Investigating the Relationship Between Spiritual Health, Meaning in Life, and Death Attitudes among COVID-19 Patients Discharged from ICUs: A Cross-Sectional Study in Iran.

The COVID-19 pandemic has been shown to affect both physical and mental health. Because of this mental health burden, it is important to pay attention to issues such as the relationship between spiritual health, death attitudes and meaning in life - all issues made more prominent during the pandemic. This study was conducted to determine the correlation between these three factors - spiritual health, meaning in life, and death attitudes, among patients with COVID-19 discharged from the intensive care units of hospitals affiliated with Tehran University of Medical Sciences, Tehran, Iran.This cross-sectional, descriptive-analytical study was conducted between April 2020 and August 2021 with 260 participants. The data collection instruments were a demographic characteristics questionnaire, Polotzin and Ellison's Spiritual Health Questionnaire, The Meaning in Life Questionnaire (MLQ), and Death Attitude Profile-Revised (DAP-R).The correlation between meaning in life, spiritual health, and death attitudes was determined by Spearman's correlation coefficient. The research results showed that there is an inverse and significant correlation between spiritual health and death attitudes (p = 0.01); an inverse, but insignificant correlation between existential health and subscales of death attitudes, except for the subscales of approach acceptance and neutral acceptance (p > 0.05); and an inverse, but insignificant, correlation between spiritual health and death attitudes, (p > 0.05). In addition, there was an inverse and significant correlation between the presence of meaning in life and escape acceptance (p = 0.002); an inverse and significant correlation between the search for meaning in life and neutral acceptance (p = 0.007); and an inverse and significant correlation between the meaning in life and death attitudes (p = 0.04). Besides, the findings showed an inverse but insignificant correlation between all spiritual health subscales and the meaning in life subscales (p > 0.05). Spiritual health has an inverse correlation with death attitudes.Also, there is an inverse correlation between the total score of spiritual health and death attitudes. Regarding the subscales of spiritual health, there is an inverse correlation between existential health and death attitudes subscales, except for approach acceptance and neutral acceptance. Also, the results showed an inverse and significant correlation between meaning in life and death acceptance and avoidance subscales, and there was an inverse and significant correlation between the meaning in life and death attitudes. Finally, the increase in spiritual health reduces patients' risks of thinking about death. The research results double the significance of the role of nurses, especially those dealing with critically ill patients and those who have experienced severe disease conditions.

Death Attitudes Among Middle-Aged and Older Adults in Japan: A Qualitative Study Based on Erikson's Theory of Generativity.

There are few opportunities for ordinary people not familiar with death to think about it, whereas basic research on death attitudes is insufficient. This study thus examined the attitudes toward death among ordinary people through a qualitative analysis using Erikson's theory of generativity. Semi-structured interviews were conducted with 13 middle-aged and older Japanese individuals. The results showed that death attitudes were individualized and consisted of seven components, mainly those related to agency and communion. The change in death attitudes manifested as a change in weight from agency to communion, a change in meaning and perspective, and an orientation toward well-being. In conclusion, the change in death attitudes is to become more generative by balancing agency and communion through the function of narration. This change might be termed "the maturity of death attitudes" because it is oriented toward eudaimonic well-being.

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.

Is Death Taboo for Older Chinese Immigrants?

Much of the scholarly literature sees death as a taboo topic for Chinese. To test this assumption, this study held seven focus groups in the Greater Toronto Area in 2017. It found that the majority of the older Chinese immigrant participants talked about death freely using either the word death or a euphemism. They talked about various issues including medical treatment and end-of-life care, medical assistance in dying, death preparation, and so on. A small number did not talk about death, but it seemed their reluctance was related to anxiety or discomfort or simply reflected a choice of words. The study concludes death as taboo could be a myth, at least for older Chinese immigrants.

Can We Talk About Life Without Taking Death Into Account? Early Childhood Educators' Self-Perceived Ability to Approach the Topic of Death With Children.

