Empirically tested interventions for death anxiety among older americans: a systematic review.

Background: Death anxiety is one of the concerns of the elderly population in the late stages of life. In this context, recalling memories is one of the favorite characteristics of these people that can affect different aspects of their mental and social health. Objectives: This study aimed to determine the effect of reminiscence therapy on the death anxiety of men retried from the Islamic Republic of Iran Army living in Zahedan. Methods: A quasi-experimental study was performed on 90 retired men over 60 years of age. The subjects were recruited through convenience sampling at the Army Retirement Center in Zahedan in winter 2019. The participants were randomly divided into the intervention (n = 45) and control (n = 45) groups. In the intervention group, reminiscence therapy was carried out based on major life events twice a week for six sessions. Data were gathered again two months after the intervention. The control group did not take part in any program. Data collection tools included a demographic form and the Death Anxiety scale (Templer, 1970). The results were analyzed by SPSS-21 using descriptive and inferential statistics. The P values < 0.05 were considered statistically significant. Results: The mean scores of death anxiety were 25.37 ± 1.89 and 25.17 ± 1.61 in the intervention and control groups, respectively. After the experiment, this score was 9.09 ± 1.79 in the intervention group and 25.04 ± 1.62 in the control group. Thus, while reminiscence therapy significantly relieved death anxiety in the intervention group (P < 0.0001), the control group showed no significant difference in this respect at the end of the study (P = 0.63). Conclusions: Group reminiscence therapy can reduce the death anxiety of older adults. Since the elderly are fond of expressing their memories, and such storytelling is an attractive, simple, and inexpensive intervention, it could be used to help these people mitigate their death anxiety.

Objective: Researchers have identified death anxiety (DA) as a crucial factor in the onset and persistence of psychopathology, affecting both physical and mental health, and often leading to a diminished quality of life. Despite the well-established link between DA and various forms of psychopathological conditions, therapeutic interventions targeting DA, particularly in clinical samples, are limited. DA is observed across diverse populations, including university students, physicians, and mothers over the age of 18, and is not limited to aging or physiological illness. While it peaks in young to middle adulthood and declines in older age, it remains a critical concern in clinical settings, underscoring the importance of addressing DA beyond its traditional association with aging or disease. Despite the growing interest in the topic, the existing literature on DA remains limited, particularly in clinical samples. Given the link between DA and psychopathology, identifying effective psychological interventions for reducing DA in clinical samples is crucial. Yet, most studies in these populations remain descriptive, with limited interventional research. Systematic reviews can bridge this gap by synthesizing evidence to inform more effective therapies. None of the studies reviewed psychological protocol guidelines or interventions for DA within clinical populations. To address this gap, the present study aims to systematically review psychological protocols and interventions designed to alleviate DA in clinical settings conducted between January 2000 and January 2023. Methods: Following PRISMA guidelines, a search was conducted across PsycArticles, PubMed, Web of Science, ScienceDirect, and Scopus, utilizing the keywords “death, " “death anxiety, " “death phobia, " “fear of death, " “thanatophobia, " “intervention, " “treatment, "and “therapy." Results: Out of 3918 studies, 890 duplicates were excluded using Rayyan. Then, two independent examiners reviewed the full text of the remaining studies, and disagreements were resolved by consensus. Eight studies were identified through consensus. Conclusion: Intervention studies in clinical settings are notably scarce and often hindered by several limitations. Key limitations include insufficient sample sizes, lack of follow-up assessments, and limited reporting on intervention effects for pre-existing psychopathology. Additionally, there is a scarcity of specifically developed DA-focused interventions, challenges in balancing online applications with therapeutic alliance, and inadequate consideration of cultural beliefs, such as afterlife perspectives. Advancing the field requires the development of innovative protocols that incorporate concepts related to the afterlife into interventions aimed at reducing DA. Future research could prioritize exploring the complex interplay between religious beliefs, particularly those concerning the afterlife, coping strategies, and psychological outcomes among individuals facing significant stressors.

200 male and 277 female undergraduates at the University of Kuwait completed the Templer's Death Anxiety Scale and Spielberger, et al.'s State-Trait Anxiety Inventory for which retest reliabilities were adequate. Women had higher mean scores than men on death and trait anxiety but they were similar in state anxiety. The mean death anxiety score for Kuwaitians was very close to that of Egyptians. There was similarity in death anxiety between Kuwaitian and United States men, but not women. Significant differences appeared on trait anxiety, showing the order from low to high mean scores: United States, Kuwaitian, and Egyptian university students. Correlations among the scales were significant; however, the correlation between state and trait anxiety was higher than that between death anxiety and both state and trait anxiety for men and women. Death anxiety was associated more closely with trait than with state anxiety.

