exploration into the nature of the grandparent-adolescent relationship as well as the impact of type of death experienced.

Einstellungen zu Sterben und Tod im höheren und hohen Lebensalter

Zusammenfassung: Der Artikel behandelt konzeptionelle Strukturierungen, Theoriebildung, Untersuchungsverfahren und Forschungsergebnisse zu Einstellungen gegenüber Sterben und Tod bei alten Menschen. Im Einzelnen werden die Dimensionen “Angst” und “Akzeptieren” der Einstellung gegenüber Sterben und Tod mit ihren jeweiligen Komponenten, ein umfassender und ein integrativer theoretischer Ansatz zur Erklärung der Angst vor dem Tod im höheren und hohen Lebensalter, deutschsprachige Verfahren zur Messung der Einstellungen gegenüber Sterben und Tod sowie Ergebnisse zu den Korrelaten “Alter”, “Geschlecht”, “Institutionalisierung”, “körperliche und psychische Beeinträchtigung”, “Ich-Integrität” und “Religiosität” vorgestellt. Der Beitrag schließt mit Schlussfolgerungen in sechs Punkten.