The experience of death anxiety in Iranian war veterans: a phenomenology study

Development and Validation of Apeiroanxiety Scale in the Context of the Afterlife for Pakistani Muslim Adults

Apeiroanxiety is a fear of infinity. Some people may experience anxiety or discomfort when contemplating the vastness or endless nature of certain concepts, such as time or space. Addressing any form of anxiety is important as it can impact an individual's daily functioning, wellbeing, and quality of life. The current study is aimed at developing a reliable and valid measure of apeiroanxiety in the context of the afterlife for the Pakistani Muslim population. The research had three studies: Query Study I generated an item pool of 18 items based on a literature review, semi-structured interviews, and expert opinion. This item pool was administered to a convenient sample of Pakistani Muslim participants (n = 1277). As a result of exploratory factor analysis, a uni-dimensional factor solution with five items was yielded (α = 0.90). Confirmatory factor analysis confirmed the obtained uni-dimensional factor solution in study II of the research with an excellent model fit. In study III, the convergent and discriminant validity of the scale was established on a separate independent sample (n = 485). Results yielded evidence of convergent validity as negative afterlife belief and rumination had a positive correlation with apeiroanxiety. The discriminant validity was established by a non-significant relationship between positive afterlife belief and apeiroanxiety. Moreover, the limitations, suggestions, and implications of the study are discussed.

Psychometric evaluation of the Persian version of the spiritual well-being scale (SWBS) in Iranian patients with cancer

OBJECTIVE

The spiritual well-being scale (SWBS) is a widely used clinical scale which should be evaluated for Iranian patients with cancer. The aim of this study is to evaluate the psychometric properties of the Persian version of the SWBS in Iranian patients with cancer.

METHOD

This cross-sectional, methodological study was conducted among Iranian patients with cancer (n = 400). The participants were recruited using convenience sampling. The content, construct, convergent and discriminant validity, and reliability of the Persian version of the SWBS were evaluated.

RESULTS

A two-factor structure for the scale was indicated with the factors being: connecting with God and meaningless life that explained 54.18% of the total variance of the concept of spiritual well-being. The results demonstrated the model had a good fit. Cronbach's alpha, McDonald's omega, and the inter-item correlation values of the factors indicated good internal consistency of the scale.

SIGNIFICANCE OF RESULTS

These results suggest that the Persian version of the SWBS is a reliable and valid measure to assess the spiritual well-being of patients with cancer through 16 items related to connecting with God and meaningless life.

The Relationship Between Spirituality Dimensions and Death Anxiety among Iranian Veterans: Partial Least Squares Structural Equation Modeling Approach

The purpose of the present study was to examine the relationship among spiritual intelligence, spiritual well-being and death anxiety among Iranian veterans. In this predictive correlational study, 211 veterans completed King and DeCicco's Spiritual Intelligence Scale, Paloutzian and Ellison's Spiritual Well-being Scale and Templer's Death Anxiety Scale-Extended. After confirming the reliability of the constructs using intra-class correlation coefficient, partial least squares structural equation modeling method was utilized to assess the impact of spiritual well-being and spiritual intelligence on death anxiety. This study found a significant positive relationship between spiritual intelligence and death anxiety after controlling for the effects of age, education level and disability. However, there was a significant negative relationship between spiritual well-being and death anxiety among Iranian veterans. Negative relationships were found between spiritual well-being and death anxiety among Iranian veterans. However, spiritual intelligence had a positive impact on death anxiety.

Hope in Iranian mothers of children with cancer: a descriptive correlational study

PURPOSE

This study aims to examine the relationship between the level of hope in mothers who have a child with cancer and its related factors in Iran.

METHOD

A cross-sectional and descriptive correlational design was used in this study. A demographic questionnaire and the Herth Hope Index (HHI) were administered to a sample of 240 mothers who have a child with cancer to assess level of hope. Mothers were also asked to indicate their highest priority hopes such as view of their supportive resources including financial support, psychosocial support, religiosity and spirituality. Data was analysed using descriptive statistics, Spearman's rho, independent sample t test and one-way ANOVA.

RESULTS

The mean HHI score was 35.44 (n = 237). There was a positive correlation between HHI total score and spirituality (r = 0.267, P < 0.001), and psychosocial support (r = 0.281, P < 0.001). No significant differences were found between HHI total score and respondents who saw themselves as a religious person and the family financial support. There was a significant difference in HHI total scores for a mother who has a disabled child (M = 32.92, SD = 2.75; t (235) = 2.00, P = 0.046) and mothers of a child who do not have any disability besides their cancer (M = 35.59, SD = 4.91). No significant differences were found in the HHI total score and different group of the child's diagnoses and the mother's age or/and child's age.

