How to Deal With Death: An Empirical Path Analysis of a Simplified Model of Death Anxiety

Abstract

How anxious are you about dying? According to Tomer and Eliason, this depends on various personal circumstances, which they identified in their model on death anxiety. This study aims to verify various aspects of Tomer and Eliason’s theoretical model. We therefore collected data from 652 German participants about demographic variables, religiosity, life satisfaction, death acceptance, and death anxiety. We then conducted a path analysis in order to verify whether the empirical data supported the theoretical model. Our results demonstrate a very good model fit, indicating that the analyzed model is valid and can be maintained. Further mediation analysis demonstrates the specific relations of variables within the model and their influence on death anxiety.

Keywords

attitudes toward death death anxiety religion or spirituality thanatology death

Introduction

If you pause for a second and think about the possibility that you might die tomorrow—what kind of thoughts would be running through your head? How would you feel about it? According to Tomer and Eliason (2000), your reaction in this situation would largely depend on your attitudes toward existential questions; does the thought of death fill you with terror or do you accept it as an important part of life. Using data from previous correlational studies, Tomer and Eliason identified the factors likely to influence death anxiety and the connections between them. The authors then loaded the participants’ demographic factors, religiosity levels, mortality salience, beliefs about the self and the world, and attitudes toward death into a theoretical model on death anxiety, illuminating not only the impact of the factors on death anxiety levels but also the likely impact the factors have on each other (Figure 1; Tomer & Eliason, 2000).

Figure 1.

A model of death anxiety (Tomer & Eliason, 2000).

In this model, age and gender variables are straightforward if operationalized for use in model tests. However, factors like ‘beliefs about the self and the world’ and ‘death attitudes’ are much more subjective when operationalized.

In their own empirical test of the model, Tomer and Eliason (2000) operationalized, for example, ‘attitudes toward death’ as death acceptance, ‘beliefs about the self’ as life satisfaction, and ‘religiosity’ as believing in the afterlife, regardless of religion. The model was then tested using the empirical data of 191 participants. They used a path analysis to verify their model for younger (18–54 years) and older (>55 years) adults. The results showed a good model fit, indicating that the empirical data supported the theoretical model. However, this result was, to the best of our knowledge, never replicated. In addition, Tomer and Eliason tested their model for age differences by comparing two path analyses for younger and older adults. But, according to Royston, Altman, and Sauerbrei (2006), the dichotomization of a continuous variable causes two main problems: Information gets lost (which reduces the accuracy of statistical tests) and variance within groups gets underestimated (so subjects near the threshold are considered to be different rather than similar). Hence, it is advisable to regard age as a continuous variable when investigating its influence on death anxiety and related variables.

This study aims to replicate Tomer and Eliason’s findings for all model components (the relationships between religiosity, age, beliefs about the self and the world, attitudes toward death, and death anxiety), with the exception of mortality salience, in a large, independent study where age is regarded as a continuous variable.

Attitudes Toward Death

Tomer and Eliason (2000) conceptionalized attitudes toward death as the perceived meaningfulness of death and, therefore, the acceptance of death. Several studies have demonstrated a negative correlation between death acceptance and death anxiety (Harding, Flannelly, Weaver, & Costa, 2005; Ray & Najman, 1975; Wittkowski, 1996), indicating that if death acceptance is high, death anxiety is generally low. Nevertheless, it is important to note that death acceptance is not quite the opposite of death anxiety (Ray & Najman, 1975), as people can accept death as a necessity and still fear it, such as when someone with test anxiety fears every test situation but still accepts the general necessity of examinations.

Belief About the Self

Another important factor in Tomer and Eliason’s (2000) model is beliefs about the self and the world. This factor is a measure of the degree to which one is satisfied with the way one has lived life so far (Antonovsky, 1987). Therefore, the factor ‘beliefs about the self and the world’ has often been operationalized through the general concept of life satisfaction or, where possible, with the subscale ‘Satisfaction with Oneself.’ Here, most studies have agreed on a negative correlation between life satisfaction and death anxiety so that the more people are satisfied with their life and themselves, the less they fear their own death (Cohen et al., 2005; Flint, Gayton, & Ozmon, 1983).

In addition, Flint et al. (1983) showed that a high level of life satisfaction is positively correlated with a high level of death acceptance; this result was further supported by Gesser, Wong, and Reker (1988) who found a positive correlation between psychological well-being and death acceptance.

Finally, Cohen et al. (2005) found a positive correlation between life satisfaction and belief in the afterlife, which demonstrated that the more satisfied participants were with their life, the more they tended to believe in some form of afterlife.

To summarize, there is evidence that a high level of life satisfaction correlates with a low level of death anxiety, a high level of death acceptance, and a strong belief in the afterlife.

