A Qualitative Study of How Hospice Workers Cope With Their Level of Exposure to Death

OBJECTIVE

To identify whether hospice workers hold unique and theoretically-informative perspectives about death, especially as they relate to terror management processes.

METHOD

Twelve hospice workers from two hospices in Tucson, Arizona, United States, participated in semi-structured interviews. Interview and analytic practices were guided by Grounded Theory (Glaser & Strauss, 1967).

RESULTS

Three categories were identified in relation to death attitudes: effects of chronic confrontation with death; reasons for working in hospice; and perceptions of death in others.

CONCLUSIONS

Two theoretically informative trends appeared. First, hospice workers largely manage death anxiety as identified by existing literature with the notable exception that hospice workers overall seem to integrate death and dying into their worldviews as a meaningful category, as opposed to avoiding thinking about death. Second, even among those regularly exposed to death, there seems to be a range across participants on a continuum from avoiding to confronting the topic of death.

Differences in Existential Perspectives as a Function of Having a Mystical-Type Experience

Prior research suggests that unique phenomenological experiences called “mystical-type experiences” (MTEs) have the potential to induce significant and persisting worldview changes. In this article, two studies add to this literature by using cross-sectional data from 837 and 1,086 participants, respectively, to investigate whether people who have had one of these experiences differ in predictable ways from those who have not on relevant existential variables. Specifically, we tested two novel hypotheses rooted in terror management theory, along with two predictions based on past research. In specific, the yes-MTE group was hypothesized to have (a) less fear of death and greater belief in death as a passage, (b) a more intrinsic and growth-oriented worldview, (c) fewer mental health symptoms, and (d) higher trait absorption. The data largely supported hypotheses 1, 2, and 4 while the results for hypothesis 3 were opposite of expectations, suggesting that clinical research with psychedelic-induced MTEs may not be generalizable to MTEs experienced outside the supportive therapeutic context.

Predictors of posttraumatic stress symptoms, COVID-related functional impairment, and burnout among medical professionals during the COVID-19 pandemic

Physicians are particularly vulnerable to mental health symptoms during global stressors such as the COVID-19 pandemic. Such stressors can increase death anxiety, which is a vulnerability factor for psychological dysfunction. Thus, exposure to COVID-related death may play a unique role in physicians' mental health during the pandemic. This cross-sectional study collected self-reported data from 485 resident physicians and fellows. Participants reported mental health symptoms, including posttraumatic stress symptoms (PTSS), burnout, and functional impairment due to the pandemic. Participants also reported death anxiety, COVID-19 anxiety, cognitive accessibility of death-related thoughts (DTA), and workplace exposure to COVID-19. Death anxiety, COVID-19 anxiety, DTA, and workplace COVID-19 exposure all independently predicted PTSS. Furthermore, COVID-19 anxiety and DTA interacted to predict PTSS, such that high levels of COVID-19 anxiety predicted higher PTSS, regardless of DTA level. Death anxiety and COVID-19 workplace exposure interacted to predict PTSS as well, such that death anxiety predicted PTSS only when COVID-19 exposure was high. Burnout was predicted by COVID-19 anxiety and workplace exposure, and COVID-related functional impairment was predicted by death anxiety and COVID anxiety. These findings demonstrate that death-related and COVID-related concerns, independently and in interaction with each other, play an important role in psychological distress among physicians.

Perceived Similarity of the Self to Animals, Creativity, and Anxiety-: A Terror Management Analysis

According to terror management theory, humans avoid death anxiety by embedding themselves within cultural worldviews that allow them to perceive themselves as more than mortal animals. However, individuals also differ in their trait-like tendency to dissociate from other animals. In six studies, we tested whether individuals who perceive themselves as more similar to animals (high-perceived similarity of the self to animals [PSSA]) invest more in creativity for terror management than low-PSSA individuals, but are also more vulnerable to experiencing anxiety and existential concerns. Supporting our hypotheses, PSSA was associated with investment in creativity and arts, especially after death primes (Studies 3 and 4). High-PSSA individuals had heightened trait anxiety and death-thought accessibility (Studies 5 and 6), and showed increased state anxiety following a negative feedback about their creativity (Study 6). Findings highlight the role of PSSA as a personality variable predicting human motivation and emotion.

