Based on the edge theory, it is said that humans generally have moderate levels of death anxiety (Kastenbaum, 2007). As one is always on the brink of possible danger, one’s death anxiety levels fluctuate with the possibility of danger. When one feels unsafe or in the face of death, one would have increased levels of death anxiety. During other times, one would have relatively low levels of death anxiety. This is because there is no need for constant anxiety. However, when there is danger, it is important to be anxious in order to protect one’s own self. This anxiousness, known as death anxiety, is influenced by one’s characteristics. This may include age, gender, social economic status, physical and mental health, religiousness, past or present personal contact with death-related occurrences or life threatening events, personality, and culture. In this research, the researchers are investigating whether there are differences between young adults and older adults in terms of their perception of death and whether there is a relationship between perception of death and self control over health. Young adults can be defined as individuals between the ages of 20 and 40 whereas older adults can be defined as individuals above 60 years old (Berk, 2004). However, in this research, young adults are defined as individuals between the ages of 18 and 25 whereas older adults are defined as individuals above 40 years old. On the other hand, perception of death can be defined as the comprehension of death and the emotions that are linked to it (Berk). It can also be defined as the thoughts, feelings, beliefs, and general opinion about death, the process of dying, and sorrow (Kastenbaum). Because the common feelings and thoughts linked to death are denial, acceptance, and anxiety, death anxiety can be used as a measure of an individual’s perception of death (Kastenbaum). Therefore, in this research, one’s perception of death will be defined as one’s view and anxiety towards death. Death anxiety, on the other hand, can be defined as the tension, fear, discomfort, and dread linked to death (Kastenbaum). It can also be defined as the fear and anxiety linked to one’s own death and dying, the death and dying process of other people, and death-related items such as corpses (Lyons, & Chamberlain, 2006). It is said that death anxiety can actually be divided into several categories which are fear towards one’s own death and dying, the death and dying process of other people, and corpses as well as the acknowledgement of one’s own death and dying and that of others people (Lyons, & Chamberlain). Thus, in this research, death anxiety is defined as the fear associated with any death-related events or items. On the other hand, health locus of control is defined as the degree in which one believes one can control one’s health (Lau, Hartman, & Ware, 1986). It can be divided in to internal and external health locus control. Internal health locus of control is the degree in which one believes that one’s own health is personally controlled (Barnyard, 1996). External health locus of control is the amount in which one believes that one’s health is controlled by outside factors (Barnyard). These factors may include powerful others such as doctors and nurses as well as chance (Barnyard). However, in this research, health locus of control is only measure in terms of self control over health which is the amount in which one believes that one’s health is internally or self- controlled.
Studies show that age affects one’s perception of death. Although it is often assumed that as individuals age and are closer to the end of their lives, they will be increasingly anxious towards death. This is, however, not true. Older adults actually have lower death anxiety compared to young adults. This is because older adults have led a fuller, more complete life, thus allowing them to more readily accept death as a part of life (Kastenbaum, 2007). Besides that, they may also be undergoing social isolation as well as physical deterioration, where illnesses are frequently contracted as the body and immune system becomes weak (Kastenbaum). Therefore, they may have lower life satisfaction and may actually hope for death (Kastenbaum). However, they may feel sudden, drastic increase in death anxiety when people they know, especially loved ones, become severely ill or pass away (Kastenbaum). This feeling, however, quickly passes with the presence of social support from friends and family. On the other hand, young adults have a much higher death anxiety level. Common reasons for this are fear of the afterlife, fear of being unable to fulfil their dreams, and not being remembered by other individuals after death (Twelker, 2004). Death anxiety decreases as predictability of life and amount of life experiences increases.
In a study of middle class participants, the Templer Death Anxiety Scale (TDAS) was administered (Lonetto, & Templer,1983). This questionnaire measures an individual’s death anxiety level. Results showed that youths had a mean score of 7.50, young adults had a mean score of 7.25, middle aged adults had a mean score of 6.85, and elderly adults had a mean score of 5.74 (Lonetto). From this results, it can be inferred that younger adults have higher death anxiety compared to older adults.
