Death Anxiety Resilience; a Mixed Methods Investigation

'Not a panacea' - Expert perspectives on the concept of resilience and its potential for palliative care

Background

Resilience is an increasingly used term in medicine and subject to various definitions, often not easy to grasp. There are established core concepts for patients receiving palliative care, for example, meaning in life, that have already been researched a lot. Resilience, relative to these concepts, is a new object of research in palliative care, where it has so far been used predominantly with regard to the well-being of teams.

Aim

To explore how experts in palliative care define the concept of resilience and its suitability for patients, significant others, and professionals.

Design

Qualitative study using summarizing content analysis according to Mayring.

Setting/participants

Twenty-one health and social care professionals with expertise caring for persons with life-threatening/limiting illnesses and their relatives were interviewed in three individual interviews and four focus groups. All conversations were recorded, transcribed, coded via MAXQDA, and validated by another researcher.

Results

Resilience has been described as something procedural, dynamic, individual, and flexible. In connection with well-known concepts such as posttraumatic growth or terms from the field of mindfulness, social environment or personal factors have also been linked to resilience. Resources such as spirituality can contribute to resilience, and resilience itself can function as a resource, for example, by contributing to quality of life. An active use of the term in practical work with patients or relatives is rare, but it is used in education or team measures. Limited lifespan can pose a challenge to an active use of the concept of resilience.

Conclusion

Resilience as a very individual approach provides added value to other core concepts of palliative care. Within the palliative context, the normative dimension of resilience must be well reflected. A broader definition of resilience is recommended, leaving room for everyone to find their own form of resilience. The concept of resilience in palliative care includes opportunities as well as risks and should, therefore, be implemented carefully, requiring specific training.

Cancer-Related Stigmatization, Quality of Life, and Fear of Death Among Newly Diagnosed Cancer Patients

The purpose of the study is to investigate the gender differences among newly diagnosed cancer patients from the cultural perspective of Pakistan. The data comprised two equal groups: men (50%) and women (50%). Most participants were 31-45 years old, and the duration of the cancer diagnosis was less than 6 months (74.6%). The data was collected on the following scales: the discrimination and stigma scale, the internalized stigma scale, the WHO-quality of life scale, and the fear of death scale. Data was analyzed using SPSS v.25; descriptive statistics, an independent sample t-test, and simple linear regression were applied to the data. The results revealed that men and women are both experiencing cancer-related stigmatization in Pakistan. However, women face a higher level of stigmatization, lower quality of life, and higher fear of death than men. Furthermore, the regression analysis result confirms that the cancer-related stigma faced by the diagnosed patients decreases the patient's quality of life and induces the fear of death.

The Impact of Death Anxiety, Meaning and Coping on Posttraumatic Stress Disorder and Psychiatric Co-Morbidity Among Iraqi Civilians Exposed to a Car Bomb Attack A Latent Class Analysis

Much has been documented that the experience of a bombing is associated with posttraumatic stress disorder and psychiatric co-morbidity. Whether the co-existing relationship between death anxiety, meaning in life and coping styles would influence the aforementioned association is unknown. The present study aimed to identify latent classes of victims with different levels of death anxiety, meaning in life and coping styles, and to examine whether the severity of PTSD and co-morbid psychiatric symptoms differed between classes. One hundred and eighty-five victims who had experienced the first car bombing completed a demographic page, the Posttraumatic Stress Diagnosis Scale, General Health Questionnaire-28, Multidimensional Fear of Death Scale, Meaning in Life Questionnaire and Coping Responses Inventory. The results showed that 82% and 18% of the victims met the criteria for PTSD and no-PTSD, respectively. Four classes of victims were identified: Class 1 victims were approach copers with low levels of death anxiety and meaning. Class 2 victims were minimal copers with high levels of death anxiety and meaning. Class 3 victims were approach copers with a high level of death anxiety and meaning. Class 4 victims were avoidance copers with high levels of death anxiety. Individuals in Class 1 reported significantly lower levels of PTSD and psychiatric co-morbidity than the other three classes. Class 3 victims also reported significantly lower levels of psychiatric co-morbidity than Class 2 victims. To conclude, victims exposed to a car bombing were likely to exhibit posttraumatic stress symptoms in addition to other psychological symptoms. The severity of these symptoms tended to be lower among those who had little fear of death, did not search for meaning in life and approached their distress proactively.

