A Chinese version of a Likert-type death anxiety scale for colorectal cancer patients

Structural Equation Model of Factors Related to Death Anxiety for Chinese Patients with Cancer

This study aimed to develop a model that specifies the predictive effects of factors on death anxiety among Chinese patients with cancer using structural equation modeling. Using convenience sampling, data were collected from 353 cancer patients. Self-administered questionnaires included Social Support Rating Scale, Rosenberg Self-Esteem Scale, Connor Davidson Resilience Scale, Templer's Death Anxiety Scale, and socio-demographic factors. The results showed that social support, self-esteem, and resilience significantly impacted death anxiety. The final model fitted the data acceptably (χ2 = 37.319, df =31, p = 0.201). Social support mediated death anxiety through self-esteem and resilience. Resilience mediated the buffer effect of self-esteem on death anxiety as an intermediary factor. Findings suggest the need for further studies to explore effective interventions to provide social support and improve self-esteem and resilience among patients with cancer to alleviate death anxiety.

We Fear So We Judge: A Mediation Analysis on the Relations Among Ageing Anxiety, Ageism, and Ageist Microaggressions

Ageism remains an obstacle to building an age-friendly environment. Although the rise of ageist microaggressions (i.e., subtle discrimination) threatens older adults from maintaining well-being, the mechanism of ageist microaggressions remains understudied. The present study examined ageist microaggressions using a transactional model. Specifically, we examined whether ageing and death anxieties contribute to self-ageism and influence benevolent and hostile ageism. These ageist beliefs might lead to benevolent and hostile ageist microaggressions, respectively. Cross-sectional data from 214 Hong Kong middle-aged adults (Mage = 50.97) were obtained. The results from a structural equation model revealed that ageing anxiety, but not death anxiety, was a significant predictor of self-ageism, hostile ageism, and hostile ageist microaggressions. A revised model further suggested that benevolent and hostile ageism were predictive of hostile ageist microaggressions. The results highlight the importance of defying the conventional perception of ageing to reduce ageing anxiety, ageism and ageist microaggressions for an age-friendly society.

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.

Associations of Death Anxiety, Inclusion of Smartphone in the Self, and Affiliation Motivation with Smartphone use and Addiction: A Multiple Mediation Study

This study is the first to apply terror management theory to understanding smartphone addiction by examining the potential indirect effect of death anxiety on smartphone addiction via inclusion of smartphone in the self (i.e., self-expansion), affiliation motivation (the desire to connect with others) for emotional support, and smartphone use. The sample consisted of 1483 Chinese university students between the ages of 18 and 24 (M = 19.14, SD = 1.03) who voluntarily completed an anonymous questionnaire survey. As hypothesized, death anxiety, inclusion of smartphone in the self, affiliation motivation, and smartphone use were directly, positively correlated with smartphone addiction. In addition, death anxiety exerted significant indirect effects via various pathways, including (i) affiliation motivation for emotional support and smartphone use and (ii) inclusion of smartphone in the self and smartphone use. Findings suggest that effective interventions for smartphone addiction should include targeting death anxiety, self-expansion, and affiliation need frustration.

Death Anxiety During COVID-19 and its Related Factors among Chinese Elderly People

This study aimed at investigating death anxiety and its related factors in Chinese elderly people during COVID-19. This study totally interviewed 264 participants from four cities in different regions of China. Death anxiety scale (DAS), NEO-Five-Factor Inventory (Neo-FFI) and Brief COPE were scored on the basis of one-on-one interviews. Quarantine experience didn't make significant difference in death anxiety among the elderly; Elderly people with high death anxiety had higher scores of neuroticism, and were more likely to use a Behavior Disengagement coping strategy; Multiple linear regression analysis showed that neuroticism, openness and COVID impact predicted 44.6% of the variance in the death anxiety among elderly people. The results support both theories of vulnerability-stress model and terror management theory (TMT). In the post-epidemic era, we suggest to pay attention to the mental health status of elderly people with personality susceptibility to handling the stress of infection badly.

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.

Mental health consequences during alerting situations and recovering to a new normal of coronavirus epidemic in 2019: a cross-sectional study based on the affected population

BACKGROUND

As a major virus outbreak in the twenty-first century, the coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented hazards to mental health globally.

