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Death Anxiety and Education: A Comparison Among Undergraduate and Graduate Students a
Kristie Nienaber B.A. & Eric Goedereis PhD
a
a
Webster University, Saint Louis, MO Accepted author version posted online: 27 May 2015.
Click for updates To cite this article: Kristie Nienaber B.A. & Eric Goedereis PhD (2015): Death Anxiety and Education: A Comparison Among Undergraduate and Graduate Students, Death Studies, DOI: 10.1080/07481187.2015.1047057 To link to this article: http://dx.doi.org/10.1080/07481187.2015.1047057
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Death Anxiety and Education: A Comparison Among Undergraduate and Graduate Students Kristie Nienaber, B.A.1, Eric Goedereis, PhD1 1
Webster University, Saint Louis, MO
Address Correspondence to Kristie Nienaber, Webster University, 7614 Suffolk, Saint Louis, MO 63119, Email: [email protected]
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Abstract The present study investigated the association between level of education and selfreported levels of anxiety regarding death of self and others among undergraduate students (n = 149) and graduate students (n = 92). Participants completed the Multidimensional Fear of Death Scale (MFODS) and the Revised Death Anxiety Scale (RDAS). Although undergraduate and graduate students did not differ on Fear of Being Destroyed, graduate students reported lower levels of death anxiety on all remaining measures. Suggestions for future research and implications are discussed.
KEYWORDS: Death anxiety, Higher Education
Death is an inevitable occurrence which creates distress and apprehension for many human beings (Rasmunssen & Brems,1996). Such distress and apprehension can be conceptualized as death anxiety, which refers to the negative thought processes that often accompany the thought of death, with regard to oneself or others. (Rasmunssen & Brems,1996). More specifically, death anxiety can be defined as the trepidation that is caused by morbid thinking (Kastenbaum & Heflick, 2011). However, Neimeyer (1998) 1
expands upon this common sense definition by including a variety of attitudes towards death such as “fear, threat, unease, and discomfort” (p. 96).
Prior research has demonstrated that death anxiety varies as a function of a variety of personal factors, including age (Russac, Gatliff, Reece, & Spottswood, 2007), sex (Okafor, 1995), and choice of major (Sharma, Monsen, & Gary, 1997). More specifically
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to choice of major, Sharma et al. (1997) found that nursing students indicated less fear of their own death, the dying process, being near the dead, and their bodies being destroyed after death than undergraduate students pursuing other disciplines. Furthermore, their results indicated that among all undergraduate students, freshman students indicated more fear of death than their sophomore, junior, and senior counterparts. Although these findings suggest that several individually-specific variables, including choice of major, may contribute to death anxiety, the specific role of different levels of education remains less clear.
General death education efforts have been found to influence levels of death anxiety. For instance, students enrolled in a class on either death or aging reported a reduction in death anxiety (Berman, 1998). Similarly, medical students taking a course on death and dying reported less concern about working with dying patients in contrast to medical students who did not take the course (Schwartz et al., 2005). Further, compared to funeral service students, university students reported significantly higher death anxiety (Basset & Dabbs, 2003). In addition, Abengozar, Bueno, and Vega (1999) found that older adults who participated in a workshop-style class in which they could exchange ideas and feelings
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about death reported overall lower levels of death anxiety than other older adults who received a traditional conference-style format in which they were given information through lecture.
It is important to highlight that college students’ perceptions of death and desire for death education have been found to vary over time. Compared to college students in a 1935
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cohort, Lester and Becker (1993) found that college students in 1991 were more likely to think about their deaths, encompassed a greater fear of death, and showed greater interest in knowing about the existence of life after death. Given their findings, Lester and Becker (1993) argued that even though society may be becoming increasingly aware of death and dying, more recent generations of younger grievers are not equipped with the belief systems to help them cope with death.
From this perspective, it may be that as many contemporary societies move away from a more explicit religious orientation, individuals are searching for comprehension of the complex issues of death through secular institutions such as universities. Recent research supports the increasing need to utilize the classroom as a means to process death. For example, Mak (2011) found through interviewing university students in Hong Kong about their attitudes and experiences with death that most students were interested in education programs about both life and death across the school years (Mak, 2011). Furthermore, Wong (2009) found that overall university students in Hong Kong had negative attitudes towards death. However, students who completed even one death education course showed significant improvement in several dimensions of death
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attitudes including one’s fear of death. While both the findings of Mak (2011) and Wong (2009) support the benefit of death education as a means to improve attitudes and decrease anxiety regarding death, it should be noted that Eastern students may have more overall positive views of death than Western students due to the greater connection and significance of death in Eastern culture (e.g. burial rites, ancestor worship).
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There are few studies that have examined the variation in death anxiety among differing levels of education. One exception, however, was a study of rehabilitation counselors (Hass-Thompson, Alston, & Holbert, 2008). Specifically, rehabilitation counselors who had obtained master’s degrees had more favorable attitudes toward death and less fear of death than those who only obtained bachelor’s degrees. Furthermore, those counselors who had received specific death education did not report significant differences in fear of their personal death, but only the death of others.
In another study, Aradilla-Herroro, Tomas-Sabado, and Gomez-Benito (2012) studied relationships between self-reported death attitudes and perceived emotional intelligence among Spanish nursing students across three years of their nursing programs. One particular goal of the study was to investigate differences in death attitudes between academic years. Results showed that there was a progressive decrease of death anxiety and death depression across the three years. However, it should be noted that only Fear of Death of Others reached levels of significant difference with gained level of education (Aradilla-Herroro et al., 2012). In a similar study, Chen, Ben, Fortson, and Lewis (2006) looked at death anxiety levels in groups of first year nursing students with no prior
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nursing experience, final year nursing students with nursing experience (e.g. practicum, internship, field placement), and non-nursing undergraduate students. Results showed that experienced nursing students reported significantly higher levels of fear of the dying process and that both inexperienced and experienced nursing students had higher levels of fear of the unknown than non-nursing students. Chen et al. (2006) suggest that these results highlight how fear of the unknown may develop as a function of attending nursing
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programs that overtly integrate death and dying into their curriculum and how fear of the dying process may increase with gained experience with death in nursing programs.
Taken together, these studies emphasize how the discrepancy between level of education, type of death education received, and experience level within educational programs highlight the complex nature of how death anxiety is experienced. Thus, a further examination of how education is associated with death anxiety is warranted in order to better understand how level of education may alter our perception of death.
The primary objective of the present study was to examine variability in self-reported death anxiety, both global and domain-specific, among undergraduate and graduate students. Specifically, our goal was to examine how one’s pursuit of higher education is associated with one’s fear of death regarding both self and others. In light of prior research which suggested that increased age (Russac et al., 2007), type of education received (Abengozar et al., 1999; Berman, 1998), and level of education completed (Aradilla-Herrero et al., 2012; Hass-Thompson et al., 2008) are associated with variability in self-reported death anxiety, we expected that an increased knowledge base,
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as indicated by greater educational attainment, would be associated with lower levels of death anxiety. Thus, compared to undergraduate students, graduate students were hypothesized to report lower levels of anxiety across all domains.
METHOD Participants
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Convenience sampling methods were used in order to select participants from a mid-size Midwestern university. Graduate and undergraduate faculty members were contacted by email in order to obtain permission to solicit participation during regularly scheduled courses. Approval from the Webster University Institutional Review Board was obtained prior to soliciting participants. Participants consisted of both undergraduate and graduate students who were over the age of 18 and were enrolled at the university. Responses from four participants could not be used due to missing information. The final sample of students surveyed was comprised of 149 undergraduate students (Mean Age= 21.59 years, SD = 5.24) and 92 graduate students (Mean Age = 33.93 years, SD = 11.14). The majority (75%) of the sample were female. With respect to self-reported ethnicity, participants identified themselves as Caucasian/White (77%), African-American/Black (14%), Latino/Hispanic (3%), Asian/Pacific Islander (2%), or Other (4%). Most participants identified themselves as single (79%) or married (16%); 17% of participants had children. Christianity (62%) was the most commonly identified religious orientation, with 16% of participants reporting another specific religion (e.g., Muslim, Pagan, or Hindu) or “other”, with the remaining participants identifying themselves as agnostic (14%) or atheist (6%). With
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respect to personal experiences with death, only 17% of our participants had experienced the death of a parent, while only 5% reported the death of a sibling.
Procedure Participants were asked to review and sign consent forms prior to participation. The first author or a trained research assistant administered the study
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protocol in which each participant was provided a consent form, a packet of questionnaires, and a short personal data form. The questionnaires consisted of two selfreport scales: the Multidimensional Fear of Death Scale (Hoelter, 1979) and the Revised Death Anxiety Scale (Thorson & Powell, 1994) (each described below), in order to measure death anxiety among undergraduate and graduate students. Following completion of the survey, participants were debriefed. Certain instructors awarded extra credit in their courses for participation.