The prevalence and risk factors of death anxiety and fear of COVID-19 in an Iranian community: A cross-sectional study

Background and Aims

COVID-19 has adversely impacted the public's mental health. One of the causes of psychopathology during the present pandemic is death anxiety and fear of COVID-19. The present study aimed to determine the prevalence and risk factors of death anxiety and fear of COVID-19 in Shiraz city, south of Iran.

Methods

This cross-sectional study was conducted among 982 participants in Shiraz from October to November 2021. Data were collected using Templer's Death Anxiety Scale and the Fear of COVID-19 Scale. Trained interviewers collected data throughout different city districts. A data-driven approach (latent class analysis) was applied to categorize the participants and determine the risk factors.

Results

Among the participants, 507 (51.6%) were female, and 475 (48.4%) were male. The participants' mean age was 38.26 ± 15.16 years. Based on the analysis, 259 (26.4%), 512 (52.1%), and 211 (21.5%) participants had low, moderate, and severe levels of death anxiety. Also, 393 (40.06%) and 588 (59.94%) of the participants had low and high levels of fear, respectively. Higher death anxiety was significantly associated with being female, having an associate degree, being retired, share of medical expenditure from total expenditure of more than 10%, having a history of hospital admission due to COVID-19, history of COVID-19 in relatives, and having fear of COVID-19. Also, being female, expenses equal to income, history of hospital admission due to COVID-19, death in relatives, and higher death anxiety were linked to higher levels of fear of COVID-19.

Conclusions

Death anxiety and fear of COVID-19 are closely associated with each other and affected by various sociodemographic and economic factors. Given this pandemic's unpredictable nature and chronicity, interventions at the community level to support high-risk groups are crucial.

Death anxiety among advanced cancer patients: a cross-sectional survey

PURPOSE

This study aimed to investigate death anxiety in advanced cancer patients and identify associated factors in the context of Chinese culture.

METHODS

Participants (N = 270) with advanced cancer in a tertiary cancer hospital completed anonymous questionnaire surveys. Measures included the Chinese version of a Likert-type Templer-Death Anxiety Scale, Rosenberg's Self-esteem Scale, Medical Coping Modes Questionnaire, the Social Support Rating Scale, and Connor-Davidson Resilience Scale. Data were analyzed in SPSS using descriptive statistics, Student's t test, Pearson correlation test, and linear regression.

RESULTS

Respondents returned 252 (93.33%) of the 270 questionnaires. The total CL-TDAS score was 39.56 ± 10.20. The top three items were "I fear dying a painful death" (3.59 ± 1.41), "I often think about how shortly life really is" (3.11 ± 1.33), and "1 am not particularly afraid of getting cancer" (3.09 ± 1.35). Associated factors of death anxiety (R² = .333, F = 15.756, p < .001) were the medical coping mode (resignation, confronce), self-esteem, the participants' adult children, the patient-primary caregivers' relationship, resilience, and the level of activity of daily living.

CONCLUSIONS

Our results demonstrate high levels of death anxiety in advanced cancer patients. Generally, patients with adult children, high self-esteem and resilience had low death anxiety. Conversely, patients with low levels of activity of daily living and high coping mode (resignation, confrontation) reported high death anxiety. We determined that associated factors contributed to reduce death anxiety. Social interventions are recommended to improve the end-of-life transition for patients and caregivers.

Posttraumatic stress disorder and death anxiety among Iraqi civilians exposed to a suicide car bombing: the role of religious coping and attachment

BACKGROUND

Posttraumatic stress disorder (PTSD) as a result of a bombing has been studied in the literature. Limited studies have focused attention on PTSD following a suicide car bombing. However, more research is needed to explore the risk factors for this psychological response.

AIMS

To examine a hypothesised model that death anxiety would be associated with PTSD and psychiatric comorbidity following a suicide car bombing, and that attachment styles and religious coping would influence the impact of this anxiety on distress outcomes.

METHODS

185 Iraqi civilians exposed to the first suicide car bombing completed questionnaires measuring PTSD, psychiatric comorbidity, death anxiety, religious coping, and attachment experiences.