BackgroundDeath anxiety in physicians is considered to be a possible factor affecting the quality of palliative care. As the reserve force of future medical careers, the level of death anxiety among clinical medical freshmen and its impact mechanism deserves attention. Previous studies have indicated that personality traits and self-efficacy may be factors influencing death anxiety. However, there is limited research on the current state of death anxiety among clinical medical freshmen, and the impact of health personality, death coping self-efficacy on death anxiety. The objectives of this study were to investigate the death anxiety levels of clinical medical freshmen, explore whether death anxiety is affected by health personality and death coping self-efficacy, and examine whether death coping self-efficacy mediates the association between health personality and death anxiety among clinical freshmen.MethodsA cross-sectional survey among 378 clinical medical freshmen was conducted at a university in Wuhan, Hubei Province, China between June and July 2023. Demographic questionnaire, the Chinese versions of the Health Personality Assessment (HPA), Death Coping Self-efficacy Scale (DCSS) and Death Anxiety Scale (DCS) were used. SPSS 25.0 statistical software was used for descriptive analysis, independent sample t-tests, one-way ANOVA, and Pearson correlation analysis. The mediating effect analysis was performed with PROCESS version 4.1 Model.ResultsA total of 360 valid questionnaires were collected. Clinical medical freshmen exhibited high levels of death anxiety was (45.55 ± 7.57). Health neuroticism has a significant positive impact on death anxiety (β = 0.407, t = 2.323, P < 0.05). In contrast, death anxiety was significantly impacted negatively by death coping self-efficacy (β=-0.105, t=-3.441, P < 0.05). The association between health neuroticism and death anxiety was partially mediated by death coping self-efficacy; the mediating impact accounted for 18.44% of the total effect, with a 0.092 coefficient.ConclusionsThis study revealed that clinical medical freshmen had high levels of death anxiety. Health neuroticism and death coping self-efficacy directly affected clinical medical freshmen’ death anxiety. Death coping self-efficacy mediated the relationship between health neuroticism and death anxiety among clinical medical freshmen. Interventions by medical educators that focus on both individuals’ health personality and death coping self-efficacy may be most effective in reducing death anxiety among clinical medical freshmen.

Introduction: Death anxiety and low self-esteem are major problems in patients with Multiple Sclerosis (MS). Spiritual interventions, along with other nursing interventions, can restore the balance between body and soul. Objective: This study aimed to determine the effect of the spiritual care program on death anxiety and self-esteem in MS patients. Materials and Methods: In this clinical trial, 60 patients with MS were randomly assigned into the intervention (n=30) and control (n=30) groups. The intervention group received spiritual care program in four sessions. Templer death anxiety and Rosenberg self-esteem scale were completed by samples before and after the intervention. Data analysis was performed using the independent t test, Chi-square, and Fisher exact tests. The significance level is considered less than 0.05. Results: The Mean±SD ages of the intervention and control group samples were 32.8±6.39 and 35.1±8.35 years, respectively. The Mean±SD scores of death anxiety in the control group 12.27±0.85 and the intervention group 11.8±0.88 before the intervention were not significantly different. After the intervention, the difference between the Mean±SD scores of the control group 12.10±0.61 and the interventional group 8.13±0.71 was statistically significant (P=0.001). The Mean±SD scores of self-esteem in the control group 14.63±1.51 and the interventional group 15.5±1.5 before the intervention were not significantly different. The difference between the Mean±SD scores of self-esteem in the control group 14.67±1.9 and the interventional group 18.03±1.85 was significant after the intervention (P=0.001). The results of ANCOVA demonstrated a significant difference between the control and intervention groups in terms of death anxiety (F=6.41, P=0.014, partial Eta2=0.101) and self-esteem (F=13.079, P=0.001, partial Eta2=0.187) of MS patients. Conclusion: Since spiritual care intervention in patients with MS reduced their death anxiety and increased their self-esteem, this simple and low-cost care program can be recommended for those suffering from this disease.