Religiosity

Unlike the more established results reported earlier, the findings concerning the correlations between religiousness or afterlife beliefs and death anxiety are contradictive; several studies have supported the intuitive notion that believing in life after death reduces death anxiety (Cohen et al., 2005; Harding et al., 2005; Rigdon & Epting, 1985). However, there are other studies finding no such correlation (Aday, 2016; Chaiwutikornwanich, 2015), and others demonstrating significant reverse u-formed correlations (McMordie, 1981; Smith, Nehemkis, & Charter, 1984; Wink & Scott, 2005). The latter indicates that those participants who did not believe at all and those with a very strong belief in the afterlife experienced the least anxiety. This has led to speculation that it is not the belief itself, but the certainty of the belief that has an impact on fear, even if the belief is that of nonexistence after death. Therefore, from the literature, the influence of religiosity on death anxiety or death acceptance remains unclear. As a result, the model predicts no direct impact on the variables; rather, there will be an impact on life satisfaction (and death salience, which is not being tested here). Here, the impact on life satisfaction is a well-established result, demonstrating that high values in religiosity usually correlate with higher life satisfaction (for a review on this topic, see Moreira-Almeida, Lotufo Neto, & Koenig, 2006).

Age

Tomer and Eliason (2000) chose age to represent the demographics factor, which has also been included in our study. The model assumes that age has a direct effect on death anxiety as well as an indirect effect through beliefs about the self and death acceptance. Intuitively, one could suggest that older persons, who are closer to death, would fear it more than younger persons. Instead, numerous studies support the opposite hypothesis: Death anxiety decreases with age (Neimeyer, 2015; Russac, Gatliff, Reece, & Spottswood, 2007) and then reaches a constant level in old age (Fortner & Neimeyer, 1999; Wittkowski, 2005). Thorson and Powell (2000), whose results reflected that of the aforementioned studies, argued that younger persons have more to lose (more future-related regrets) when confronted with the possibility of an early death. In addition, they proposed that older persons have experienced death more often due to the loss of friends or family, which might have encouraged the use of effective coping strategies. This might also underline the finding that death acceptance generally increases with age (Gesser et al., 1988; Neimeyer, 2015; Wong, Reker, & Gesser, 1994).

Inconsistent results begin to emerge when examining the relationship between age and life satisfaction. Some studies have demonstrated a decrease in life satisfaction as we age (Gerstorf, Ram, Röcke, Lindenberger, & Smith, 2008). Other studies, however, have contradicted these findings: the German Age-Survey (Deutsche Alterssurvey; Klaus & Engstler, 2017; Motel-Klingebiel, Wurm, & Tesch-Römer, 2010), a representative longitudinal study, showed that approximately 75% of participants between 40 and 85 years were satisfied with their lives. In addition, Wolff and Tesch-Römer (2017) reported that the number of satisfied persons is even higher in the highest age classes. They discussed the possibility that our criteria and standards for satisfaction may change in old age, allowing older people to maintain or even increase their life satisfaction. In short, age seems to have both a direct impact on death anxiety and an indirect effect through our influences on death acceptance, belief in the afterlife, and life satisfaction.

Overall, this study aims to combine the numerous results of single studies and therefore to replicate several aspects of Tomer and Eliason’s (2000) model of death anxiety. We used single path analysis to verify the validity of the model in a large German sample. In terms of the impact of individual factors, we assumed that high levels of death acceptance led to low death anxiety. A high satisfaction with oneself influences death anxiety directly as well as indirectly through death acceptance. Here, high values should lead to high values of death acceptance and low values of death anxiety. Religiosity is assumed to correlate with age; the older the participant, the higher the religiosity score. Religiosity also influences satisfaction with oneself; participants who engage more in religiosity tend to have higher satisfaction scores.

In addition, we are interested in discovering to what extent death acceptance mediates the relationship between life satisfaction and death anxiety. As high levels of acceptance correlate with high values of life satisfaction and lower levels of death anxiety, the theoretical model assumes that acceptance incompletely mediates the life satisfaction and death anxiety. We test the assumption of an incomplete mediation, in additional to the path analysis.

Methods

The study received ethic approval from the Ethics Committee of the University of Bielefeld, Germany.

Participants

In total, 666 participants responded to flyers located on the University of Bielefeld campus, Facebook advertising, and personal invitations via e-mail, all of which advertised the online survey. After exclusions due to incomplete data, 652 participants (62% female, 38% male) remained. The participants were aged between 18 and 87 years, with a mean age of 49 years. Our sample covered a wide range of educational levels: 1% had no educational attainment, 13% finished secondary school, 35% finished Abitur, 6% completed apprenticeship training, 42% held a university degree, and 3% a doctor thesis. The participants’ religious beliefs were as follows: 35% of the participants were Protestants, 22% Catholics, 20% Atheists, 4% Muslims, 2% Buddhists, and 17% held other beliefs. Participation was voluntary, took about 25 minutes, and was only rewarded with course credits for Psychology students of the University of Bielefeld.

