A Grounded Theory on Interment Stress Among Filipino Older Adults

Older adults deal with age-related challenges concerning death and dying. Their cognitive and emotional interactions on burial arrangement, funeral expenses and body disposition encapsulate interment stresses. This grounded theory research underscored the development of interment stress among Filipino older adults (n = 26). A three-stage (Yielding, Inflowing and Discharging) model, 'The spillway for cognitive and emotional interactions of interment stress' represented interment stress as a cognitive and emotional interactive process experienced by older adults. The emergent model may be vital to offer death awareness and preparation, and a basis for creating appropriate programs to cope with the interment stress among older adults. This interment stress framework may also contribute to geriatric and gerontological psychology focused on promoting the older adults' psychological well-being and assist in achieving harmonious aging. Ultimately, the findings hope to achieve advances on individuals' and organizations' management of older adults' interment stress within personal, social and professional context.

Surviving COVID-19: Biopsychosocial Impacts, Death Anxiety, and Coping Strategies

As the COVID-19 pandemic erupted, attempts to contain the spread of the virus took two concurrent forms, including mobility restrictions (aka lockdowns) and the race to produce a vaccine. However, it is quite striking that, amidst both the lockdown and the race to produce a vaccine, the question of how COVID-19 survivors/patients coped with the disease has not received the degree of attention it deserved. To navigate this issue, we employed a sample consisting of 100 COVID-19 survivors; this paper explores the relationship between the biopsychosocial (BPS) impacts of COVID-19, death anxiety, and coping strategies. In this context, the mediating role of death anxiety is placed in the spotlight. The analysis reveals a significant positive association between the BPS impact of COVID-19 and death anxiety and a significant negative association between death anxiety and coping strategies among COVID-19 survivors. Thus, death anxiety mediates the relationship between the BPS impact and the coping strategies that COVID-19 survivors adopt. Given the general recognition of the validity of the BPS model in contemporary medical science and practice, a thorough examination of COVID-19 survivors and their experiences related to surviving is necessary to match the challenges of today, including the increased probability of pandemics.

COVID-19 symptoms and compliance: The mediating role of fundamental social motives

Background

Understanding the compliance of infected individuals and the psychological process underlying compliance during pandemics is important for preventing and controlling the spread of pathogens. Our study investigated whether fundamental social motives mediate the relationship between having infectious disease and compliance.

Methods

An online survey was conducted in March 2020, during the severe phase of the COVID-19 outbreak in China to collect data from 15,758 participants. The survey comprised self-report questionnaires with items pertaining to current symptoms (COVID-19 symptoms, other symptoms or no symptoms), the Fundamental Social Motive Inventory, and measures of compliance. Correlation analysis, linear regression analysis, and structural equation model were used for data analysis.

Results

The participants with COVID-19 symptoms had lower levels of compliance than those without symptoms, and their lower compliance was caused by a decrease in disease avoidance (indirect effect = -0.058, 95% CI = [-0.061, -0.056]) and familial motives (indirect effect = -0.113, 95% CI = [-0.116, -0.062]). Whereas exclusion concern (indirect effect = 0.014, 95% CI = [0.011, 0.017]) suppressed the effects of COVID-19 symptoms on compliance, the effect disappeared in the multiple mediation model, while those of disease avoidance and familial motives remained.

Conclusion

Our findings emphasize the critical role of disease avoidance and familial motives in promoting compliance with public health norms during pandemics and suggest that enhancing these motives may serve as an effective intervention strategy to mitigate noncompliance among potentially infected individuals.

