Dumitru Elisa P, Cardoș Roxana A I, Milea Ion, Gambarota Filippo, Altoè Gianmarco, David Daniel O, Cristea Ioana A
Doctoral School 'Evidence-Based Assessment and Psychological Interventions', Babeș-Bolyai University, Cluj-Napoca, Romania.
International Institute for the Advanced Studies of Psychotherapy and Applied Mental Health, Cluj-Napoca, Romania.
Nat Hum Behav. 2025 Mar 3. doi: 10.1038/s41562-025-02115-7.
Death anxiety (DA), apprehension when thinking about death, has long been associated with distress. Studies have suggested that DA may transdiagnostically contribute to mental disorders. We conducted a systematic review and meta-analysis, aiming to estimate the relationship between DA and distress or symptoms of mental disorders. The included studies reported the correlation between DA and distress or symptoms of mental disorders, across general population and clinical samples, using previously validated measures for all outcomes. PsychInfo and the Psychology and Behavioral Sciences Collection (via EBSCO), Embase, and Medline (via PubMed) were systematically searched up to 30 October 2023. Study quality was evaluated with the Study Quality Assessment Tools (National Heart, Lung, and Blood Institute). A total of 129 studies were included, reporting on 158 independent samples, for a total of 34,147 participants. Most studies were rated as poor quality. The findings indicated consistently positive associations between DA and distress outcomes (general anxiety: r = 0.42, P < 0.001; depression: r = 0.41, P < 0.001; distress: r = 0.36, P < 0.001). Heterogeneity was substantial, and prediction intervals crossed zero for all outcomes, except for anxiety and distress. We found no moderation by DA measure, sample type or the proportion of women in the sample. However, the association was stronger (t(35.37) = -2.055, P = 0.047) when medical conditions were present (r = 0.48, P < 0.001) than when they were absent (r = 0.37, P < 0.001). There was evidence of small-study effects, indicating possible publication bias. DA should be investigated in longitudinal studies across diverse samples of patients to clarify its contribution to psychopathology.
死亡焦虑（DA），即想到死亡时的忧虑，长期以来一直与痛苦相关。研究表明，DA可能在多种诊断中导致精神障碍。我们进行了一项系统综述和荟萃分析，旨在评估DA与精神障碍的痛苦或症状之间的关系。纳入的研究报告了DA与精神障碍的痛苦或症状之间的相关性，涵盖普通人群和临床样本，所有结果均使用先前验证的测量方法。截至2023年10月30日，我们系统检索了PsychInfo、心理学与行为科学数据库（通过EBSCO）、Embase和Medline（通过PubMed）。使用研究质量评估工具（美国国立心肺血液研究所）评估研究质量。共纳入129项研究，报告了158个独立样本，总计34147名参与者。大多数研究质量被评为较差。研究结果表明，DA与痛苦结果之间始终存在正相关（一般焦虑：r = 0.42，P < 0.001；抑郁：r = 0.41，P < 0.001；痛苦：r = 0.36，P < 0.001）。异质性很大，除焦虑和痛苦外，所有结果的预测区间都穿过了零点。我们发现DA测量方法、样本类型或样本中女性比例不存在调节作用。然而，存在医疗状况时的关联（r = 0.48，P < 0.001）比不存在时（r = 0.37，P < 0.001）更强（t(35.37) = -2.055，P = 0.047）。有证据表明存在小研究效应，表明可能存在发表偏倚。应在不同患者样本的纵向研究中对DA进行调查，以阐明其对精神病理学的影响。