However, some research have shown that age is not a predictor of death anxiety levels, instead other factors predict death anxiety levels. One of the factors that have been shown to affect death anxiety level is gender. Women have been shown to have higher death anxiety compared to men (Kastenbaum, 2007). However, women tend to be better at handling emotions than men, and thus are able to handle their high death anxiety levels well. It has been known that women are much more likely to attend seminars and talks about death, the dying process, and grief compared to men (Kastenbaum). They also outnumber men in jobs related to hospice care such as nurses. These expose women to death and illness related situations more than men, which may explain women’s higher death anxiety levels. However, women still accept death as an inevitable end to life (Kastenbaum). Women also have a higher likelihood of practicing health behaviours (Sarafino, 2006). This was found from a study done on European adults (Sarafino). Based on the health belief model theory, the likelihood of an individual practicing health behaviours is dependent on the individual’s anxiety towards death and the advantages and disadvantages of practicing the particular behaviour (Sarafino). Thus, it can be said that women have higher death anxiety level. However, this cannot be concluded with accuracy as women are more expressive than men in general. Therefore, women are more likely to acknowledge their emotions than men who generally refuse to acknowledge their emotions as they see it as a sign of weakness (Berk, 2004).
A research was done by Marks, Richardson, Graham, and Levine, on 137 18 to 86 year old cancer patients (1986). It was conducted to investigate the effect of health locus of control and belief of the efficacy of the treatment on the difference between the true severity of the individual’s condition and their believed severity. The research was done by combining questions measuring all the stated variables into a questionnaire and administering it onto the participants. Results show that participants with higher internal health locus of control and greater belief in the efficacy of the treatment had lower believed illness severity and less depression. They were also found to have more positive belief in their likelihood of survival and recovering from cancer. On the other hand, those with low internal health locus of control and less belief in the efficacy of the treatment had more depression and high believed illness severity. Because thoughts and emotion predicts death anxiety levels, negative thoughts and emotion may predict higher levels of death anxiety. Thus, negativity in one’s believed illness severity and in one’s belief of one’s survival and recovery outcomes may predict higher death anxiety. Since those who have lower internal health locus of control are more negative, it can be inferred that lower health locus of control may predict higher death anxiety levels. Thus, there is a relationship between internal health locus of control and death anxiety.
Only an individual who believes that he or she is in control over his or her health would bother to perform health behaviours. Thus, an individual who is more likely to perform health behaviours are also more likely to have high internal health locus of control. The individual is more likely to believe that these health behaviours affect his or her health status. In the research on European adults mentioned in earlier paragraphs, it was shown that women had a higher probability of engaging in health behaviours compared to men (Sarafino, 2006). Thus, it can be inferred that women have higher internal health locus of control. Since women were proven to have higher death anxiety in earlier paragraphs and higher internal health locus of control, it can be inferred that when internal health locus of control is high, death anxiety is also high. Thus, there is a relationship between the two variables.
However, some studies have found that there is no relationship between death anxiety and internal health locus of control. A research on 282 Chinese college students was done by Tang, Wu, and Yan, where the Death Anxiety Scale, the Revised Death Anxiety Scale, the Multidimensional Fear of Death Scale as well as measurement instruments for self efficacy and health locus of control were administered on to the participants (2002). The purpose of this research was to understand the perception and attitude of Chinese towards death and the dying process. Results showed that although there was a relationship between death anxiety and external health locus of control as well as self efficacy, there was a lack of relationship between internal health locus of control and death anxiety.
Based on the points made above, two hypotheses were made in this research. The first one is that younger adults have higher death anxiety than older adults. The second one is that there is a negative relationship between perception of death and self control over health. The higher the self control over health of an individual, the lower the death anxiety of the individual.
A between-group survey design was used as there are two comparison groups, where each group is independent of the other, and questionnaires were used to gather data. For the first research hypothesis, the independent variable is the age of the participants whereas the dependent variable is their death anxiety level. For the second research hypothesis, the independent variable is the participants’ death anxiety level whereas the dependent variable is their self control over health.
There were a total of 100 Malaysian participants consisting of 25 young males, 25 young females, 25 older males, and 25 older females. There were six divorced, 42 married, and 52 single participants. The participants consisted of 87 Chinese, seven Indians, four Malays, and two participants of other races. There were 70 Buddhists, 13 Christians, five Hindus, four Muslims, and eight participants of other races. 27 of the participants have had life threatening experience(s) before whereas the other 73 participants have not. Refer to Table 1. Participants were friends and relatives of the researchers as well as the acquaintances of their relatives. Participants also included neighbours of one of the researchers living in Cheras and customers at certain cafes in Sunway Pyramid. This is known as convenience sampling where participants were recruited based on convenience as they were either people known to the researchers or people who were at nearby locations.
