1. Death Attitudes UCFYP Cheung Ho Yin (CSC / 3) Chu Kai Chung (NRS / 3) Hui Chun Wai (PSY / 3) Hui Ling Fung (CHM / 3)

2. Outline of Presentation  Introduction  Literature review  Methodology  Analysis and Explanation  Limitation and Improvement  Implication and future direction

3. Introduction What is death ??? Death is an irreversible process, eventually experienced by all living things, involving stopping of all living functions. Three phases of dying: Agonal phase Clinical death Mortality

4. Introduction Who is considered to be really DEAD? Decades ago, loss of heartbeat & respiration is considered to be death For most industrialized nations now, Brain death (including brain stem) = Death

5. Literature review Different people have different reaction & attitudes towards death. People from different culture also have different death attitudes Traditional culture – social taboo Western culture – more open How can we classify death attitudes???

6. Literature review Different definitions of Death attitudes: The Death Anxiety Scale (Templer, 1970) the Collett-Lester Fear of Death Scale (Lester, 1994) the Death Self Efficacy Scale (Robbins, 1994) Death Attitude Profile-Revised (Wong, Reker, Gesser, 1994) Negative attitudes of death => Not a thorough measurement of subjects’ death attitudes. How can we classify death attitudes???

7. Literature review Wong, Reker and Gesser (1994) --- Five types of death attitudes: 1. Fear of Death 2. Death Avoidance 3. Approach Acceptance 4. Neutral Acceptance 5. Escape Acceptance Positive aspect of death attitudes => Three types of death acceptance – approach, neutral and escape

8. Literature review Most researches on thanatology are done in the Western Not many studies are done in Hong Kong Aim of study: To examine the correlates of death attitudes (e.g. demographic, frequency of suicidal thought, sense of worthlessness & tiredness of life) Why do research on death attitudes?

9. Literature review What are the correlates of death attitudes? GENDER ~~~ Western findings ~~~ Older women show more negative attitudes than men (Okafor, 1994; Neimeyer, 2003) Older women show more negative attitudes than men (Okafor, 1994; Neimeyer, 2003) Women have higher fear of death, lower avoidance than men (Wong et al, 1994) Women have higher fear of death, lower avoidance than men (Wong et al, 1994) Not many research done in HK, especially for younger people

10. Literature review AGE ~~~ Western findings ~~~ mixed findings mixed findings According to Terror Management Terror, fear of death should increase with age (Greenberg, Solomon & Pyszczynski, 1997) According to Terror Management Terror, fear of death should increase with age (Greenberg, Solomon & Pyszczynski, 1997) Quadratic age trend in fear of death (Katz, 1979) Quadratic age trend in fear of death (Katz, 1979) Death anxiety is negatively related to age (Rasmussen and Brems, 1996;, 2005) Death anxiety is negatively related to age (Rasmussen and Brems, 1996; Fessler and Navarrete, 2005) What are the correlates of death attitudes?

11. Literature review AGE ~~~ Chinese finding ~~~ Fear of death in elderly is negatively related to age (Wu et al, 2002) Fear of death in elderly is negatively related to age (Wu et al, 2002) What are the correlates of death attitudes?

12. Literature review What are the correlates of death attitudes? Socio-economic status Hypothesize well-educated => less likely to be superstitious Higher socio-economic status => more nutritious food and better medical care => decrease fear to death? Richer => More properties left for descendents => Chinese’s view of “dying with no regret” Will all these influence people’s death attitudes?

13. Literature review What are the correlates of death attitudes? Religion Religious beliefs will alter death attitudes? Religious views such as afterlife are related to death anxiety and death acceptance of elderly (Falkenhain & Handal, 2003). Western researches are applicable to Chinese participants with religious beliefs?

14. Literature review Suicidal Thought, Worthlessness & Tiredness of Life Why people commit suicide or think about suicide? (Xzanto, Gildengers & Mulsant, 2002) chronic pain chronic illness low self esteem hopelessness about oneself Most of the predictors identified are external factors and not many intrinsic factors What are the correlates of death attitudes?

15. Literature review Based on Neimeyer and Moore (1994), “…death anxieties may be one factor to consider in diagnosing the lethality of a self-destructive individual in clinical contexts”. Is there a relation between death attitudes and suicidal tendency, sense of worthlessness and tiredness of life? What are the correlates of death attitudes?

