Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct

Death Anxiety Among Users and Non-Users of Psychedelics

This study is a survey-type, cross-sectional study conducted in Brazil (n = 517), with online data collection taking place from April to June 2022. The main objective of this study was to evaluate the death anxiety in users and non-users of psychedelics. To this end, we also assessed the validity and reliability of the Death Anxiety Scale in Brazil. The following instruments were used for data collection: a questionnaire for sociodemographic characterization, Death Anxiety Scale, Death Transcendence Scale, and Spiritual Well-Being Scale. Our main results indicated the following: 1) increased death anxiety is associated with never or almost never having used psychedelics; 2) death transcendence, especially creative and religious factors, was the only constant variable in all the explanatory models of the variation in death anxiety; 3) there is a negative relationship between death anxiety and mystical and religious factors of death transcendence. We interpret these results as follows: it's not psychedelics that reduce death anxiety - psychedelics can favor the experience of transcending death. And it's the possibility of transcending death, (idea of continuity beyond physical death, taking both spiritual and symbolic forms) that helps reduce death anxiety. These findings offer valuable insights into the role of psychedelics in human mortality perception.

Psychosocial Correlates of Death Anxiety in Advanced Cancer: A Scoping Review

OBJECTIVES

Individuals living with advanced cancer commonly experience death anxiety, which refers to the distressing thoughts or feelings associated with awareness of one's mortality. Deriving an overview of existing literature on the psychological and social factors linked to death anxiety may inform conceptual models, clinical screening, and intervention strategies in oncology and palliative care. Therefore, the present scoping review was conducted to summarize the current literature on the psychosocial correlates of death anxiety among individuals with advanced cancer.

METHODS

A comprehensive scoping review methodology was used following the Arksey and O'Malley framework. A literature search was conducted using four electronic databases: CINAHL, Embase, PsycInfo, and MEDLINE. Abstracts and full-text articles were screened, and relevant data were extracted and summarized.

RESULTS

Sixteen studies met the inclusion criteria. Seventeen psychosocial correlates of death anxiety were identified, with depression, spiritual well-being, and attachment security representing the most frequently investigated. Four previously tested death anxiety models were also identified, two of which were designed longitudinally.

CONCLUSIONS

This review provides a current summary of psychosocial factors and established models related to death anxiety in advanced cancer. Multiple psychosocial correlates should be targeted concurrently in research and clinical practice to address death anxiety. Longitudinal studies designed to test new models are especially needed to identify unique pathways contributing to death anxiety across the disease trajectory of advanced cancer.

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.

The Effect of Mindfulness Training on the Self-Regulation of Socio-Moral Thoughts

The change in moral attitude due to discrimination of the degree of reality of thought is an unexplored potential effect of mindfulness training. In this article we examine whether the mindfulness training of novices reduces the defensive reaction to normative transgressions when the threatening thought is salient, that is, a thought that stands out regardless of the objective reality that threatens self-survival. To test the study hypotheses, we used a bifactorial design mindfulness training (pre vs. post) x threatened thought salience (low vs high) in a sample of 115 participants. The dependent variable (punishment of social norm transgression) was measured on two different occasions: (1) pre-training (T1), (2) after training (T2). One group receives training in mindfulness in the threatened thought salience low condition (N = 47), and a second group receives the same training in the threatened thought salience high condition (N = 38). A third group did not receive training in threatening thought salience high condition (N = 30). The results show that training mindfulness reduces moral punishment with high threatening thought salience and reduces moral judgment with low threatening thought salience. The shift in reactivity (punishment) is more representative of a MT effect than the shift in moral judgment (seriousness). Implications of the results and limitations of the study are also explored.

Study of the Relationship Between Death Anxiety and Quality of Life in Patients With Heart Failure

This study aimed to investigate the relationship between death anxiety and QoL in a sample of Iranian heart failure (HF) patients. A cross-sectional correlational design was employed to examine this relationship in a sample of 296 HF patients. Participants were recruited using convenience sampling from teaching hospitals in Kermanshah City, western Iran, between October and December 2023. Data were collected using a demographic questionnaire, the Templer Death Anxiety Scale (TDAS), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Participants reported moderate to high levels of death anxiety (Mean [SD] = 7.54 [2.35]) on the TDAS and moderate to poor QoL (Mean [SD] = 36.24 [12.26]) on the MLHFQ. The statistical methods used in this study included descriptive statistics, independent t-tests, one-way analysis of variance (ANOVA), Pearson correlation coefficient, multiple linear regression analysis, and the Kolmogorov-Smirnov test. All statistical analyses were performed using SPSS version 26, with a significance level set at 0.05. A significant positive correlation was found between death anxiety and QoL (r = 0.329, p < .001), indicating that higher levels of death anxiety were associated with lower QoL. These results underscore the importance of addressing death anxiety in HF patients to improve their QoL. Interventions targeting the reduction of death anxiety and the enhancement of QoL are essential for optimizing care for this vulnerable population. The study recommends the implementation of psychological interventions, support groups, comprehensive counseling, education, and regular assessments for this purpose.

Illness Experiences of Advanced Cancer Patients in Taiwan

The illness experiences of advanced cancer patients are discussed in a Taiwanese cultural context, using an interpretive ethnographic approach (interviews and participant observations) emphasizing holism and symbolic interactionism. A total of 23 advanced cancer patients from different counties in Taiwan were recruited over a 42-month period. The researcher followed their progress as they approached death to better understand their terminal cancer experiences. An interpretive analysis guided by Agar's hermeneutic cycle approach revealed five emic dimensions: feeling the oppression of death, fighting alongside family, intensifying bodily healing efforts, settling unfinished business, and ending the struggle to control pain. Implications for caregivers are discussed.

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.

Evaluation of the death anxiety beliefs and behaviors scale in Iranian adolescents

Numerous tools assess death anxiety, but many have questionable psychometric properties. The Death Anxiety Beliefs and Behaviors Scale (DABBS) addresses these shortcomings, assessing death-related maladaptive affect, beliefs, and behaviors that could be foundational to fears associated with death. We translated the DABBS into Persian and examined its psychometric properties among Iranian adolescents (n = 598, Mage = 14.80, range = 12-18 years old). Confirmatory factor analyses supported the intended three-factor structure that comprises death-related affect, beliefs, and behaviors. Furthermore, the DABBS demonstrated good internal consistency, as well as expected associations with other measures of death anxiety and psychopathology measures, except that the Behaviors subscale unexpectedly did not relate to theoretically relevant constructs. Our findings indicate that the DABBS affect and belief subscales have strong psychometric properties among Iranian adolescents. However, further research is needed to elucidate whether the overall DABBS score demonstrates improved validity when used with other populations.

