Death anxiety measurement using Templer Death Anxiety Scale: a systematic review and validation study

Death anxiety, defined as the fear of mortality of oneself and others, is a significant psychological concern among healthcare professionals, particularly nurses, who frequently encounter end-of-life situations. Despite its global relevance, in the Indian context, cultural and religious attitudes toward death, often marked by avoidance of open discussion combined with high patient loads, limited resources, and limited validation studies, underscore the necessity of studying death anxiety in this context.

To address this gap, two studies were conducted. Study 1 systematically reviewed previous validation studies on Templer's death anxiety scale; the findings highlighted limitations in the current literature. Informed by these gaps, Study 2 aimed to empirically assess the psychometric properties of a widely used Templer's death anxiety scale among Indian nurses.

For study 1, a systematic review was conducted following PRISMA guidelines, covering studies published between 1970 and 2024 across five databases. After applying inclusion and exclusion criteria, 19 studies were retained for final synthesis following the STROBE quality checklist. For study 2, a cross-sectional design using cluster sampling was employed to collect data from nurses (N = 1360) working in both public and private hospitals in India. Data were collected using the 15-item TDAS.

Study 1 found that existing validation studies often reported multidimensional structures of the TDAS, contrary to Templer's original unidimensional model, but were limited by small sample sizes, cultural biases, and reliance on exploratory methods without confirmatory validation. For Study 2, Exploratory and confirmatory factor analyses identified a three-factor structure comprising (1) Fear of Personal Mortality, (2) Philosophical and Temporal Fear/Anxiety, and (3) Fear of Societal Violence and Uncertainty. The 9-item model demonstrated acceptable reliability (Cronbach's α = 0.71), with CFA indices indicating good model fit (RMSEA = 0.06, SRMR = 0.07, GFI = 0.96, CFI = 0.97, NFI = 0.96). Both of these analyses identified and confirmed a three-factor structure for Templer's death anxiety scale.

This study strengthens the psychometric foundation of death anxiety assessments in Indian healthcare settings and underscores the importance of culturally relevant validation processes to enhance clinical and research applications.