Autonomy Support for Gender Expression and Managing Existential Concerns: An Initial Study Among Transgender Individuals

This pre-registered study was conducted online in March 2022 and was designed to (1) test whether individuals who identify as transgender report greater death-thought accessibility (DTA), greater symptoms of post-traumatic stress (PTS), lower meaning in life (MIL), and greater existential isolation (EI) compared to those who do not identify as transgender (i.e., cisgender); (2) examine whether autonomy support and autonomy frustration for gender expression differentially predict these outcomes among transgender individuals; and (3) examine whether perceptions of symbolic immortality mediate these relationships. Results found that transgender (vs. cisgender) participants reported higher DTA, greater PTS, lower MIL, and greater EI. Moreover, among transgender participants, autonomy frustration for gender expression predicted greater PTS, and autonomy support for gender expression predicted both greater MIL and lower EI. Finally, although the indirect effects through symbolic immortality were nonsignificant, autonomy support for gender expression appeared to predict perceptions of symbolic immortality. Implications for transgender people’s mental health and future research directions are discussed.

Investigating the Role of Normative Support in Atheists' Perceptions of Meaning Following Reminders of Death

According to terror management theory, humans rely on meaningful and permanence-promising cultural worldviews, like religion, to manage mortality concerns. Prior research indicates that, compared to religious individuals, atheists experience lower levels of meaning in life following reminders of death. The present study investigated whether reminders of death would change atheists' meaning in life after exposure to normative support for atheism. Atheists (N = 222) were either reminded of death or a control topic (dental pain) and exposed to information portraying atheism as either common or rare, and then asked to rate their perceived meaning in life. Results showed that reminders of death reduced meaning in life among atheists who were told that atheism is common. Results were consistent with the view that atheism reflects the rejection of religious faith rather than a meaningful secular terror managing worldview. Discussion considers implications for maintaining healthy existential wellbeing, identifies limitations, and highlights future research directions.

Bigotry and the human-animal divide: (Dis)belief in human evolution and bigoted attitudes across different cultures

The current investigation tested if people's basic belief in the notion that human beings have developed from other animals (i.e., belief in evolution) can predict human-to-human prejudice and intergroup hostility. Using data from the American General Social Survey and Pew Research Center (Studies 1-4), and from three online samples (Studies 5, 7, 8) we tested this hypothesis across 45 countries, in diverse populations and religious settings, across time, in nationally representative data (N = 60,703), and with more comprehensive measures in online crowdsourced data (N = 2,846). Supporting the hypothesis, low belief in human evolution was associated with higher levels of prejudice, racist attitudes, and support for discriminatory behaviors against Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ), Blacks, and immigrants in the United States (Study 1), with higher ingroup biases, prejudicial attitudes toward outgroups, and less support for conflict resolution in samples collected from 19 Eastern European countries (Study 2), 25 Muslim countries (Study 3), and Israel (Study 4). Further, among Americans, lower belief in evolution was associated with greater prejudice and militaristic attitudes toward political outgroups (Study 5). Finally, perceived similarity to animals (a construct distinct from belief in evolution, Study 6) partially mediated the link between belief in evolution and prejudice (Studies 7 and 8), even when controlling for religious beliefs, political views, and other demographic variables, and were also observed for nondominant groups (i.e., religious and racial minorities). Overall, these findings highlight the importance of belief in human evolution as a potentially key individual-difference variable predicting racism and prejudice. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

The role of perceived level of threat, reactance proneness, political orientation, and coronavirus salience on health behavior intentions

OBJECTIVE

This pre-registered study was designed to test whether reminders of death and coronavirus would have similar or different effects on health behavior intentions concerning COVID-19 (e.g., mask wearing, social distancing) and whether the type of framing of these behaviors would moderate these effects.

