The connection between subjective nearness-to-death and depressive symptoms: The mediating role of meaning in life

An Intergenerational Telehealth Music Therapy Group Intervention to Improve Grandparents' Meaning in life

The lockdown policies in Israel during the COVID-19 pandemic hampered familial grandparents-grandchildren relations. There is initial evidence that older adults' meaning in life and will-to-live decreased. Grandparents could no longer meet their grandchildren in person. In response, we utilized an intergenerational telehealth music therapy group intervention during the onset of the COVID-19 pandemic. Forty-four pairs of grandparents and grandchildren enrolled in a quasi-experimental study with an intervention and waitlist control group. Twenty-one pairs of grandparents-grandchildren participated in a weekly virtual group music therapy intervention (via Zoom) for 8 weeks (experimental group) and the remainder were waitlisted and received no intervention (control group). Participants in both groups completed the same questionnaires in parallel before and after the intervention. The grandparents' meaning in life, will-to-live and behavioral grandparenthood increased compared to no change observed in the control group. Further research with randomized-controlled treatment is recommended.

Do Work-Related Factors Moderate the Association Between Subjective Nearness-to-Death and Psychological Distress?

The COVID-19 pandemic has been associated with increased existential concerns, as well as with significant changes in the work force. The current study examined the availability of meaning in work and belonging to a work group as personal resources which may mitigate psychological distress associated with feeling close to death. Data were collected from 450 working Israelis, and results indicated that the connection between feeling close to death and distress was not significant for individuals reporting high levels of belonging and meaning. Implications are discussed from the perspective of Terror Management Theory.

Subjective Nearness-to-Death and COVID-19 Worries Among Ultra-Orthodox Jews in Israel: The Moderating Role of Israeli Identity and Sense of Community

The Ultra-Orthodox community in Israel is characterized by close everyday contact and a strong sense of community. While the COVID-19 pandemic has resulted in global uncertainty, fear, and fatalities, this group was particularly affected by the pandemic. Accordingly, the current study examines whether subjective nearness-to-death was associated with increased COVID-19 concerns, and whether Israeli identity and sense of community moderate this association. Data were gathered from 255 Israeli Ultra-Orthodox Jews, and results yielded a significant link between subjective nearness-to-death and COVID-19 worries, moderated by both moderators. Results are discussed in line with terror management theory, and theoretical/practical implications are suggested.

Self and Perceived Others' Views of Aging and Their Association with Mental Health in the Second Half of Life

This study focuses on the concepts of subjective age and subjective nearness-to-death (views-of-aging) and examines the association between individuals' chronological age, self, and others' perceptions of these variables and mental health. A total of 267 participants aged 40-95 M = 64.33 provided sociodemographic information and filled out scales assessing self and others' views-of-aging, depressive symptoms, and their well-being. After controlling for covariates, age was not related to the dependent variables, whereas young/far from death self, and perceived others' views-of-aging was related to better mental health. The interaction between young age and young/far from death perceived others', but not self, views-of-aging was associated with lower depressive symptoms and higher well-being. Finally, the interaction between young/far from death self and perceived others' views-of-aging was associated with lower depressive symptoms but not with well-being. These findings provide an initial glance at the complex relations between two types of personal views-of-aging and emphasize the importance of how individuals appraise others' perceptions of their own aging process and life expectancy.

Afterlife future thinking: imagining oneself beyond death

Studies on episodic future thinking (the capacity to simulate possible experiences in one's personal future) have ignored future thinking that extends beyond death. We here examined personal afterlife projections in comparison with autobiographical memories and future projections in Thai (Study 1) and American (Study 2) samples. Participants reported all three types of events and rated their characteristics. In both studies, the characteristics of afterlife events were rated lower than those of memories and future events. Participants who believed in the afterlife generally rated afterlife events higher than non-believers and those who were uncertain, although this effect was most pronounced in Study 2. The content of afterlife events followed religious beliefs in the afterlife, and the majority of afterlife events were expected to take place immediately after death. The findings show that afterlife thoughts demonstrate characteristics that are comparable to memories and episodic future thoughts, and are shaped by religious beliefs.