RESULTS

82% met diagnostic criteria for PTSD, the remainder did not. Path analysis showed that death anxiety was significantly correlated with psychiatric comorbidity; it was also correlated with attachment, which was correlated with psychiatric comorbidity. Death anxiety was also significantly correlated with religious coping, which was correlated with both distress outcomes.

CONCLUSIONS

Although Iraqi civilians reported increased death anxiety following a suicide car bombing, those who used religion to cope with the traumatic experience and had functional attachment experiences in the past reported low levels of psychological distress.

Traumatic experiences and resilience: Associations with mental health, death attitudes, and religion in university students

Resilience may be related to mental health and profound beliefs and attitudes. Utilizing a survey design, we examined relationships among resilience, clinical syndromes, death attitudes, and religion. Mexican university students (N = 161) answered a sociodemographic questionnaire, the Global Post-Traumatic Stress Scale, the Millon Multiaxial Inventory, the Connor-Davidson Resilience Scale, and the Death Attitudes Profile. Pearson correlation analyses showed that resilience correlated inversely with clinical syndromes and fear of death and positively with approach acceptance. Religion entailed higher death attitudes and resilience. Regression analysis revealed that lower anxiety, alcohol use, persistent depression, and higher delusion and death approach acceptance explained resilience.

Self-Efficacy as an Agentic Protective Factor against Death Anxiety in PTSD and Psychiatric Co-Morbidity

PTSD has profound personal, social and economic impact. Understanding factors that influence strong recovery is a priority for informing the use of limited treatment resources. This study follows up a preliminary finding from Hoelterhoff and Cheung Chung, Psychiatr Q, 88, 635-651, [30] which found that death anxiety is related to PTSD and suggested that self-efficacy may mediate this relationship. Specifically, this study examined self-efficacy as a protective factor in the context of people who have experienced a life-threatening event. 109 undergraduate university students completed self-report questionnaires on, self-efficacy, death anxiety, trauma and well-being as well as a number of demographic factors. Self-efficacy was found that to be significantly and inversely related to death anxiety and psychiatric co-morbidity, but not PTSD. Results were discussed in light of literature regarding death anxiety. It seems that self-efficacy is related to death anxiety and well-being; however, it interacts with these processes independently and not as a mediating factor. More research is needed to understand coping mechanisms that help develop resilience against the negative effects of death anxiety against PTSD and minimize its detrimental impact on mental health.

Let's Start With the End: Bibliodrama in an Italian Death Education Course on Managing Fear of Death, Fantasy-Proneness, and Alexithymia With a Mixed-Method Analysis

This article presents the results of an experience of death education (DE) course with bibliodrama in Italian high schools, which focused on emotions and existential themes. The research analyzed the inability to recognize or describe one's own emotions (alexithymia), fantasy-proneness, and attitudes toward death in two different groups of students: one who took a course on DE (with 113 students) and another who did not participate in it (with 114 students). The use of a mixed method allowed this study to explore the quantitative results that the students indicated in the questionnaire and the qualitative open answers to the final question about how they had profited from this DE course. The results showed that the course had a positive effect, as the DE group significantly decreased alexithymia and negative attitudes toward death, particularly in fear and avoidance of death, making their representation of death less traumatic.

The impact of past trauma on psychological distress among Chinese students: The roles of cognitive distortion and alexithymia

Past traumatic events are distressing experiences which can result in the emergence of posttraumatic stress disorders (PTSD) and other psychological symptoms among university students. However, little is known as to whether or not cognitive distortion and alexithymia would influence the severity of these distress outcomes. This study examined a cognitive-emotional framework depicting potential roles that cognitive distortion and alexithymia could play in influencing the relationship between past trauma and psychiatric co-morbidities among university students in China. One thousand one hundred and eleven participants completed the PTSD Checklist for DSM-5, Cognitive Distortion Scale (CDS), Toronto Alexithymia Scale (TAS-20), and General Health Questionnaire (GHQ-28). Results indicated that PTSD following past trauma was significantly associated with increased psychiatric co-morbidities after controlling for covariates. Both alexithymia and distorted cognition mediated the association between PTSD and psychiatric co-morbidities. To conclude, university students can develop PTSD from past trauma and other mental health problems. The severity of psychological distress can be influenced by their distorted perceptions of themselves, the world, and the future, as well as their ability to identify, describe, and express distressing emotions.