DESIGN

The study utilized a 3 (threat: mortality salience vs. coronavirus reminder vs. control topic) x 3 (framing: autonomy-supportive vs. controlled vs. neutral) design. Measures of perceived threat of COVID-19, reactance proneness, and political orientation were included as individual differences.

RESULTS

Although the interaction between threat and framing conditions was not significant, the data revealed that (1) lower perceived threat of COVID-19 was associated with lower health behavior intentions to reduce the spread of the virus; (2) after an induction to express their thoughts and feelings about COVID-19, participants with low perceived threat of COVID-19 significantly increased their health intentions; (3) perceived threat of COVID-19 moderated the relationship between reactance proneness and health intentions, such that those high in reactance proneness reported lower intentions unless they had high perceptions of threat; and (4) politically conservative participants reported lower intentions to engage in healthy behaviors, and this relationship was mediated by their lower perceived threat of COVID-19.

Anticipated Stigma and Dementia-Related Anxiety in Middle-Aged and Older Adults

Heightened awareness and perceived negativity of Alzheimer's disease and related dementias (ADRD) may increase health-related concerns about developing ADRD, also called dementia-related anxiety. Anticipating greater levels of ADRD stigma was expected to be associated with greater dementia-related anxiety. Middle-aged and older adults (N = 183, aged 40-80, M = 59.57) responded to online questionnaires about anticipated ADRD stigma, ADRD exposure, dementia-related anxiety, and potential psychosocial correlates of dementia-related anxiety. Multivariate regression analyses revealed that self-perceived ADRD risk, ADRD exposure, and anticipated stigma remained significantly associated with dementia-related anxiety, after controlling for demographic variables. Reducing ADRD stigma may ease dementia-related anxiety, an area for future research.

Terror Management Theory and the COVID-19 Pandemic

Terror management theory is focused on the role that awareness of death plays in diverse aspects of life. Here, we discuss the theory's implications for understanding the widely varying ways in which people have responded to the COVID-19 pandemic. We argue that regardless of whether one consciously believes that the virus is a major threat to life or only a minor inconvenience, fear of death plays an important role in driving one's attitudes and behavior related to the virus. We focus on the terror management theory distinction between proximal defenses, which are activated when thoughts of death are in current focal attention and are logically related to the threat at hand, and distal defenses, which are activated when thoughts of death are on the fringes of one's consciousness and entail the pursuit of meaning, personal value, and close relationships. We use this framework to discuss the many ways in which COVID-19 undermines psychological equanimity, the diverse ways people have responded to this threat, and the role of ineffective terror management in psychological distress and disorder that may emerge in response to the virus.

Isotope-specific reactions of acetonitrile (CH3CN) with trapped, translationally cold CCl. J Chem Phys 2021;154:074305. [PMID: 33607907 DOI: 10.1063/5.0038113]

The gas-phase reaction of CCl⁺ with acetonitrile (CH₃CN) is studied using a linear Paul ion trap coupled to a time-of-flight mass spectrometer. This work builds on a previous study of the reaction of CCl⁺ with acetylene [K. J. Catani et al., J. Chem. Phys. 152, 234310 (2020)] and further explores the reactivity of CCl⁺ with organic neutral molecules. Both of the reactant species are relevant in observations and models of chemistry in the interstellar medium. Nitriles, in particular, are noted for their relevance in prebiotic chemistry and are found in the atmosphere of Titan, one of Saturn's moons. This work represents one of the first studied reactions of a halogenated carbocation with a nitrile and the first exploration of CCl⁺ with a nitrile. Reactant isotopologues are used to unambiguously assign ionic primary products from this reaction: HNCCl⁺ and C₂H₃ ⁺. Branching ratios are measured, and both primary products are determined to be equally probable. Quantum chemical and statistical reaction rate theory calculations illuminate pertinent information for interpreting the reaction data, including reaction thermodynamics and a potential energy surface for the reaction, as well as rate constants and branching ratios for the observed products. In particular, the reaction products and potential energy surface stimulate questions regarding the strength and role of the nitrile functional group, which can be further explored with more reactions of this class.