Implementation

On the front page of the online survey, the participants were informed about the content of the study, its data storage methods, and how the analysis would be conducted; in addition, they were assured that their responses would be anonymous. They had to agree to each of these methods in order to take part in the study. After general demographic questions, the following questionnaires were presented in a randomized order: the German version of the “Multidimensional Orientation Toward Dying and Death Inventory” (MODDI-F; Wittkowski, 2001), the “Questionnaire about life satisfaction” (FLZ; Fahrnberg, Myrtek, Schumacher, & Brähler, 2000) MODDI-F; and three scales of the German NEO-Five-Factors Inventory (Borkenau & Ostendorf, 2008; the results of which are not reported here). Finally, the participants had to answer questions about their religiosity, their knowledge of and willingness to take part in organ transplantation, as well as their knowledge of hospices. For this study, only the five questions about religiosity and afterlife beliefs were analyzed.

Measuring Instruments

Multidimensional Orientation Toward Dying and Death Inventory

The MODDI-F measures attitudes of fear and acceptance toward dying and death, with eight independent subscales (Wittkowski, 2001). Here, the two relevant subscales ‘Fear of One’s Own Death’ (six items to evaluate how the participants felt about the threat of nonexistence) and ‘Acceptance of One’s Own Dying and Death’ (eight items evaluating whether death is accepted as natural and meaningful) were analyzed. Both subscales used a Likert-type scale from 0 (completely disagree) to 3 (completely agree). Scale totals for both subscales were calculated and transformed into T values according to norm tables.

Questionnaire about life satisfaction

The questionnaire about life satisfaction (FLZ) measures participants’ satisfaction levels in 10 different areas of life (Fahrenberg et al., 2000). Seven can be combined to obtain an overall life satisfaction level. The scales are rated on a 7-point Likert-type scale, from 1 (very unsatisfied) to 7 (very satisfied). However, every subscale can also be analyzed independently. For our analysis, we used the subscale ‘Satisfaction With Oneself,’ which contained seven items; these can be reviewed in Supplement 1. The scale’s total scores were calculated according to the FLZ manual and then were transformed into Stanine values.

Belief in the afterlife

We created a religiosity index from the answers to seven questions concerning the participants’ religious beliefs. We first totaled the answers to the following questions: How strongly do you believe in . . . (a) heaven? (b) hell? (c) nirvana? (d) reincarnation? The participants had to rate their response on a scale from 1 (not at all) to 6 (very strongly). (e) How religious would you say you are? (1 = not at all to 6 = deeply religious) and (f) How spiritual would you say you are? (1 = not at all to 6 = very spiritual). We then subtracted the value of the statement: (g) I believe that nothing exists after death (1 = strongly disagree to 6 = strongly agree). This index can therefore range from 0 (resembling a person with a strong belief in nonexistence after death and without any religious or spiritual convictions) to 35 (a highly religious or spiritual person who strongly believes in an afterlife). The mean value of 652 participants was 12.4 (standard deviation 3.81, range 1–23).

Statistical Methods

Analysis of data using IBM SPSS Statistics 22 and IBM SPSS Amos 22

To test our hypotheses, a path model was established to verify whether the empirical data supported the model postulated by Tomer and Eliason (2000). To calculate a path analysis, several preconditions had to be met:

First, a path analysis requires a causal model, which is derived from literature, as well as a sample size 5 times larger than the number of tested parameters (Backhaus, Erichson, Plinke, & Weiber, 2006; Weiber & Mühlhaus, 2014). First, the theoretical model was given by Tomer and Eliason (2000). Second, our model consists of 13 parameters with a total of 652 participants; both preconditions were therefore met. In addition, a multivariate normal distribution is required. We tested this with Mardia’s measure of multivariate skewness (Weiber & Mühlhaus, 2014); our data reached a value of −.95 which is under the critical value of 1.95 so that the precondition of normal distribution was also achieved.

The χ² test calculates the fit between the empirical data and the covariance matrix that is implicated in the theoretical model. The smaller the χ² value, the better the theoretical model is represented by the empirical data. The accompanying p value indicates the probability that rejecting the null hypothesis (a perfect fit between the empirical data and the theoretical model) would be incorrect (Weiber & Mühlhaus, 2014). Therefore, a p value of >.05 ensures a good model fit. Nevertheless, the p value is greatly influenced by sample size (Allison, 2002), and so additional fit indices were calculated: here, a root mean square error of approximation (RMSEA) of ≤.05 as well as a comparative fit index (CFI) of ≥.95 would indicate a very good fit model (Bentler, 1990).