CONCLUSION

Mothers who have a child with cancer with better psychosocial and spiritual support showed a higher level of hope. A thorough knowledge of factors associated with hope in mothers caring for children suffering from cancer could provide a means to further advance the support delivered and the available resources given to the parents, especially the mothers.

The Relationship Between Death and Do Not Resuscitation Attitudes Among Intensive Care Nurses

This study aimed to determine the relationship between death and DNR attitudes among ICNs. This descriptive-analytical study was performed on 156 ICNs in 2018. All nurses were enrolled in the study; data collection instruments included Death Attitude Profile-Revised (DAP-R) and the DNR attitude questionnaires. The mean scores of DAP-R and DNR items were 150.89/ ± 23.59 and 91.82 ± 11.41, respectively. There was a significant relationship between death attitude and DNR attitude Famong ICNs. All dimensions of DAP-R significantly predicted attitude toward DNR (P < 0.05). Among those, "neutral acceptance" (1.17 [95% CI (0.68--1.65)] was the strongest predictor and "death avoidance" was the weakest predictor (0.36 [95% CI (0.09--0.62)]. There was a significant relationship between the ICNs' work experience and attitude toward DNR (p = 0.03). The findings can be used in formulation of the national guideline for DNR order.

Economics of death and dying: a critical evaluation of environmental damages and healthcare reforms across the globe

The economics of death and dying highlighted that environmental factors negatively influence healthcare sustainability. Therefore, this study conducted a system-based literature review to identify the negative externality of environmental damages on global healthcare reforms. Based on 42 peer-reviewed papers in the field of healthcare reforms and 12 papers in the field of environmental hazards, we identified 25 factors associated with death and dying and 15 factors associated with health-related damages across the world respectively. We noted that environmental factors are largely responsible to affect healthcare sustainability reforms by associating with the number of healthcare diseases pertaining to air pollutants. The study suggests healthcare practitioners and environmentalists to devise long-term sustainable healthcare policies by limiting highly toxic air pollutants through technology-embodied green healthcare infrastructure to attained efficient global healthcare recovery.

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.

The Factor Structure of the Spiritual Well-Being Scale in Veterans Experienced Chemical Weapon Exposure

This study aimed to determine the factor structure of the spiritual well-being among a sample of the Iranian veterans. In this methodological research, 211 male veterans of Iran-Iraq warfare completed the Paloutzian and Ellison spiritual well-being scale. Maximum likelihood (ML) with oblique rotation was used to assess domain structure of the spiritual well-being. The construct validity of the scale was assessed using confirmatory factor analysis (CFA), convergent validity, and discriminant validity. Reliability was evaluated with Cronbach's alpha, Theta (θ), and McDonald Omega (Ω) coefficients, intra-class correlation coefficient (ICC), and construct reliability (CR). Results of ML and CFA suggested three factors which were labeled "relationship with God," "belief in fate and destiny," and "life optimism." The ICC, coefficients of the internal consistency, and CR were >.7 for the factors of the scale. Convergent validity and discriminant validity did not fulfill the requirements. The Persian version of spiritual well-being scale demonstrated suitable validity and reliability among the veterans of Iran-Iraq warfare.

Psychometric Properties of the Death Anxiety Scale-Extended among Patients with End-Stage Renal Disease

This study aimed to evaluate the validity and reliability of the Persian version of Death Anxiety Scale-Extended (DAS-E). A total of 507 patients with end-stage renal disease completed the DAS-E. The factor structure of the scale was evaluated using exploratory factor analysis with an oblique rotation and confirmatory factor analysis. The content and construct validity of the DAS-E were assessed. Average variance extracted, maximum shared squared variance, and average shared squared variance were estimated to assess discriminant and convergent validity. Reliability was assessed using Cronbach’s alpha coefficient (α = .839 and .831), composite reliability (CR = .845 and .832), Theta (θ = .893 and .867), and McDonald Omega (Ω = .796 and .743). The analysis indicated a two-factor solution. Reliability and discriminant validity of the factors was established. Findings revealed that the present scale was a valid and reliable instrument that can be used in assessment of death anxiety in Iranian patients with end-stage renal disease.

Cronbach's α reliability, concurrent validity, and factorial structure of the Death Depression Scale in an Iranian hospital staff sample

OBJECTIVE

Death depression is an important component in the process of death and dying. Death depression is the second element of death. Depression is one of the important features in death distress. The aim of this study was to explore the performance of the Farsi version of the Death Depression Scale with an Iranian convenience sample of nurses (n = 106).