Autonomy, Meaning, and the Mediating Role of Symbolic Immortality

The present work built on self-determination theory, terror management theory, and related existential and humanistic perspectives to test the mediating role of symbolic immortality in the association between autonomy and meaning in life. In two samples (Sample 1, n = 1,414; Sample 2, n = 882), autonomy was significantly associated with symbolic immortality, which in turn was significantly associated with meaning in life. Moreover, in both samples, multiple regression analyses supported the view that autonomy is a unique and significant predictor of symbolic immortality, and the proposed indirect effect remained significant after controlling for self-esteem. These results extend prior work addressing autonomy and meaning in life and point to interesting empirical directions for further understanding the existential role of autonomy in managing death-related concerns.

Will Life Extension Affect Our Social Judgments? Evidence That the Possibility of Indefinite Life Extension Increases Harshness Toward Social Transgressors

We tested the hypothesis that if indefinite life extension (ILE) through medical technologies were to become a reality, then people may become harsher in their judgment of social transgressors. In support of this hypothesis, we found that higher positive attitudes towards ILE technologies related to harshness in judgment of social transgressions (Study 1), and that making ILE plausible (compared to not plausible) led participants to endorse harsher punishments for social transgressors (Studies 2-3). We replicated this effect and found that it is not amplified by subliminal death primes, although the primes also increased harshness (Study 3). These results may have implications to understanding how social judgment may be affected by the prospect of ILE.

Preparation for Future Care Needs in Middle-Aged and Older Adults: What Promotes Feeling of Preparedness?

OBJECTIVE

To examine whether demographic, dementia-related, and control-related variables predict preparation for future care needs (PFCN) in a sample of middle-aged and older adults. PFCN is defined in this study as a self-perceived sense of preparedness for one's own future care needs, including general awareness of future care needs, gathering relevant information, decision-making about care preferences, concrete planning, and non-avoidance of care planning.

METHODS

Participants (N = 122; age 40 to 88 years: M = 65.83, SD = 9.80) completed self-report measures in an in-person study. Hierarchical multiple regression was calculated to predict PFCN.

RESULTS

Being female, having more positive dementia attitudes, higher attribution to powerful others for health condition(s), and more completed end-of-life (EOL) planning significantly predicted greater PFCN.

CONCLUSION

Findings indicate a positive relationship between objective (completed EOL planning items) and subjective (PFCN) components of planning, thus highlighting the importance of taking concrete steps in EOL planning to yield greater feelings of preparedness, which has been associated with positive psychological outcomes.

EXISTENTIAL ISOLATION, LONELINESS, DEPRESSION, AND SUICIDE IDEATION IN YOUNG ADULTS

Introduction: The relationships between loneliness, depression, and suicide ideation have been well established in the literature. Yet almost no research has examined how feelings of existential isolation (EI; Yalom, 1980), a form of interpersonal isolation conceptually similar, but distinct from loneliness, relates to depressive symptomology or suicide ideation.

Method: Four independent samples of undergraduates completed measures of loneliness, depression (which included a suicide ideation item), and EI.

Results: We find EI and loneliness both independently predict depression and suicide ideation, as well as interact to predict greater depression, such that those who are both existentially isolated and lonely report the greatest depression. Moreover, those with both high loneliness and high EI report an average depression that qualifies them for mild clinical depression according to established clinical cutoffs.

Discussion: Our findings suggest EI and loneliness may be independent antecedents for depression. Implications for interventions are discussed.