In addition, we used a mediator analysis to examine whether the correlation between satisfaction with oneself and death anxiety was mediated by death acceptance; the mediator analysis was performed with RMediation (Tofighi & MacKinnon, 2011)

Results

General Participant Results

On the subscales of the MODDI-F, the mean T values of M = 49.5 for death anxiety and of M = 50.6 for death acceptance were within the normal range. On average, the participants also reached normal Stanine values on the Satisfaction With Oneself subscale of the FLZ (M = 4.92).

Preanalysis

First, the correlations between model factors were calculated (Table 1).

Table 1.

Bivariate Correlations (Pearson) for Relevant Model Factors.

	(1)	(2)	(3)	(4)
1. Death anxiety
2. Death acceptance	−.63***
3. Satisfaction with oneself	−.22***	.25***
4. Religiosity	−.12**	.10*	.11*
5. Age	−.32**	.32**	.18**	.34**

Note. N = 652.

*p < .05. **p < .01. ***p < .001 (two-sided).

Main Analysis

The analysis of our path model with manifest variables gave us a detailed view of the single path coefficients (Table 2) as well as an overall model fit by calculating fit indices (Figure 2). The results demonstrated a very good fit between empirical data and our model (χ² = .545, df = 2, p = .761; CFI = 1.000, RMSEA = .000) so that the model can be maintained.

Table 2.

Standardized and Nonstandardized Path Coefficients, SE, and Significances.

	ß	b	SE	p
Age → Satisfaction with oneself	.16	.02	.00	.001
Age → Death acceptance	.28	.12	.02	.001
Age → Death anxiety	−.13	−.05	.01	.001
Religiosity → Satisfaction with oneself	.05	.03	.02	.194
Satisfaction with oneself → Death acceptance	.20	.90	.17	.001
Satisfaction with oneself → Death anxiety	−.06	−.25	.14	.077
Death acceptance → Death anxiety	−.58	−.57	.03	.001

Note. ß = standardized path coefficient; b = nonstandardized path coefficient; SE = standard error; p = significance.

Figure 2.

Path analysis of a model of death anxiety. χ²(13, N = 652) =.545, p = .761, CFI = 1.000, RMSEA = .000; single arrows indicate path coefficients, double arrows indicate a correlation. *p < .05. **p < .01. ***p < .001.

A mediation analysis was performed for the effect that death acceptance had on the relationship between satisfaction with oneself and death anxiety. The analysis for a = .90 (standard error [SE] =.17) and b = −.58 (SE = .03) resulted in an indirect effect of μ = −.509 (SE = .10). As 0 is outside the confidence interval [−.54, −.32], this effect is significant. This can be considered to be a full mediation because there is no longer a significant direct effect of satisfaction with oneself on death anxiety (p = .075; c = −.06, SE = −.25).

Discussion

This study aimed, predominantly, to verify aspects of the theoretical model on death anxiety by Tomer and Eliason (2000). Therefore, we established a theoretical model based on Tomer and Eliason as well as on previous empiric results, including factors such as age, religiosity, satisfaction with oneself, and death acceptance, in order to explain death anxiety.

The path analysis resulted in a very good empirical fit, showing that the model is valid and can be maintained. The age, satisfaction with oneself, death acceptance, and belief in the afterlife variables explained 42% of the variance of death anxiety, with neutral acceptance providing the biggest contribution. Here, the higher the level of death acceptance, the lower the death anxiety value.

Aside from the generally very good model fit, not every assumed path turned out to be significant; religiosity did not have the assumed impact on satisfaction with oneself, nor did satisfaction with oneself have the assumed direct impact on death anxiety. The latter was further substantiated by our mediation analysis. Here, the model suggested that death acceptance partially mediates the relationship between satisfaction with oneself and death anxiety. However, based on the path and mediation analyses, the relationship between satisfaction with oneself and death anxiety is actually fully mediated by death acceptance.

Death Acceptance

Our study has shown that multiple factors influence the level of anxiety we feel when we are confronted with our own death. Nevertheless, as our results show, people react with defense mechanisms, as postulated in the terror management theory (Greenberg, Pyszczynski, & Solomon, 1986) where death is seen as the ultimate threat. Here, the knowledge of the finite nature of life leads to a paralyzing fear. On the other hand, the meaning management theory (MMT; Wong, 2008) assumes similar reactions to death but for other reasons. Whereas the terror management theory focuses on the avoidance and reduction in death anxiety, the primary motive of the MMT is enhancing the personal meaning of life and death. Death is therefore not seen as a threat to life but as the main motivator for a meaningful life. So, the MMT postulates that the ability to give death a meaning and therefore attaining an accepting attitude decreases death anxiety. Our results fit well with this theory, as we found that high values of death acceptance reduce death anxiety. In addition, given that acceptance and age are the only two factors that directly impact on death anxiety, it is a crucial variable, as it is the only one that can be altered. Therefore, practitioners working with dying persons and their relatives could try to guide patients into finding and ascribing meaning to their death in order to reduce death anxiety. However, given the critical importance of death acceptance, and its practical value, more studies are needed in order to learn how death acceptance can be achieved.

