Grief Instruments in Children and Adolescents: A Systematic Review

Many children and adolescents experience the death of a close person, such as a family member or a friend. However, there is a scarcity of literature on the assessment of grief in bereaved youth. The use of validated instruments is essential to advance our knowledge of grief in children and adolescents. We conducted a systematic review, adhering to PRISMA guidelines, to identify instruments that measure grief in this population and explore their characteristics. Searches in six databases (Medline, PsycINFO, Embase, Emcare, Scopus, and Web of Science) identified 24 instruments, encompassing three categories: general-purpose grief scales, maladaptive grief scales, and specialized grief scales. We extracted data using a predetermined list of descriptive and psychometric properties. Findings indicate a need to direct research towards more stringent validation of existing instruments and the design of new instruments in line with developments in the understanding of grief in this population.

Relationship of Muslim Religiosity and Death Anxiety with the Mediating Effect of Optimism and Depression Among Cancer Patients in Pakistan

Optimism and the practice of any religion are known to reduce depression and anxiety in cancer patients. In the present study, the specific role of Muslim religiosity, optimism, depression, and death anxiety in cancer patients has been explored. The sample of this study consisted of 200 cancer patients from different hospitals of the districts Faisalabad and Lahore (Pakistan). The sample's average age was 26.6 years. Parallel mediation findings show that optimism and depression are significant mediators between Muslim religiosity and death anxiety among cancer patients. Muslim religiosity is positively associated with optimism, and it helps to decrease the level of death anxiety, while depression is negatively associated with Muslim religiosity, and high depression increases the death anxiety level of cancer patients. In conclusion, Muslim religiosity and optimism play significant roles in managing depressive symptoms and death anxiety among cancer patients.

Death education and photovoice at school: A workshop with Italian high school students

The study shows the effects of a death education workshop with Italian high school students. Students (N = 416) from 10 high schools throughout Italy participated: 212 in the experimental group and 204 in the control group. Four weekly, two-hour workshops about the themes of death, with theoretical lessons and an experiential artistic activity of photovoice. Results show that the students in the experimental group showed significantly increased self-efficacy levels and existential anxiety levels did not increase after death education intervention. Educating youth about death could give them the skills to improve the management of death-related events and cope with negative emotions.

Attitudes promoting coping with death anxiety among parents of children with disabilities

We investigated death anxiety among parents of children with disabilities and its associations with coping attitudes and psycho-demographic factors. Surveys were administered to 382 parents of children who possess a severe disability and data were analyzed via descriptive and inferential statistics. Findings revealed that parents experienced high levels of death anxiety; the level of death anxiety changed according to some psycho-demographic factors, such as external support, type of disability, and death-related beliefs; and death anxiety was significantly explained by demographic variables, death-related thoughts, and experiences, and adaptive and maladaptive coping attitudes.

Death Anxiety, Religiosity and Culture: Implications for Therapeutic Process and Future Research

Death anxiety is a common phenomenon that humans experience. It is multidimensional. There has been an upsurged interest around the discussion on death anxiety across the globe, however, much of the literature focuses on the concept of death anxiety, religiosity, and its role in mental health conditions. Further, studies on death anxiety are scattered and at times disconnected. It is important to review existing literature to get an overview of the current direction in research and understand its relevance to facilitate therapeutic processes. In this scoping review, literature was searched in databases such as PubMed, Scopus, and PsychINFO using key words such as “death anxiety”, “fear of death”, religion”, “culture”, and “psychopathology” combined with Boolean operators to narrow down the search results. The initial search yielded 614 records, of which 546 records were removed based on title review (363), abstract review (94), and full-text review (89). Finally, 68 articles were appraised, narratively synthesized, and thematically presented. Major themes revealed in the literature were theoretical frameworks of death anxiety, religiosity, universality, psychological effects of death anxiety, psychopathology, and religious coping strategies. There is a need to assess client’s death anxiety and address them using religious rituals and coping mechanisms.

Testing the High-Risk Behavior Model Among the Students Based on Religious Orientation With the Mediation of Fear of Death

Adolescents are at high-risk for adverse health outcomes associated with high-risk behavior. The present study aimed to test the high-risk behavior model among the students based on religious orientation with the mediation of fear of death. This descriptive correlational study utilized structural equation modeling. The statistical population comprised all senior high school female students in Mashhad. 200 students were selected using cluster random sampling method. Data collection tools included the Iranian Adolescents Risk-taking Scale, Templer Death Anxiety Scale, and Allport and Ross Religious Orientation Scale. The result of a structural equation model suggested that the relationship between religious orientation and high-risk behavior was mediated through fear of death. Furthermore intrinsic religiosity has a negative direct relation with fear of death and high-risk behavior, and extrinsic religious orientation have a positive direct relation with fear of death and high-risk behavior. On this basis, it was concluded that religious orientation influences high-risk behavior indirectly through fear of death.