The current explorative cross-sectional study evaluated the knowledge, attitudes, and practices of early childhood educators towards death education and their self-perceived comfort to approach the topic of death in the classroom. All data were collected from June to July 2020. One hundred eight (108) early childhood educators participated in the study. The study was promoted through early childhood educators' support groups and social networks. Demographic characteristics, an ad hoc questionnaire, and the Greek version of the Death Attitude Profile-R questionnaire were used to assess the educators' comfort and attitudes. Results showed that participants' self-perceived ability to approach the topic of death in the classroom was affected by gender and personal attitudes towards death (specifically death avoidance and fear of death). Overall, this study emphasized early childhood educators' role in extreme situations which their students may face as death.

Nurses' Attitudes Towards Death and Its Relationship With Anxiety Levels.

This study examined nurses' attitudes towards death, anxiety levels, and socio-demographic characteristics affecting their attitudes towards death. Three hundred and eighty-four nurses participated in the study. A questionnaire form, the Death Attitude Profile-Revised (DAP-R), and the Penn State Worry Questionnaire were applied to the nurses. Nurses' attitudes towards death were positive and their level of fear of death was low. Approach acceptance was high in younger ones; the escape acceptance score was higher in single ones. The neutral acceptance score was higher in those who received training on death. A statistically significant positive correlation was found between nurses' anxiety level and escape acceptance score. There was a statistically significant positive correlation between the length of working years of nurses and the escape acceptance and approach acceptance. Nurses should be prepared for and supported on death with in-service training. It will be useful to provide these training programs to nursing students during their education process.

Examining the Relationship Between Nursing Students' Belief in a Just World and Their Attitudes Towards Death.

The belief in a just world is a mindset that facilitates our ability to cope with life events by fostering a sense of control. Nursing students' beliefs in a just world and their attitudes towards death can influence how they will care for their patients. The intent of this descriptive and cross-sectional study was to examine the relationship between nursing students and their beliefs in a just world and their attitudes towards death. Quantitative data was collected using the Descriptive Characteristics Questionnaire, the Belief in a Just World Scale, and the Attitude towards Death Scale. The sample included 270 participants. It was determined that as nursing students' beliefs in a just world increased, they developed positive attitudes towards death. It is recommended that discussions on the subject should be included in the education curriculum to increase nursing students' beliefs in a just world and their awareness about death.

Fear of Death and Death Acceptance Among Bereaved Adults: Associations With Prolonged Grief.

This study aimed to analyze fear of death and neutral acceptance of death after a significant loss and their associations with prolonged grief. The sample of the study included 239 bereaved participants. Time since the loss ranged from 6 to 72 months. We found that neutral acceptance of death was associated with older age, a natural cause of death, and the ability to find meaning in the death of a close one. Fear of death was negatively associated with the frequency of practicing religion. We found that fear of death but not neutral acceptance was significantly associated with prolonged grief symptoms.

Factors Affecting California College Students' Attitudes Toward Assisted Dying.

This study focuses on college students' experiences and beliefs, which affect attitudes toward assisted dying. Of 324 students, 35% wanted the option of assisted dying for a family member with a life-threatening illness. Results of multiple logistic regression indicate students who favored assisted dying were significantly influenced by having a family member die, experiencing hospitalization, thinking about end-of-life issues, and being comfortable with palliative care. Belief in an afterlife and being a caregiver were negatively associated with assisted dying. Students need to receive training in end-of-life care issues, as increasingly professionals will face such requests.

Personification of Death: What Types of Death Are Personified by Macabre, Gentle Comforter, Gay Deceiver, and Automaton?

Kastenbaum and Aisenberg identified a phenomenon, wherein American subjects personified death in four distinctive figures: Macabre, Gentle Comforter, Gay Deceiver, and Automaton. Until recently, though, researchers did not attempt to answer the question, "What specific aspects of the death experience can be attributed to each of those four personifications?" To answer this question, the current qualitative research asked individuals to envision the causes, places, and contexts of death after imagining each personification of death. The results have revealed that people associated each personification of death with distinct causes, places, and contexts of death: Macabre-murder taking place outside the home, Gentle Comforter-peaceful death by old age at home, Gay Deceiver-death from heart attack, and Automaton-death from cancer in a modern hospital. This article also discusses unanswered questions, limitations, and directions to take its research in the future.