Background: Cancer is one of the most important health problems, which cause anxiety. Owing to physical and psychological problems it may lead to thinking about impending death. Logotherapy is the most powerful method to treat problems that exist in nature.Objectives: This study aimed to determine the effect of group logotherapy on spirituality and death anxiety in patients with cancer.Methods: This randomized clinical trial study was done on patients with cancer referred to Imam Khomeini Hospital in Sari in 2017. Sixty-four eligible patients were selected from the oncology clinic using convenience sampling method. Patients were randomly allocated to the control and intervention groups (n = 32). Group logotherapy was done for the intervention group for five weeks. Data was gathered through a questionnaire, including demographic, Templer Death Anxiety Scale (DAS), and Spirituality Questionnaire (SQ) one week before and one week after the intervention. Data were analyzed in SPSS V.16 software using independent t-test, Wilcoxon, and Mann-Whitney U test. The significant level was considered 0.05.Results: There were no significant differences in death anxiety and spirituality scores between the two groups at baseline, indicating that the two groups were matched in terms of death anxiety and spirituality. Before the logotherapy, the mean score of death anxiety in both groups was high (more than 8). After the logotherapy, the mean and SD of death anxiety score in the intervention and control groups were 7.14 +/- 4.12 and 9.76 +/- 2.64, respectively, there were statistically significant differences in death anxiety scores between the groups (P &lt; 0.05). There were statistically significant differences between the mean of spirituality score in the intervention group before and after the logotherapy (P &lt; 0.05), but it was not significant in the control group, indicating that group logotherapy was effective in increasing the spirituality score.Conclusions: Based on the findings, group logotherapy can increase the spirituality score of the patients. Moreover, the logotherapy may result in decreasing death anxiety, and spirituality-oriented meetings may be beneficial for patients.

BackgroundDeath anxiety is fast becoming recognised as a transdiagnostic construct across myriad mental health conditions. Though existing clinical treatments of death anxiety, such as Cognitive Behaviour Therapy type interventions, have been shown to be effective, Terror Management Theory (TMT) proposes self-esteem as a protective factor against death anxiety by endowing individuals with a feeling of significance in life and helping them to process the nature of death and its inevitability. Despite the centrality of self-esteem to TMT, however, extant research examining its relationship with death anxiety has yet to be synthesised. The current study aims to systematically review peer-reviewed, quantitative research examining the association between death anxiety and self-esteem and, where possible, to test the strength of these associations through meta-analysis.MethodA systematic search of quantitative and mixed-methods studies will be conducted across six databases: MEDLINE; PsycINFO; PubMed; Web of Science; CINAHL and; EMBASE. Google Scholar will also be searched and the first 200 records by relevance will be screened for eligibility. Searches will be conducted by TC, and records will be screened by TC, SK, CF, RH and KB, so that each record is screened for eligibility by at least two authors. Data extraction and quality assessment, using the Joanna Briggs Inventory Risk of Bias tools, will be performed by TC, SK, CF, RH and KB, so that each record is assessed by at least two authors, with doubts and discrepancies being resolved through discussion with AS and MM. A narrative synthesis of relevant data will be presented and, where sufficient data are available, meta-analysis will be conducted using the MAJOR extension for Jamovi to establish an overall effect size for the association between death anxiety and self-esteem. Should sufficient data be available, demographic factors, such as gender and age, and clinical population status (clinical vs. non-clinical population) will be examined as moderators of the effect. This protocol was developed in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and has been registered in PROSPERO (CRD42024591775).DiscussionThe current review will systematically examine the relationship between death anxiety and self-esteem. Should sufficient data be available, an overall effect size of the relationship will be generated. By better understanding how death anxiety is related to self-esteem, and by establishing the size and significance of the relationship will aid firstly in systematically validating TMT and, secondly, identify whether self-esteem may be targeted in future death anxiety interventions to reduce death anxiety and improve individuals’ overall mental health.

Death anxietyis the "feeling of dread, apprehension or solicitude (anxiety) when one thinks of the process of dying, or ceasing to ‘be’." (1)IntroductionRecognition of death anxiety is important in hospice...

This review explored associations between death anxiety and a range of psychosocial outcomes, such as fear of cancer recurrence (FCR), depression, anxiety, and quality of life, in people living with or beyond cancer. We also investigated culture (individualistic versus collectivist) as a moderator of the relationship between death anxiety and psychosocial outcomes. We included studies that measured death anxiety and one or more psychosocial outcomes in people with a history of cancer. Forty-one studies were included and meta-analysed to identify the strength of relationships between death anxiety and psychosocial outcomes. Cultural orientation was investigated as a moderator of these relationships. The quality of included studies was appraised. Death anxiety was strongly associated with all psychosocial outcomes, including increased FCR, depression, anxiety, and poorer quality of life, self-esteem, and sense of meaning. Younger people and those currently in active treatment had higher levels of death anxiety. The relationship between death anxiety and depression was stronger in collectivist than individualistic cultures. Collectivist versus individualistic cultures differed in their death anxiety depending on the outcome measure used. Death anxiety is an important construct for people living with or beyond cancer, and this review confirms that different cultures may be concerned about different aspects of death, which warrants further empirical research. These findings highlight the importance of providing targeted and culturally sensitive psychological interventions for death anxiety in those living beyond cancer.