Let's Start With the End: Bibliodrama in an Italian Death Education Course on Managing Fear of Death, Fantasy-Proneness, and Alexithymia With a Mixed-Method Analysis

This article presents the results of an experience of death education (DE) course with bibliodrama in Italian high schools, which focused on emotions and existential themes. The research analyzed the inability to recognize or describe one's own emotions (alexithymia), fantasy-proneness, and attitudes toward death in two different groups of students: one who took a course on DE (with 113 students) and another who did not participate in it (with 114 students). The use of a mixed method allowed this study to explore the quantitative results that the students indicated in the questionnaire and the qualitative open answers to the final question about how they had profited from this DE course. The results showed that the course had a positive effect, as the DE group significantly decreased alexithymia and negative attitudes toward death, particularly in fear and avoidance of death, making their representation of death less traumatic.

Religiousness, religious doubt, and death anxiety

Terror Management Theory (TMT) (Greenberg, Pyszczynski, & Solomon, 1986) suggests that culturally-provided worldviews (e.g., religion) may protect individuals from experiencing death anxiety, and several studies have supported this position. However, if one's worldview can offer protection, doubts concerning one's worldview could undermine this protection. The current study investigated whether age, gender, religiousness, and religious doubt were associated with death anxiety. Using data from 635 younger, middle-aged, and older adults, a structural equation model with age, gender, religiousness, and religious doubt predicting death anxiety was tested. The model had a good fit (chi2 (76) = 193.467, p < .001; GFI = .961, CFI = .976, TLI = .967, RMSEA = .049) and accounted for 12.3% of the variance in death anxiety. Results were consistent with TMT, as religiousness was inversely associated with death anxiety, while religious doubt was positively associated with death anxiety.

Belief in a day of judgment and death anxiety: a brief note

The reliability of a scale to measure belief in a day of judgment was assessed using a sample of 162 undergraduate students. The scale had good reliability, and 12 of the 20 items constituted a homogenous subset of items. Scores on the scale were moderately associated with scores on a traditional religiosity scale, but were not associated with fears of death and dying.

Does Superstition Help? A Study of the Role of Superstitions and Death Beliefs on Death Anxiety Amongst Chinese Undergraduates in Hong Kong

Past research has shown that traditional Chinese death beliefs, which mostly consisted of superstitious thoughts, are related to death anxiety. However, other studies have shown that superstitions may help people cope with uncertainty and, therefore, reduce uncertainty-induced anxiety. The role of superstitions, whether related to heightened death anxiety or reduced death anxiety, is unclear. This study attempted to address the knowledge gap by examining the relationships among superstitions and Chinese death beliefs on death anxiety in the Chinese context. One hundred twenty-four undergraduates in Hong Kong completed measures of superstition (R-PBS), death anxiety (MFODS), and Chinese death beliefs scale. Superstition was found to be predictor of death anxiety, as expected. With superstitions highly prevalent in Chinese societies, the study has practical implications in end-of-life care, bereavement support, and death education in the Chinese context.

Bereavement and anxiety

Bereavement, one of life's most difficult experiences, usually triggers acute grief with yearning and longing for the deceased person that is often intense and preoccupying, along with frequent thoughts and memories of the person who died and relatively little interest in anything unrelated to the deceased loved one. Anxiety is a very common feature of grief that is often neglected. Anxiety is a natural response of the attachment system to separation from a loved one, seen in adults as well as children. Confrontation with one's own death is also a natural trigger of anxiety, though we usually protect ourselves from mortality salience using terror management strategies related to cultural values and self-esteem. In addition, loss of a loved one can trigger the onset of a DSM-IV anxiety disorder that, when present, can derail the mourning process and prolong acute grief. Bereavement-related anxiety disorders need to be recognized and treated.

Measurement of religiosity/spirituality in adolescent health outcomes research: trends and recommendations

The relationship between religious/spiritual (R/S) factors and adolescent health outcomes has been studied for decades; however, the R/S measurement tools used may not be developmentally relevant for adolescents. A systematic literature review was conducted to review and evaluate trends in measuring R/S in adolescent health outcomes research. In this review a total of 100 articles met criteria for inclusion. Relatively few (n = 15) included adolescent-specific R/S measures or items accounting for developmentally relevant issues such as parental religiosity or age-appropriate language. Future R/S and health research with adolescents would be strengthened by incorporating developmentally relevant R/S measurement tools, psychometrics, and multidimensional measures.

Measuring spirituality, religiosity, and denial in individuals working in funeral service to predict death anxiety

The aim of the present study was to examine predictors of death anxiety in U.S. funeral directors/embalmers who were part of a larger study (n = 234). Backward stepwise multiple regression was conducted to determine whether or not spirituality, intrinsic religiosity, extrinsic religiosity, and denial predicted levels of death anxiety. Results indicated that spirituality along with age of the participants accounted for 19% of the variance of death anxiety, R2 = .190, R2(adj) = .180, F(2, 168) = 19.64, p < .001. Intrinsic religiosity, extrinsic religiosity, and denial were not significant in the regression model. Several items, however, in the model had a significant positive correlation with each other at the .01 alpha level including spirituality with intrinsic religiosity (r = .63) and age (r = .21), and intrinsic religiosity with denial (r = .22) and age (r = .24). Other variables correlated negatively with one another at the .01 alpha level. Namely, death anxiety with spirituality (-.38), intrinsic religiosity (r = -.36), and age (-.28); spirituality with extrinsic religiosity (-.22); intrinsic religiosity with extrinsic religiosity (-.45); and extrinsic religiosity with age (r = -.19). Limitations of the study and implications for practice were discussed.