A bibliometric analysis of studies on death anxiety in patients with cancer

Purpose: This study evaluates the evolution and focal points of research on death anxiety among cancer patients over the last three decades, utilizing bibliometric analyses.

Methods: We analyzed publications related to death anxiety among cancer patients from January 1994 to January 2024 using data from the Web of Science Core Collection. Bibliometric indicators such as the number of publications, leading countries, institutions, and research themes were examined.

Results: A total of 2,602 papers from 286 institutions across 97 countries were identified. There has been a significant increase in research interest, particularly between 2014 and 2023, with a peak in 2022. The United States and Harvard University were found to be the most prolific contributors. Major research themes include quality of life, palliative care, mental health, and cancer-specific concerns.

Conclusion: The results highlight the rapid development in the field of death anxiety research among cancer patients, with an increase in publications and emerging research themes. However, there is limited international and institutional collaboration. The study underscores the need for enhanced cooperative efforts to advance understanding and research in this area, suggesting directions for future research.

Death attitudes in Chronic Obstructive Pulmonary Disease (COPD) patients: A mixed-methods study

Research shows the significance of death attitudes for the mental health of somatically ill people, but findings that focus on multidimensionality in processing death are scarce. Patients with Chronic Obstructive Pulmonary Disease (COPD) report shortness of breath, pain and anxiety about suffocation and high mental distress. Utilizing a mixed-methods approach from 64 hospitalized COPD patients, we examined how they cope with mortality. We conducted a narrative interview with two questions. Patients completed the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F). Findings reveal a spectrum of death-related narratives, with most patients reporting at least 3 different attitudes. The sample showed below average scores in the Rejection of One's Own Death and Dying subscale of the MODDI-F. Assessing death attitudes using two simple questions proved highly applicable in this population and may serve as a potential approach to engage patients in discussions about existential matters, as suggested in the literature.

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.

When meaning in life protects against fear of death: The moderating role of self-alienation

OBJECTIVE

A sense of meaning in life (MIL) is thought to help protect people against experiencing explicit anxiety about death. However, the experience of meaning is complex and subjective and may relate to death anxiety in nuanced ways. We examine how self-alienation-a feeling of not knowing/being disconnected from one's self-might moderate the relationship between MIL and death anxiety.

METHOD

Across five studies, we tested the hypothesis that MIL would negatively predict death anxiety more strongly for people relatively low in self-alienation. These studies were similar in design and included exploratory, confirmatory, and pre-registered tests.

RESULTS

A meta-regression across our five studies (N = 2001) provided clear evidence that MIL was most strongly associated with lower death anxiety at low self-alienation. We also observed that MIL was positively associated with death anxiety at high self-alienation. These effects were consistent in direction but inconsistent in strength.

CONCLUSIONS

We interpreted these results as evidence that MIL is existentially protective when experienced in combination with a relatively strong, clear, and connected sense of self. In contrast, MIL may be existentially problematic when people feel relatively unaware and disconnected from themselves. These findings align with aspects of terror management theory and highlight the potentially complex ways that MIL might relate to death anxiety.

Delay of Gratification, Gender Role Attitudes, and Death Reflections Predict Death Anxiety

Previous work has established that gender, age, and self-control can predict Death Anxiety (DA), the distress that centers around thoughts of one's mortality. However, it has not been determined if DA is associated with Delay of Gratification (DG; a tendency to forgo immediate rewards to receive a more favorable outcome in the future), attitudes toward gender roles (as compared to gender identity itself), and Death Reflections (DR; positive goals that occur when contemplating death). To examine these relations, 131 adults (45% women; aged 23-67 years) completed questionnaires that assess these constructs. We found that greater DG, egalitarian gender role attitudes, and engagement with DR were all associated with reduced DA. Gender identity was not associated with any variable, including DA. Age correlated independently with DA, but not when included in the regression models. These results demonstrate that elements of self-regulation and prosocial attitudes may predict baseline DA.

A Distant Ally?: Mortality Salience and Parasocial Attachment

Research in Terror Management Theory finds that close interpersonal relationships (e.g., parents, romantic partners) mitigate threat reactions to reminders of mortality. Parasocial relationships (imagined relationships with media personalities) afford many of the same benefits as interpersonal relationships. Do these benefits extend to mortality concerns? We investigated whether those with strong parasocial attachments were differentially influenced by reminders of death. Results showed that those with strong parasocial relationships had more defensive reactions to a mortality prime, suggesting that such attachments may not afford the same existential benefits given by close human others and may instead indicate a heightened vulnerability.

The Impact of Death and Dying Education for Undergraduate Students During the COVID-19 Pandemic

Fear of COVID-19 may make the imminence of death prescient for undergraduate students, increasing death anxiety and worsening mental health. Formal death education may provide benefits such as reduced fear of COVID-19 and death anxiety, and improved mental health. In this study, 86 undergraduate students completed a pre- and post-semester online questionnaire on fear of COVID-19, death anxiety, and mental health outcomes. Findings indicate indirect effects of death anxiety on fear of COVID-19 to anxiety. Moreover, fear of COVID-19, individual concerns about death, and death anxiety were reduced over the semester for undergraduate students in formal death education.

Death Obsession, COVID-19-Related Fear and Religiosity in People Living with Type 2 Diabetes

Patients diagnosed with type 2 diabetes were included among high-risk groups for more severe manifestations in case of COVID-19 infection and higher risk of mortality. The current study aims to (1) examine the relationship between death obsession, religiosity, and fear of COVID-19 among type 2 diabetes patients, and (2) assess if religiosity moderates the relationship between death obsession and fear of COVID-19. This cross-sectional online survey involved 306 type 2 diabetes patients. We found that 35.6 % of the participants were overweight and 14.6 % were suffering from obesity. Results showed that death obsession was positively associated with fear of COVID-19 and more religious individuals experience higher levels of fear. The overall level of religiosity did not moderate the relationship between death obsession and fear of COVID-19 but only the preoccupation with God dimension of the religiosity scale. The practical implications of these findings are discussed.