Satisfaction With Oneself

As predicted, we found that satisfaction with oneself was a significant predictor of death acceptance. Results showed a positive correlation between the two factors so that higher values in life satisfaction correlated with higher levels of death acceptance, which is in line with the extant literature (e.g., Flint et al., 1983; Gesser et al., 1988).

Contrary to the model’s prediction, we did not find any direct effects between satisfaction with oneself and death anxiety. However, it is noteworthy that the bivariate correlation was significant, demonstrating the existence of a small negative correlation so that the more one is satisfied with oneself, the less death is feared. This result is in line with other studies (Sedei, 1995; Tate, 1983), which found a significant negative correlation between death anxiety and life satisfaction as well. However, our results showed that this influence is actually fully mediated by death acceptance, indicating that death anxiety decreases when higher satisfaction with our self helps us to have an accepting attitude toward death. This highlights one of the benefits of model testing; it helps to indicate possible mediating effects. Where correlation studies would have assumed a direct connection between satisfaction with oneself and death anxiety, our results revealed that this connection is actually fully mediated through death acceptance. However, as our cross-sectional study is not capable of making statements about causality, a longitudinal study would contribute more specific information about the causal relationship between the model components.

Religiosity

Another rather unexpected result is seen when analyzing the impact of religiosity. Intuitively, one would assume that a strong belief in an afterlife should ease death anxiety as it adds meaning and takes away the finality of death. Nevertheless, our results showed only a small linear correlation between our religiosity index (combining the results from the strength of a participant’s belief in the afterlife and how religious a participant would describe themselves to be) and death anxiety. To confirm whether or not this correlation justifies a direct model path between religiousness and death anxiety, we calculated a post hoc path analysis which included this additional direct path. This analysis, in general, reaches the same explanatory value and the same excellent model fit; however, the added path is not significant (path coefficient −.01; p = .71). This strengthens the contra intuitive position of religiosity within the model where no direct impact on death anxiety is assumed.

As mentioned earlier, there is also research demonstrating a stronger curvilinear relation (Wink & Scott, 2005) between afterlife beliefs and death anxiety. It has been discussed that it is not actually the belief in an afterlife itself, but rather the certainty of the belief that reduces death anxiety. To test for this possibility, we also performed post hoc correlations for belief in the afterlife (using only values from the belief in the afterlife question) and death anxiety. The linear correlation here was no longer significant (ß = .02, p > .05), whereas the quadratic test resulted in a significant curvilinear relationship, y = 43.60 + 3.67 × 1 − 0.46 × 2. R² = .02, F(2, 649) = 7.73, p < .001. So, the certainty of a belief seems to make a difference and further research should take this into account as, in terms of religiosity and afterlife beliefs, the questions asked could easily change the focus from religious beliefs to certainty effects.

In this regard, it would also be interesting to see whether different variations of the afterlife belief would have a different impact within the model. For example, it is possible that a belief in reincarnation, or say, ‘multiple chances to do better next time,’ has a different effect on death anxiety as the belief in a ‘one trial only’ religion of heaven and hell. However, as our sample mainly contains Christians and Atheists, sample sizes of other religious beliefs were too small to allow for further analysis.

Age

Tomer and Eliason further assumed that age would influence all the other model variables, which we were able to confirm in our data. In our model, higher age correlates, as expected, with less death anxiety, higher death acceptance, higher satisfaction with oneself, and with higher religiosity values. Furthermore, all the assumed path coefficients reached significance too. This is in line with, for example, Wittkowski (2005) who states that older people would experience less death anxiety because of a cognitive reorganization which helps them to cope more easily with death. The results of our study, as well as previous other studies (Bengtson, Cuellar, & Ragan, 1977; Fortner, Neimeyer, & Rybarczyk, 2000; Thorson & Powell, 2000), support this theory. Furthermore, as mentioned earlier, Thorson and Powell state that older people have experienced more loss and death, demanding a more frequent cognitive processing of death-related experiences and therefore more developed coping strategies. On the other hand, Stricherz and Cunnington (1982) disagreed with the assumption that older people would experience less death anxiety in general. They state that each age-group has specific death-related fears. They showed that younger people fear primarily the loss of loved ones and the finality of death, whereas middle-aged adults fear a painful and untimely death. Finally, older participants were first and foremost concerned about a steady deterioration of health, dependency, and an unworthy and protracted dying. These results indicate, for future studies, that it would be interesting to distinguish between specific fears about death rather than a single Death Anxiety Scale. A more detailed timeline of death-related anxieties and influencing factors could also be very helpful for professionals dealing with dying persons of different ages and their relatives. Besides, Wittkowski (2005) criticized that neither the fear of the loss of loved ones nor the fear of one’s own dying process was considered in the model of Tomer and Eliason.