Loss and lastingness? Further exploring the relationship between the death of a close other, belief in an everlasting soul, and terror management processes

This research explored the relationship between the death of a close other (DOCO) and terror management processes. In Study 1 (n = 810), university students who experienced DOCO (vs. not) reported higher university and American identification; greater self-esteem and meaning in life; lower death-thought accessibility; greater "death-as-passage" representations; and higher belief in an everlasting soul. We pre-registered Study 2 (n = 497) as an attempt to replicate these findings; although the patterns of means were consistent with Study 1, the tests did not reach statistical significance. However, analyses on the merged data (N = 1,307) supported the present theoretical analysis.

Editorial Foreword: Applying Existential Social Psychology to Mental Health

Human existence is characterized by some rather unique psychological challenges. Because people can reflect on their lives and place in the world, they are regularly confronted with a variety of existential concerns: death and mortality; the burdens of freedom; uncertainty regarding one's identity; isolation from others; and indeterminate meaning in life. Existential social psychology (Greenberg, Koole, & Pyszczynski, 2004; Vail & Routledge, 2020) investigates whether and how such existential concerns shape everyday life and, as highlighted in the present special issue, how such processes impact mental health and social functioning.

Current practice patterns for initial umbilical hernia repair in the United States

PURPOSE

The approach to repairing an initial umbilical hernia (IUH) varies substantially, and this likely depends on hernia size, patient age, sex, BMI, comorbidities including diabetes mellitus, and surgeon preference. Of these, only hernia size has been widely studied. This cross-sectional study aims to look at the practice pattern of umbilical hernia repair in the United States.

METHODS

A retrospective study was performed using data from the America Hernia Society Quality Collaborative. Patient characteristics included age, sex, hernia width, BMI, smoking status, and diabetes. Outcomes were use of mesh for repair, as well as surgical approach (open vs minimally invasive). Multivariate logistic regression was performed to assess the independent effect of age, sex, hernia width, BMI, smoking status, and diabetes on use of mesh and approach to repair.

RESULTS

3475 patients were included. 74% were men. Mesh use was more common in men (67% vs 60%, P < 0.001). Mesh was used in 33% of repairs ≤ 1 cm, and 82% of repairs > 1 cm (P < 0.001). Younger patients were less likely to receive a mesh repair (54% if age ≤ 35 vs 67% for age > 35, P < 0.001). However, on multivariate analysis, mesh use was associated with increasing hernia width (OR 5.474, 95% CI 4.7-6.3) as well as BMI (OR 1.8, 95% CI 1.5-2.1) but not with age or sex.

CONCLUSION

The majority of IUH are performed open. Patient BMI and hernia defect size contribute to choice of surgical technique including use of mesh. The use of mesh in 33% of hernias below 1 cm demonstrates a gap between evidence and practice. Patient factors including patient age and sex had no impact on operative approach or use of mesh.

Isomer-selected ion–molecule reactions of acetylene cations with propyne and allene

A combined experimental and quantum chemistry study between sympathetically cooled acetylene cations and propyne or allene explains the dramatically different reaction mechanisms.

Women Want the Heavens, Men Want the Earth

Abstract. Efforts are being made in the field of medicine to promote the possibility of indefinite life extension (ILE). Past research on attitudes toward ILE technologies showed that women and more religious individuals usually have more negative attitudes toward ILE. The purpose of this research was to investigate whether gender differences in attitude toward indefinite life extension technologies could be explained by religiosity, afterlife beliefs, and general attitudes toward science. In four studies ( N = 5,000), undergraduate participants completed self-report questionnaires measuring their support for life extension as well as religiosity, afterlife beliefs, and attitude toward science (in Study 3). In all studies, men supported ILE more than women, whereas women reported greater belief in an afterlife. The relationship between gender and attitude toward ILE was only partially mediated by religiosity (Studies 2–4) and by attitudes toward science (Study 3).