Materials Multidimensional Fear Of Death Scale (MFODS; Hoelter, 1979) The MFODS consists of a variety of questions (organized into eight subscales) designed to assess the domain-specific concerns one may have regarding their personal death. The MFODS requires participants to rate the extent to which they agree or disagree with 42 items on a 5 point Likert Scale (1 = Strongly agree, 5 = Strongly disagree). Items are designed to obtain information with respect to concerns about both personal death and fear of those who are already dead. Sample items included statements such as “I am afraid of dying very slowly” and “I am afraid of meeting my creator.” In order to gain
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subscale scores, each participant’s scores were added, with five of the items being reverse scored to reduce response bias (Neimeyer & Moore, 1994).
Because there are different numbers of items within each subscale, the possible range for each varies. Specifically, scores on the Fear of Dying Process, Fear of Body after Death, and Fear for Significant Others subscales range from 6 to 30; the range for the Fear of the
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Dead, Fear of Conscious Death, and Fear of the Unknown subscales is from 5 to 25; and scores on the Fear of Being Destroyed and Fear of Premature Death subscales range from 4 to 20. Lower scores on each subscale represent greater death anxiety (Neimeyer & Moore, 1994).
Prior internal consistency estimates provided by Hoelter (1979) indicate good internal consistency, with an overall alpha for the entire scale as 0.75. Alpha values for each of the subscales range from α = .65 (Fear of Conscious Death) to α = .81 (Fear of Being Destroyed) (Hoelter, 1979). The present study’s alpha values suggest good internal consistency, with alpha values for each of the subscales ranging from α =.73 (Fear for the Body after Death) to α =.78 (Fear of the Unknown).
Revised Death Anxiety Scale (RDAS; Thorson & Powell, 1994) Similar to the MFODS, the RDAS consists of a variety of questions designed to assess the global concerns one may have regarding their personal death. The RDAS requires participants to rate 25 items on a 5 point Likert scale (0 = Strongly disagree, 4 = Strongly agree). Sample items include statements such as “I fear dying a painful death” and “I hate
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the idea that I will be helpless after I die.” Eight of the 25 items were reverse scored to reduce response bias. The total score of all items can range from a 0 (lowest) to 100 (highest), with higher scores indicating greater death anxiety (Thorson & Powell, 1994). Prior research involving college students and adults indicated a Cronbach’s alpha of .80 (Thorson & Powell, 1994). The Cronbach’s alpha in the present study was 0.90,
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indicating a strong internal consistency within this scale.
Personal Data The personal data form asked participants to provide a variety of demographic information including age, sex, highest level of education, current degree they were pursuing, and religion. In addition to this basic information, participants’ were asked if they had experienced the death of a parent or sibling. Finally, if they had experienced the death of a parent or sibling, they were asked to list the age in which this occurred.
Such personal experiences are no doubt relevant to the subject of death anxiety. In our sample, individuals who experienced the death of a parent or sibling (n = 51) reported less death anxiety on several dimensions of the MFODS, including Fear of the Dying Process, Fear of the Dead, Fear of Conscious Death, Fear of the Body After Death, and Fear of Premature Death compared to those who did not report such experiences (n = 188), all t (237) ≥ 1.97, all p ≤ .05 (all mean differences ≥ 1.58). In addition, compared to those who did not experience a death of a parent or sibling, those who did reported less death anxiety overall as measured by the RDAS, t (237) = 2.47, p = .01. Thus, because
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experience with the death of a parent or sibling was associated with variance in selfreported death anxiety, we included this variable as a covariate in our primary analyses.
Given that our primary focus was to examine the variability in death anxiety between undergraduate and graduate students, it was important that we next attempt to disentangle the confounded relationship between age and level of education. Because (a) graduate
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students tend to be older than undergraduate students and (b) the age distribution for our sample was positively skewed (i.e., most of our participants were “younger”), we collapsed participants’ ages into quartiles within each of the two groups. Specifically, within the sample of undergraduate students, those individuals 19 years of age and younger represented the youngest 25%, 20 year-olds the next youngest quartile, and 2122 year-olds the next-youngest quartile, with those aged 23 years and above comprising the oldest quartile among undergraduates. Similarly, individuals 25 years and younger comprised the youngest quartile of the graduate student group. Graduate students aged 26-29 represented the next-youngest quartile, while those aged 30-43 years comprised the next-youngest quartile. Graduate students aged 44 and above were identified as the oldest quartile among the group. Treating age in this manner allowed us to retain the ordinal nature of the data, yet also utilize the overall structure of participants’ ages within each group as a covariate in our analyses.
RESULTS Based on a statistical and visual inspection of the dependent variables, it was determined that the MFODS subscales “Fear of Dying Process”, “Fear of Being Destroyed”, “Fear
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for Significant Others”, and “Fear for Body after Death” were not normally distributed and thus, transformations were performed in order to approximate a normal distribution on these scales. Specifically, a reciprocal transformation was performed on the subscales “Fear of Dying Process”, “Fear of Being Destroyed”, and “Fear for Significant Others” in order to correct the positive skew and unequal variance (Field, 2009). In addition, a reverse score transformation was performed on “Fear for the Body after Death” in order
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to correct a negative skew (Field, 2009). Following the transformations, separate analyses were conducted using transformed values as well as raw values. Preliminary analyses indicated a similar pattern of results and thus the findings reported below are based on raw scores in order to facilitate interpretation.
Sample-level bivariate correlations between the various death anxiety measures are presented in Table 1. Next, significant positive relationships were found between quartiled age and the MFODS subscales (all r >.15, all p < .05), with the exception of the domain “Fear of Being Destroyed,” suggesting that as age increases, death anxiety as measured by these subscales decreases. Similarly, a significant negative correlation was found between quartiled age and RDAS, r = -.18, p < .01, also suggesting that as age increases, death anxiety decreases. In light of these significant correlations between age and various measures of death anxiety and because of the confounded relationship between age and level of education, participants’ quartiled ages were used as a covariate in our primary analyses.
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The primary research objective was to examine statistically whether there was a difference in death anxiety between graduate and undergraduate students, irrespective of participants’ ages. Further, because our analyses revealed significant variability on death anxiety as a function of personal experiences with death (i.e., death of a parent or death of a sibling), we determined that it would be important to include such experience in our analyses. Thus, a multivariate analysis of covariance (MANCOVA) was conducted in
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order to investigate whether significant group differences on the domain-specific death anxiety dependent variables emerged as a function of education. With respect to the death anxiety variables and after accounting for variability due to the age quartile and personal experience with death covariates, significant differences were found among undergraduate and graduate students, Wilk’s λ = .91, F (9, 229) = 2.53, p = .009, indicating that after controlling for age and participants’ personal experiences with death of loved ones, level of education was associated with differences on the multivariate dependent measures.
Given the results of the robust MANCOVA test, follow-up Analyses of Covariance (ANCOVAs) were performed for each subscale, using participants’ quartiled age and personal experiences with death of loved ones as covariates, in order to examine the effect of level of education on each of the individual self-reported death anxiety measures. Based on the existing literature, it was expected that compared to undergraduate students, graduate students would report less death anxiety across all measures, irrespective of age and experience with death.
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Contrary to our hypothesis, when including the covariates, there were no differences found between undergraduate and graduate students on the Fear of Being Destroyed dimension of the MFODS, F (1, 237) = .001, p = .979. However, there were a number of significant differences found between graduate and undergraduate students in the remaining measures of death anxiety. Of the remaining multidimensional fear of death subscales, graduate students exhibited less death anxiety than undergraduates on Fear of
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the Dead, F (1, 237) = 4.32, p = .04, Fear for Significant Others' Death, F (1, 237) = 7.86, p = .005, Fear of the Unknown, F (1, 237) = 9.63, p = .002, Fear of Conscious Death, F (1, 237) = 10.99, p = .001, Fear of Premature Death, F (1, 237) = 8.05, p = .005, and the Fear of the Dying Process, F (1, 237) = 8.50, p = .004 measures. In addition, compared to undergraduate students, graduate students reported less overall death anxiety as measured by the RDAS, F (1, 237) = 4.23, p = .04. Means and standard deviations for the dependent death anxiety measures controlling for age and personal experience with death of a loved one are presented in Table 2 below.
