Death Anxiety in Psychopathology: A Systematic Review

Abstract

Death anxiety has been proposed to be a transdiagnostic construct underlying the development and maintenance of numerous psychopathological conditions. The relationship between death anxiety and mental disorders has been largely studied in specific disorders. On the other hand, it has been suggested that interventions to transdiagnostic components such as death anxiety have the potential to increase therapy efficacy for many psychological disorders. Accordingly, the aim of the study was to identify studies examined relationships between death anxiety and various mental disorders and outline measurement methods for evaluating death anxiety. Of the 933 references identified at Web of Science, Google Scholar, PubMed and APA databases, 17 articles met inclusion criteria. In the studies, the relationship between death anxiety and psychopathology and the measurement tools used to evaluate death anxiety were examined. Studies included in this review have examined the role of death anxiety in various psychological disorders including obsessive-compulsive disorder, health anxiety, social anxiety, depression, schizophrenia, generalized anxiety disorder and panic disorder. Overall, results suggested that there is a clear association between death anxiety and psychopathology, symptom severity, number of psychiatric medications and hospitalizations, depression and anxiety. Furthermore, Templer’s Death Anxiety Scale was most widely used scale for measuring death anxiety. The findings indicate that death anxiety may be an important risk factor in the development or maintaining of many psychological disorders and it is significant to include death anxiety in the treatment of mental disorders in which death anxiety may play a role.

Keywords

• Death anxiety
• fear of death
• psychopathology
• transdiagnostic

Psikopatolojide Ölüm Kaygısı: Sistematik Derleme

Öz

Ölüm kaygısının birçok psikolojik durumun ortaya çıkması ve devam etmesini etkileyen tanılar üstü bir yapı olduğu öne sürülmektedir. Alan yazında ölüm kaygısı ve ruhsal bozukluklar arasındaki ilişki genellikle belirli bir ruhsal bozukluk kapsamında incelenmiştir. Bununla birlikte, ölüm kaygısı gibi tanılar üstü bileşenlere yönelik müdahalelerin birçok psikolojik bozukluk için terapi etkinliğini arttırma potansiyeline sahip olduğu ileri sürülmektedir. Bu derlemenin amacı, ölüm kaygısı ile farklı ruhsal bozukluklar arasındaki ilişkileri inceleyen çalışmaları değerlendirmek ve ölüm kaygısını değerlendirmeye yönelik ölçüm araçlarını tanıtmaktır. Bu amaç doğrultusunda, Web of Science, Google Scholar, PubMed ve APA veritabanları taranmıştır ve seçilen makalelerin referans listeleri ilgili makalelere ulaşmak için gözden geçirilmiştir. Tarama sonucunda belirlenen 933 çalışma içinde 17 makale mevcut derleme çalışmasına dahil edilme kriterlerini karşılamıştır. Çalışmalarda ölüm kaygısı ile psikolojik bozukluk arasındaki ilişki ve ölüm kaygısını değerlendirmeye yönelik kullanılan ölçüm araçları incelenmiştir. Bu derlemeye dahil edilen çalışmaların obsesif-kompulsif bozukluk, sağlık kaygısı, sosyal kaygı, depresyon, şizofreni, yaygın kaygı bozukluğu ve panik bozukluk gibi çeşitli psikolojik bozukluklarda ölüm kaygısının rolünü incelediği görülmüştür. Çalışmalardan elde edilen sonuçlar genel olarak değerlendirildiğinde, farklı ruhsal bozukluklarda yüksek düzeyde ölüm kaygısı ile psikopatoloji, belirti şiddeti, psikiyatrik ilaç kullanımı, hastaneye yatış sayısı, depresyon ve anksiyete arasında olumlu yönde bir ilişki olduğu görülmektedir. Ayrıca, ölüm kaygısını ölçmek için en yaygın kullanılan ölçüm aracının Templer Ölüm Kaygısı Ölçeği olduğu görülmektedir. Elde edilen bulgular, ölüm kaygısının birçok psikolojik bozukluğun gelişimi ya da devam etmesinde önemli bir risk faktörü olabileceğini ve ölüm kaygısının rol oynayabileceği ruhsal sorunların tedavisinde ele alınmasının önemini göstermektedir.