Death Attitudes as Possible Predictors of Death Preparedness across Lifespan among Nonclinical Populations in Nairobi County, Kenya.

CONTEXT: Death is an important part of lifespan development, yet it remains trivialized or feared across many cultures. The perpetuation of death as a taboo subject continues to negatively affect the society. Death anxiety inhibits death preparedness which could affect the quality of dying. The pool of unclaimed assets held by different organizations continues to increase, intestate deaths remain high, and post death conflicts continue to affect many families. AIMS: This study intended to examine death attitudes as possible predictors of death preparedness and explore the rationale for various death attitudes across lifespan in Nairobi, Kenya. METHODS: The study adopted the mixed-methods explanatory sequential research design combining cross-sectional and phenomenological designs. The study targeted young adults, middle-aged adults, and seniors with a sample of 335 participants selected using multistage, stratified, and extreme case sampling designs. Data were collected using the Death Attitude Profile-Revised and interview guides. ANALYSIS: Data were analyzed using univariate and thematic analyses. RESULTS: The findings indicated that negative death attitudes declined with increase in age, whereas positive death attitudes increased with increase in age. Some of the reasons for negative death attitudes included threatening dying process, unfulfilled life goals, fear of hell, unresolved past deaths, and families with young children among others. The reasons for positive death attitude included reuniting with deceased loved ones and peers, meeting the creator, and end to a prolonged miserable life and fulfilled past life. CONCLUSION: This study implies that mental health practitioners need to target younger adults with death education programs to promote death preparedness and quality dying. For the older adults, addressing life regrets, family conflicts, and past unresolved deaths would significantly improve the quality of dying.

Death attitudes and truth disclosure: A survey of family caregivers of elders with terminal cancer in China.

BACKGROUND: Although family caregivers play an important role in end-of-life care decisions, few studies have examined the communication between family caregivers and patients at the end of life. OBJECTIVE: The objective was to describe family caregivers' attitudes toward death, hospice, and truth disclosure. RESEARCH DESIGN: A quantitative method was used, and a closed-ended survey of 140 family caregivers was conducted in China. The subjects included 140 primary family caregivers of elders with terminal cancer enrolled at a hospice center from April to August 2017. PARTICIPANTS: 140 primary family caregivers of elders with terminal cancer participated the study. RESEARCH CONTEXT: A high proportion of cancer patients continue to receive inadequate information about their illness. Family caregivers' inhibitions about disclosing information to cancer patients have not yet been the objects of research in China. ETHICAL CONSIDERATIONS: This study was reported to and approved by the Regional Ethics Committee in Shenzhen, China. FINDINGS: A questionnaire survey collected information on family caregivers' background information, emotional state, personal needs, death attitudes, and truth-disclosure opinions. The results revealed that family caregivers' death attitudes and truth-disclosure opinions played an important role in the process of caring for elders with terminal cancer. DISCUSSION: By adopting a quantitative method, the author revealed not only the general patterns of family caregivers' attitudes toward cancer diagnosis disclosure but also the reasons for their actions and the practices of family disclosure. CONCLUSION: The findings suggested that ineffective communication concerning end-of-life issues resulted from family caregivers' lack of discussion and difficulty in hearing the news. Future studies should examine strategies for optimal communication between family caregivers and patients, especially with regard to breaking the bad news. Professional training in breaking bad news is important and is associated with self-reported truth-disclosure practices among family caregivers.

Transforming Students' Attitudes and Anxieties Toward Death and Loss: The Role of Prior Death Experiences.

This study examines the impact of a death and dying course on 39 undergraduate students' attitudes and anxieties about death. Authors outline key aspects of the curriculum used in the course and discuss how the approach lends itself to a transformative learning experience related to death and loss, preparing students who will face clients with a variety of needs in these areas across practice settings. The majority of students ( n = 34) experienced a decrease in death avoidance, fear of death, and overall death anxiety. Students with a history of multiple violent, traumatic, or unexpected deaths ( n = 5) did not experience any significant changes but demonstrated increased scores of death anxiety suggesting that they may be in need of greater support while engaging in death education.