DISCUSSION The primary goal of the present study was to examine variability in domain-specific as well as overall self-reported death anxiety for self and others among undergraduate and graduate students. Irrespective of age and self-reported experiences with death of a parent or sibling, graduate students were expected to report lower levels of death anxiety than undergraduate students in all domains, presumably due to their increased knowledge base and further understanding of the lifespan. As hypothesized, graduate students reported lower levels of death anxiety in all but one of the MFODS subscales as well as lower
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“Overall Death Anxiety” as measured by the RDAS. However, contrary to predictions, undergraduate and graduate students showed no significant differences in “Fear of Being Destroyed. These findings will be discussed in relation to the existing research literature concerning death anxiety across the lifespan and among varying levels of education.
Our hypotheses that “Fear of the Dying Process” and “Fear of Conscious Death” would
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be higher in undergraduate than graduate students, irrespective of age and experience with death of a loved one, were confirmed. These significant findings were consistent with prior research which has found that men and women report increased levels of personal death anxiety during their twenties due to factors related to bearing and raising offspring (Russac et al., 2007). Similarly, it has been found that as psychosocial maturity increases, self-reported levels of death anxiety decrease (Rasmussen & Brems, 1996). Thus, one may expect that graduate students would report lower death anxiety due to the overall increase in education and life experiences. Although our analyses controlled for age and self-reported experiences with death of loved ones, our sample did not allow us to statistically examine the role of having children or other important life experiences as they relate to death anxiety. Future efforts should work to recruit specifically individuals with such experiences in order to examine the contribution of these person-level experiences on self-reported variability in death anxiety.
Reflecting prior research (Aradilla-Herrero et al., 2012; Chen et al., 2006; HassThompson et al., 2008), it is also clear that certain types of degree programs (e.g. medical school, nursing, gerontology) deal with the complex issues of death more frequently and
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in greater detail than do other programs. In addition, our findings are consistent with the work of Sharma et al. (1997) that nursing students were less fearful than undergraduate students in regards to “Fear of Conscious Death.” When considering these previous findings, it is important to note that the variable of age was not controlled for when examining death anxiety. Our study similarly examined undergraduate and graduate students from behavioral and social science programs (e.g. psychology, gerontology, and
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counseling). However, by accounting for age in our analyses, our findings add further clarity to previous work in this area. Taken together, one may theorize that variation in death anxiety levels is not necessarily due to the general level of formal education attained, but rather the specific type of formal education received. Future research should continue to disentangle such findings.
Similarly, our hypotheses that “Fear of Premature Death”, “Fear for Significant Others”, and “Fear of the Unknown” would be higher in undergraduate students than graduate students, irrespective of age and personal experience with death of loved ones, were also confirmed. These findings are interesting because prior research has suggested that undergraduates often view the deaths of others as an immediate threat, but not their own (Evans, Walters, & Hatch-Woodruff, 1999; Kastenbaum & Heflick, 2011). However, these findings are consistent and support the work of Lester and Becker (1993) which suggested that college students are not only becoming more aware of their impending deaths, but also struggle more to understand about the existence of life after death than prior generations. This conclusion is also consistent with Mak (2011), who found that undergraduate students were aware of the possibility of death in young age and reported
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regret for those who die young because of their inability to fulfill life goals. Furthermore, this finding supported the work of Aradilla-Herrero et al. (2012) in which nursing students reported less fear of death of others as they progressed through their three-year nursing programs.
Taken together, one may speculate that graduate students have more acceptance of their
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own premature death, the death of significant others, and the unknown due to a more accurate perception of the lifespan and fulfillment of educational goals attained through higher education curriculum. However, contrary to predictions, undergraduate students did not report greater ‘Fear of Being Destroyed,” than graduate students. This finding is particularly interesting in that this subscale pertains to fear of bodily remains (Hoelter, 1979). Consistent with the work of Goldberg, Pyszczynski, Greenberg, and Solomon (2000), the present study supports the idea that issues with the body arise because of our awareness that death will eventually pass through our body and bring about ultimate annihilation. Therefore, it may be that it is harder to minimize anxiety for bodily remains because it is a salient reminder of our inevitable death.
Finally, the present study confirmed the hypothesis that graduate students would report lower levels of overall death anxiety than undergraduate students when controlling for age and experience with death of loved ones. This finding is consistent with prior research that discovered significant differences in levels of death anxiety due to the type of formal education (Bassett & Dabbs, 2003; Sharma et al., 1997) and level of education received (Haas-Thompson, 2008). Our study extends these findings by controlling for age
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and self-reported experiences with death of loved ones and provides further evidence that death anxiety is a complex and multidimensional phenomenon, and may vary as a function of where one is within the lifespan. Future research should examine how developmental milestones (e.g. post-secondary education, retirement) contribute to death anxiety.
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Other novel findings emerged in the current study which merit discussion. First, it is important to note the negative correlations between the RDAS and the eight subscales of the MFODS (see Table 1). Although such negative correlations provide an indication of the construct validity of these measures, they are weaker than reported in prior research (Neimeyer & Moore, 1994; Thorson & Powell, 1994). Therefore, it may be that even though the MFODS and RDAS are both measuring death anxiety, they may be measuring slightly different components of fear of death. For example, it could be argued that the MFODS focuses more on rating specific death situations while the RDAS concentrates on rating feelings toward death.
Next, a large body of prior research has supported the notion that age plays a major role in how individuals perceive their own death (Abengozar et al., 1999; Russac et al., 2007, Evans et al., 1999). In regards to the current study, the variable of age was positively correlated in all of the MFODS subscales and negatively correlated with RDAS suggesting that as individuals age, death anxiety may decline. Thus, our study collapsed age in order to covary for the confounded association between age and education so that we could more specifically examine level of education as it relates to variability in
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undergraduate and graduate students’ self-reported death anxiety. That level of education remained a significant contributing variable to participants’ self-reported death anxiety after controlling for variability due to age (and personal experience with death of loved ones) underscores the notion that level of educational pursuit offers a unique contribution to our understanding of how individuals experience death anxiety.
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Results from the present study contribute to the larger death anxiety literature and provide a number of novel findings. However, our results should be interpreted in light of certain limitations and scholars interested in better discerning how education level obtained in particular is associated with self-reported variability in death anxiety levels could extend and clarify our findings in a number of ways. Specifically, the recruitment and data collection methods we used resulted a sample where level of education was confounded with a number of other factors. For example, our study included students from various years of their specific degree programs. However, because students admitted to graduate school are often selected from the top of their respective classes, it would be useful to clarify and subsequently compare undergraduates who were planning on attending graduate school to students already enrolled in graduate programs. Similarly, future research might survey students who are completing the final year of their programs in order to control for “experience” within their degree programs. Furthermore, it may be beneficial to compare within the undergraduate student population (i.e., to compare freshmen, sophomores, juniors, and seniors) or to include high school graduates as well as current doctoral students in order to sample a wider spectrum of variability in terms of the association between death anxiety and students’
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educational experiences. Future research efforts could also measure specifically students’ general knowledge about the lifespan or aging in particular (e.g., the Facts on Aging Quiz; Palmore, 1981) in order to examine how such domain-specific knowledge correlates with death anxiety.
Further, the cross-sectional design of the present study did not permit causal
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interpretations of our findings. Including a large enough sample of various underclassmen, while identifying those bound for graduate school or otherwise, as well as both high school graduates and doctoral students and measuring participants’ specific, conceptually relevant knowledge may yield more conclusive and specific results in terms of whether (and how) levels of death anxiety change as a function of an increased knowledge base. A longitudinal extension of this work would allow scholars to assess the temporal ordering of the relationship between educational pursuit and death anxiety.
An additional limitation of the present study was that the sample was drawn from primarily undergraduate and graduate students within specific degree programs at a Midwestern university. Conceptual knowledge of the lifespan in general and familiarity with death and dying in particular are obviously more central to certain degree programs (e.g., nursing, gerontology) than others (e.g., business, fine arts) and this reality is also represented in the existing empirical literature. Future research efforts should examine students drawn from a wider assortment of degree programs in order to provide a more complete picture of the association between education and death anxiety.
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Finally, and importantly, although efforts were made to recruit a similar number of men and women, because the resulting sample consisted primarily of White females, our findings cannot be generalized beyond the general population of White females attending a Midwestern university. In order to gain a more accurate and comprehensive understanding of how death anxiety varies with one’s level of education, future research should make a concerted effort to include a larger amount of males and individuals from
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diverse sociodemographic backgrounds. Additionally, it may be beneficial to conduct research from universities that vary in geographical location in order to take into account the culture of the students being studied. With recent emphases on globalization among institutions of higher education, it would be interesting to examine how death anxiety is experienced by undergraduate and graduate students worldwide.