Association between Self-Stigma and Suicide Risk in Individuals with Schizophrenia: Moderating Effects of Self-Esteem and Perceived Support from Friends

This cross-sectional study assessed the moderating effects of self-esteem and perceived support from friends on the association between self-stigma and suicide risk in individuals with schizophrenia. We included 300 participants (267 with schizophrenia and 33 with schizoaffective disorder). Suicide risk was assessed using items adopted from the suicide module of the Mini-International Neuropsychiatric Interview; self-stigma was assessed using the Self-Stigma Scale-Short; perceived support from friends was assessed using the Friend Adaptation, Partnership, Growth, Affection, and Resolve Index; and self-esteem was assessed using the Rosenberg Self-Esteem Scale. A moderation analysis was performed to examine the moderating effects of self-esteem and perceived support from friends on the association between self-stigma and suicide risk. The results indicated that self-stigma was positively associated with suicide risk after the effects of other factors were controlled for. Both perceived support from friends and self-esteem significantly reduced the magnitude of suicide risk in participants with self-stigma. Our findings highlight the value of interventions geared toward ameliorating self-stigma and enhancing self-esteem in order to reduce suicide risk in individuals with schizophrenia.

Subjective Nearness-To-Death and Retirement Anxiety Among Older Workers: A Three-Way Interaction With Work Group Identification

Retirement anxiety represents a major challenge for older workers who hold negative expectations and concerns regarding the consequences of their future retirement. Although prior studies suggest that retirement is an age-related transition that may serve as a reminder that life is nearing its end, little is known about how subjective nearness-to-death is related to retirement anxiety, and the role of work group identification as a boundary condition. The current study draws on terror management and social identity theories to hypothesize and investigate these relationships. A three-way interaction model was tested on a sample of 327 Israeli older workers. We found a positive association between subjective nearness-to-death and retirement anxiety. Further, we demonstrated that the positive relationship between subjective nearness-to-death and retirement anxiety was more prominent for older workers whose work group self-definition and self-investment were both high or were both low. The theoretical and practical implications of these findings are discussed.

Vaccination anxiety when vaccinations are available: The role of existential concerns

This study examined how existential fears are related to COVID-19 vaccination anxiety and followed the Terror Management Theory (TMT) by examining the contribution of two existential concerns, subjective nearness-to-death (SNtD) and death anxiety, to COVID-19 vaccination anxiety during the first month of COVID-19 vaccinations. Data were collected during January 2021, when Israel was in lockdown, from a convenience sample of 381 Jewish Israelis (M = 55.39, SD = 17.17). Participants completed questionnaires examining demographics, SNtD, death anxiety and COVID-19 vaccination anxiety. A hierarchical regression analysis examined the connections between these variables and COVID-19 vaccination anxiety while controlling for demographics and for receiving COVID-19 vaccinations. In line with the hypotheses, SNtD and death anxiety were each positively associated with COVID-19 vaccination anxiety, and death anxiety levels moderated the positive connection between SNtD and COVID-19 vaccination anxiety, as this association was not significant for individuals with low death anxiety. The findings of this study provide preliminary evidence concerning the role of death anxiety in moderating the effect that SNtD has on COVID-19 vaccination anxiety. These findings are in line with the TMT and justify further investigation and may be utilized in future research in order to address COVID-19 vaccination anxiety more effectively.

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

BACKGROUND

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

AIM

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

DESIGN

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

DATA SOURCES

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

RESULTS

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

CONCLUSION

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

Qualities of social relationships as mediators of the relationship between future perceptions and health

OBJECTIVES

Foreshortened future perceptions relate to higher mental and physical morbidity. However, socioemotional selectivity theory (SST) maintains that psychological well-being improves as future perceptions narrow due to growing tendency to prioritize meaningful goals and close relationships. The objective of this study was to reconcile this contradiction by examining a model in which the focus on close relationships suppresses the direct relationship between narrow future perceptions and physical/mental morbidity.

