Death anxiety in persons with HIV/AIDS: a systematic review and meta-analysis

One of the most commonly cited psychological sequelae of HIV/AIDS is anxiety regarding death due to the illness (i.e., death anxiety; DA). However, extant research is inconclusive on several empirical issues, such as DA's relation to HIV/AIDS diagnostic status, the impact of illness-related symptoms on DA, and factors that may protect against DA. We conducted a systematic review of the empirical literature and meta-analysis to answer specific questions concerning correlates of DA in persons with HIV/AIDS and important factors that may help explain variability in effect size estimates. The meta-analysis included 18 studies (N = 1,757) examining DA in adults with HIV/AIDS. Meta-analytic findings indicated a small-to-medium effect of HIV/AIDS diagnostic status on DA, which was moderated by duration since diagnosis and by relation to the advent of highly active antiretroviral therapy. Results also indicated a small effect of illness-related symptoms on DA, which was moderated by participant age. Social support and intrinsic religiosity were modest protective factors, but results indicated that extrinsic religiosity may exacerbate or be exacerbated by DA. Finally, results indicated a medium-to-large relation between psychological symptoms and DA. The implications of these results and other study findings are discussed.