CONCLUSION The present study contributes to the broader literature by identifying specific domains in which undergraduate students reported higher levels of death anxiety for self and others than did graduate students. Although current level of education, irrespective of age and self-reported experiences with death of close family members, appears to contribute to variations in death anxiety, it is still unclear if level of education independently and causally alters the way individuals perceive death. Future research should build upon the present findings in order to obtain a more comprehensive understanding of the role of education with respect to death anxiety among college students.
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The benefits of increasing knowledge within this domain may be considered two fold. From an educational perspective, future research may serve as a foundation for delineating a more thorough understanding of the complex relationship between death anxiety and level of education. This knowledge may be most beneficial to the behavioral sciences (e.g. psychology, gerontology, social work, counseling) that more specifically focus on understanding how individuals feel about death as they attain educational goals
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throughout the lifespan. From the practitioner perspective, knowledge gained from research in death anxiety may aid in facilitating dialogue between helping professionals and the individuals they serve who are experiencing death anxiety. Specifically, programs which help individuals cope with terminal illness, such as hospice, may benefit from understanding how patients perceive death and with what level of anxiety death is associated. Similarly, counselors may gain further understanding of how their clients feel in times of death and bereavement by comprehending death anxiety in light of the client’s education level.
The completion of higher education may be viewed as a life altering experience which allows for both psychological and social growth. Therefore, research pertaining to death anxiety during the pursuit of such a milestone will overall expand our knowledge base on how those who achieve higher education think about death and dying.
ACKNOWLEDGEMENTS The authors wish to thank Haley Koepp and Jess Bohn for their valuable efforts with data collection and study management. We also extend our gratitude to an anonymous
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reviewer, whose constructive comments helped us reconsider our findings in light of the existing literature.
REFERENCES Abengozar, M.C., Bueno, B. & Vega, J.L. (1999). Intervention on attitudes toward death along the life span. Educational Gerontology, 25, 435-447.
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Aradilla-Herrero, A., Tomas-Sabado, J., Gomez-Benito, M. (2012). Death attitudes and emotional intelligence in nursing students. Omega, 66, 39-55. Basset, J.F. & Dabbs, J.M. (2003). Evaluating explicit and implicit death attitudes in funeral and university students. Mortality, 8, 358-371. Berman, J.D. (1998). Attitudes toward aging and death anxiety: Aging and death class. Omega Journal of Death & Dying, 38, 59-63. Chen, Y., Ben, K.S., Forston, B.L., & Lewis, J. (2006). Differential dimensions of death anxiety in nursing students with and without nursing experience. Death studies, 30, 919929. Evans, J. W., Walters, A.S., & Hatch-Woodruff, M. L. (1999). Deathbed scene narratives: A construct and linguistic analysis. Death Studies, 23, 715-733. Field, A. (2009). Discovering statistics using SPSS (3rd ed.). Sage: Thousand Oaks, CA. Goldenberg, J.L., Pyszczynski, T, Greenberg, J., & Solomon, S. (2000). Fleeing the body: A terror management perspective on the problem of human corporeality. Personality and Social Psychology Review, 4, 200-218.
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Hass-Thomspon, T., Alston, P.P., & Holbert, D. (2008). The impact of education and death-related experiences on rehabilitation counselor attitudes toward death and dying. Journal of Applied Rehabilitation Counseling, 39, 20-27. Hoelter, J.W. (1979). Multidimensional treatment of fear of death. Journal of Consulting and Clinical Psychology, 47, 996-999. Hoelter, J.W., Whitlock, J.L., & Epley, R.J. (1979). Fertility attitudes and the fear of
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death. Psychological Reports, 45, 795-800. Kastenbaum, R. & Heflick, N. A. (2011). Sad to say: Is it time for sorrow management theory? Omega Journal of Death & Dying, 62, 305-327. Lester, D. & Becker, D. M. (1993). College students’ attitude toward death today as compared to the 1930s. Omega Journal of Death & Dying, 26, 219-222. Mak, M.H. (2011). Quality insights on dying, death, and death education – A preliminary study in Hong Kong. Omega Journal of Death & Dying, 62, 387-405. Neimeyer, R.A. & Moore, M.K. (1994). Validity and reliability of the multidimensional Fear of death scale. In Neimeyer, R. (Ed.)., Death Anxiety Handbook (p. 103-119). Washington, DC: Taylor and Francis. Neimeyer, R.A. (1998). Death anxiety research: The state of the art. Omega, 36, 97-120. Okafor, R.U. (1994). Death attitudes, gender, and death experience: The Nigerian evidence. Omega, 30, 67-78. Palmore, E. (1981). The facts on aging quiz: Part two. The Gerontologist, 21, 431-437. Rasmussen, C.A. & Brems, C. (1996) The relationship of death anxiety with age and psychosocial maturity. The Journal of Psychology, 130, 141-144.
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Russac, R.J, Gatliff, C., Reece, M., & Spottswood, D. (2007). Death anxiety across the adult years: An examination of age and gender effects. Death studies, 31, 549-561. Schwartz, C.E., Clive, D.M., Mazor, K.M., Ma, Y., Reed, G. & Clay, M. (2005). Detecting attitudinal changes about death and dying as a result of end-of-life care curricula for medical undergraduates. Journal of Palliative Medicine, 8, 975-987. Sharma, S., Monsen, R.B, & Gary, B. (1997). Comparison of attitudes toward death and
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dying among nursing majors and other college students. Omega, 34, 219-232. Thorson, J.A & Powell, F.C. (1994). A revised death anxiety scale. In Neimeyer, R. (Ed.), Death Anxiety Handbook (p. 31-43). Washington, DC: Taylor and Francis. Wong, W.Y. (2009). The growth of death awareness through death education among university students in Hong Kong. Omega, 59, 113-128.
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Table 1. Pearson correlations between subscales of the MFODS and RDAS Subscales
RDAS
FODP
FOD
FOBD
FFSO
FOU
FOCD
FBAD
FPD
----
-.55**
-.46**
-.28**
-.40**
-.39**
-.49**
-.70**
-.51**
2. FODP
----
----
.37**
.03
.41**
.32**
.48**
.45**
.59**
3. FOD
----
----
----
.35**
.38**
.16*
.34**
.49**
.30**
4. FOBD
----
----
----
----
.16*
-.01
.23**
.34**
.02
5. FFSO
----
----
----
----
----
.18**
.27**
.29**
.34**
6. FOU
----
----
----
----
----
----
.29**
.27**
.24**
7. FOCD
----
----
----
----
----
----
----
.53**
.33**
8. FBAD
----
----
----
----
----
----
----
----
.41**
9. FPD
----
----
----
----
----
----
----
----
----
Total 1. RDAS
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Total
Note: **. Correlation is significant at the 0.01 level (1-tailed). *. Correlation is significant at the 0.05 level (1-tailed). RDAS = Revised Death Anxiety Scale; FOU
= Fear of the Unknown
FODP = Fear of Dying Process; FOCD = Fear of Conscious Death FOD = Fear of the Dead; FBAD = Fear for Body After Death FOBD = Fear of Being Destroyed; FPD
= Fear of Premature Death
FFSO = Fear for Significant Others
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Table 2. Descriptive statistics for education levels, MFODS, and RDAS FODP
FOD
FOBD FFSO
FOU
FOCD FBAD FPD
RDAS
(SD)
(SD)
(SD)
(SD)
(SD)
(SD)
(SD)
(SD)
(SD)
Graduate
15.25* 17.66* 11.70
14.50* 16.09* 16.89* 22.80* 12.27* 46.41*
(n = 92)
(5.34)
(5.53)
(4.39)
(3.60)
(3.74)
(5.33)
(6.13)
(4.31)
(18.16)
Undergraduate
13.06
16.21
11.64
13.21
14.49
14.67
21.16
10.65
51.65
(n = 149)
(5.40)
(4.79)
(4.67)
(2.86)
(3.98)
(4.06)
(5.17)
(4.05)
(17.27)
Total
13.90
16.77
11.66
13.71
15.10
15.51
21.79
11.27
49.65
(N = 241) Note: For the eight subscales of the MFODS lower scores represent greater death anxiety. For the RDAS Total higher scores represent greater death anxiety. * p < .05, two tailed RDAS = Revised Death Anxiety Scale; FOU
= Fear of the Unknown
FODP = Fear of Dying Process; FOCD = Fear of Conscious Death FOD = Fear of the Dead; FBAD = Fear for Body After Death FOBD = Fear of Being Destroyed; FPD
= Fear of Premature Death
FFSO = Fear for Significant Others
26
Death Studies Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/udst20
Death Anxiety and Education: A Comparison Among Undergraduate and Graduate Students a
Kristie Nienaber B.A. & Eric Goedereis PhD
a
a
Webster University, Saint Louis, MO Accepted author version posted online: 27 May 2015.
