From dread to disorder: A meta-analysis of the impact of death anxiety on mental illness symptoms

Abstract

Growing research suggests that death anxiety may be transdiagnostic, playing a key role in the development and symptomology of psychopathology. This meta-analysis examined the relationship between death anxiety and mental illness symptoms. In total, 104 papers were included, representing cross-sectional data from 99 studies (n_total = 24,434), and experimental data from 11 studies (n_total = 1372). Meta-analyses of cross-sectional studies indicated a moderate correlation (r = 0.397) between death anxiety and overall mental illness symptoms. The clinical nature of the group emerged as a significant moderator of this effect. In addition, the relationship between death anxiety and mental illness symptoms was larger for clinical samples (r = 0.580), and for anxiety-related symptoms (r = 0.506) than for depression. Additional meta-analyses of 11 mortality salience studies revealed that death reminders had an overall moderate impact on clinical symptoms (Hedge's g = 0.481). The relevance of the sample to the symptom being measured significantly predicted this relationship; that is, the effect was moderate-to-large (Hedge's g = 0.671) when excluding comparison subgroups for which the effect was not predicted by the authors. The clinical nature of the sample did not significantly moderate the effect. The experimental studies were generally of higher quality and lower risk of publication bias compared to cross-sectional studies. These findings support the strong transdiagnostic role of death anxiety across numerous disorders. Clinical implications include the potential need to treat death anxiety directly, to maximise long-term therapy benefits.