METHODS

We performed a cross-sectional study based on the results of an online survey. The survey was conducted 1 month after the outbreak (February 18-29, 2020) and repeated at the time of resuming activity (April 8-14, 2020). The 15-item Death Anxiety Scale (T-DAS) was used to assess the degree of death anxiety, and the Chinese version of PTSD checklist-civilian version (PCL-C), for PTSD symptom clusters. Through convenient sampling, a total of 7678 cases were collected.

RESULTS

Our findings showed that even after the lockdown was lifted, the prevalence of the symptoms of post-traumatic stress disorder (PTSD) and death anxiety remained significantly high in the general population affected by the outbreak. Regression model analysis showed that PTSD was significantly associated with age > 50 years, contact history/living community, poor health status of participants, past traumatic experience (PTE), and medical occupation. Moreover, death anxiety mediated the relationship between life-threatening PTE and PTSD, indicating that reducing death anxiety could buffer the negative effects of PTE on PTSD.

CONCLUSIONS

Despite the lifting of the lockdown, long-term adverse psychological effects remain in the affected general population. The management of mental health after major public health events is important, and high-risk groups such as the elderly and healthcare workers should receive targeted interventions. In addition, the study suggests that methods for alleviating death anxiety must be included in plans to manage the psychological impact of public health emergencies.

Exploring the relationship between spiritual well-being and death anxiety in patients with gynecological cancer: a cross-section study

Background

In recent years, spiritual well-being has gradually gained the attention of health care providers in China, especially those in oncology departments, who have recognized the importance of improving spiritual well-being in cancer patients. Since most of the current research on spiritual well-being has been carried out in areas with religious beliefs, this study was conducted in the context of no development of formal religion. The purpose of this study was to explore the relationship between death anxiety and spiritual well-being and the related factors of spiritual well-being among gynecological cancer patients.

Methods

This cross-section study was conducted among 586 gynecological cancer patients. The European Organization for Research and Treatment for Cancer Quality of Life Questionnaire-spiritual well-being32 (EORTC QLQ-SWB32) and Templer's Death Anxiety Scale (T-DAS) were used to measure spiritual well-being and death anxiety. The Multiple Linear Regression Model was used to determine the relationship between spiritual well-being and death anxiety.

Results

For all participants, the highest QLQ-SWB32 centesimal score was 75.13 on the Relationship with Other scale, and the lowest was 60.33 on the Relationship with Someone or Something Greater Scale. The mean Death Anxiety score was 5.31 (SD 3.18). We found that Relationship with Someone or Something Greater was the only scale not associated with death anxiety. Overall, patients with lower death anxiety have a higher level of spiritual well-being. Besides, a high Relationship with Other score was associated with living with a partner (B = 2.471, P < 0.001) and married (B = -6.475, P = 0.001). Patients with higher Global-SWB were retired (B = 0.387, P = 0.019).

Conclusions

Our study found that the spiritual well-being of patients with gynecological cancer in China was no worse than in other countries with religious beliefs and patients with lower death anxiety have a higher level of spiritual well-being. Clinical staff should pay attention to the spiritual health of cancer patients, and spiritual care should be regarded as an essential element in cancer care.

Religious factors affecting death anxiety in older adults practicing Hinduism

The aim of the study was to examine the influence of religion on death anxiety in older adults (N = 105) practicing Hinduism and visiting the Kumbh pilgrimage. Standardized questionnaires and brief interviews were administered in participants' native language. Pilgrims with higher religiosity had lower death anxiety compared to pilgrims with lower religiosity. Greater belief in the cycle of rebirth, an increased presence of meaning in life, and less continued search of meaning in life were significantly associated with lower death anxiety. The findings provide support for incorporating religious and spiritual awareness for older adults in community health settings.

Validation of Death and Dying Distress Scale-Chinese Version and Prevalence of Death Anxiety Among Patients With Advanced Cancer