Life Threatening Experience
Two measurement instruments were used in this research which are th Templer Death Anxiety Scale (TDAS) and the Health Value and Health Locus of Control (HLC) scale.
TDAS. The TDAS consists of 15 true-false items which measures the respondent’s death anxiety level (Lonetto, & Templer, 1983). The TDAS is calculated by adding one mark for each correct answer (correct answers for each question: 1=T, 2-3=F, 4=T, 5-7=F, 8-14=T, 15=F). The total score is the sum of the marks obtained. Although the TDAS measures several different factors concerning death, the total score is used. The higher the score, the higher the death anxiety level of the respondent. The TDAS has high internal reliability, with a Kuder-Richardson formula coefficient of 0.76. It also has high stability, with a three-week test-retest correlation of 0.83. Besides that, it has a high concurrent validity with a similar measurement instrument, the Fear of Death Scale. It also has high known-groups validity, showing that psychiatric patients had significantly higher death anxiety score compared to a control group. Refer to Appendix 3.
HV and HLC scale. The HV and HLC scale consists of 30 Likert scale questions which can be divided into HV questions and HLC questions (Lau, Hartman, Ware, 1986). The reason for the combination of these two scales is because only individuals who value their health would actually bother to engage in healthy behaviours. HV is used to measure the value one places on one’s health and can be used either in general health studies or in clinical practice. It consists of normal items 17 and 27 as well as reverse-score items six and 20. The higher the score, the higher the value one places on health. The total score is the sum of scores for all the four questions. On the other hand, HLC measures the amount in which an individual believes he or she can control his or her health. The HLC scale is divided into four subscales which are Self Control Over Health (SCOH), Provider Control Over Health (PCOH), Chance Health Outcomes (CHO), and General Health Threat (GHT). The SCOH measures internal health locus of control which is the amount in which one believes one’s health is internally or self controlled. It consists of normal items five, 14, and 24 as well as reverse-score items one, seven, nine, 18, and 28. The higher the score, the greater the amount in which one believes one can control one’s health. The PCOH measures the amount in which one believes proper healthcare from healthcare professionals, such as doctors and nurses, control one’s health. It consists of normal items four, eight, 12, and 15 as well as reverse-score items 10, 19, 23, and 26. The higher the score, the greater the amount in which one believes that proper healthcare can control one’s health. On the other hand, the CHO measures the amount in which one believes that one’s health is due to chance. It consists of normal items 11, 25, and, 30 as well as reverse-score items three, 16, and 21. The higher the score, the greater the amount in which one believe that one’s health is by chance. The GHT measures the amount in which one believes that illnesses are generally severe. It consists of normal item 13 as well as reverse-score items two, 22, and 29. The higher the score, the greater the amount in which one believes that illnesses are severe. The total score for each subscale is the sum of scores of the subscales. The total score for the HLC is the sum of scores the SCOH, PCOH, CHO and GHT. Refer to Appendix 4.
First, a consent form is given to the participants. The form informs the participant about the purpose of the study and the duration that may be required to complete the questionnaires. It also ensures the participant that all information given by the participant will be kept private and that withdrawal from the research is allowed at any time. Besides that, it also informs the participant that help will be given if he or she needs it to complete the questionnaires. Name and education background of the researchers are also provided in the form. Refer to Appendix 1. Data was then collected by administration of a demographic form and both the TDAS and the HV and HLC questionnaires. Refer to Appendix 2. The forms and questionnaires were administered either face to face or through email. Those who filled in the forms and questionnaires face to face gave them back to the researchers directly whereas those who received them through email typed in their answers and sent them back to the researchers through email as well. The demographic form requires information on the participant’s age, gender, marital status, ethnicity, religion, and occurrence of life threatening event(s) in the participant’s past. The duration taken for the administration of the forms and questionnaires for each participant took around 15 minutes. However, the researchers took about a total of two weeks to collect data from all 100 participants.
Age and death anxiety. There is significant difference between death anxiety in young adults and in older adults [t (98) = 3.166, p < 0.01)]. Young adults (mean=8.10, std. deviation=3.431) have higher death anxiety than older adults (mean = 6.02, std. deviation = 5.914). Refer to Table 2 and 3.