When it comes to the relationship between age and death acceptance, the integrative theory of Wittkowski (2005) assumes that the cognitive reorganization occurring in older persons would lead to increased strivings to find a meaning in one’s life and death. This, in turn, would lead to higher levels of death acceptance; our data were able to support the main statement of the integrative theory with empirical data.

A nonintuitive result is the positive correlation between age and satisfaction with oneself, as we did not naturally assume old age to be the most satisfying time of life. Staudinger (1997) explains this ‘paradox of subjective well-being’ (p. 185) with several mechanisms of self-regulation people use when confronted with adverse circumstances. She argues that older people would enhance their subjective well-being by comparing themselves to persons who feel worse. Besides, they would profit from a selective memory that remembers past successes rather than past failures. This is also in line with Wittkowski’s (2005) theory of cognitive reorganization, which helps older people to obtain high levels of satisfaction from their past life rather than from their present circumstances. Furthermore, Staudinger pointed out people’s tendency to adapt their personal level of aspiration in difficult circumstances to their new situation. Nonetheless, these coping mechanisms would reach their limit when circumstances became so bad that they were actually endangering one’s very existence (e.g., severe health problems; Staudinger, 1997). This assumption could empirically be supported by Orth, Trzesniewski, and Robins’s (2010) study, which showed that subjective well-being and life satisfaction significantly decreases in the months before death. One possible explanation for both this decrease and the stable death anxiety in old age could be that death is seen as a relief due to severe health problems, pain, and loss of body control.

Finally, our results showed a positive correlation between age and religiosity so that older participants reached higher values in our religiosity index. This result is in line with the results of a 35-year longitudinal study (Bengtson, Silverstein, Putney, & Harris, 2015), which pointed out that religiosity and strength of faith intensify with age. However, a further analysis showed that this development was influenced by both age and generational effects. Given this result, another longitudinal study about the development of beliefs in the afterlife over the course of people’s lives would be helpful to achieve a differentiated perspective on age effects and cohort effects.

In general, and with regard to our results on death acceptance, it would also be interesting to distinguish which other operationalizations of the ‘meaningfulness of death’ could have an influence on death anxiety. One possible meaningful act concerning death could be to donate one’s organs after death in order to save the life of others. However, despite all the educational work and advertising by governments and health insurance companies, there are only a few registered organ donors in Germany. A deeper knowledge about the relationship between the meaningfulness of death and death anxiety would not only help us to understand the causes of death anxiety but also help to increase motivation to save lives with organ donations.

Taken together, our analysis not only showed a good fit between the empirical data and the theoretical model but also gave an important overview of the specific determinants of death anxiety. However, we only considered factors identified by the model of Tomer and Eliason. Despite the fact that we achieved a very good model fit and were able to explain 42% of the death anxiety variance, there are likely to be factors that we did not consider (e.g., specific fears about death and dying, general personality traits, and cultural influences). Here, further research is needed not only to test the complete model of Tomer and Eliason but also to find out which other factors could contribute and whether the model needs to be expanded.

Supplemental Material

Supplemental material for How to Deal With Death: An Empirical Path Analysis of a Simplified Model of Death Anxiety

Supplemental material for How to Deal With Death: An Empirical Path Analysis of a Simplified Model of Death Anxiety by Vera Surall and Inga Steppacher in OMEGA—Journal of Death and Dying

Footnotes

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

Supplemental Material

Supplementary material for this article is available online.

Author Biographies

Vera Surall BSC, MSc has studied Psychology from University of Bielefeld in the year from October 2011 to October 2016. At present, she is receiving Training in Child and Adolescent Psychotherapy (Cognitive Behavioral Therapy), Ruhr-University Bochum.

Inga Steppacher, Dr rer nat, has received diploma in Psychology from University of Konstanz in the year 2000-2006. She has also studied Neuropsychology in a clinic in Kliniken Schmieder, Allensbach in the year 2010–2011. From the year 2012 until today she is a Post-Doc in Affective Neuropsychology, University of Bielefeld.

References

Aday

R. H.

(2016). Belief in afterlife and death anxiety: Correlates and comparisons. OMEGA—Journal of Death and Dying, 15(1), 67–75.

Allison

P. D.

(2002). Structural equation modeling with Amos: Basic concepts, applications, and programming. New York, NY: Taylor and Francis Group.

Antonovsky

(1987). Unraveling the mystery of health: How people manage stress and stay well. Hoboken, NJ: Jossey-Bass.