Evaluation of an automated process for disclosure of negative noninvasive prenatal test results

We designed and implemented a novel automated negative non-invasive prenatal test (NIPT) result disclosure process using a proprietary, HIPAA-compliant web-based portal. High-risk pregnant patients who opted for NIPT from 04/2017 to 12/2018 were given the option to receive their negative result through the automated process. Patients were required to watch a brief educational video and answer evaluative questions before downloading their result. After completing the process, patients completed a survey regarding their opinion of the efficiency and convenience of the process and their satisfaction. A total of 10,170 women registered online during the study period, and 8,965 completed the automated process (88%). Out of 8,965 women, 2,121 women responded to the survey (24%). Most (2,030 of 2,101) strongly agreed/agreed that they could easily navigate the patient portal (97%); 1,852 of 1,966 strongly agreed/agreed that disclosure was efficient and convenient (94%); 1,852 of 1,960 strongly agreed/agreed that they felt informed after watching a short educational video (94%); and 1,903 of 1,967 strongly agreed/agreed that they preferred downloading results rather than waiting for their next doctor's appointment (97%). This study demonstrates high patient satisfaction with this automated and scalable solution in a high-volume health system. As the utilization of genetic testing increases, we predict greater need for innovative healthcare delivery models.

An ion trap time-of-flight mass spectrometer with high mass resolution for cold trapped ion experiments

Trapping molecular ions that have been sympathetically cooled with laser-cooled atomic ions is a useful platform for exploring cold ion chemistry. We designed and characterized a new experimental apparatus for probing chemical reaction dynamics between molecular cations and neutral radicals at temperatures below 1 K. The ions are trapped in a linear quadrupole radio-frequency trap and sympathetically cooled by co-trapped, laser-cooled, atomic ions. The ion trap is coupled to a time-of-flight mass spectrometer to readily identify product ion species and to accurately determine trapped ion numbers. We discuss, and present in detail, the design of this ion trap time-of-flight mass spectrometer and the electronics required for driving the trap and mass spectrometer. Furthermore, we measure the performance of this system, which yields mass resolutions of m/Δm ≥ 1100 over a wide mass range, and discuss its relevance for future measurements in chemical reaction kinetics and dynamics.

Searching for God: Illness-Related Mortality Threats and Religious Search Volume in Google in 16 Nations

We tested predictions about religiosity and terror management processes in 16 nations. Specifically, we examined weekly variation in Google search volume in each nation for 12 years (all weeks for which data were available). In all 16 nations, higher than usual weekly Google search volume for life-threatening illnesses (cancer, diabetes, and hypertension) predicted increases in search volume for religious content (e.g., God, Jesus, prayer) in the following week. This effect held up after controlling for (a) recent past and annual variation in religious search volume, (b) increases in search volume associated with religious holidays, and (c) variation in searches for a non-life-threatening illness ("sore throat"). Terror management threat reduction processes appear to occur across the globe. Furthermore, they may occur over much longer periods than those studied in the laboratory. Managing fears of death via religious belief regulation appears to be culturally pervasive.

The Evil Animal: A Terror Management Theory Perspective on the Human Tendency to Kill Animals

This research tested whether support for the killing of animals serves a terror management function. In five studies, death primes caused participants to support the killing of animals more than control primes, unless the participants' self-esteem had been elevated (Study 4). This effect was not moderated by gender, preexisting attitudes toward killing animals or animal rights, perceived human-animal similarity, religiosity, political orientation, or by the degree to which the killing was justified. Support for killing animals after subliminal death primes was also associated with an increased sense of power and invulnerability (Study 5). Implications and future directions are discussed.

Age Differences in the Effects of Mortality Salience on the Correspondence Bias

According to terror management theory, awareness of death affects diverse aspects of human thought and behavior. Studies have shown that older and younger adults differ in how they respond to reminders of their mortality. The present study investigated one hypothesized explanation for these findings: Age-related differences in the tendency to make correspondent inferences. The correspondence bias was assessed in younger and older samples after death-related, negative, or neutral primes. Younger adults displayed increased correspondent inferences following mortality primes, whereas older adults' inferences were not affected by the reminder of death. As in prior research, age differences were evident in control conditions; however, age differences were eliminated in the death condition. Results support the existence of age-related differences in responses to mortality, with only younger adults displaying increased reliance on simplistic information structuring after a death reminder.