16. Methodology Target Group: Local, aged 18 – 65 (5 Age Groups) Number of participants recruited = 139 Male : Female = 71 : 68 Participants

17. Methodology Participants Education level: Group 1 = Primary school or below Group 2 = Secondary school Group 3 = Form 6 / 7 Group 4 = College Group 5 = Postgraduate Family monthly income per person Group 1 = below $3000 Group 2 = $3000 - $5000 Group 3 = $5000 - $8000 Group 4 = $8000 - $10000 Group 5 = above $10000

18. Methodology Religion: Group 1 = No religion Group 2 = Christians / Catholics Group 3 = Daoist Group 4 = Buddhist Group 5 = Islam Group 6 = Others Subjects only belong to Group 1, 2 and 4 Participants

19. Methodology Questionnaire Part I: the Death Attitude Profile Revised (DAP-R) (Wong, Leker & Lesser, 1994) Part II: Three questions about psychological well- being How often do you think of ending your life? How often do you feel tired of your life? How often do you feel you are not worth-living? Part III: Demographic information – Gender, Age, Education, Income Level, Religion

20. Methodology Questionnaire The Death-Attitudes Profiles-Revised - -32 items, 5 subscales: Fear of Death, Death Avoidance, Approach Acceptance, Neutral Acceptance, Escape Acceptance - -7-point Likert Scale (1 = strongly disagree to 7 = strongly agree) - -Good-internal reliability and validity (Clements & Rooda, 2000) - -The scale is originally in English => back translation

21. Methodology Questionnaire 1. 1.Fear of Death Item 1: Death is no doubt a grim experience 2. 2.Death Avoidance Item 12: I always try not to think about death 3. 3.Approach Acceptance Item 4: I believe I will be in heaven after I die 4. 4.Neutral Acceptance Item 24: Death is simply a part of the process of life 5. 5.Escape Acceptance Item 9: Death provides an escape from this terrible world

22. Methodology Questionnaire Reliability test shows acceptable internal consistency of the scale (Cronbach’s Alpha > 0.7) SubscaleAlpha Fear of Death (7 items).923 Death Avoidance (5 items).890 Approach Acceptance (10 items).896 Neutral Acceptance (5 items).744 Escape Acceptance (5 items).873

23. Methodology Procedures 1. 1.Questionnaires distributed in dormitory, church, workplace, domestics condition and canteens 2. 2.Consent obtained from participants 3. 3.Items input (SPSS) 4. 4.Statistical Analysis (ANOVAs & correlations) 5. 5.Number of participants recruited = 142 (3 are discarded – 2 incomplete, 1 fill in randomly)

24. Analysis & Explanations Any Gender Differences? Females have significantly higher Fear of Death than males Possible explanations: (1) (1)Females are found to be more neurotic/anxious (Lynn & Martin, 1997). (2) (2)Males are less reluctant to show that they are feared of something.

25. Analysis & Explanations Any Gender Differences? Males have significantly higher Death Avoidance than females. Possible explanations: - Males are less likely to express their own feelings. Consistent with the view of Wong, Reker & Lesser (1994) that men are more prone to avoid all thoughts of death.

26. Analysis & Explanations Any Age Differences? Group 4 (aged 46 – 55) has the highest fear of death   FD increases from middle-adulthood to mid-life then decrease through late adulthood Possible explanations: (1) Younger people (especially in mid-adulthood) are healthier and with lower perceived vulnerability to risk and illness, perhaps other possible life-threats (Millstein & Halpern-Felsher, 2002).

27. Analysis & Explanations Any Age Differences? Possible explanations (con’t): (2) In mid-life, probably people’s closely attached (e.g. parents) start to pass away – high separation anxiety. (3) In mid-life, health begins to get bad (4) In late-adulthood, fear of death declines due to habituation (Fessler & Navarrete, 2005), decrease in emotionality (Henley & Donovan, 2003) and readiness to die (Kalish, 1976).

28. Analysis & Explanations Any Age Differences? Group 3 (aged 36 – 45) has the highest Death Avoidance. Death Avoidance decreases significantly from middle- adulthood to midlife, but increases through late-adulthood.

29. Analysis & Explanations Any Age Differences? Possible explanation: Probably, middle-adults focus on career and family more and they perceived themselves as somewhat healthier and death is still a long way from them. The oldest group are mostly traditional Chinese  view death as taboo, avoid it to greater extend.

30. Analysis & Explanations Any Age Differences? Older people tend to have greater escape acceptance. Group 3,4,5 (aged 36-65) has significantly higher escape acceptance than the younger groups.

31. Analysis & Explanations Any Age Differences? Possible explanations: “Decreased opportunities for engaging in meaningful activities and increased isolation contribute to the increase in escape acceptance with advancing age” (Wong at el, 1994) People in older ages experience more difficulties and life problems  death enables relief

32. Analysis & Explanations Any Socio-Economic Difference? Income doesn’t predict death attitudes well, more samples are needed probably. For education level, results are contradictory Lower educators have somewhat higher neutral acceptance than higher educators, who suppose to have better death education.