METHOD

Community-dwelling older adults (N = 249, mean age = 75.60, SD = 7.54) recruited through social clubs and day centers were interviewed at home. They filled self-report questionnaires measuring future time perspective, subjective nearness to death, positivity of relationships with others and inclusion of others in the self, while rating several physical/mental health indices. A structural equation modeling analysis tested direct and indirect effects.

RESULTS

Narrow future perceptions related to higher mental (|β| ranged .28 to .47, p < .001) and physical morbidity (|β| ranged .37 to .45, p < .001) and, surprisingly, also to lower positivity of close relationships (|β| ranged .24 to .31, p < .01) and less inclusion of others (|β| ranged .17 to .21, p < .01). Both social indices mediated the relationship with lower physical health, while positivity of close relationships also mediated the relationship with psychological distress.

CONCLUSION

The findings challenge SST assumptions by underscoring the negative effects of narrow future perceptions on social relationship, making the latter a mediator rather than suppressor in the link between future perceptions and physical/mental morbidity. The findings should be viewed in light of the study's limitations, including convenience sampling and cross-sectional design.

The protective effect of self-esteem on suicidal ideation among nursing home residents with limited social support in China: A cross-sectional study

Aim

This cross‐sectional study aimed to assess the impact of limited social support and loneliness on suicidal ideation, under the influence of self‐esteem, an important inner resource for quality living.

Design

An observational cross‐sectional study conducted from September 2018–April 2019.

Methods

The participants comprised 538 nursing home residents selected by a stratified sampling method from all seven administrative districts in a capital city of eastern China. All the participants completed the survey that constituted the measurement of suicidal ideation, self‐esteem, social support and loneliness. Path analysis was performed using the structural equation modelling method.

Results

A moderating effect, with satisfactory model fit indices and significant path coefficients, was detected between self‐esteem and suicidal ideation through limited social support and loneliness, revealing the multiple protective mechanisms of this psychological characteristic on the change of suicidal ideation.

Correlates of Psychological Distress Among Pakistani Adults During the COVID-19 Outbreak: Parallel and Serial Mediation Analyses

Objective: The global outbreak of COVID-19 has greatly affected individual's lives around the world and resulted in various negative psychological consequences. During the pandemic, reflection on and attention to COVID-19 may help in dealing with its symptomology but frequent and persistent thoughts about the situation can be unhealthy. The present study examined the direct and indirect associations between obsession concerning COVID-19, psychological distress, life satisfaction, and meaning in life.

Design: This mediation study presents a primary analysis of normative data collected after the initial outbreak of COVID-19 in Pakistan. Parametric bootstrapping was used to test the mediation models of subjective well-being, the extent of the effect, and meaning in life as parallel and serial mediators concerning the associations between COVID-19 obsession and psychological distress measures.

Setting: A sample of 1,002 adults (45% men and 55% women) were recruited utilizing an online survey between April to May 2020. They were aged between 19 and 45 years (M = 24.30, SD = 7.29) and normalized on population characteristics.

Results: Two out of three mediators in parallel mediation fully mediated the relationship between obsession and psychological distress (total effect = 0.443, SE = 0.050, p < 0.0001) illustrating that high-level obsessions were associated with low levels of satisfaction with life and presence of meaning in life and search for meaning in life. Psychological distress is likely to decrease in the presence of a high level of satisfaction with life and meaning. Moreover, satisfaction with life and search for meaning in life significantly mediated the association between COVID-19 obsession (z=-3.507, p < 0.0001 and z = −2.632, p < 0.001 respectively).

Conclusion: The present study showed that life satisfaction and search for meaning in life may play a significant role in decreasing psychological distress during the COVID-19 pandemic.

Do Informal Caregivers Expect to Die Earlier? A Longitudinal Study with a Population-Based Sample on Subjective Life Expectancy of Informal Caregivers

INTRODUCTION

Subjective life expectancy is a good predictor of health and could therefore be a relevant factor in the informal caregiving context. However, no research has been conducted on the perception of life expectancy by informal caregivers. This is the first study that examines the association between transitioning into, and out of, informal caregiving, and subjective life expectancy, and the relevance of employment status and gender for these associations.