Backhaus

Erichson

Plinke

Weiber

(2006). Multivariate Analyseverfahren. Eine anwendungsorientierte Einführung [Multivariate analysis method. An application-oriented introduction] (11th Rev. ed.). Berlin, Germany: Springer.

Bengtson

V. L.

Cuellar

J. B.

Ragan

P. K.

(1977). Stratum contrasts and similarities in attitudes toward death. Journal of Gerontology, 32(1), 76–88.

Bengtson

V. L.

Silverstein

Putney

N. M.

Harris

S. C.

(2015). Does religiousness increase with age? Age changes and generational differences over 35 years. Journal for the Scientific Study of Religion, 54(2), 363–379.

Bentler

P. M.

(1990). Comparative fit indexes in structural models. Psychological Bulletin, 107(2), 238.

Borkenau

Ostendorf

(2008). NEO-Fünf-Faktoren Inventar: Nach Costa u. McCrae; NEO-FFI [NEO five-factor inventory: After Costa u. McCrae; NEO-FFI]. Göttingen, Germany: Hogrefe, Verlag f. Psychologie.

Chaiwutikornwanich

(2015). Belief in the afterlife, death anxiety, and life satisfaction of Buddhists and Christians in Thailand: Comparisons between different religiosity. Social Indicators Research, 124(3), 1015–1032.

10.

Cohen

A. B.

Pierce

J. D.

Chambers

Meade

Gorvine

B. J.

Koenig

H. G.

(2005). Intrinsic and extrinsic religiosity, belief in the afterlife, death anxiety, and life satisfaction in young Catholics and Protestants. Journal of Research in Personality, 39(3), 307–324.

11.

Fahrenberg

Myrtek

Schumacher

Brähler

(2000). Fragebogen zur Lebenszufriedenheit (FLZ) Handanweisung [Questionnaire for life satisfaction (FLZ) manual]. Göttingen, Germany: Hogrefe.

12.

Flint

G. A.

Gayton

W. F.

Ozmon

K. L.

(1983). Relationship between life satisfaction and acceptance of death by elderly persons. Psychological Reports, 53(1), 290.

13.

Fortner

B. V.

Neimeyer

R. A.

(1999). Death anxiety in older adults: A quantitative review. Death Studies, 23(5), 387–411.

14.

Fortner

B. V.

Neimeyer

R. A.

Rybarczyk

(2000). Correlates of death anxiety in older adults: A comprehensive review. In Tomer

(Ed.), Series in death, dying, and bereavement. Death attitudes and the older adult: Theories, concepts, and applications (pp. 95–108). New York, NY: Brunner-Routledge.

15.

Gerstorf

Ram

Röcke

Lindenberger

Smith

(2008). Decline in life satisfaction in old age: Longitudinal evidence for links to distance-to-death. Psychology and Aging, 23(1), 154.

16.

Gesser

Wong

P. T. P.

Reker

G. T.

(1988). Death attitudes across the life-span: The development and validation of the Death Attitude Profile (DAP). OMEGA—Journal of Death and Dying, 18(2), 113–128.

17.

Greenberg

Pyszczynski

Solomon

(1986). The causes and consequences of a need for self-esteem: A terror management theory. Public Self and Private Self, 189, 189–212.

18.

Harding

S. R.

Flannelly

K. J.

Weaver

A. J.

Costa

K. G.

(2005). The influence of religion on death anxiety and death acceptance. Mental Health, Religion & Culture, 8(4), 253–261.

19.

Klaus

Engstler

(2017). Daten und Methoden des Deutschen Alterssurveys [Data and methods of the German age survey]. In K. Mahne, J. Wolff, J. Simonson, C. Tesch-Römer (Eds.), Altern im Wandel (pp. 29–45). Wiesbaden: Springer VS.

20.

McMordie

W. R.

(1981). Religiosity and fear of death: Strength of belief system. Psychological Reports, 49(3), 921–922.

21.

Moreira-Almeida

Lotufo Neto

Koenig

H. G.

(2006). Religiousness and mental health: A review. Revista Brasileira de Psiquiatria, 28(3), 242–250.

22.

Motel-Klingebiel

Wurm

Tesch-Römer

(2010). Altern im Wandel: Befunde des Deutschen Alterssurveys (DEAS) [Aging in Change: Findings of the German Aging Survey (DEAS)]. Stuttgart, Germany: Kohlhammer Verlag.

23.

Neimeyer

R. A.

(2015). Death anxiety handbook: Research, instrumentation, and application. Series in death education, aging, and health care. Abingdon, England: Routledge.

24.

Orth

Trzesniewski

K. H.

Robins

R. W.

(2010). Self-esteem development from young adulthood to old age: A cohort-sequential longitudinal study. Journal of Personality and Social Psychology, 98(4), 645–658.

25.