The COVID-19 pandemic has placed nurses on the front lines, facing challenging conditions and increased stress levels. The aim of this study was to examine the effect of positive thinking skills training on nurses' optimism and death anxiety while caring for COVID-19 patients. In a quasi-experimental, two-group, pre- and post-test study, a total of 52 eligible nurses working at Amir al-Momenin Hospital in Zabol, Iran, between October and December 2022, were divided into intervention and control groups. The intervention group received positive thinking skills training via email or WhatsApp, with eight, 60-minutes sessions over two months. Data were collected using a demographic questionnaire, the Templer Death Anxiety Scale (DAS), and the Scheier and Carver Life Orientation Test, both before and one month after the intervention. There were no significant differences in optimism and death anxiety scores between the two groups before the intervention. However, the intervention group showed a statistically significant increase in optimism (from 13.11±3.78 to 19.03±2.58) and decrease in death anxiety (from 55.15±7.06 to 41.76±4.48) after the intervention (P <0.001). Considering the stressful nature of COVID-19 disease, positive thinking skills training can be recommended as an effective method to reduce death anxiety and improve nurses' optimism, thus enhancing their willingness to continue caring for patients.

This study evaluated the preliminary effect of laughter therapy on the level of loneliness and death anxiety of older adults. This was a quasi-experimental study with a nonequivalent control group pretest-posttest design. The study participants were older adults living in two nursing homes set up by foundations located in the capital of Turkey. A total of 50 older adults formed the intervention group (n=20) and control group (n=30). The intervention group received laughter therapy twice a week for 5weeks. The control group received no intervention. Data were collected using a socio-demographic form, the De Jong Gierveld Loneliness Scale (DJGLS) and the Turkish Death Anxiety Scale (TDAS). After laughter therapy, the DJGLS total and subscale (emotional and social loneliness) scores decreased among older adults in the intervention group (p<0.005). While there were no significant differences for overall TDAS, death uncertainty and pain subscales scores between the intervention and control group after laughter therapy, there was a significant decrease in TDAS exposure subscale scores of the intervention group (p<0.005). The results suggest that laughter therapy can be used to decrease levels of loneliness and death anxiety among older adults living in nursing homes. Anxiety regarding death and loneliness are important issues that affect quality of life in older adults. This first pilot study demonstrates the beneficial effects of laughter therapy on loneliness and death anxiety in nursing home residents. Nurses can incorporate laughter therapy into routine programmes in nursing homes.

This study investigated death anxiety in patients with primary brain tumor (PBT). We examined the psychometric properties of two validated death anxiety measures and determined the prevalence and possible determinants of death anxiety in this often-overlooked population. Two cross-sectional studies in neuro-oncology were conducted. In Study 1, 81 patients with PBT completed psychological questionnaires, including the Templer Death Anxiety Scale (DAS). In Study 2, 109 patients with PBT completed similar questionnaires, including the Death and Dying Distress Scale (DADDS). Medical and disease-specific variables were collected across participants in both studies. Psychometric properties, including construct validity, internal consistency, and concurrent validity, were investigated. Levels of distress were analyzed using frequencies, and determinants of death anxiety were identified using logistic regression. The DADDS was more psychometrically sound than the DAS in patients with PBT. Overall, 66% of PBT patients endorsed at least one symptom of distress about death and dying, with 48% experiencing moderate-severe death anxiety. Generalized anxiety symptoms and the fear of recurrence significantly predicted death anxiety. The DADDS is a more appropriate instrument than the DAS to assess death anxiety in neuro-oncology. The proportion of patients with PBT who experience death anxiety appears to be higher than in other advanced cancer populations. Death anxiety is a highly distressing symptom, especially when coupled with generalized anxiety and fears of disease progression, which appears to be the case in patients with PBT. Our findings call for routine monitoring and the treatment of death anxiety in neuro-oncology.