The contribution of a MOOC to community discussions around death and dying.

BACKGROUND: Advances in medicine have helped many to live longer lives and to be able to meet health challenges. However death rates are anticipated to increase given the ageing population and chronic disease progression. Being able to talk about death is seen to be important in normalising death as part of life and supporting preparedness for death. Massive Open Online Courses (MOOCs) provide opportunities for the community to engage in collaborative learning. A 5 week MOOC was developed covering four main topics (language and humour, representations of death, medicalisation of dying, and digital dying) aiming: To enable participants to openly and supportively discuss and learn about issues around living, death and dying, To explore the normally unheard opinions and views of Australians around death and dying, and To determine what effect online learning and discussions offered through the MOOC had on participants' feelings and attitudes towards death and dying. METHODS: Data was captured on engagement rates in the various MOOC activities. Death Attitudes were measured by five items representing the MOOC's learning objectives and completed at enrolment and conclusion. MOOC Satisfaction was measured with six items at the end of the MOOC. Descriptive statistics were produced for each variable and Chi-Square Tests of Independence assessed the extent of the relationship between categorical variables. Socio-demographic variables were examined as predictors of the outcome variables of MOOC engagement, MOOC satisfaction, and death attitudes. Ethical approval was received from Flinders University Social and Behavioural Research Ethics Committee (Project No. 7247). RESULTS: One thousand one hundred fifty six people enrolled in the Dying2Learn MOOC with 895 participating in some way. Enrolees were primarily female (92.1%). Age ranged from 16 to 84 (mean = 49.5, SD = 12.3). MOOC satisfaction scores were high. Responses to the experience of participating in the MOOC were very positive, with mean scores ranging from 4.3 to 4.6 (aligning with agreement and strong agreement to statements on the value of participating). Death Attitudes were positive at commencement but increased significantly following participation. CONCLUSIONS: The Dying2Learn MOOC provided an environment that enabled open and supportive discussion around death and dying and influenced attitudinal change.

Death Attitudes Among Middle-Aged Koreans: Role of End-of-Life Care Planning and Death Experiences.

The purpose of this study was to examine factors affecting death attitudes among middle-aged Koreans. In addition, the study explored the interaction effect between knowledge about end-of-life care planning and the experience of death of family or friends on death attitudes. The sample was obtained from a national survey with middle-aged adults in South Korea ( n = 2,026). Multivariate regression analysis revealed significant main effects and an interaction effect between knowledge about end-of-life care planning and the experience of death on death attitudes. Greater knowledge of end-of-life care planning was associated with more positive attitudes toward death; however, the effect was stronger for those who had not experienced the death of family or friends. Being older and having greater life satisfaction were also associated with more positive attitudes toward death. This study suggests that end-of-life education can help middle-aged adults embrace the final stage of life and prepare for their own death.

The Relation Between Death Attitude and Distress: Tolerance, Aggression, and Anger.

The aim of this research was to determine the relation between death attitude and distress tolerance and aggression and anger. For this, 135 subjects among 7,535 professional and specialist members of the Iran National Library were selected using convenience sampling method. They replied to Death Attitudes Profile-Revised, distress tolerance questionnaire, and aggression questionnaire. The results showed that the attitudes of approach acceptance, neutral acceptance, and escape acceptance had positive relation to distress tolerance and negative relation to aggression and anger while the attitudes of fear of death and death avoidance had negative relation to distress tolerance and positive relation to aggression and anger. Furthermore, all death attitudes predicted distress tolerance. But only the attitudes of approach acceptance, escape acceptance, fear of death, and death avoidance predicted aggression, and only approach acceptance, neutral acceptance, fear of death, and death avoidance predicted anger.

A Review on Time Perception of Death Row Inmates' Denials in Their Last Statements in the Context of Forensic Linguistics: The Sample of Texas Huntsville Unit.