Ray

J. J.

Najman

(1975). Death anxiety and death acceptance: A preliminary approach. OMEGA—Journal of Death and Dying, 5(4), 311–315.

26.

Rigdon

M. A.

Epting

F. R.

(1985). Reduction in death threat as a basis for optimal functioning. Death Studies, 9(5-6), 427–448.

27.

Royston

Altman

D. G.

Sauerbrei

(2006). Dichotomizing continuous predictors in multiple regression: A bad idea. Statistics in Medicine, 25(1), 127–141.

28.

Russac

R. J.

Gatliff

Reece

Spottswood

(2007). Death anxiety across the adult years: An examination of age and gender effects. Death Studies, 31(6), 549–561.

29.

Sedei

G. C. A.

(1995). Death anxiety, defensive styles, and life satisfaction. Fort Collins: Colorado State University.

30.

Smith

D. K.

Nehemkis

A. M.

Charter

R. A.

(1984). Fear of death, death attitudes, and religious conviction in the terminally ill. The International Journal of Psychiatry in Medicine, 13(3), 221–232.

31.

Staudinger

U. M.

(1997). Viele Gründe sprechen dagegen, und trotzdem geht es vielen Menschen gut: Das Paradox des subjektiven Wohlbefindens [Many reasons speak against it, yet many people feel good: The paradox of subjective well-being]. Berlin, Germany: Max-Planck-Institut für Bildungsforschung.

32.

Stricherz

Cunnington

(1982). Death concerns of students, employed persons and retired persons. OMEGA—Journal of Death and Dying, 12(4), 373–379.

33.

Tate

L. A.

(1983). Life satisfaction and death anxiety in aged women. The International Journal of Aging and Human Development, 15(4), 299–306.

34.

Thorson

J. A.

Powell

F. C.

(2000). Death anxiety in younger and older adults. In Tomer

(Ed.), Series in death, dying, and bereavement. Death attitudes and the older adult: Theories, concepts, and applications (pp. 123–136). New York, NY: Brunner-Routledge.

35.

Tofighi

MacKinnon

D. P.

(2011). RMediation: An R package for mediation analysis confidence intervals. Behavior Research Methods, 43(3), 692–700.

36.

Tomer

Eliason

(2000). Beliefs about self, life, and death: Testing aspects of a comprehensive model of death anxiety and death attitudes. In . Tomer

(Ed.), Series in death, dying, and bereavement. Death attitudes and the older adult: Theories, concepts, and applications (pp. 137–153). New York, NY: Brunner-Routledge.

37.

Weiber

Mühlhaus

(2014). Strukturgleichungsmodellierung: Eine anwendungsorientierte Einführung in die Kausalanalyse mit Hilfe von AMOS, SmartPLS und SPSS [Structural equation modeling: An application-oriented introduction to causal analysis using AMOS, SmartPLS and SPSS]. Berlin, Germany: Springer-Verlag.

38.

Wink

Scott

(2005). Does religiousness buffer against the fear of death and dying in late adulthood? Findings from a longitudinal study. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 60(4), P207–P214.

39.

Wittkowski

(1996). Fragebogeninventar zur mehrdimensionalen Erfassung des Erlebens gegenüber Sterben und Tod:(FIMEST) [Questionnaire inventory for multi-dimensional recording of the experience of dying and death: (FIMEST)]. Göttingen, Germany: Hogrefe.

40.

Wittkowski

(2001). The construction of the Multidimensional Orientation Toward Dying and Death Inventory (MODDI-F). Death Studies, 25(6), 479–495.

41.

Wittkowski

(2005). Einstellungen zu Sterben und Tod im höheren und hohen Lebensalter [Attitudes to dying and death in old and old age]. Zeitschrift Für Gerontopsychologie & -Psychiatrie, 18(2), 67–79.

42.

Wolff

J. K.

Tesch-Römer

(2017). Glücklich bis ins hohe Alter? Lebenszufriedenheit und depressive Symptome in der zweiten Lebenshälfte [Happy to old age? Life satisfaction and depressive symptoms in the second half of life]. In Mahne, K., Wolff, J.K., Simonson, J., Tesch-Römer, C. (Eds.), Altern im Wandel (pp. 171–183). Berlin, Germany: Springer.

43.

Wong

P. T. P.

(2008). Meaning management theory and death acceptance. In Tomer

Grafton

Wong

P. T. P.

(Eds.), Existential & spiritual issues in death attitudes (pp. 65–88). Mahwah, NJ: Lawrence Erlbaum Associates.

44.

Wong

P. T. P.

Reker

G. T.

Gesser

(1994). Death attitude profile-revised: A multidimensional measure of attitudes toward death. In Neimeyer

R. A.

(Ed.), Death anxiety handbook. Research, instrumentation, and application (pp. 121–148). Washington, DC: Taylor & Francis.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.20 MB