METHODS

A longitudinal study was conducted with data from the German Ageing Survey (waves 2008, 2011, 2014, and 2017). Up to 20,774 observations pooled over all waves were included in the main models. In total, 1,219 transitions into and 1,198 transitions out of informal caregiving were observed. Fixed effects (FE) regression analysis was used. Moderator and stratified analyses were conducted with gender and employment status used as moderator variables and to stratify the sample. Sociodemographic information, health, and lifestyle factors were controlled for.

RESULTS

Results of adjusted FE regression analyses indicated a significant reduction of subjective life expectancy when transitioning into informal caregiving. No significant change was found when transitioning out of informal caregiving. Subjective life expectancy was significantly decreased when employed individuals transitioned into informal caregiving and significantly increased when they transitioned out of caregiving. Findings for women transitioning into informal caregiving indicated a significant decrease in subjective life expectancy, while no significant change was found among men.

CONCLUSION

The study's findings indicate that informal caregivers, female and employed caregivers in particular, perceive informal care provision as dangerous for their longevity and expect to die earlier when transitioning into informal caregiving. Thus, supportive interventions for informal caregivers, particularly employed and female informal caregivers, are recommended.

The moderating role of subjective nearness-to-death in the association between health worries and death anxieties from COVID-19

The purpose of this study was to examine whether subjective nearness-to-death moderated the association between health worries and death anxiety due to the COVID-19 outbreak among older adults in Israel. Using an online survey, 277 participants were recruited and completed self-reported questionnaires, which included background characteristics, exposure to COVID-19 risk experiences, self-rated health, subjective nearness-to-death, health worries regarding COVID-19, and death anxiety. Findings revealed that subjective nearness-to-death moderated the association between health worries and death anxiety. The importance and significance of subjective perceptions concerning the distance from death as far, which may serve as a resilient resource, is discussed.

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

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

Retirement anxiety and depressive symptoms among middle-aged adults: An indirect effect through death anxiety

Basing our argument on Terror Management Theory, we posit that retirement is an age-related transition, which could result in greater death saliency and anxiety, leading to increased depressive symptoms. An indirect-effect model was tested on a convenience sample of 574 Israeli Jewish older workers (mean age = 57), finding that the link between retirement anxiety and depressive symptoms is mediated through death anxiety. Anxious anticipation of retirement could imply that the individual perceives it as an "end," resulting in greater death saliency and death anxiety, which are related to poorer mental health. Theoretical and practical implications are discussed.

Relationship between meaning in life and death anxiety in the elderly: self-esteem as a mediator

Background

Death anxiety is a common phenomenon in all societies. Older adults may be more prone to death anxiety than their younger counterparts; however, death anxiety among older adults is not well understood. This study explores the relationship between meaning in life, self-esteem, and death anxiety in senior citizens in China.

Methods

A total of 283 older adults participated in this study; data were collected via the Meaning in Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Death Anxiety Scale.

Results

Results show that the dimensions of meaning in life, presence of meaning (r = − 0.43, p < 0.01), search for meaning (r = − 0.31, p < 0.01), and self-esteem (r = − 0.54, p < 0.01) were each negatively correlated with death anxiety. Regression analysis reveals that meaning in life significantly predicted self-esteem and death anxiety (F = 45.70, p < 0.01; R² = 0.33). Path analysis indicated that self-esteem either completely or partially mediated the effects of meaning in life on death anxiety in older adults.

Conclusions

Overall, meaning in life appears to be significantly correlated with death anxiety in older adults, and self-esteem can mediate this effect.

Which Factors do Older Adults Consider When Estimating the Time Left for Them to Live?

Objectives

The present study examines which factors older adults consider as important when rating their subjective nearness-to-death (SNtD), as well as the associations between corresponding variables as reported in a multidimensional questionnaire and responses on a SNtD question. In addition, we examine whether importance ratings fit or diverge from the actual associations between corresponding variables and SNtD.

Method

Two hundred and seventy-two participants (average age 80.75) reported their health and functioning, their SNtD, and the importance of each of 13 preselected factors in evaluating SNtD.