Effectiveness of Rational Emotive Behavior Therapy on Death Anxiety and Depression During the COVID-19 Disease: A Historical Approach

This research study investigated the effectiveness of Rational Emotive Behavior Therapy (REBT) on depression and anxiety during the coronavirus disease 2019 (COVID-19) pandemic in Nigeria. REBT is used in correcting irrational beliefs and behaviors. This study adopted a randomized pretest, post-test, control group design. Two trial-tested instruments covering; depression, anxiety, and irrational beliefs were for data collection. Data obtained with the instruments were analyzed using mean, standard deviation, and analysis of variance. The study revealed that REBT was effective in reducing depression and death anxiety in COVID-19 patients. The result of this study also showed that the introduction of REBT helped to curb the spread of COVID-19 disease by letting Nigerians to know that the existence, mode of spread, and consequences of the disease is real and not a myth.

Death-is-life-enhancing: Adaptation and validation of the Norwegian Death Mindsets Measure (NDMM)

While existing psychological frameworks and their accompanying measures focus on death as anxiety-inducing and debilitating, we highlight an overlooked perspective of death-that death can be a basis for living with more meaning and presence. The present research adapts and validates the Death Mindsets Measure (DMM), which assesses the mindset that "death-is-life-enhancing," for a Norwegian context. Firstly, we translated the DMM and consulted with Norwegian bereavement experts and bereaved Norwegians on items' clarity and relevance to cultural perspectives of death. Secondly, we validated the Norwegian DMM (NDMM) on a predominantly bereaved community sample of Norwegians (N = 241). Using structural equation modeling, we confirmed the hierarchical two-factor structure of our measure. The NDMM also demonstrated high internal consistency and discriminant validity with existing death anxiety and death attitudinal measures. Finally, our measure explained additional variance in psychological well-being beyond existing death anxiety and attitudinal measures.

Experiences of Isolation among Patients Hospitalized during an Infectious Disease Outbreak: A Systematic Review and Meta-Ethnography

Hospital isolation is common for people during infectious disease outbreaks. Anxiety, stress, depression and other psychosocial outcomes have been reported due to these measures. However, there is scarce evidence about the experience of being isolated and about best practices for empathic clinical care in these circumstances. The aim of this study was to explore the experience of isolation on patients hospitalized during an infectious disease outbreak. A systematic review and meta-ethnography was carried out. A search strategy was applied to the PubMed, CINAHL, Web of Science, and PsycINFO databases on April 14, 2021 and again May 2, 2022. Data synthesis was conducted using Noblit and Hare's method of qualitative thematic synthesis. Twenty reports were included in this review: 16 qualitative, two mixed-methods (only the qualitative part was analyzed), plus 2 personal view pieces. They described the experiences of a total of 337 people hospitalized and isolated with an infectious disease. Following analysis and coding of data, four themes emerged: 1) Feelings triggered by isolation; 2) Coping strategies; 3) Connection/disconnection; 4) Factors that influence the experience of isolation. Despite a sensitive search strategy, limited studies represent patient experiences using qualitative methods. The experience of isolation among patients hospitalized during an outbreak is characterized by fear, perceived stigma, and a sense of disconnection from others and the outside world due to a lack of information. Fostering a person-centered care model could help hospitalized patients develop adaptive mechanisms that minimize the impact of isolation.

Attitudes toward Death among Health Care Professionals in the Balkan Region

Background and Objectives: Death is an unavoidable experience in any person's life and affects not only the dying person but also their caregivers. The dying process has been displaced from homes to health care facilities in the majority of cases. Facing death and dying has become an everyday life of health care professionals (HCP), especially in palliative care (PC) settings. This study aimed to investigate the death attitudes among HCPs in Serbia. Materials and Methods: The Serbian version of the Death Attitude Profile-Revised (DAP-RSp) was used as a measurement instrument. Results: The average age of the 180 included participants was 42.2 ± 9.9 years; the majority were females (70.0%), with more than 10 years of working experience (73.0%), physicians (70.0%) and those working in a non-oncological (non-ONC) field (57.78%). The mean total score of DAP-RSp was 124.80 ± 22.44. The highest mean score was observed in the neutral acceptance dimension (NA) (5.82 ± 0.90) and lowest in the Escape acceptance (EA) (2.57 ± 1.21). Higher negative death attitudes were reported among nurses compared to physicians (p = 0.002). Statistically significant differences were observed in the fear of death (FD) and death avoidance (DA) domains, favoring PC specialists and oncologists (p = 0.004; p = 0.015). Physicians working in Oncology (ONC) showed lower FD values (p = 0.001) compared to non-ONC departments. Conclusions: Attitudes toward death among HCPs are of great importance for the well-being of both HCPs and patients. Negative attitudes can lead to deficient care. The fear of death is highly represented among Serbian HCPs working in non-ONC fields, including both nurses and physicians. This study emphasizes the need for further research to comprehensively explore and understand HCPs' attitudes toward death. This research highlights the need for the development of an educational curriculum across all levels of medical education, aimed at overcoming the fear of death and enhancing coping strategies, which will improve the care for patients diagnosed with terminal illnesses.

Psychodynamic psychotherapy in serious physical illness: A systematic literature review of approaches and techniques for the treatment of existential distress and mental disorders

Individuals with life-limiting physical illness experience lower mental health due to existential distress (e.g., demoralization, death anxiety) and mental disorders (e.g., depression, anxiety). Psychodynamic psychotherapy may be helpful in alleviating such distress by focusing patients' unconscious emotional and relational motivations. There is yet limited knowledge on the application of psychodynamic psychotherapies in this population. We systematically searched electronic databases and analyzed results using meta-ethnography. Of 15,112 identified records, we included 31 qualitative studies applying psychodynamic psychotherapies (n = 69, mean age: 49.3 [SD = 16.9)], 56% female). Psychodynamic treatment in this population can be beneficial when considering modification of the treatment setting to the illness reality, balancing needs for autonomy and separation in light of helplessness and death anxiety, and careful integration of supportive interventions and conflict-oriented interventions (e.g., exploring relational issues that interfere with mourning illness-related loss). We discuss future directions for the development and evaluation of treatments specific to serious physical illness.