Meanings and Experiences of End-of-Life Patients and Their Family Caregivers in Hospital-to-Home Transitions: A Constructivist Grounded Theory Study

This study explored the meanings and experiences of patients with terminal chronic diseases and their caregivers, who face the imminence of death in the home environment after hospital discharge. The qualitative study used constructivist grounded theory. The participants were individuals with a terminal chronic illness, discharged to home, and their family caregivers. Data were gathered from in-depth interviews and field notes, and a comparative analysis was conducted to identify categories and codes, according to Charmaz's theory. The sample consisted of 21 participants. Three inter-related data categories emerged: "Floating between acceptance and resistance: Perceiving the proximity of death", "Analysing the end from other perspectives: it is in the encounter with death that life is understood" and "Accepting the path: between the love of letting go and the love of wanting to stay". The categories translate the reconstruction of those facing end-of-life occurring in the home environment. It is amid the imminence of death that life gains intensity and talking about the finitude of life configures an opportunity to see life from other perspectives. Giving voice to individuals facing the mishaps of a terminal illness fosters the path to a comfortable death. For health professionals, it is an opportunity to provide structured and humanized care with an ethical attitude, in defence of human dignity.

Fear of Cancer Recurrence as Reminder About Death: Lived Experiences of Cancer Survivors' Spouses

Fear of cancer recurrence is the most prevalent and burdensome emotional concern among cancer survivors' spouses after treatment. This qualitative study aimed to reveal death-related experiences of spouses of cancer survivors in remission, in the context of fear of cancer recurrence. Seven spouses (aged 35-56), four women and three men were explored. Data were obtained using an unstructured interview and analyzed by inductive thematic analysis. The spouses associate cancer relapse with death, risk of losing their spouse. The threat of death triggers not only the feelings of insecurity, uncertainty about the future and loss of control, but also appreciation of life, focus on positive aspects in relationships. Planning for the "worst" scenarios and avoidance helped spouses to reduce tension and enhance control. Interventions for spouses should focus on promotion of emotional expression of death related concerns underlying fear of relapse, also developing new coping strategies to accept and tolerate uncertainty.

Introduction of the French version of the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F/fre)

Research on death-related attitudes needs complex assessment instruments for multicultural contexts. The French version of the Multidimensional Orientation Toward Dying and Death Inventory was factor analytically constructed with data from Europe and Canada (N = 370). The 24-item instrument with five and three scales in the fear and acceptance domain, respectively, shows favorable psychometric properties. The influence of social desirability is negligible. Women tended to express stronger fears and weaker acceptance of dying and death. Gender differences emerged concerning Fear of One's Own Dying and Fear of Corpses, with women scoring higher than men on both dimensions. The importance of assessing attitudes toward dying and death transdiagnostically is outlined.

Different Death Attitudes in Internalizing Symptom Context Among Norwegian and Turkish Women

The aim of the present study was to examine the association between death attitudes and depressive and anxiety symptoms among Norwegian and Turkish women. 304 participants were recruited (NNorwegian = 127 [41.8%]; NTurkish = 177 [58.2%]). The Beck Depression Inventory, the trait anxiety subscale of the State-Trait Anxiety Inventory, and the Death Attitude Profile-Revised were administered. The results showed that Fear of Death was positively correlated with anxiety symptoms among Turkish respondents; Approach Acceptance was negatively correlated with depressive and anxiety symptoms among Norwegian participants; and none of the death attitudes had significant negative associations with depressive and anxiety symptoms among Turkish participants. The analysis showed that Escape Acceptance was the only death attitude positively associated with depressive and anxiety symptoms for both countries. We may thus hypothesise that Escape Acceptance is the most maladaptive death attitude for both countries. Patients with this death attitude should be paid closer attention.

"My life became more meaningful": confronting one's own end of life and its effects on well-being-a qualitative study

Background

The perception of being closer to death can be experienced due to old age or life-limiting diseases, and can pose profound existential challenges. Actively confronting death-related issues and existential questions may increase psychosocial comfort and stimulate personal growth, whereas dysfunctional coping may lead to existential distress.

To date, research on individual and (semi-)professional approaches to confronting the own end of life and the effects on one’s well-being remain scarce. Therefore, the aim of this study was to explore individual strategies and wishes in order to derive ideas for appropriate support concepts.