Results

Respondents considered physical functioning and psychological factors as the most important factors to their SNtD evaluation, and genetic factors (i.e., age, gender, parental longevity) as the least important. Ratings of importance were strongly and positively correlated with the strength of the associations between the corresponding variables and SNtD.

Discussion

Older adults appear to have implicit knowledge of the factors that affect their SNtD. Yet, this knowledge is sometimes biased and does not necessarily represent variables that have been identified as related to actual longevity.

Prognostic accuracy of patients, caregivers, and oncologists in advanced cancer

BACKGROUND

In caring for patients with advanced cancer, accurate estimation of survival is important for clinical decision making. The purpose of this study was to assess the accuracy of 2-year survival probabilities estimated by oncologists, patients, and caregivers and to identify demographic and clinical factors associated with prognostic accuracy.

METHODS

This was a secondary observational analysis of data obtained from a cluster randomized controlled trial. Participants included 38 oncologists, 263 patients with advanced nonhematologic cancer, and 193 of their caregivers from clinics in Sacramento and Western New York. Discrimination within each group (oncologists, patients, caregivers) was evaluated using the C statistic, whereas calibration was assessed by comparing observed to predicted 2-year mortality using the chi-square statistic.

RESULTS

The median survival from study entry was 18 months, and 41.8% of patients survived for 2 years. C statistics for oncologists, patients, and caregivers were 0.81 (95% CI, 0.76-0.86), 0.62 (95% CI, 0.55-0.68), and 0.72 (95% CI, 0.65-0.78), respectively; oncologists' predictions were better than the predictions of both patients (P = .001) and caregivers (P = .03). Oncologists also had superior calibration: their predictions of 2-year survival were similar to actual survival (P = .17), whereas patients' (P = .0001) and caregivers' (P = .003) predictions diverged significantly from actual survival. Although most oncologists' predictions were classified as realistic (62.0%), approximately one-half of patients' and caregivers' predictions (50.0% and 46.0%, respectively) were unduly optimistic. Among patients, nonwhite race and higher levels of social well-being predicted undue optimism (P < .05).

CONCLUSIONS

Compared with oncologists, patients and caregivers displayed inferior prognostic discrimination, and their predictions were poorly calibrated, primarily because of overoptimism.

Subjective nearness-to-death and negative attitudes toward persons with disability: Attachment patterns moderate

We examined whether subjective nearness-to-death is associated with negative attitudes toward people with disabilities, and whether attachment patterns moderate this connection. A total of 462 Israeli adults, average age 57 years, completed scales measuring subjective nearness-to-death, negative attitudes toward people with disability, and attachment patterns. High levels of subjective nearness-to-death were associated with negative attitudes toward people with disability, and attachment patterns were significant moderators. Findings point to the theoretical importance of both perceptions of death and personal resources for coping with subjective nearness-to-death in relation to attitudes toward individuals with disabilities.

Future time perspective, loneliness, and depressive symptoms among middle-aged adults: A mediation model

BACKGROUND

Recent studies have demonstrated the relevance of subjective time perceptions with regard to depressive symptoms among aging and older adults. Moreover, loneliness was found to bear a strong connection to such symptoms. However, little is known about the connection between the three constructs. Accordingly, the current research examines whether the connection between future time perspective and depressive symptoms is mediated by loneliness.

METHODS

Data was collected from 1021 participants aged 50-67 (mean age = 57.89), who completed the Future Time Perspective Scale, a scale measuring loneliness, and the Center for Epidemiological Studies Depression Scale (CES-D), and provided relevant socio-demographic information.

RESULTS

Future time perspective was negatively linked with both loneliness and depressive symptoms. Moreover, loneliness was a significant mediator for the connection between future time perspective and depressive symptoms.

LIMITATIONS

The study focused on a specific age range, and employed a cross-sectional design.

CONCLUSIONS

This study provides a view into the manner by which subjective perceptions of time are linked with depressive symptoms during the aging process, and highlights the clinical importance of such perceptions to depressive symptoms.