Click for updates To cite this article: Kristie Nienaber B.A. & Eric Goedereis PhD (2015): Death Anxiety and Education: A Comparison Among Undergraduate and Graduate Students, Death Studies, DOI: 10.1080/07481187.2015.1047057 To link to this article: http://dx.doi.org/10.1080/07481187.2015.1047057
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Death Anxiety and Education: A Comparison Among Undergraduate and Graduate Students Kristie Nienaber, B.A.1, Eric Goedereis, PhD1 1
Webster University, Saint Louis, MO
Address Correspondence to Kristie Nienaber, Webster University, 7614 Suffolk, Saint Louis, MO 63119, Email: [email protected]
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Abstract The present study investigated the association between level of education and selfreported levels of anxiety regarding death of self and others among undergraduate students (n = 149) and graduate students (n = 92). Participants completed the Multidimensional Fear of Death Scale (MFODS) and the Revised Death Anxiety Scale (RDAS). Although undergraduate and graduate students did not differ on Fear of Being Destroyed, graduate students reported lower levels of death anxiety on all remaining measures. Suggestions for future research and implications are discussed.
KEYWORDS: Death anxiety, Higher Education
Death is an inevitable occurrence which creates distress and apprehension for many human beings (Rasmunssen & Brems,1996). Such distress and apprehension can be conceptualized as death anxiety, which refers to the negative thought processes that often accompany the thought of death, with regard to oneself or others. (Rasmunssen & Brems,1996). More specifically, death anxiety can be defined as the trepidation that is caused by morbid thinking (Kastenbaum & Heflick, 2011). However, Neimeyer (1998) 1
expands upon this common sense definition by including a variety of attitudes towards death such as “fear, threat, unease, and discomfort” (p. 96).
Prior research has demonstrated that death anxiety varies as a function of a variety of personal factors, including age (Russac, Gatliff, Reece, & Spottswood, 2007), sex (Okafor, 1995), and choice of major (Sharma, Monsen, & Gary, 1997). More specifically
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to choice of major, Sharma et al. (1997) found that nursing students indicated less fear of their own death, the dying process, being near the dead, and their bodies being destroyed after death than undergraduate students pursuing other disciplines. Furthermore, their results indicated that among all undergraduate students, freshman students indicated more fear of death than their sophomore, junior, and senior counterparts. Although these findings suggest that several individually-specific variables, including choice of major, may contribute to death anxiety, the specific role of different levels of education remains less clear.
General death education efforts have been found to influence levels of death anxiety. For instance, students enrolled in a class on either death or aging reported a reduction in death anxiety (Berman, 1998). Similarly, medical students taking a course on death and dying reported less concern about working with dying patients in contrast to medical students who did not take the course (Schwartz et al., 2005). Further, compared to funeral service students, university students reported significantly higher death anxiety (Basset & Dabbs, 2003). In addition, Abengozar, Bueno, and Vega (1999) found that older adults who participated in a workshop-style class in which they could exchange ideas and feelings
2
about death reported overall lower levels of death anxiety than other older adults who received a traditional conference-style format in which they were given information through lecture.
It is important to highlight that college students’ perceptions of death and desire for death education have been found to vary over time. Compared to college students in a 1935
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cohort, Lester and Becker (1993) found that college students in 1991 were more likely to think about their deaths, encompassed a greater fear of death, and showed greater interest in knowing about the existence of life after death. Given their findings, Lester and Becker (1993) argued that even though society may be becoming increasingly aware of death and dying, more recent generations of younger grievers are not equipped with the belief systems to help them cope with death.
From this perspective, it may be that as many contemporary societies move away from a more explicit religious orientation, individuals are searching for comprehension of the complex issues of death through secular institutions such as universities. Recent research supports the increasing need to utilize the classroom as a means to process death. For example, Mak (2011) found through interviewing university students in Hong Kong about their attitudes and experiences with death that most students were interested in education programs about both life and death across the school years (Mak, 2011). Furthermore, Wong (2009) found that overall university students in Hong Kong had negative attitudes towards death. However, students who completed even one death education course showed significant improvement in several dimensions of death
3
attitudes including one’s fear of death. While both the findings of Mak (2011) and Wong (2009) support the benefit of death education as a means to improve attitudes and decrease anxiety regarding death, it should be noted that Eastern students may have more overall positive views of death than Western students due to the greater connection and significance of death in Eastern culture (e.g. burial rites, ancestor worship).
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There are few studies that have examined the variation in death anxiety among differing levels of education. One exception, however, was a study of rehabilitation counselors (Hass-Thompson, Alston, & Holbert, 2008). Specifically, rehabilitation counselors who had obtained master’s degrees had more favorable attitudes toward death and less fear of death than those who only obtained bachelor’s degrees. Furthermore, those counselors who had received specific death education did not report significant differences in fear of their personal death, but only the death of others.
In another study, Aradilla-Herroro, Tomas-Sabado, and Gomez-Benito (2012) studied relationships between self-reported death attitudes and perceived emotional intelligence among Spanish nursing students across three years of their nursing programs. One particular goal of the study was to investigate differences in death attitudes between academic years. Results showed that there was a progressive decrease of death anxiety and death depression across the three years. However, it should be noted that only Fear of Death of Others reached levels of significant difference with gained level of education (Aradilla-Herroro et al., 2012). In a similar study, Chen, Ben, Fortson, and Lewis (2006) looked at death anxiety levels in groups of first year nursing students with no prior
4
nursing experience, final year nursing students with nursing experience (e.g. practicum, internship, field placement), and non-nursing undergraduate students. Results showed that experienced nursing students reported significantly higher levels of fear of the dying process and that both inexperienced and experienced nursing students had higher levels of fear of the unknown than non-nursing students. Chen et al. (2006) suggest that these results highlight how fear of the unknown may develop as a function of attending nursing
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programs that overtly integrate death and dying into their curriculum and how fear of the dying process may increase with gained experience with death in nursing programs.
Taken together, these studies emphasize how the discrepancy between level of education, type of death education received, and experience level within educational programs highlight the complex nature of how death anxiety is experienced. Thus, a further examination of how education is associated with death anxiety is warranted in order to better understand how level of education may alter our perception of death.
The primary objective of the present study was to examine variability in self-reported death anxiety, both global and domain-specific, among undergraduate and graduate students. Specifically, our goal was to examine how one’s pursuit of higher education is associated with one’s fear of death regarding both self and others. In light of prior research which suggested that increased age (Russac et al., 2007), type of education received (Abengozar et al., 1999; Berman, 1998), and level of education completed (Aradilla-Herrero et al., 2012; Hass-Thompson et al., 2008) are associated with variability in self-reported death anxiety, we expected that an increased knowledge base,
5
as indicated by greater educational attainment, would be associated with lower levels of death anxiety. Thus, compared to undergraduate students, graduate students were hypothesized to report lower levels of anxiety across all domains.
METHOD Participants
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Convenience sampling methods were used in order to select participants from a mid-size Midwestern university. Graduate and undergraduate faculty members were contacted by email in order to obtain permission to solicit participation during regularly scheduled courses. Approval from the Webster University Institutional Review Board was obtained prior to soliciting participants. Participants consisted of both undergraduate and graduate students who were over the age of 18 and were enrolled at the university. Responses from four participants could not be used due to missing information. The final sample of students surveyed was comprised of 149 undergraduate students (Mean Age= 21.59 years, SD = 5.24) and 92 graduate students (Mean Age = 33.93 years, SD = 11.14). The majority (75%) of the sample were female. With respect to self-reported ethnicity, participants identified themselves as Caucasian/White (77%), African-American/Black (14%), Latino/Hispanic (3%), Asian/Pacific Islander (2%), or Other (4%). Most participants identified themselves as single (79%) or married (16%); 17% of participants had children. Christianity (62%) was the most commonly identified religious orientation, with 16% of participants reporting another specific religion (e.g., Muslim, Pagan, or Hindu) or “other”, with the remaining participants identifying themselves as agnostic (14%) or atheist (6%). With
6
respect to personal experiences with death, only 17% of our participants had experienced the death of a parent, while only 5% reported the death of a sibling.