Anahtar Kelimeler

• ölüm kaygısı
• ölüm korkusu
• psikopatoloji
• transdiagnostik

Kaynakça

1. Aan de Stegge BM, Tak LM, Rosmalen JG, Oude Voshaar, RC (2018) Death anxiety and its association with hypochondriasis and medically unexplained symptoms: A systematic review. J Psychosom Res, 115:58-65.
2. Abdel-Khalek AM (2004) The Arabic Scale of Death Anxiety (ASDA): Its development, validation and results in three Arab countries. Death Stud, 28:435-457.
3. Alantar Z, Maner F (2008) Eating disorders in the context of attachment theory. Anadolu Psikiyatri Derg, 9:97-104.
4. Alvarez A, Rodriguez- Gonzalez, L (2016) Death-related Stroop cues increase materialistic choices in decision making. International Psychological Applications Conference and Trends, 30 April-2 May 2016 Lisbon, Portugal. 293–295.
5. Arndt J, Routledge C, Cox C, Goldenberg JL (2005) The worm at the core: A terror management perspective on the roots of psychological dysfunction. Appl Prev Psychol, 11:191–213.
6. Aydoğan AS, Gülseren Ş, Sarıkaya ÖÖ, Özen Ç (2015) Abdel-Khalek Ölüm Anksiyetesi Ölçeği Türkçe formunun üniversite öğrencilerinde geçerlilik ve güvenilirliği. Noro Psikiyatr Ars, 52:371-375.
7. Barlow DH, Allen LB, Choate ML (2004) Toward a unified treatment for emotional disorders. Behav Ther, 35:205-230.
8. Breitbart W, Rosenfeld B, Gibson C, Pessin H, Poppito S, Nelson C et al. (2010) Meaning‐centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology, 19:21-28.