This study aims to find out the time perception used in the denials in the last statements of 70 death row inmates, who were executed in Texas Huntsville Unit between 1982 and 2016. To accomplish this, the tenses in their last statements were specified, and their distribution was demonstrated on a horizontal timeline. Document analysis, which is one of the qualitative research methods, was utilized as the data collection tool of the study. The main data obtained from the results of the study suggest that the following 429 death row inmates out of 537 used their right for the last statement; however, 108 of them did not state anything. A total of 70 of the 429 death row inmates denied the crimes, of which they were convicted with execution, in their last statements. When the age range is taken into consideration, it is clear that the distribution of simple tenses and the distribution of compound tenses are very close to each other. The simple tense is used the least by the 60 to 70 age-group, whereas it is mostly used by 20 to 30 age-group. Considering their education level in addition to their age range, it is observed that the highest education level is that of the 60 to 70 age-group. The most frequently used tense in the last statements of death row inmates is simple tense; however, simple present tense is used as the most common tense overall. As the timeline progresses toward the future, expectations and affirmation exist in the meaning of the sentences.

Slowing Down Time: An Exploration of Personal Life Extension Desirability as it Relates to Religiosity and Specific Religious Beliefs.

As medical technology continues increasing the possibility of living a longer life, the public's valuing of these developments must be considered. This study examines attitudes toward extending the human life span within a student population at a Christian university. Religious factors were hypothesized to affect life extension desirability. Scores on measures of willingness to defer to God's will, meaning derived from religion, positive afterlife beliefs, and intrinsic religiosity were significantly and inversely related to life extension desirability. Implications of these findings are discussed, including encouraging medical practitioners to respect decision-making processes of religious persons who may find life extension interventions undesirable.

Resilience and vulnerability: prolonged grief in the bereaved spouses of marital partners who died of AIDS.

Spousal bereavement is closely linked to prolonged grief, that is, significant adjustment symptoms that last for more than six months after the loss. This article focused on potential risk and protective factors that may influence bereavement outcomes. Participants in this study were surviving spouses of individuals who died of acquired immune deficiency syndrome (AIDS). These participants were themselves living with human immunodeficiency syndrome. In this cross-sectional study, 120 bereaved participants completed measures of grief, quality of dying and death of the deceased, negative conceptions of death resulting from AIDS, death attitudes, and personal resilience. The results showed that one-third (35.0%) of the bereaved participants reported grief levels above the prolonged grief cut-off scores, and can be categorized as the "prolonged grief" group. Although quality of dying and death was not associated with the intensity of grief, negative conceptions of death from AIDS, fear of death and resilience independently predicted grief symptoms in the regression models. Our findings provide insight into the grief process for the surviving spouse of AIDS victims in rural China. Since resilience is malleable, developing resilience interventions to enhance adjustment to bereavement may be a promising direction in grief counselling and therapies.

Are religiousness and death attitudes associated with the wish to die in older people?

BACKGROUND: A wish to die is common in older persons and is associated with increased mortality. Several risk factors have been identified, but the association between religiousness and a wish to die in older adults has been underexplored, and the association between death attitudes and the presence of a wish to die has not been investigated yet. The aim of this study is to explore the relationship between religiousness and death attitudes on the one hand and wish to die on the other hand, adjusting for clinical factors such as the presence of depression or somatic disorder. METHODS: The sample comprised 113 older inpatients (from a psychiatric and somatic ward) with a mean age of 74 years. Psychiatric diagnoses were assessed by the Structured Clinical Interview for DSM-IV Disorders, and logistic regression analyses estimated the unique contribution of religiousness and death attitudes to the wish to die, controlling for socio-demographic variables, depressive disorder, and somatic symptoms. RESULTS: Both religiousness and death attitudes were associated with a wish to die in univariate models. Adding these variables in a multivariate logistic hierarchical model, death attitudes remained significant predictors but religiousness did not; 55% of the pseudovariance of the wish to die was explained by these variables, with an effective size of 0.89. Major depressive episode, somatic symptoms, Fear of Death, and Escape Acceptance were the most important predictors of the wish to die. CONCLUSIONS: This study suggests that how older adults perceive death partly determines whether they have a wish to die. There may be a clinical, patient-oriented benefit in discussing with older patients about how they perceive death, as this can play a role in the early detection (and prevention) of death or suicide ideation and associated behaviors in older adults.