Methods

Twenty semi-structured interviews were conducted with people over the age of 80 (n = 11) and with a life-limiting disease (n = 10). The interviews were transcribed verbatim and independently coded by two researchers according to Braun and Clarke's thematic analysis approach.

Results

While the use of (semi-)professional approaches (e.g., therapeutic support) to confronting existential questions in the shape of one’s impending death was rare, individual coping strategies did have a positive impact on psychosocial comfort. There were hardly any significant differences between the participants aged 80 and over and those with a life-limiting disease in terms of individual coping strategies or how they approached the ends of their lives. Both groups reported that theoretical education, preparing for the ends of their lives (e.g., funerals), talking about death-related topics, reflecting on death-related topics, and contemplating death in a spiritual sense had positive effects on their assurance, self-determination and relief. The necessity of confrontation and a desire for low-threshold, accessible and flexible services to meet their existential and spiritual needs were highlighted.

Conclusions

There is both a desire and a need for the addressing of existential questions. Outside of private contexts, however, the participants possessed little awareness of support services that focused on confronting end-of-life issues, and rarely used such services. Efforts to raise awareness for psychosocial and spiritual needs should be implemented within the care system, together with low-threshold support concepts, in order to increase psychosocial well-being. More research evaluating individual approaches to confronting the own end of life are needed to better understand this determinant of well-being and its mechanisms of action.

Trial registration

www.germanctr.de, DRKS-ID: DRKS00020577.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12904-022-00950-3.

Effects of COVID-19 on Mental Health and Its Relationship With Death Attitudes and Coping Styles Among Hungarian, Norwegian, and Turkish Psychology Students

The purpose of this study was to investigate mental effects of coronavirus disease 2019 (COVID-19) and its relationship with death attitudes and coping styles among Hungarian, Norwegian, and Turkish psychology students. A total of 388 participants from Hungary (N = 122, 31.4%), Norway (N = 96, 24.7%), and Turkey (N = 170, 43.8%) were recruited during the pandemic. The Depression, Anxiety and Stress Scale, the Impact of Event Scale-Revised, the Carver Brief COPE Inventory, and the Death Attitude Profile-Revised were used. The results indicated that escape acceptance might be the most maladaptive death attitude during COVID-19, as it was related to poorer mental health among the Hungarian, Norwegian, and Turkish psychology students. Self-blame, behavioral disengagement, self-distraction, and substance use coping styles were also related to poorer mental health, whereas positive-reframing (only among the Hungarian and Turkish participants) and humor (only among the Norwegian participants) were related to better mental health among our sample in the context of COVID-19. The findings implied that death attitudes and coping styles may differ in their efficacy among the Hungarian, Norwegian, and Turkish participants. These differences were discussed in detail in the discussion part. During the pandemic, practitioners might pay closer attention to patients with higher escape acceptance death attitude and patients who use dysfunctional coping styles. Additionally, patients can be encouraged to use techniques involving positive reframing and humor coping styles.

Does Psychosocial Ego Development Partially Mediate the Association Between Defense Mechanisms and Death Attitude?

Some authors suggest the existence of links between the mechanisms of defense and attitude toward death, however, mechanisms underlying these relationships are not well understood. The objective of the present research was to investigate whether psychosocial ego development is a partial mediator in the association between mechanisms of defense and death attitude. The study included participants (N = 382) aged 19-85 (M = 47.02, SD = 16.19). Three measures were used: Defense Style Questionnaire-40, Psychosocial Inventory of Ego Strengths, and Death Attitude Profile-Revised. Findings partly confirmed the hypotheses. Psychosocial ego development is a partial mediator in positive relationships between maladaptive defenses and fear of death, death avoidance, and escape acceptance. Psychosocial ego development is also a partial mediator in the positive association between more adaptive defenses and approach acceptance. The study provides novel information on the mechanisms underlying the association between defense mechanisms and multidimensional death attitude.