Procedure Participants were asked to review and sign consent forms prior to participation. The first author or a trained research assistant administered the study
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protocol in which each participant was provided a consent form, a packet of questionnaires, and a short personal data form. The questionnaires consisted of two selfreport scales: the Multidimensional Fear of Death Scale (Hoelter, 1979) and the Revised Death Anxiety Scale (Thorson & Powell, 1994) (each described below), in order to measure death anxiety among undergraduate and graduate students. Following completion of the survey, participants were debriefed. Certain instructors awarded extra credit in their courses for participation.
Materials Multidimensional Fear Of Death Scale (MFODS; Hoelter, 1979) The MFODS consists of a variety of questions (organized into eight subscales) designed to assess the domain-specific concerns one may have regarding their personal death. The MFODS requires participants to rate the extent to which they agree or disagree with 42 items on a 5 point Likert Scale (1 = Strongly agree, 5 = Strongly disagree). Items are designed to obtain information with respect to concerns about both personal death and fear of those who are already dead. Sample items included statements such as “I am afraid of dying very slowly” and “I am afraid of meeting my creator.” In order to gain
7
subscale scores, each participant’s scores were added, with five of the items being reverse scored to reduce response bias (Neimeyer & Moore, 1994).
Because there are different numbers of items within each subscale, the possible range for each varies. Specifically, scores on the Fear of Dying Process, Fear of Body after Death, and Fear for Significant Others subscales range from 6 to 30; the range for the Fear of the
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Dead, Fear of Conscious Death, and Fear of the Unknown subscales is from 5 to 25; and scores on the Fear of Being Destroyed and Fear of Premature Death subscales range from 4 to 20. Lower scores on each subscale represent greater death anxiety (Neimeyer & Moore, 1994).
Prior internal consistency estimates provided by Hoelter (1979) indicate good internal consistency, with an overall alpha for the entire scale as 0.75. Alpha values for each of the subscales range from α = .65 (Fear of Conscious Death) to α = .81 (Fear of Being Destroyed) (Hoelter, 1979). The present study’s alpha values suggest good internal consistency, with alpha values for each of the subscales ranging from α =.73 (Fear for the Body after Death) to α =.78 (Fear of the Unknown).
Revised Death Anxiety Scale (RDAS; Thorson & Powell, 1994) Similar to the MFODS, the RDAS consists of a variety of questions designed to assess the global concerns one may have regarding their personal death. The RDAS requires participants to rate 25 items on a 5 point Likert scale (0 = Strongly disagree, 4 = Strongly agree). Sample items include statements such as “I fear dying a painful death” and “I hate
8
the idea that I will be helpless after I die.” Eight of the 25 items were reverse scored to reduce response bias. The total score of all items can range from a 0 (lowest) to 100 (highest), with higher scores indicating greater death anxiety (Thorson & Powell, 1994). Prior research involving college students and adults indicated a Cronbach’s alpha of .80 (Thorson & Powell, 1994). The Cronbach’s alpha in the present study was 0.90,
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indicating a strong internal consistency within this scale.
Personal Data The personal data form asked participants to provide a variety of demographic information including age, sex, highest level of education, current degree they were pursuing, and religion. In addition to this basic information, participants’ were asked if they had experienced the death of a parent or sibling. Finally, if they had experienced the death of a parent or sibling, they were asked to list the age in which this occurred.
Such personal experiences are no doubt relevant to the subject of death anxiety. In our sample, individuals who experienced the death of a parent or sibling (n = 51) reported less death anxiety on several dimensions of the MFODS, including Fear of the Dying Process, Fear of the Dead, Fear of Conscious Death, Fear of the Body After Death, and Fear of Premature Death compared to those who did not report such experiences (n = 188), all t (237) ≥ 1.97, all p ≤ .05 (all mean differences ≥ 1.58). In addition, compared to those who did not experience a death of a parent or sibling, those who did reported less death anxiety overall as measured by the RDAS, t (237) = 2.47, p = .01. Thus, because
9
experience with the death of a parent or sibling was associated with variance in selfreported death anxiety, we included this variable as a covariate in our primary analyses.
Given that our primary focus was to examine the variability in death anxiety between undergraduate and graduate students, it was important that we next attempt to disentangle the confounded relationship between age and level of education. Because (a) graduate
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students tend to be older than undergraduate students and (b) the age distribution for our sample was positively skewed (i.e., most of our participants were “younger”), we collapsed participants’ ages into quartiles within each of the two groups. Specifically, within the sample of undergraduate students, those individuals 19 years of age and younger represented the youngest 25%, 20 year-olds the next youngest quartile, and 2122 year-olds the next-youngest quartile, with those aged 23 years and above comprising the oldest quartile among undergraduates. Similarly, individuals 25 years and younger comprised the youngest quartile of the graduate student group. Graduate students aged 26-29 represented the next-youngest quartile, while those aged 30-43 years comprised the next-youngest quartile. Graduate students aged 44 and above were identified as the oldest quartile among the group. Treating age in this manner allowed us to retain the ordinal nature of the data, yet also utilize the overall structure of participants’ ages within each group as a covariate in our analyses.
RESULTS Based on a statistical and visual inspection of the dependent variables, it was determined that the MFODS subscales “Fear of Dying Process”, “Fear of Being Destroyed”, “Fear
10
for Significant Others”, and “Fear for Body after Death” were not normally distributed and thus, transformations were performed in order to approximate a normal distribution on these scales. Specifically, a reciprocal transformation was performed on the subscales “Fear of Dying Process”, “Fear of Being Destroyed”, and “Fear for Significant Others” in order to correct the positive skew and unequal variance (Field, 2009). In addition, a reverse score transformation was performed on “Fear for the Body after Death” in order
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to correct a negative skew (Field, 2009). Following the transformations, separate analyses were conducted using transformed values as well as raw values. Preliminary analyses indicated a similar pattern of results and thus the findings reported below are based on raw scores in order to facilitate interpretation.
Sample-level bivariate correlations between the various death anxiety measures are presented in Table 1. Next, significant positive relationships were found between quartiled age and the MFODS subscales (all r >.15, all p < .05), with the exception of the domain “Fear of Being Destroyed,” suggesting that as age increases, death anxiety as measured by these subscales decreases. Similarly, a significant negative correlation was found between quartiled age and RDAS, r = -.18, p < .01, also suggesting that as age increases, death anxiety decreases. In light of these significant correlations between age and various measures of death anxiety and because of the confounded relationship between age and level of education, participants’ quartiled ages were used as a covariate in our primary analyses.
11
The primary research objective was to examine statistically whether there was a difference in death anxiety between graduate and undergraduate students, irrespective of participants’ ages. Further, because our analyses revealed significant variability on death anxiety as a function of personal experiences with death (i.e., death of a parent or death of a sibling), we determined that it would be important to include such experience in our analyses. Thus, a multivariate analysis of covariance (MANCOVA) was conducted in
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order to investigate whether significant group differences on the domain-specific death anxiety dependent variables emerged as a function of education. With respect to the death anxiety variables and after accounting for variability due to the age quartile and personal experience with death covariates, significant differences were found among undergraduate and graduate students, Wilk’s λ = .91, F (9, 229) = 2.53, p = .009, indicating that after controlling for age and participants’ personal experiences with death of loved ones, level of education was associated with differences on the multivariate dependent measures.
Given the results of the robust MANCOVA test, follow-up Analyses of Covariance (ANCOVAs) were performed for each subscale, using participants’ quartiled age and personal experiences with death of loved ones as covariates, in order to examine the effect of level of education on each of the individual self-reported death anxiety measures. Based on the existing literature, it was expected that compared to undergraduate students, graduate students would report less death anxiety across all measures, irrespective of age and experience with death.
12
Contrary to our hypothesis, when including the covariates, there were no differences found between undergraduate and graduate students on the Fear of Being Destroyed dimension of the MFODS, F (1, 237) = .001, p = .979. However, there were a number of significant differences found between graduate and undergraduate students in the remaining measures of death anxiety. Of the remaining multidimensional fear of death subscales, graduate students exhibited less death anxiety than undergraduates on Fear of
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the Dead, F (1, 237) = 4.32, p = .04, Fear for Significant Others' Death, F (1, 237) = 7.86, p = .005, Fear of the Unknown, F (1, 237) = 9.63, p = .002, Fear of Conscious Death, F (1, 237) = 10.99, p = .001, Fear of Premature Death, F (1, 237) = 8.05, p = .005, and the Fear of the Dying Process, F (1, 237) = 8.50, p = .004 measures. In addition, compared to undergraduate students, graduate students reported less overall death anxiety as measured by the RDAS, F (1, 237) = 4.23, p = .04. Means and standard deviations for the dependent death anxiety measures controlling for age and personal experience with death of a loved one are presented in Table 2 below.