The role of psychologists in supporting illness-related dying and death: A systematic mixed studies review

Psychologists remain underrepresented in end-of-life care, and there is limited understanding of their role among healthcare professionals, patients, and caregivers. This systematic mixed-studies review, prospectively registered on PROSPERO (CRD42020215775), explored the role of psychologists, and the facilitators and barriers they experience, in supporting clients with illness-related dying and death. A search of six research databases was conducted in October 2023. Fifty-one studies, mainly qualitative and from the perspectives of psychologists, met inclusion criteria. Thematic synthesis highlighted how psychologists provided expertise across various contexts. They supported clients with preparing for death, and adjusting to dying, provided professional consultancy and support, and undertook leadership in enhancing psychological end-of-life care. Results illustrated the sustaining factors and ongoing challenges working in end-of-life care, namely, the unique nature of navigating the death space, recognition and awareness of psychologists' contribution, and the support, training and development required. Given the universality of dying and death, this review is relevant to psychologists working within and beyond more traditional end-of-life care contexts, such as employee assistance programs, private practice, schools, and other psychological services. Policy, clinical and research implications are discussed, including the need for greater engagement and training of psychologists in the dying and death space.

The 'revolving door' of mental illness: A meta-analysis and systematic review of current versus lifetime rates of psychological disorders

OBJECTIVES

Therapists have long observed a phenomenon referred to as the 'revolving door' of mental health services, in which individuals often develop, seek treatment for, and recover from multiple mental illnesses across their life. However, this has not been systematically examined. If this phenomenon is widespread, one would expect that the number of lifetime disorders would exceed that of current disorders. The aim of this meta-analysis was to test this hypothesis.

METHODS

A search was conducted of the following databases: MEDLINE, PsycINFO and Web of Science. In total, 38 studies were included in the current review; 27 of these contained sufficient quantitative data to be included in the meta-analysis, addressing the primary research aim. The remaining 11 studies were included in the systematic review only.

RESULTS

Meta-analyses of the 27 studies indicated that the average number of lifetime disorders was 1.84 times that of current disorders. Previous treatment significantly moderated this relationship, while the clinical nature of the sample did not. Examination of the remaining studies revealed common temporal sequences, indicating disorders which typically develop first or consequently to other disorders.

CONCLUSIONS

These findings provide support for the revolving door of mental illness, suggesting a need for transdiagnostic treatments and broader conceptualisation of relapse prevention.

The mediating role of meaning in life between experiential avoidance and death anxiety among cancer patients: a cross-sectional study

BACKGROUND

Death anxiety is thought to cause a range of mental disorders among cancer patients, which may affect their mental health and even quality of life. This study sought to investigate experiential avoidance, meaning in life, and death anxiety among Chinese cancer patients and then explore the relationship between these 3 variables.

METHODS

A total of 300 cancer patients recruited from a tertiary cancer hospital participated in this study from October to December 2021. A cross-sectional survey was conducted using a demographic and clinical characteristics questionnaire, the Acceptance and Action Questionnaire II, the Meaning in Life Questionnaire, and Templer's Death Anxiety Scale. Correlation analysis, hierarchical regression analysis, and mediating effect analysis were used to analyze the relationship among experiential avoidance, meaning in life (including 2 dimensions: presence of meaning and search for meaning), and death anxiety.

RESULTS

A total of 315 questionnaires were distributed, and 300 valid questionnaires were returned, resulting in a valid response rate of 95.2%. Experiential avoidance (r = 0.552, p < 0.01) was moderately positively correlated with death anxiety. Presence of meaning (r = - 0.400, p < 0.01) was moderately negatively correlated with death anxiety, while search for meaning (r = - 0.151, p < 0.01) was weakly negatively correlated with death anxiety. Regression analysis showed that experiential avoidance (β = 0.464) and presence of meaning (β = -0.228) were predictors of death anxiety. Mediating effect analysis revealed that presence of meaning either completely or partially mediated the effect of experiential avoidance and death anxiety, and the indirect effect accounted for 14.52% of the total effect.

CONCLUSION

Overall, experiential avoidance predicts death anxiety in cancer patients, and meaning in life can mediate this effect. The results of this study provide a new path for studying the mechanism of death anxiety and suggest a more positive and promising strategy for its management.

Death anxiety and religiosity in a multicultural sample: a pilot study examining curvilinearity, age and gender in Singapore

This study investigated the association between multidimensional death anxiety and religiosity in multicultural Singapore by examining potential variations by age and gender. We also explored the possibility of a curvilinear effect, where highly religious or non-religious individuals report lower death anxiety than moderately religious people, forming an inverted U-curve pattern. Data were collected from 110 participants using questionnaires that assessed death anxiety and religiosity. Parametric and non-parametric tests were then conducted. The findings showed that women had significantly higher death anxiety and religiosity than men, and highly and moderately religious people had significantly higher death anxiety than non-religious people. People of all age groups had similar levels of death anxiety. These findings highlight the importance of developing targeted death anxiety interventions that integrate spiritual aspects in Singapore so that clinicians can provide culturally competent care.

Starving off death: Mortality salience impacts women's body image and disordered eating

From a Terror Management perspective, the pursuit of thinness that characterizes eating disorders (EDs) is arguably a culturally endorsed way to mitigate death anxiety. In the present studies, we used the mortality salience (MS) paradigm to examine whether priming death increases ED symptoms. We recruited two samples of women from undergraduate (Study 1, N = 120), and clinically relevant (Study 2, N = 154) populations. After priming, participants completed measures of potential confounds (e.g., neuroticism, affect). Next, we assessed ED attitudes and behavior using a portion size estimation task, and measures of body dissatisfaction and eating intention. Study 1 findings were inconsistent with the claimed role of death anxiety in ED related behavior. However, in Study 2, MS priming led to increased dissatisfaction with current thinness and smaller portion sizes for high-fat compared to low-fat food. Overall, the results suggest that death anxiety may, at least partially, drive ED symptoms.

Investigating the relationship between changes in metaphysical beliefs and death anxiety following a significant psychedelic experience

Research examining the potential of the psychedelic experience to alter attitudes toward death is steadily emerging. However, the specific mechanisms leading to this change are not well understood. The present study investigated the potential relationship between changes in metaphysical beliefs and changes in death anxiety following a single significant psychedelic experience. A total of 155 participants completed a retrospective questionnaire that included questions about their acute experience and changes in death anxiety and metaphysical beliefs following a significant psychedelic experience. Although some participants reported an increase in death anxiety, there was an overall significant reduction in death anxiety from before to after the experience. Improvements in death anxiety were positively correlated with changes in belief in panpsychism, but no other measured metaphysical beliefs. The findings from this exploratory study provide direction for future research looking at the relationship between changes in metaphysical beliefs and death anxiety in the context of psychedelic experiences.