METHODS

Nurses were selected using a convenience sampling method, and completed the Death Depression Scale (DDS), Death Concern Scale (DCS), Collett-Lester Fear of Death Scale (CLFDS), Reasons for Death Fear Scale (RDFS), Templer's Death Anxiety Scale (DAS), and Death Obsession Scale (DOS).

RESULTS

The results of exploratory factor analysis on DDS identified 4 factors (56.16% of variance). Factor 1 labeled "Death sadness", Factor 2 labeled "Death finality/end and Death dread/fear", Factor 3 labeled "Death despair and Death depression", and Factor 4 labeled "Death loneliness". Cronbach's α coefficient was 0.84, Spearman-Brown coefficient 0.85, and Guttman Split-Half coefficient 0.81 The DDS correlated 0.40 with the DCS, 0.39 with the CLFDS, 0.50 with the DAS, 0.35 with the RDFS, and 0.44 with the DOS, indicating good construct and criterion-related validity. Concurrent validity for the DDS with the other scales were significant.

CONCLUSIONS

The DDS has good validity and reliability, and it can use in clinical and research settings.

Psychometric evaluation of the Persian version of the Templer's Death Anxiety Scale in cancer patients

In this study, 398 Iranian cancer patients completed the 15-item Templer's Death Anxiety Scale (TDAS). Tests of internal consistency, principal components analysis, and confirmatory factor analysis were conducted to assess the internal consistency and factorial validity of the Persian TDAS. The construct reliability statistic and average variance extracted were also calculated to measure construct reliability, convergent validity, and discriminant validity. Principal components analysis indicated a 3-component solution, which was generally supported in the confirmatory analysis. However, acceptable cutoffs for construct reliability, convergent validity, and discriminant validity were not fulfilled for the three subscales that were derived from the principal component analysis. This study demonstrated both the advantages and potential limitations of using the TDAS with Persian-speaking cancer patients.

The development and psychometric properties of the Turkish death anxiety scale (TDAS)

The purpose of the present study was to develop the Turkish Death Anxiety Scale (TDAS) and test its initial psychometric properties. Four independent samples participated in the study: 943 college students in item generation, 388 college students in validation, 171 college students in reliability investigation, and 338 adults in cross-validation. Principal component analysis with a varimax rotation revealed that 20 items of the scale contained three factors (i.e., Ambiguity of Death, Exposure to Death, and Agony of Death), which explained over 67% of the total variability. Confirmatory factor analyses indicated acceptable fit. Significant correlations were found between the scale and death anxiety, state anxiety, trait anxiety, depression, and hopelessness in the student sample. In the adult sample, death anxiety significantly correlated with trait anxiety. Reliability coefficients were also found acceptable. The authors conclude that the TDAS is a promising instrument in assessing the death anxiety levels in Turkey.

Validity and reliability of the persian version of templer death anxiety scale in family caregivers of cancer patients

Background:

Due to increasing recognition of the importance of death anxiety for understanding human nature, it is important that researchers who investigate death anxiety have reliable and valid methodology to measure. The purpose of this study was to evaluate the validity and reliability of the Persian version of Templer Death Anxiety Scale (TDAS) in family caregivers of cancer patients.

Materials and Methods:

A sample of 326 caregivers of cancer patients completed a 15-item questionnaire. Principal components analysis (PCA) followed by a varimax rotation was used to assess factor structure of the DAS. The construct validity of the scale was assessed using exploratory and confirmatory factor analyses. Convergent and discriminant validity were also examined. Reliability was assessed with Cronbach's alpha coefficients and construction reliability.

Results:

Based on the results of the PCA and consideration of the meaning of our items, a three-factor solution, explaining 60.38% of the variance, was identified. A confirmatory factor analysis (CFA) then supported the adequacy of the three-domain structure of the DAS. Goodness-of-fit indices showed an acceptable fit overall with the full model {χ²(df) = 262.32 (61), χ²/df = 2.04 [adjusted goodness of fit index (AGFI) = 0.922, parsimonious comparative fit index (PCFI) = 0.703, normed fit Index (NFI) = 0.912, CMIN/DF = 2.048, root mean square error of approximation (RMSEA) = 0.055]}. Convergent and discriminant validity were shown with construct fulfilled. The Cronbach's alpha and construct reliability were greater than 0.70.

Conclusions:

The findings show that the Persian version of the TDAS has a three-factor structure and acceptable validity and reliability.