DISCUSSION The primary goal of the present study was to examine variability in domain-specific as well as overall self-reported death anxiety for self and others among undergraduate and graduate students. Irrespective of age and self-reported experiences with death of a parent or sibling, graduate students were expected to report lower levels of death anxiety than undergraduate students in all domains, presumably due to their increased knowledge base and further understanding of the lifespan. As hypothesized, graduate students reported lower levels of death anxiety in all but one of the MFODS subscales as well as lower
13
“Overall Death Anxiety” as measured by the RDAS. However, contrary to predictions, undergraduate and graduate students showed no significant differences in “Fear of Being Destroyed. These findings will be discussed in relation to the existing research literature concerning death anxiety across the lifespan and among varying levels of education.
Our hypotheses that “Fear of the Dying Process” and “Fear of Conscious Death” would
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be higher in undergraduate than graduate students, irrespective of age and experience with death of a loved one, were confirmed. These significant findings were consistent with prior research which has found that men and women report increased levels of personal death anxiety during their twenties due to factors related to bearing and raising offspring (Russac et al., 2007). Similarly, it has been found that as psychosocial maturity increases, self-reported levels of death anxiety decrease (Rasmussen & Brems, 1996). Thus, one may expect that graduate students would report lower death anxiety due to the overall increase in education and life experiences. Although our analyses controlled for age and self-reported experiences with death of loved ones, our sample did not allow us to statistically examine the role of having children or other important life experiences as they relate to death anxiety. Future efforts should work to recruit specifically individuals with such experiences in order to examine the contribution of these person-level experiences on self-reported variability in death anxiety.
Reflecting prior research (Aradilla-Herrero et al., 2012; Chen et al., 2006; HassThompson et al., 2008), it is also clear that certain types of degree programs (e.g. medical school, nursing, gerontology) deal with the complex issues of death more frequently and
14
in greater detail than do other programs. In addition, our findings are consistent with the work of Sharma et al. (1997) that nursing students were less fearful than undergraduate students in regards to “Fear of Conscious Death.” When considering these previous findings, it is important to note that the variable of age was not controlled for when examining death anxiety. Our study similarly examined undergraduate and graduate students from behavioral and social science programs (e.g. psychology, gerontology, and
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counseling). However, by accounting for age in our analyses, our findings add further clarity to previous work in this area. Taken together, one may theorize that variation in death anxiety levels is not necessarily due to the general level of formal education attained, but rather the specific type of formal education received. Future research should continue to disentangle such findings.
Similarly, our hypotheses that “Fear of Premature Death”, “Fear for Significant Others”, and “Fear of the Unknown” would be higher in undergraduate students than graduate students, irrespective of age and personal experience with death of loved ones, were also confirmed. These findings are interesting because prior research has suggested that undergraduates often view the deaths of others as an immediate threat, but not their own (Evans, Walters, & Hatch-Woodruff, 1999; Kastenbaum & Heflick, 2011). However, these findings are consistent and support the work of Lester and Becker (1993) which suggested that college students are not only becoming more aware of their impending deaths, but also struggle more to understand about the existence of life after death than prior generations. This conclusion is also consistent with Mak (2011), who found that undergraduate students were aware of the possibility of death in young age and reported
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regret for those who die young because of their inability to fulfill life goals. Furthermore, this finding supported the work of Aradilla-Herrero et al. (2012) in which nursing students reported less fear of death of others as they progressed through their three-year nursing programs.
Taken together, one may speculate that graduate students have more acceptance of their
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own premature death, the death of significant others, and the unknown due to a more accurate perception of the lifespan and fulfillment of educational goals attained through higher education curriculum. However, contrary to predictions, undergraduate students did not report greater ‘Fear of Being Destroyed,” than graduate students. This finding is particularly interesting in that this subscale pertains to fear of bodily remains (Hoelter, 1979). Consistent with the work of Goldberg, Pyszczynski, Greenberg, and Solomon (2000), the present study supports the idea that issues with the body arise because of our awareness that death will eventually pass through our body and bring about ultimate annihilation. Therefore, it may be that it is harder to minimize anxiety for bodily remains because it is a salient reminder of our inevitable death.
Finally, the present study confirmed the hypothesis that graduate students would report lower levels of overall death anxiety than undergraduate students when controlling for age and experience with death of loved ones. This finding is consistent with prior research that discovered significant differences in levels of death anxiety due to the type of formal education (Bassett & Dabbs, 2003; Sharma et al., 1997) and level of education received (Haas-Thompson, 2008). Our study extends these findings by controlling for age
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and self-reported experiences with death of loved ones and provides further evidence that death anxiety is a complex and multidimensional phenomenon, and may vary as a function of where one is within the lifespan. Future research should examine how developmental milestones (e.g. post-secondary education, retirement) contribute to death anxiety.
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Other novel findings emerged in the current study which merit discussion. First, it is important to note the negative correlations between the RDAS and the eight subscales of the MFODS (see Table 1). Although such negative correlations provide an indication of the construct validity of these measures, they are weaker than reported in prior research (Neimeyer & Moore, 1994; Thorson & Powell, 1994). Therefore, it may be that even though the MFODS and RDAS are both measuring death anxiety, they may be measuring slightly different components of fear of death. For example, it could be argued that the MFODS focuses more on rating specific death situations while the RDAS concentrates on rating feelings toward death.
Next, a large body of prior research has supported the notion that age plays a major role in how individuals perceive their own death (Abengozar et al., 1999; Russac et al., 2007, Evans et al., 1999). In regards to the current study, the variable of age was positively correlated in all of the MFODS subscales and negatively correlated with RDAS suggesting that as individuals age, death anxiety may decline. Thus, our study collapsed age in order to covary for the confounded association between age and education so that we could more specifically examine level of education as it relates to variability in
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undergraduate and graduate students’ self-reported death anxiety. That level of education remained a significant contributing variable to participants’ self-reported death anxiety after controlling for variability due to age (and personal experience with death of loved ones) underscores the notion that level of educational pursuit offers a unique contribution to our understanding of how individuals experience death anxiety.
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Results from the present study contribute to the larger death anxiety literature and provide a number of novel findings. However, our results should be interpreted in light of certain limitations and scholars interested in better discerning how education level obtained in particular is associated with self-reported variability in death anxiety levels could extend and clarify our findings in a number of ways. Specifically, the recruitment and data collection methods we used resulted a sample where level of education was confounded with a number of other factors. For example, our study included students from various years of their specific degree programs. However, because students admitted to graduate school are often selected from the top of their respective classes, it would be useful to clarify and subsequently compare undergraduates who were planning on attending graduate school to students already enrolled in graduate programs. Similarly, future research might survey students who are completing the final year of their programs in order to control for “experience” within their degree programs. Furthermore, it may be beneficial to compare within the undergraduate student population (i.e., to compare freshmen, sophomores, juniors, and seniors) or to include high school graduates as well as current doctoral students in order to sample a wider spectrum of variability in terms of the association between death anxiety and students’
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educational experiences. Future research efforts could also measure specifically students’ general knowledge about the lifespan or aging in particular (e.g., the Facts on Aging Quiz; Palmore, 1981) in order to examine how such domain-specific knowledge correlates with death anxiety.
Further, the cross-sectional design of the present study did not permit causal
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interpretations of our findings. Including a large enough sample of various underclassmen, while identifying those bound for graduate school or otherwise, as well as both high school graduates and doctoral students and measuring participants’ specific, conceptually relevant knowledge may yield more conclusive and specific results in terms of whether (and how) levels of death anxiety change as a function of an increased knowledge base. A longitudinal extension of this work would allow scholars to assess the temporal ordering of the relationship between educational pursuit and death anxiety.
An additional limitation of the present study was that the sample was drawn from primarily undergraduate and graduate students within specific degree programs at a Midwestern university. Conceptual knowledge of the lifespan in general and familiarity with death and dying in particular are obviously more central to certain degree programs (e.g., nursing, gerontology) than others (e.g., business, fine arts) and this reality is also represented in the existing empirical literature. Future research efforts should examine students drawn from a wider assortment of degree programs in order to provide a more complete picture of the association between education and death anxiety.
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Finally, and importantly, although efforts were made to recruit a similar number of men and women, because the resulting sample consisted primarily of White females, our findings cannot be generalized beyond the general population of White females attending a Midwestern university. In order to gain a more accurate and comprehensive understanding of how death anxiety varies with one’s level of education, future research should make a concerted effort to include a larger amount of males and individuals from
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diverse sociodemographic backgrounds. Additionally, it may be beneficial to conduct research from universities that vary in geographical location in order to take into account the culture of the students being studied. With recent emphases on globalization among institutions of higher education, it would be interesting to examine how death anxiety is experienced by undergraduate and graduate students worldwide.