The stuff that nightmares are made of: Israeli dreams in times of the Israel-Hamas war

This qualitative study explored the mortality salience effect as it manifested in the dreams of Israelis in the aftermath of the Hamas terror attack on October 7, 2023, and during the ensuing war. Over a two-month period, a sample of 242 dreams was collected via an online survey. Two forms of thematic analysis, namely, inductive and deductive, were utilized. Viewed through the theoretical lens of terror management theory, the findings suggest that exposure to the attack's horrors and the resulting strong mortality salience were reflected in the participants' dream contents. This indicates that the anxiety-buffering roles of the three psychological coping mechanisms-cultural worldviews, self-esteem, and close personal relationships-have been compromised. The examination of collective dream content offers a glimpse into subtle human psychic processes and how they might be affected during times of national trauma that necessitate robust psychological mechanisms to cope with the heightened mortality salience.

Self-Transcendence as a Mediator of the Relationship Between Reminiscence Functions and Death Anxiety: Implications for Psychiatric Nurses

BACKGROUND

Jordan's population of older adults is growing due to improved health care and lifestyle, but the country has limited mental health care resources, causing challenges for the health care system. Reminiscence is a point of nursing intervention and a way for psychiatric nurses to help people improve their mental health by expanding their personal boundaries (self-transcendence).

AIMS

The study aimed to examine the mediating effects of self-transcendence on the relationship between reminiscence functions and death anxiety in a sample of Jordanian older adults. Psychiatric nurses can refine reminiscence therapy by targeting aspects of self-transcendence to reduce death anxiety.

METHODS

An online cross-sectional survey was employed to collect the data. A total of 319 older adults participated in the study. The sample was recruited using convenience and snowball sampling strategies through social media and personal contacts.

RESULTS

The reminiscence function of "Bitterness Revival," gender, the presence of a life-threatening disease, a history of psychiatric disorder, and the work sector were statistically significant predictors of death anxiety. This model accounts for 24% of the death anxiety score (F = 7.789, p < .001). Reminiscence functions 1, 2, and 5 predicted self-transcendence. This model explained 25% of the variance in the self-transcendence score (F = 6.548, p < .001). Self-transcendence exerts a positive, partial mediating effect between "Bitterness Revival" and death anxiety, controlling for other covariates in the death anxiety model (p = .016).

CONCLUSIONS

The study is informative for understanding the role of self-transcendence in buffering death anxiety, notwithstanding "Bitterness Revival" reminiscences. This knowledge reveals practical implications for psychiatric nurses about the importance of developing reminiscence interventions to promote self-transcendence and ease death anxiety.

Mental Health Burden and Facilitators Among Frontline Healthcare Professionals in Nigeria Amid COVID-19 Pandemic: A Cross-sectional Study

BACKGROUND

During the COVID-19 pandemic, the frontline healthcare providers faced significant mental health stressors. Previous pandemics have revealed the need for psychosocial support and healthy coping mechanisms to mitigate mental health risks.

AIM

The study aimed to assess psychological impact and supportive mechanisms experienced by frontline healthcare workers treating COVID-19 patients in Kaduna State.

METHODS

This study involved 38 frontline healthcare providers mainly from Kaduna State Infectious Disease Treatment Center. Participants' mental health burden was captured through Hospital Anxiety and Depression Scale. Mental health facilitators were assessed through six tools: Ten-Item Values Inventory, healthy defense section of the Defense Style Questionnaire, Existential Anxiety Questionnaire, Brief Resilience Scale, Oslo Social Support Scale, and the Insomnia Severity Index.

RESULTS

The mean age of the study participants was 35.5 ± 6.6 years, with the majority being males (68.4%) and doctors (39.5%). More than a quarter of the participants showed appreciable symptoms of depression and anxiety. Psychosocial facilitators such as moral values, openness to change, self-transcendence, sublimation, anticipation, and humor scored above average for more than half of the participants. Most participants demonstrated moderate resilience and social support, with few experiencing sleep challenges. Comparisons of variables indicated "openness to change" was significantly higher among males, whereas symptoms of depression and anxiety were associated with higher levels of existential concerns and sleep challenges.

CONCLUSION

Our study finds that Nigerian frontline health workers experienced significant mental health challenges during the COVID-19 pandemic. It identified specific facilitators linked to gender and psychological burdens, informing the need for tailored support interventions.

Dressing up social psychology: Empirically investigating the psychological functions of clothing using the example of symbolic protection

Clothing behaviour remains an understudied research area within social psychology. Through the present research, we aim to anchor attire as an empirical research subject by investigating the psychological properties of one of its functionalities, namely, to provide protection. We argue that attire's undisputed role in shielding humans from environmental hazards may extend to the psychological level and protect them from the incorporeal consequences of existential threats symbolically. In this Registered Report, a mixed-methods approach links an ecologically valid field study of self-presentation in social media posts during Russia's war on Ukraine (Study 1; N = 248) with supraliminal priming of mortality salience in an online experiment (Study 2; N = 248). Across both studies, we expect that mortality concerns let people accentuate the physically protective attributes of clothing (e.g. more layers of clothing) and resort to more in-group prototypical dress styles (i.e. more gender-stereotypical). Findings show that people adjust their clothing preferences in response to existential threats, favouring in-group prototypical clothing (more gender-typical for both women and men in Study 1) and physically protective attire (higher in women and lower in men in Study 2) during high (vs. low) levels of existential threat. By positioning clothing as a research area within social psychology, our goal is to stimulate a wave of research on its profound role for humankind. Furthermore, we provide a dynamic and robust methodological approach to researching terror management theory.

Questionnaires About the End of Life for Cancer Patients - Is the Response Burden Acceptable?

CONTEXT

Research about the end of life with the help of patient-reported outcomes in vulnerable populations such as cancer patients is needed but is potentially burdensome and can therefore raise concerns.

OBJECTIVES

To assess the response burden due to questionnaires about the end of life in cancer patients and to explore associations with individual variables.

METHODS

In a cross-sectional design response burden was assessed using a six-item instrument after completion of a survey that concerned the end of life. Associations with age, gender, type of care (curative/palliative), years since diagnosis, distress, depression, anxiety, death anxiety, readiness for end-of-life conversations, and readiness for advance care planning were explored via correlational analyses and multiple regressions. Burden due to the topic of end-of-life and completing questionnaires in general was compared.