9. Chatard A, Pyszczynski T, Arndt, J, Selimbegovic L, Konan PN, Van der Linden M (2012) Extent of trauma exposure and PTSD symptom severity as predictors of anxiety-buffer functioning. Psychol Trauma, 4:47-55.
10. Collett L, Lester D (1969) The fear of death and dying. J Psychol, 72:179-181.
11. Conte HR, Weiner MB, Plutchik R (1982) Measuring death anxiety: conceptual, psychometric, and factor-analytic aspects. J Pers Soc Psychol, 43:775-785.
12. Craske MG, Kircanski K, Epstein A, Wittchen H, Pine R, Hinton D (2010) Panic disorder: a review of DSM-IV panic disorder and proposals for DSM-V. Depress Anxiety, 27:93-112
13. Dozois DJA, Seeds PM, Collins KA (2009) Transdiagnostic approaches to the prevention of depression and anxiety. J Cogn Psychother, 23:44-59.
14. Dursun P, Alyagut P, Yılmaz I (2022) Meaning in life, psychological hardiness and death anxiety: individuals with or without generalized anxiety disorder (GAD). Curr Psychol, 41:3299-3317.
15. Egan SJ, Wade TD, Shafran R (2011) Perfectionism as a transdiagnostic process: A clinical review. Clin Psychol Rev, 31:203-212.
16. Eshbaugh E, Henninger W (2013) Potential mediators of the relationships between gender and death anxiety. Individ Differ Res, 11:22–30.
17. Finch EC, Iverach L, Menzies RG, Jones M (2016) Terror mismanagement: Evidence that mortality salience exacerbates attentional bias in social anxiety. Cogn Emot, 30:1370–1379.
18. Fleet RP, Beitman BD (1998) Cardiovascular death from panic disorder and panic-like anxiety: A critical review of the literature. J Psychosom Res, 44:71–80.
19. Foa EB, Steketee G, Young MC (1984) Agoraphobia: Phenomenological aspects, associated characteristics, and theoretical considerations. Clin Psychol Rev, 4:431–457.
20. Fortner BV, Neimeyer RA (1999) Death anxiety in older adults: A quantitative review. Death Stud, 23:387-411.
21. Furer P, Walker JR (2008) Death anxiety: A cognitive–behavioral approach. J Cogn Psychother, 22:167–182.
22. Furer P, Walker JR, Chartier MJ, Stein MB (1997) Hypochondriacal concerns and somatization in panic disorder. Depress Anxiety, 6:78–85.
23. Gazarian D, Multach M, Ellison W, Zimmerman D (2016) Does ‘fear of dying’ indicate a more severe presentation of panic disorder? J Anxiey Disord, 40:52-57.
24. Gire J (2014) How death imitates life: Cultural influences on conceptions of death and dying. Online Readings in Psychology and Culture, 6(2):3.
25. Grabler MR, Weyen U, Juckel G, Tegenthoff M, Mavrogiorgou-Juckel P (2018) Death anxiety and depression in amyotrophic lateral sclerosis patients and their primary caregivers. Front Neurol, 9:1035.
26. Hamama-Raz Y, Mahat-Shamir M, Pitcho S, Zaken A, David U, Ben-Ezra M et al. (2016) The link between death anxiety and post-traumatic symptomatology during terror: Direct links and possible moderators. Psychiatry Res, 245:379-386.
27. Harvey A, Murray G, Chandler R, Soehner A (2011) Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms. Clin Psychol Rev, 31:225-235.
28. Havens LL, Ghaemi SN (2005) Existential despair and bipolar disorder: The therapeutic alliance as a mood stabilizer. Am J Psychother, 59:137−147.
29. Hayes SC, Smith S (2005) Get Out of Your Mind and Into Your Life: The New Acceptance and Commitment Therapy, 2nd ed. Oakland, New Harbinger.
30. Heidegger M (1962) Being and Time. New York, Harper.
31. Hoelter JW (1979) Multidimensional treatment of fear of death. J Consult Clin Psychol, 47:996–999.
32. Iverach L, Menzies RG, Menzies RE (2014) Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clin Psychol Rev, 34:580–593.
33. İnci F, Öz F (2012) Palyatif bakım ve ölüm kaygısı. Psikiyatride Güncel Yaklaşımlar, 4:178-187.
34. James A, Wells A (2002) Death beliefs, superstitious beliefs and health anxiety. Br J Clin Psychol, 41:43–53.
35. Kellner R (1986) Somatization and Hypochondriasis. New York, Praeger Publishers.
36. Kesebir P (2014) A quiet ego quiets death anxiety: humility as an existential anxiety buffer. J Pers Soc Psychol, 106:610–623.
37. Keser V (2018) Psikoz: Gerçekliğin öteki yüzü. InPsikoz- Psikanaliz Buluşmaları -1, 2 ed (Ed AG Küey):51-59. İstanbul, Bağlam Yayınları.
38. Klackl J, Jonas E (2019) Effects of mortality salience on physiological arousal. Front Psychol, 10:1893.