Purpose: Death anxiety is commonly experienced by individuals with advanced cancer who have a limited life expectancy. The Death and Dying Distress Scale (DADDS) is a validated measure that was created to capture this experience; but no Chinese version is available to date. We conducted a cross-sectional study to explore the psychometric properties of a Chinese version DADDS (DADDS-C) and address prevalence of death anxiety among patients with advanced cancer. Methods: Patients with advanced cancer were recruited from Peking University Cancer Hospital. Measures administered included: DADDS-C, Patient Health Questionnaire (PHQ-9), General Anxiety Disorder-7(GAD-7), Quality of Life at End of Life in Cancer (QUAL-EC), Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-sp). McDonald's Omega, Cronbach's alpha, Exploratory Factor Analysis and Confirmatory Factor Analysis were used to test DADDS-C's reliability and validity. Logistic regression analysis was used to identify risk factors for death anxiety. Results: Of 300 patients approached, 256 (85%) provided informed consent and completed the questionnaires. Of these participants, 43 (16.8%) had moderate death anxiety based on scores of ≥45 on the DADDS-C. Three factors (feeling shortness of time, dying and death distress, being a burden to others) explained 71.643% of shared variation with factor loadings ranging from 0.629 to 0.822. Cronbach's alpha was 0.939; Omega total was 0.959. DADDS-C had acceptable convergent and discriminant validity. Logistic regression analysis indicated that two factors (better relationship with healthcare providers and preparation for end of life) protected patients from death anxiety. Conclusion: DADDS-C is a valid tool for measuring death anxiety in Chinese patients with advanced cancer. The presence of at least moderate death anxiety in a substantial minority of these patients calls for screening for this symptom and for more routine psychological interventions to alleviate and prevent such distress in this population.

The influence of humanised anatomical pedagogy on psychophysiological responses and academic achievement in nursing students

Anatomy, a fundamental subject in nursing education, provides students with knowledge of human structure and function. The study was to explore the influence of humanised anatomy educational method on nursing students' psychophysiological responses and academic achievement to human anatomy using cadavers, and to examine the correlations between the students' characteristics (such as gender), psychophysiological responses, and academic achievement in anatomy. A correlational study design was adopted. A total of 80 participants with a 4-year BSN degree were recruited from a nursing school located in eastern Taiwan. Human anatomy teaching using cadavers was delivered. Standardised and researcher-modified questionnaires were used to collect data. Either parametric or nonparametric methods were used for data analysis depending on data distribution. A small proportion of students experienced physical symptoms and stress. Gender difference was observed in death anxiety caused by working with cadavers. All psychophysiological responses of students did not influence their achievement. Further, the students demonstrated that using cadavers had a certain level of engagement with the course, which was positively correlated with academic grades. This study suggests that human anatomy using cadavers is a feasible educational method to broaden students learning experience in class.

A Cross-Cultural Evaluation of the Construct Validity of Templer's Death Anxiety Scale: A Systematic Review

Ensuring use of valid and reliable scales for evaluating death anxiety that are relevant to the cultural context where they are applied is essential. The purpose of the study was to conduct a systematic review of the psychometric properties of Templer's Death Anxiety Scale (DAS) across cultures. PubMed, Scopus, Web of Knowledge, SID, and Magiran databases were systematically searched for studies published between 1970 and 2017 using Mesh terms. Two independent researchers used Quality Assessment of Diagnostic Accuracy Studies and Checklist of Standards for Reporting of Diagnostic Accuracy to evaluate study quality. Included studies were conducted in Iran, United States, Italy, China, Egypt, Spain, and Australia. Overall study quality was acceptable in 15 evaluated articles. However, findings demonstrated that two (one study), three (seven studies), four (four studies), and five factors (three studies) were extracted across the respective studies. Confirmatory concurrent validity was assessed in two studies. While Templer's DAS has stood the test of time as a commonly used index of capturing the conscious experience of death anxiety, there are psychometric inconsistencies in identified factor solutions across cultures. Findings emphasize the need for continued evaluation of how the DAS is translated in specific countries with assessment in relation to other death construct tools.

Structure of Arabic Scale of Death Anxiety With Chinese College Students: A Bifactor Approach

The Arabic Scale of Death Anxiety (ASDA), as one of the most widely used measures of death anxiety (DA), has increasingly been applied in many studies. However, the structures derived from different studies are highly inconsistent. In this study, both traditional and novel (bifactor) modeling approaches were used, to investigate the most optimal structure of the ASDA in a sample of 984 Chinese college students. After a series of comparisons, the results showed that the bifactor model, with a dominant general DA factor and three distinct sub-dimensions, was the most optimal measurement structure, and measurement invariance of this bifactor model between sexes was also confirmed. Based on the implications of this bifactor model, the discussion was focused mainly on whether distinct dimensions should be interpreted or not. Some strengths and limitations of the study were also discussed at the end of the paper.