RESULTS

A total of 269 cancer patients (mean age 61.4 (SD =12.3); 59.5% male; 58.4% in palliative care) completed the survey in a German hospital. The majority did not report response burden; 29.7% reported at least some burden due to study participation. The multiple regression (F [10,26] = 9.97, p < 0.001) indicated that stable predictors of response burden were higher death anxiety (ß = 0.4), lower readiness to talk about one's end of life (ß = -0.34) and higher age (ß = 0.23). No additional subjective burden due to the topic of end-of-life was reported.

CONCLUSION

The reported response burden seems acceptable since it was generally low. However, a subgroup did report some burden. Minimising burden and enhancing participants' benefits without compromising the research quality should further influence study designs in this field.

Trends in the disease burden of anxiety disorders in middle-aged and older adults in China

BACKGROUND

Anxiety disorders in middle-aged and older adults are an important public health concern in China. Based on the data in the global disease burden (GDB) research database, this study evaluated and analyzed the trend of the disease burden of middle-aged and older patients living with anxiety in China in the past 30 years.

METHODS

The incidence and disability-adjusted life years (DALYs) data of anxiety disorders in China for individuals aged 45-89 years were collected from the Global Burden of Disease Study 2019, and the effects of age, period, and cohort on the incidence of and DALY rate for anxiety disorders were analysed using an age-period-cohort model. Because of the COVID-19 pandemic, the global disease burden research database has not been updated since 2019. However, this did not affect the analysis of future trends in this study, which combined data in the past three decades from 1990 to 2019.

RESULTS

(1) The overall age-standardised incidence rate (ASIR) and age-standardised DALY rate (ASDR) for anxiety disorders in middle-aged and older adults in China decreased by 4.0 and 7.7% from 1990 to 2019, respectively, and the ASIR and ASDR were always higher in women than in men. (2)Age-period-cohort analysis showed that the net drifts for incidence and DALY rate were - 0.27% and - 0.55% per year, respectively. For both genders, the local drifts for incidence were lower than zero in those aged 45-79 years and higher than zero in those aged 80-89 years; the local drifts for the DALY rate were lower than zero in all groups. (3) From the 1990-1994 to 2015-2019, the relative risks of anxiety disorder incidence and DALY decreased by 5.6 and 7.3% in men and 4.3 and 11.7% in women, respectively.

CONCLUSION

The disease burden of anxiety disorders in middle-aged and older adults in China has been relieved over the past 30 years; however, recent ASDR, ASDR, period, and cohort effects have shown adverse trends. The incidence and DALY rate decreased with age in women, while men showed a trend of increasing first and decreasing afterwards.

Dialectical Behavior Therapy: Effect on Emotion Regulation and Death Anxiety in Older Female Adults

This study examined the effectiveness of dialectical behavior therapy intervention on emotion regulation and death anxiety in old women. This quasi-experimental study was conducted using a pretest-posttest design with a control group. The research population included elderly women aged 60-75 years who were members of the Tehran Municipality Retirees Association in 2020. A total of 30 women were assigned to intervention and control groups (15 persons in each group). The participants in the intervention group received the dialectical behavior therapy (DBT) intervention for 10 sessions while the participants in the control group did not receive any intervention. The results of the analysis of covariance (ANCOVA) showed that there was a significant difference between the women in the intervention and control groups in terms of cognitive emotion regulation and death anxiety on the posttest. This therapy can be used for the elderly living in nursing homes and aging associations and institutions.

Death Anxiety in Caregivers of Chronic Patients

This study aimed to determine the extent to which caregivers of patients with chronic illnesses experience death anxiety, and which variables from caregivers and patients might potentially be related to their death anxiety. It also aimed to compare the levels of death anxiety between patients and caregivers. Web of Science, Scopus, PubMed, Psychology Database, Cochrane, and Google Scholar were searched for original studies available until December 2022 that quantitatively addressed death anxiety in family and informal caregivers of individuals with chronic illnesses. The methodological quality of the included studies was assessed, and a meta-analysis was conducted using Hedges' g as the effect size index and the DerSimonian-Laird method to analyze differences between patients and caregivers in death anxiety. The results of the 11 included studies showed moderate levels of death anxiety in caregivers, and the meta-analysis (k = 7; 614 patients and 586 caregivers) revealed non-significant differences between the death anxiety experienced by patients and caregivers (pooled Hedges' g = -0.03, 95% CI = -0.29 to 0.25, p = 0.802). Some sociodemographic and psychological factors (e.g., gender, depression, and anxiety) might be related to the death anxiety experienced, but additional research is necessary to validate these findings.

Death anxiety and satisfaction with life among the adults in the social isolation process of Covid-19 pandemic: the mediating role of perceived stress

BACKGROUND

The present study examined the mediating role of perceived stress during the social isolation process of the Covid-19 pandemic on the association between death anxiety and satisfaction with life. The participants of the study included 410 individuals (212 females and 198 males) from Turkey. Data were collected using the Death Anxiety Scale, the Perceived Stress Scale and the Satisfaction with Life Scale.

AIMS

The aim of this study was to reveal the relationships between death anxiety, perceived stress and satisfaction with life and to test the mediating role of perceived stress on the effect of death anxiety and satisfaction with life in the Covid-19 pandemic process.

METHODS AND RESULTS

The structural equation modelling results indicated that stress mediated the impact of death anxiety on satisfaction with life. Moreover, the bootstrapping procedure revealed significant links from death anxiety to satisfaction with life through perceived stress in the social isolation process of Covid-19.

CONCLUSIONS

The findings of the study contributed to the structuring of psychological health services to be offered within the scope of public health during the Covid-19 pandemic and the understanding of the complex nature of the relationship between psychological factors and satisfaction with life. Possible explanations and limitations were discussed.

A cross-sectional study of existential concerns and fear of progression in people with Rheumatoid Arthritis

OBJECTIVES

People with rheumatoid arthritis (RA) have higher levels of fear of disease progression (FOP) than cancer survivors. In cancer, FOP is inextricably linked with existential concerns. However, this has not been investigated in people with RA.

METHODS

We recruited 165 people with RA (96%F) who volunteered for a treatment trial of psychological intervention. Participants completed the Existential Concerns Questionnaire (ECQ) and questionnaires measuring constructs associated with FOP in cancer. We created groups of people with RA, with and without clinically significant levels of FOP (clinical and control groups) and compared their existential concerns. We hypothesized that existential concerns would add to the variance in FOP over and above pain, psychopathology, and disability.

RESULTS

Nearly two-thirds of people with RA scored in the clinical range for FOP. The clinical group had higher levels of all existential concerns than the control group. When subscales of the ECQ were entered into a multiple regression with FOP as the dependent variable, death anxiety, meaninglessness and guilt domains accounted for significant variance in FOP. Moreover, when added to a regression equation controlling all other variables, existential concerns continued to account for unique variance in FOP (t = 2.712, p = 0.007).