Death anxiety and self control over health. On the other hand, there is no significant relationship between death anxiety and self control over health (r = -0.126, p > 0.05). Refer to Table 2 and 4.
Descriptive Statistics for the Sample of Young Adults and Older Adults (N=100)
Range of scores
Note: SCOH = Self Control Over Health; PCOH = Provider Control Over Health; CHO = Chance Health Outcomes; GHT= General Health Threat; TDAS= Templer Death Anxiety Scale; HLC= Health Locus of Control.
Summary of Independent T-test on age group and level of death anxiety
Templer Death Anxiety Scale (TDAS)
Note. *=p<.05, **=p<.01. Standard Deviations appear in parentheses below means.
Pearson Correlation Matrix among TDAS Scale and HLC
Note. **=p < 0.01
Description of Analysis
T-test. An independent sample t-test is a parametric test, where samples are drawn from a normal population, which allows for the comparison of the mean differences between two groups. It shows the significance of the mean differences by calculating the probability that the research results are due to sampling error. If the probability, p, is less than 0.05 or 5%, the results are said to be significant. It also only applies to between-group research design, where each participant can only belong to one group.
Correlational analysis. A bivariate correlational analysis using Pearson’s r is a parametric test which analyses the significance and strength of a relationship between two variables. If the probability of the results being due to sampling error, p, is less than 0.05, the research results are said to be significant. The relationship can be explained by the correlation coefficient, r, which varies from -1 to 1, with -1 being a perfect negative relationship and 1 being a perfect positive relationship. A negative relationship is when higher values of one variable predict lower values of the other variable and vice versa. On the other hand, a positive relationship is when higher values of one variable predict higher values of the other variable and vice versa. If the correlation coefficient is 0, then it is said that there is no relationship.
Age and death anxiety. This research examined whether there were differences between young adults and older adults in terms of their perception of death. Results showed that younger adults have significantly higher death anxiety compared to older adults. Therefore, hypothesis 1 is supported. This may be due to the fact that older adults have led a fuller life and have been able to experience many more things compared to younger adults (Kastenbaum, 2007). Thus, older adults may be more prepared for death (Kastenbaum).
Death anxiety and self control over health. This research also examined the relationship between perception of death and self control over health. Results showed that there is no significant relationship between death anxiety and self control over health. Therefore, hypothesis 2 is not accepted. Although certain research have supported this hypothesis, other research have shown that other factors are more significantly related to death anxiety, such as external health locus of control (Tang, Wu, & Yan, 2002). External health locus of control is affected by the Provider Control Over Health (PCOH) and Chance Health Outcomes (CHO; Wallston, Wallston, & Kaplan, 1976). In the results section, although PCOH had no significant relationship with death anxiety, there was a significant relationship between death anxiety and CHO.
Strengths. Sample in this research has varied demographics. There is a large range of age of participants between 18 to 63 years old, more than three races, and more than four religions. This factor enables the results of this study to be generalised to the Malaysian population. Besides that, gender and age are strictly controlled, ensuring that the number of participants of each gender in each age group are equal. Therefore, it can be said that the comparison between older adults and young adults in terms of death anxiety was not affected by gender frequency inequality.
Limitations. As other death anxiety factors such as gender, personality, race, and social economic status were not analysed, it cannot be concluded that age is the cause of the differences between the death anxiety levels. Besides that, samples were done via convenience sampling. This may affect the accuracy of the results as only people known to the researchers were recruited for the experiment.
Future studies. Research can be conducted to analyse the effect of race, gender, social economic status, religiousness, personality, and other possible death anxiety factors, on death anxiety levels. Death anxiety should also be separated into its main components to study each component specifically. The main components include fear of death, fear of the dying process, and fear of death-related items. This is because a person who fears dying may not necessarily be afraid of death as dying may be painful but death is just the natural end of life. Besides that, research should be done to investigate the effect of death anxiety and self control over health on the likelihood of developing severe illnesses and the likelihood of recovery from said illnesses. These would be useful as if a relationship is found, patients can undergo psychological therapy to assist in their recovery process.
Conclusion. The first hypothesis is supported whereas the second hypothesis is not supported. Young adults were found to have significantly higher death anxiety compared to older adults but there was no significant relationship between death anxiety and self control over health.