39. Kübler-Ross E (2002) On Death and Dying; Questions and Answers on Death and Dying; On Life After Death. New York, Quality Paper Book Club.
40. Krippendorff K, Bock MA (2009) The Content Analysis Reader. Thousand Oaks, CA, Sage Publications.
41. Lehto RH, Stein KF (2009) Death anxiety: An analysis of an evolving concept. Res Theory Nurs Pract. 1:23-41.
42. Le Marne KM, Harris LM (2016) Death anxiety, perfectionism and disordered eating. Behav Change, 33:193-211.
43. Loeser LH, Bry T (1960) The role of death fears in the etiology of phobic anxiety as revealed in group psychotherapy, Int J Group Psychother, 10:287-297.
44. Lowe J, Harris LM (2019). A comparison of death anxiety, intolerance of uncertainty and self-esteem as predictors of social anxiety symptoms. Behaviour Change, 36:165–179.
45. Ma-Kellams C, Blascovich J (2012) Enjoying life in the face of death: East–West differences in responses to mortality salience. J Pers Soc Psychol, 103: 773–786.
46. Marks I (1987) Fears, Phobias and Rituals: Panic, Anxiety, and Their Disorders. New York, Oxford University Press.
47. Martz E (2004) Death anxiety as a Predictor of posttraumatıc stress levels among individuals with spinal cord injuries, Death Stud, 28:1-17.
48. Mavrogiorgou P, Haller K, Jucke G (2020) Death anxiety and attitude to death in patients with schizophrenia and depression. Psychiatry Res, 290:113148
49. Maxfield M, John S, Pyszczynski T (2014). A terror management perspective on the role of death-related anxiety in psychological dysfunction. J Humanist Psychol, 42:35-53.
50. McManus F, Shafran R, Cooper Z (2010) What does a transdiagnostic approach have to offer the treatment of anxiety disorders? Br J Clin Psychol, 49:491–505.
51. McEvoy PM, Hyett MP, Shihata S, Price JE, Strachan, L (2019) The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: A meta-analysis. Clin Psychol Rev, 73:101778.
52. Menzies RG, Menzies RE, Iverach L (2015) The role of death fears in obsessive-compulsive disorder. Aust Psychol, 1:6–11.
53. Menzies RE, Dar-Nimrod I (2017) Death anxiety and its relationship with obsessive-compulsive disorder. J Abnorm Psychol, 126:367–377.
54. Menzies RE, Rachel E, Zuccala M, Sharpe L, Dar-Nimrod I. (2018) The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomised controlled trials. J Anxiety Disord, 59:64–73.
55. Menzies RE, Zuccala M, Sharpe L, Dar-Nimrod I (2018) The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomised controlled trials. J Anxiety Disord, 59:64-73.
56. Menzies RG, Sharpe L, Dar-Nimrod I (2019) The relationship between death anxiety and severity of mental illnesses. Br J Clin Psychol, 58:452–467.
57. Menzies RE, Menzies RG (2020) Death anxiety in the time of COVID-19: Theoretical explanations and clinical implications. Cogn Behav Therap, 13:e19.
58. Menzies RE, Zuccala M, Sharpe L, Dar-Nimrod I (2020) Subtypes of obsessive-compulsive disorder and their relationship to death anxiety. J Obsessive Compuls Relat Disord, 27:100572.
59. Miller AK, Lee BL, Henderson CE (2012) Death anxiety in persons with HIV/AIDS: A systematic review and meta-analysis. Death Stud, 36:640-663.
60. Moher D, Liberati MD, Tetzlaff J, Altman DG, the PRISMA Group (2009) Preferred reporting items for systematic reviews and metaanalyses: the PRISMA statement. BMJ, 151:264-269.
61. Nia HS, Lehto RH, Ebadi A, Peyrovi H (2016) Death anxiety among nurses and health care professionals: A review article. Int J Community Based Nurs Midwifery, 4:2-10.
62. Noyes R, Stuart S, Longley SL, Langbehn DR, Happel RL (2002) Hypochondriasis and fear of death. J Nerv Ment Dis, 190:503–509.
63. Oker K, Schmelowszky A, Reinhardt M (2021) Comparison of the relationship between death anxiety and depressive and anxiety symptoms among Norwegian and Turkish female psychology students. J Death Dying, 83:816–830.
64. Öngider N, Eyüboğlu SÖ (2013) Depresyon tanısı almış hastalarda ölüm kaygısının araştırılması. Klinik Psikiyatri Dergisi, 16:34-46.
65. Öztürk Z, Karakuş G, Tamam, L (2011) Yaşlı bireylerde ölüm kaygısı. Anadolu Psikiyatri Derg, 12:37-43
66. Pandya A, Kathuria T (2021) Death anxiety, religiosity and culture: Implications for therapeutic process and future research. Religions, 12:61.