33. Analysis & Explanations Any Age Differences? Possible explanations: May be they know less about death-related issue, a looser standpoint about whether it is good or not, tends to maintain a neutral view towards it. Any Socio-Economic Difference?

34. Analysis & Explanations Any Age Differences? People of relatively higher education level and lower education level have higher Fear of Death Possible explanations: 1. People with medium level of education have less uncertainty about causes and prevalence, other death- related knowledge than the lower-educated. Any Socio-Economic Difference?

35. Analysis & Explanations Any Age Differences? Possible explanations (con’t): 2. The higher educated people might know more risk- factors about death, hence perceived death as easier, eliciting more fear towards death. 3. Higher educators invest more in education, afraid of losing them if they die. 4. Existences of other correlates or predictors not studied here Any Socio-Economic Difference?

36. Analysis & Explanations Any Age Differences? Christians have significantly lower Neutral Acceptance than Buddhist and the non-religious Possible Explanation: Probably Christians view death as a planned action by God, rather than natural. Buddhists view everything as “Follow the fate” Any Religion Difference?

37. Analysis & Explanations Any Age Differences? Christians have significantly higher Approach Acceptance than Buddhist and the non-religious Possible Explanation: Central faith of Christianity: People can claim righteous by faith  the righteous can enter Heaven. Heaven is the most beautiful place where they can union with God Any Religion Difference?

38. Analysis & Explanations Any Age Differences? Death related to suicidal thought frequency? FDDANAAAEA Correlations -.263-.283-.120-.145.314 Significance.002.001.159.090.000 Explanations: FD: Fearful about death  afraid of ending of life including suicide DA: Avoid all thought concerning death, including killing themselves. EA: Dying can be a way of relief from pain  more likely to think about ending their lives.

39. Analysis & Explanations Any Age Differences? Death related to sense of tiredness of life? FDDANAAAEA Correlations -.110-.071.072-.129.215 Significance.196.404.400.132.011 Explanations: More likely to perceive death as a way to get out of this boring life Given older people have higher EA, they experience more negative events in life. This factor leads to both increase in EA and sense of tiredness

40. Analysis & Explanations Any Age Differences? Death related to sense of worthlessness? FDDANAAAEA Correlations -.028-.0.16.038-.155.246 Significance.744.851.658.068.003 Explanations: Perceive themselves worthless  perceive themselves as unimportant to the world. “better leave the world for the sake of everybody” Older people are more likely to perceive themselves as worthless (deterioration of psychomotor and cognitive ability, burden to the family) and they have higher EA.

41. Limitation and Improvement Confounding variables: Sampling errors (e.g. age groups not evenly distributed) Rather small sample size Death attitudes might be affected by instantaneous mood

42. Limitation and Improvement Confounding variables (con’t): Death attitudes can be a function of other factors (e.g., recently watch a movie about death, recent death of a friend or relative) Subjects answer questions in socially desirably way

43. Limitation and Improvement More subjects recruited Balance the subject demographic differences Include more aspect of correlates which might possibly affect one’s death attitudes Emphasize privacy of the questionnaire to participants Test-retest reliability How to improve our research?

44. Implications According to Wong, Reker and Lesser (1994), Death attitudes are related to psychological well-beings Death anxiety and fear are components of depression (Templer, 1971) Death avoidance is associated with psychological distress Escape acceptance is associated with reduced physical well-being What is the significance of this research?

45. Implications Neutral acceptance is positively related to psychological and physical well-being, particularly for younger people Approach acceptance is positively associate with well-being, especially for older people What is the significance of this research?

46. Implications In our study, People with greater escape acceptance have more frequent suicidal thought, perceive life as more tired and worthless Alter their pessimistic cognition Teach them to live life fully What is the significance of this research?

47. Implications Possibly, death attitudes will affect the psychological well-being of people when facing death of loved ones and bereavement Coping strategies could be taught when facing death Cognitively alter the more-prone group’s death attitudes might help, especially the middle-aged What is the significance of this research?

48. Implications By knowing what groups of the people are more prone to what kind of death attitudes Intervention to improve their well-beings E.g. male are more prone to death avoidance, teaching them cognitively to face death-related issues might reduce psychological distress E.g. Religions seems to reduce FD and increase AA of people, which can lead to better well-being  As a tactic to persuade people to convert? E.g. The middle-aged have more fear of death. Help these people to cope with this fear and anxiety. What is the significance of this research?

49. Future Directions Investigate more correlates of death attitudes Test for the causality of death attitudes with suicidal frequency, sense of worthlessness or tiredness towards life Confirmatory study of the explanation we suggest for our findings What can be researched more on “Death”?

50. This is the End … Questions and Answer Session