CONCLUSION

Existential concerns were strongly associated with FOP. While this cross-sectional study cannot determine whether existential concerns underlie FOP in RA, these results show robust relationships that warrant future investigation.

Existential Matters and Quality of Dying: A Model of Maturation Processes

Background: How people face mortality is a crucial matter for medicine. Yet, there is not a coherent and comprehensive understanding of how people can process the experience such that it is not traumatic. Methods: This article offers a "logic model" of how existential maturation occurs, using analogies from cell biology to explain the process. Results: This model depicts 10 mechanisms that together deal with mortality-salient events. Collectively, they are termed the existential function, which is seen as an innate, ever-evolving, integral part of the mind. An operational boundary selectively manages how realities are taken in. Processing is initiated with other essential people, ushering in reiterative steps of listening, finding, exploring, making meaning, and adjusting. The result is adaptive, integrated, mortality-acknowledging dispositions of mind. The process allows quality of life at the end of life and healthy mourning; impediments to it make for existential suffering and complicated grief. Conclusions: This conceptual model describes how people can face mortality. Its merit depends on its source in human experience, its explanatory power, its ability to guide people as they face mortality, and its ability to stimulate productive perspectives. It is therefore offered as an invitation for discussion, research, revision, and evolution.

Dimensions of Death-Related Attitudes in a French-Speaking Sample

This study examines the structure of death-related attitudes among French-speaking people. Participants from Canada, Belgium, France, and from Switzerland whose mother tongue was French in an online survey responded to the French adaptation of the item pool of the Multidimensional Orientation Toward Dying and Death Inventory (MODDI; N = 373). Exploratory factor analyses with orthogonal and oblique rotation yielded a 5-factor Fear domain and a 3-factor Acceptance domain, thereby reproducing the a-priori conceptualization. These results are discussed with respect to the issue of universal dimensions of death-related attitudes across cultures.

Examining terror management theory in Ukraine: impact of air-raid alarms and explosions on mental health, somatic symptoms, and well-being

Objective

This study sought to evaluate Terror Management Theory (TMT) assumptions about death awareness and its psychological impact in the context of a real-world war situation with high external validity. We examined if factors such as habituation to war circumstances and psychological resilience could buffer the effects on civilians' anxiety, physical and mental health, and affect.

Method

We implemented a pre-registered smartphone-based experience sampling method study over four weeks, with 307 participants (k = 7,824) living in war-affected areas in Ukraine whereby participants were regularly exposed to war situations, including air-raid alarms, explosions, and infrastructural problems.

Results

The data indicated that war situations significantly increased anxiety, negatively impacting mental health, and raising somatic symptom severity. While habituation showed a mild buffering effect on these impacts, resilience did not.

Conclusion

This real-world investigation supports TMT's fundamental assumptions about death awareness and its psychological implications. However, even amidst the presence of real, life-threatening situations, the buffering effects of habituation were surprisingly minimal. This suggests that further exploration of TMT's buffering factors in real-world scenarios is warranted.

Mediating effect of successful aging on the relationship between psychological resilience and death anxiety among middle-aged and older adults with hypertension

Objective

The aging trend of China's population is severe and successful aging (SA) is imminent. Aging can lead to various chronic diseases, with hypertension being the most common. Due to this lifelong disease, patients suffer from many anxieties, as death anxiety (DA) can be the most prevalent. Studies have exhibited that middle-aged adults approaching the transition to an older state show more pronounced DA than the more senior. It has been suggested that psychological resilience (PR) can reduce DA. Therefore, this study aimed to analyze the mediating effect of SA between PR and DA in middle-aged and older adults with hypertension.

Methods

A cross-sectional survey was designed. From August to December 2021, 298 middle-aged and older adults with hypertension were selected by multistage cluster random sampling in three districts (Ling he District, Gu ta District, and Tai He District) of Jinzhou City, Liaoning Province. They were surveyed using the demographic questionnaires, the Conner-Davidson Resilience Scale, the Successful Aging Inventory, and the Chinese version of a Likert-type Templer-Death Anxiety Scale. Descriptive analyses, independent sample T-test, and one-way analysis of variance (ANOVA) were used to describe demographic characteristics among hypertensive patients with different characteristics, respectively. Statistics were considered significant when P < 0.05. Pearson correlation coefficients describe the relationship between PR, SA, and DA. The research model was shaped through Structural Equation Modeling (SEM). SPSS PROCESS macro was used to verify the mediation model. A binary logistic regression model was used with DA as the dependent variable.

Results

The scores for PR, SA, and DA in hypertensive patients are (49.52 ± 14.38) points, (51.22 ± 7.63) points, and (46.67 ± 9.03) points. PR was negatively correlated with DA (r = -0.307, P < 0.01). Moreover, incorporating SA as a mediating variable in PR and DA, SA was positively correlated with PR (r = 0.335, P < 0.01) and DA (r = 0.085, P > 0.05). The direct effect is opposite to the sign of the indirect effect. There is a suppression between PR and DA with a percentage of 20.7%. Good self-assessed health status [0.057 (0.018, 0.183)] may be a protective factor for DA.

Conclusion

Healthcare providers should improve the PR of middle-aged and older adults with hypertension through interventions that reduce DA and increase the likelihood of SA.

A meta-analysis of systematic reviews and meta-analyses to evaluate the psychological consequences of COVID-19

BACKGROUND

Several meta-analysis studies have been reported in the literature on the incidence of psychopathological conditions resulting from the COVID-19 pandemic. This investigation aims to compile and analyze the findings of previously published meta-analysis research, as shown by the present meta-analysis of previous meta-analysis studies.

METHODS

The PubMed and Scopus databases were searched from 1 January 2019 to 30 May 2022. The procedure was carried out according to the PRISMA flow chart and the qualities of the identified studies were analyzed using AMSTAR 2. Heterogeneities and risk of bias were assessed using the Meta-MUMS tool. The corresponding results, forest and funnel plots of the psychological consequences of COVID-19 were synthesized.