CONCLUSION The present study contributes to the broader literature by identifying specific domains in which undergraduate students reported higher levels of death anxiety for self and others than did graduate students. Although current level of education, irrespective of age and self-reported experiences with death of close family members, appears to contribute to variations in death anxiety, it is still unclear if level of education independently and causally alters the way individuals perceive death. Future research should build upon the present findings in order to obtain a more comprehensive understanding of the role of education with respect to death anxiety among college students.
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The benefits of increasing knowledge within this domain may be considered two fold. From an educational perspective, future research may serve as a foundation for delineating a more thorough understanding of the complex relationship between death anxiety and level of education. This knowledge may be most beneficial to the behavioral sciences (e.g. psychology, gerontology, social work, counseling) that more specifically focus on understanding how individuals feel about death as they attain educational goals
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throughout the lifespan. From the practitioner perspective, knowledge gained from research in death anxiety may aid in facilitating dialogue between helping professionals and the individuals they serve who are experiencing death anxiety. Specifically, programs which help individuals cope with terminal illness, such as hospice, may benefit from understanding how patients perceive death and with what level of anxiety death is associated. Similarly, counselors may gain further understanding of how their clients feel in times of death and bereavement by comprehending death anxiety in light of the client’s education level.
The completion of higher education may be viewed as a life altering experience which allows for both psychological and social growth. Therefore, research pertaining to death anxiety during the pursuit of such a milestone will overall expand our knowledge base on how those who achieve higher education think about death and dying.
ACKNOWLEDGEMENTS The authors wish to thank Haley Koepp and Jess Bohn for their valuable efforts with data collection and study management. We also extend our gratitude to an anonymous
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reviewer, whose constructive comments helped us reconsider our findings in light of the existing literature.
REFERENCES Abengozar, M.C., Bueno, B. & Vega, J.L. (1999). Intervention on attitudes toward death along the life span. Educational Gerontology, 25, 435-447.
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Aradilla-Herrero, A., Tomas-Sabado, J., Gomez-Benito, M. (2012). Death attitudes and emotional intelligence in nursing students. Omega, 66, 39-55. Basset, J.F. & Dabbs, J.M. (2003). Evaluating explicit and implicit death attitudes in funeral and university students. Mortality, 8, 358-371. Berman, J.D. (1998). Attitudes toward aging and death anxiety: Aging and death class. Omega Journal of Death & Dying, 38, 59-63. Chen, Y., Ben, K.S., Forston, B.L., & Lewis, J. (2006). Differential dimensions of death anxiety in nursing students with and without nursing experience. Death studies, 30, 919929. Evans, J. W., Walters, A.S., & Hatch-Woodruff, M. L. (1999). Deathbed scene narratives: A construct and linguistic analysis. Death Studies, 23, 715-733. Field, A. (2009). Discovering statistics using SPSS (3rd ed.). Sage: Thousand Oaks, CA. Goldenberg, J.L., Pyszczynski, T, Greenberg, J., & Solomon, S. (2000). Fleeing the body: A terror management perspective on the problem of human corporeality. Personality and Social Psychology Review, 4, 200-218.
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Hass-Thomspon, T., Alston, P.P., & Holbert, D. (2008). The impact of education and death-related experiences on rehabilitation counselor attitudes toward death and dying. Journal of Applied Rehabilitation Counseling, 39, 20-27. Hoelter, J.W. (1979). Multidimensional treatment of fear of death. Journal of Consulting and Clinical Psychology, 47, 996-999. Hoelter, J.W., Whitlock, J.L., & Epley, R.J. (1979). Fertility attitudes and the fear of
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death. Psychological Reports, 45, 795-800. Kastenbaum, R. & Heflick, N. A. (2011). Sad to say: Is it time for sorrow management theory? Omega Journal of Death & Dying, 62, 305-327. Lester, D. & Becker, D. M. (1993). College students’ attitude toward death today as compared to the 1930s. Omega Journal of Death & Dying, 26, 219-222. Mak, M.H. (2011). Quality insights on dying, death, and death education – A preliminary study in Hong Kong. Omega Journal of Death & Dying, 62, 387-405. Neimeyer, R.A. & Moore, M.K. (1994). Validity and reliability of the multidimensional Fear of death scale. In Neimeyer, R. (Ed.)., Death Anxiety Handbook (p. 103-119). Washington, DC: Taylor and Francis. Neimeyer, R.A. (1998). Death anxiety research: The state of the art. Omega, 36, 97-120. Okafor, R.U. (1994). Death attitudes, gender, and death experience: The Nigerian evidence. Omega, 30, 67-78. Palmore, E. (1981). The facts on aging quiz: Part two. The Gerontologist, 21, 431-437. Rasmussen, C.A. & Brems, C. (1996) The relationship of death anxiety with age and psychosocial maturity. The Journal of Psychology, 130, 141-144.
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Russac, R.J, Gatliff, C., Reece, M., & Spottswood, D. (2007). Death anxiety across the adult years: An examination of age and gender effects. Death studies, 31, 549-561. Schwartz, C.E., Clive, D.M., Mazor, K.M., Ma, Y., Reed, G. & Clay, M. (2005). Detecting attitudinal changes about death and dying as a result of end-of-life care curricula for medical undergraduates. Journal of Palliative Medicine, 8, 975-987. Sharma, S., Monsen, R.B, & Gary, B. (1997). Comparison of attitudes toward death and
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dying among nursing majors and other college students. Omega, 34, 219-232. Thorson, J.A & Powell, F.C. (1994). A revised death anxiety scale. In Neimeyer, R. (Ed.), Death Anxiety Handbook (p. 31-43). Washington, DC: Taylor and Francis. Wong, W.Y. (2009). The growth of death awareness through death education among university students in Hong Kong. Omega, 59, 113-128.
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Table 1. Pearson correlations between subscales of the MFODS and RDAS Subscales
RDAS
FODP
FOD
FOBD
FFSO
FOU
FOCD
FBAD
FPD
----
-.55**
-.46**
-.28**
-.40**
-.39**
-.49**
-.70**
-.51**
2. FODP
----
----
.37**
.03
.41**
.32**
.48**
.45**
.59**
3. FOD
----
----
----
.35**
.38**
.16*
.34**
.49**
.30**
4. FOBD
----
----
----
----
.16*
-.01
.23**
.34**
.02
5. FFSO
----
----
----
----
----
.18**
.27**
.29**
.34**
6. FOU
----
----
----
----
----
----
.29**
.27**
.24**
7. FOCD
----
----
----
----
----
----
----
.53**
.33**
8. FBAD
----
----
----
----
----
----
----
----
.41**
9. FPD
----
----
----
----
----
----
----
----
----
Total 1. RDAS
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Total
Note: **. Correlation is significant at the 0.01 level (1-tailed). *. Correlation is significant at the 0.05 level (1-tailed). RDAS = Revised Death Anxiety Scale; FOU
= Fear of the Unknown
FODP = Fear of Dying Process; FOCD = Fear of Conscious Death FOD = Fear of the Dead; FBAD = Fear for Body After Death FOBD = Fear of Being Destroyed; FPD
= Fear of Premature Death
FFSO = Fear for Significant Others
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Table 2. Descriptive statistics for education levels, MFODS, and RDAS FODP
FOD
FOBD FFSO
FOU
FOCD FBAD FPD
RDAS
(SD)
(SD)
(SD)
(SD)
(SD)
(SD)
(SD)
(SD)
(SD)
Graduate
15.25* 17.66* 11.70
14.50* 16.09* 16.89* 22.80* 12.27* 46.41*
(n = 92)
(5.34)
(5.53)
(4.39)
(3.60)
(3.74)
(5.33)
(6.13)
(4.31)
(18.16)
Undergraduate
13.06
16.21
11.64
13.21
14.49
14.67
21.16
10.65
51.65
(n = 149)
(5.40)
(4.79)
(4.67)
(2.86)
(3.98)
(4.06)
(5.17)
(4.05)
(17.27)
Total
13.90
16.77
11.66
13.71
15.10
15.51
21.79
11.27
49.65
(N = 241) Note: For the eight subscales of the MFODS lower scores represent greater death anxiety. For the RDAS Total higher scores represent greater death anxiety. * p < .05, two tailed RDAS = Revised Death Anxiety Scale; FOU
= Fear of the Unknown
FODP = Fear of Dying Process; FOCD = Fear of Conscious Death FOD = Fear of the Dead; FBAD = Fear for Body After Death FOBD = Fear of Being Destroyed; FPD
= Fear of Premature Death
FFSO = Fear for Significant Others
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