Background: Coronary artery bypass graft (CABG) is associated with death anxiety and endangers the feeling of well-being. Objectives: This study was designed to examine the impact of foot reflexology massage on well-being and death anxiety in patients undergoing CABG surgery. Methods: This randomized controlled clinical trial was conducted on 66 patients undergoing CABG hospitalized in Fatemeh Zahra Hospital in Sari, Iran, in 2021. The patients were assigned to control (receiving routine care) and intervention (receiving reflexology massage of the foot sole) groups by permuted-block randomization. Massage therapy was conducted after the surgery for half an hour for each foot during 3 sequential days (from the second to the fourth day after surgery) for patients of the intervention group. A sociodemographic and medical information questionnaire, Templer Death Anxiety Scale, Subjective Well-being Scale, and Hospital Anxiety and Depression Scale were completed for the patients. The data were analyzed by descriptive and analytical statistics, including the Mann-Whitney U test, chi-square test, Fisher’s exact test, Friedman’s test, and generalized estimating equations (GEE). Results: The study results revealed a significant difference in the level of death anxiety of the intervention group (before: 52.57 ± 3.97, second day: 50.07 ± 3.38, 4th day: 36.61 ± 5.25) compared to the control group (before: 51.25 ± 3.06, second day: 49.57 ± 3.83, fourth day: 47.71 ± 3.01) (P &lt; 0.001). Additionally, comparing the well-being mean of the group undergoing reflexology massage of the foot sole (before: 52.57 ± 3.97, second day: 50.07 ± 3.38, fourth day: 36.61 ± 5.25) and the control group (before: 52.57 ± 3.97, second day: 50.07 ± 3.38, fourth day: 36.61 ±5 .25) during the 3 days by GEE showed a significant difference between the two groups (P = 0.001). Conclusions: According to the findings, reflexology foot massage reduced death anxiety and increased feeling of well-being. Due to low costs, no complications, and ease of performance, this method is recommended to reduce death anxiety and promote well-being in patients after CABG.

Introduction: Aging is one of the critical stages of human development, characterized by its own specific features and conditions. Among the most common mental health issues in the elderly are death anxiety and sense of coherence. Therefore, the present study aimed to determine the effectiveness of mindfulness training on death anxiety and sense of coherence among elderly women attending daily rehabilitation and educational centers in Gorgan. Methods: This research employed a quasi-experimental design with a control group and a follow-up period. The statistical population consisted of elderly women (aged 70–80) living in elderly care centers in Gorgan in 2024. A purposive sampling method was used, and based on the inclusion and exclusion criteria, a total of 30 participants were randomly selected from two centers and assigned to two equal groups. Data were collected using Antonovsky’s Sense of Coherence Questionnaire and Templer’s Death Anxiety Scale. Only the intervention group received Van Son’s mindfulness training program in eight sessions (each lasting 60 minutes). Data were analyzed using multivariate analysis of covariance (MANCOVA) with SPSS version 26. Results: The results showed that in the intervention group, the mean and standard deviation of sense of coherence scores in the pre-test, post-test, and follow-up phases were 48/46 ± 1/80, 55/86 ± 1/88, and 54/86 ± 1/99, respectively. The mean and standard deviation of death anxiety scores were 10/06 ± 1/57, 5/40 ± 1/40, and 6/20 ± 1/32, respectively. Compared to the control group, these changes were statistically significant (p&lt; 0/001). Conclusion: The findings of this study indicated that mindfulness training is an effective method for increasing the sense of coherence and reducing death anxiety among elderly women.

Objective To explore the status quo of emotional intelligence and death anxiety in oncology nurses and the effects of emotional intelligence on their death anxiety, and to provide reference to reducing death anxiety in oncology nurses. Methods Nurses working in oncology departments of 5 ClassⅢ hospitals in Zhejiang Province were selected by convenient sampling from September to December 2017. Templer's Death Anxiety Scale (T-DAS) and Emotional Intelligence Scale (EIS) were used to evaluate the nurses' death anxiety and emotional intelligence. Univariate analysis, correlation analysis and multivariate analysis were used to explore the relationship between the two. Totally 450 questionnaires were distributed, and 409 valid questionnaires were collected, with an valid collection rate of 90.9%. Results The total score of EIS in the 409 oncology nurses was (97.68±12.54) , and the score of T-DAS totaled (45.16±6.07) . Univariate analysis showed that there was statistically significant difference in total scores of T-DAS between oncology nurses with different sex, age, educational background, title, death education or hospice care training received or not, and end-of-life disposal of patients or family members attended or not (P<0.05) . According to Pearson correlation analysis, emotional intelligence was negatively correlated with death anxiety in oncology nurses (r=-0.337, P<0.01) . Regression analysis showed that the dimensions of emotional perception and emotion management of others in emotional intelligence had negative impact on death anxiety in oncology nurses. Conclusions Nursing managers in oncology departments take targeted interventions and reduce death anxiety in oncology nurses based on the shortcomings in emotional intelligence. Key words: Oncology service, hospital; Nurses; Emotional intelligence; Death anxiety