RESULTS

Eleven meta-analysis studies were included. Random-effects meta-analysis of anxiety and depression showed (ER = 0.318 p-value < 0.001, ER = 0.295 p-value < 0.001) high heterogeneities (I2 = 99.70%, I2 = 99.75) between studies. Random-effects meta-analyses of sleep difficulties and insomnia were shown (ER = 0.347 p-value < 0.001, ER = 0.265, p-value < 0.001) along with heterogeneities (I2 = 99.89, I2 = 99.64). According to the random meta-analysis of post-traumatic stress syndrome (PTSS) and post-traumatic stress disorder (PTSD) (ER = 0.246, p-value = 0.001, ER = 0.223 p-value < 0.001) with heterogeneities (I2 = 99.75, I2 = 99.17). Random-effects meta-analyses of somatic and fear symptoms have been shown (ER = 0.16 p-value < 0.001, ER = 0.41, p-value = 0.089) with high heterogeneities (I2 = 99.62, I2 = 98.63). Random-effects meta-analysis of obsessive-compulsive symptoms and distress (ER = 0.297 p-value = 0.103; ER = 0.428, p-value = 0.013) with high heterogeneity, as I2 = 99.38%. Subgroup analysis of all symptoms and Egger's tests for detecting publication bias were also assessed.

CONCLUSION

The data from the current meta-analysis showed different psychological disorders of COVID-19 during the pandemic. Clinicians should be aware of the prevalence with which COVID-19-infected patients experience emotional distress, anxiety, fatigue, and PTSD. About half of the included systematic reviews (SRs)/meta-analyses (MAs) suffered from poorer methodological quality and increased risk of bias, reducing confidence in the findings. There must be more SRs/MAs and high-quality clinical trials conducted to confirm these findings.

Depression and death anxiety among patients undergoing hemodialysis during the COVID-19 pandemic in Palestine: a cross sectional study

Background

Hemodialysis patients are vulnerable to serious complications such as prolonged hospital stay and psychosocial issues like depression and death anxiety. Studies on psychosocial factors on end-stage renal disease patients' outcomes during COVID-19 pandemic are limited. We aimed to determine the prevalence of depression and death anxiety among Palestinian hemodialysis patients and the evaluate the relationship between their sociodemographic and clinical characteristics during COVID-19 Pandemic.

Methods

A cross-sectional study was conducted using a convenience sampling technique. We recruited 308 hemodialysis patients from five hemodialysis units located in government hospitals in Palestine. Beck Depression Inventory and the Templers Death Anxiety Scale were used to collect data, which were then analyzed using SPSS version 20. Descriptive statistics (frequencies and means), t-test, ANOVA and multiple linear regression models were used for data analysis.

Results

Nearly 66.2% of the sample had depression symptoms, 61.4% met the diagnostic threshold for depression, and 69.8% had death anxiety. Furthermore, the multivariate analysis revealed that having a female identity, residing in a city or refugee camp, and patients who reported not experiencing depression had a significant relationship with death anxiety, while having a higher educational level than 12 years, having one or more chronic co-morbidities, and patients who reported experiencing death anxiety had a significant correlation with depression.

Conclusion

Patients receiving hemodialysis frequently experience depression and death anxiety. These patients should receive a psychiatric evaluation in the early stages of their illness so that timely and appropriate psychological interventions can be given in hemodialysis facilities in Palestine during and after future pandemics.

Do mortality cues increase state autonomy? The moderating roles of trait autonomy, flexibility, and curiosity

This study tested the effects of deep and subtle mortality cues on state autonomy, in addition to the moderating roles of trait autonomy, psychological flexibility, and curiosity. Australian undergraduate students (N = 442) self-reported on moderator variables before being randomly allocated to receive either deep mortality cues, subtle mortality cues, or a control task, and finally reported their state autonomy for life goals. Trait autonomy did not moderate the effect of mortality cues on state autonomy. However, for individuals high on psychological flexibility, any mortality cues led to increased state autonomy compared to the control. For individuals high on curiosity, there was some evidence that only deep mortality cues led to increased state autonomy. These findings help clarify the nature of growth outcomes (in terms of more authentic, autonomous motivation for life goals), and the personal characteristics that facilitate growth-oriented processing of death awareness.

Death anxiety in connection to anxiety and depressive disorders: A meta-analysis on emotional distress in clinical and community samples

Awareness of one's mortality bears noteworthy implications on psychological functioning, proposing death anxiety as a transdiagnostic construct, with connections to psychopathology. The present meta-analysis investigates the relationship between death anxiety, depression, and anxiety disorders, as well as in symptomatology labeled as emotional distress. A random-effects model was used for extracting the effect size from 105 selected studies, comprising both clinical and community samples (N = 11,803). Results revealed a large overall effect size, g = 1.47 (95% CI [1.27; 1.67]), and a higher effect size favoring anxiety disorders. The instruments evaluating death anxiety and the presence of chronic conditions moderated the relationship. A higher effect size was observed for instruments other than Templer's Death Anxiety Scale, and for participants with chronic/terminal illness compared to healthy samples. Overall, the results highlight the need for a transdiagnostic perspective on death anxiety, as well as for reaching a consensus regarding its conceptualization and measurement.

Death Distress and Religiosity Among Spanish Patients Diagnosed With Depression and Anxiety

Death is a common source of uncertainty and fear for humans. Religious beliefs are among the strategies that alleviate such discomfort. The aim of this study was to explore the correlation between Death Distress and religious practices while considering other associated variables (near-death experiences, death of loved ones, and psychiatric diagnoses). The Death Anxiety Scale, Death Depression Scale-Revised, and Death Obsession Scale were administered to 400 Spanish psychiatric outpatients. Anxiety was found to be crucial for the development of Death Distress across all associations. A relation between Death Distress and Catholicism was found, albeit significantly mediated by the frequency of practice.

Perspectives on a good death: A comparative study of veterans and civilians

This study aimed to identify any differences between veterans and non-veterans in the importance of domains of the Good Death Inventory. Participants were recruited from Amazon Mechanical Turk to complete a Qualtrics survey on the importance of the 18 domains of the Good Death Inventory scale. Logistic regression models were then used to analyze any differences between veterans (n = 241) and nonveterans (n = 1151). Results showed that veterans (mostly aged 31-50, men, and White) were more likely to indicate that pursuing all treatment possible and maintaining their pride were important aspects of a good death. The results support other studies that have found military culture to be a significant factor in the way veterans view preferences at the end of life. Interventions may include increasing access to palliative care and hospice services for military members and veterans and providing education/training on end-of-life care for healthcare providers who work with this population.

Insomnia and Death Anxiety: A Theoretical Model with Therapeutic Implications

Insomnia is common, growing in prevalence [...].

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.