67. Pyszczynski T, Greenberg J, Solomon S (1999) A dual-process model of defense against conscious and unconscious death-related thoughts: An extension of terror management theory. Psychol Rev, 106:835–845.
68. Randall E (2001) Existential therapy of panic disorder: A single system study. Clin Soc Work J, 29:259−267.
69. Russac RJ, Gatliff C, Reece M, Spottswood D (2007) Death anxiety across the adult years: An examination of age and gender effects. Death Stud, 31:549–561.
70. Rycroft P (2005) Touching the heart and soul of therapy: Surviving client suicide. Women Ther, 28:83-94.
71. Saeed F, Bokharey IZ (2016) Gender differences, life satisfaction, its correlate and death anxiety in retirement. J Psychol Clin Psychiatry, 5:00280.
72. Sarıkaya Y (2013) Ölüm kaygısı ölçeği geliştirilmesi: Geçerlik ve güvenirlik çalışması (Yüksek lisans tezi). Tokat, Gaziosmanpaşa Üniversitesi.
73. Schütte K, Vocks S, Waldorf M (2016) Fears, coping styles, and health behaviors: a comparison of patients with hypochondriasis, panic disorder and depression. J Nerv Ment Dis, 204:778–786.
74. Sedei GCA (1995) Death Anxiety, Defensive Styles and Life Satisfaction. Fort Collins, Colorado State University.
75. Soleimani MA, Bahrami N, Allen K, Alimoradi Z (2020) Death anxiety in patients with cancer: A systematic review and meta-analysis. Eur J Oncol Nurs, 48:101803.
76. Solomon S, Greenberg J, Pyszczynski T (1991) A Terror management theory of social behavior: The psychological functions of self-esteem and cultural worldviews. Adv Exp Soc Psychol, 24:93–159.
77. Spilka B, Stout L, Minton B, Sizemore D (1977) Death and personal faith: Apsychometric investigation. J Sci Study Relig, 16:169–178.
78. Strachan E, Schimel J, Arndt J, Williams T, Solomon S, Pyszczynski T. Greenberg J (2007) Terror mismangement: Evidence that mortality salience exacerbates phobic and compulsive behaviors. Pers Soc Psychol Bull, 33:1137−1151.
79. Templer DI (1970) The construction and validation of a death anxiety scale. J Gen Psychol, 82:165–177.
80. Templer DI (1971) Death anxiety as related to depression and health of retired persons. J Gerontol, 26: 521-523.
81. Tolstikova K, Fleming S, Chartier B (2005). Grief, complicated grief, and trauma: The role of the search for meaning, impaired self-reference, and death anxiety. Illn Crises Loss, 13: 293-313.
82. Topuz İ (2013) Ölüm Algısı Ölçeği (ÖAÖ) Türkçe versiyonunun geliştirilmesi: Geçerlik ve güvenirlik çalışması. Değerler Eğitimi Dergisi, 11:279-300.
83. Torres AR, Crepaldi AL (2002) Panic disorder and hypochondriasis: A review. Revista Brasileira de Psiquiatria, 24:144−151.
84. Walter T (2012) Why different countries manage death differently: a comparative analysis of modern urban societies. Br J Sociol, 63:124-145.
85. Wells A, Hackman A (1993) Death Beliefs Questionnaire. Unpublished manuscript, Department of Psychiatry Oxford, Oxford University.
86. Wink P, Scott J (2005) Does religiousness buffer against the fear of death and dying in late adulthood? Findings from a longitudinal study. J Gerontol B Psychol Sci Soc Sci, 60:P207-P214.
87. Wittkowski J (1996) Fragebogeninventar zur mehrdimensionalen Erfassung des Erlebens gegenüber Sterben und Tod (FIMEST) Handanweisung. Göttingen, Hogrefe.
88. Yalom ID (2008) Staring at the Sun: Overcoming the Terror of Death. San Francisco, CA, Jossey-Bass.
89. Yıldız M, Bulut MB (2017) Ölüm kaygısı ile kişilik özellikleri arasındaki ilişkiler. Turkish Studies, 12/13:659-676.
90. Zhang Q, Zheng R, Fu Y, Mu Q, Li J (2021) Mental health consequences during alerting situations and recovering to a new normal of coronavirus epidemic in 2019: a cross-sectional study based on the affected population. BMC Public Health, 21:1499.
91. Zhang J, Peng J, Gao P, Huang H, Cao Y, Zheng L et al. (2019) Relationship between meaning in life and death anxiety in the elderly: self-esteem as a mediator. BMC Geriatrics, 19:308.
92. Zorlu F, Ünübol H (2018) The multidimensional orientation toward dying and death inventory: Validity and reliability in a Turkey sample. Anadolu Psikiyatri Derg, 19:39–46.
93. Zeyrek EY, Lester D (2008) Cronbach alpha reliability and concurrent validity of the Collett-Lester Fear of Death Scale in a Turkish sample. Psychol Rep, 102:706-708.