Mortality salience: A critical synthesis of its effects on psychological symptoms

Terror Management Theory (TMT) proposes that awareness of one's mortality can trigger emotional distress and amplify symptoms in vulnerable individuals when protective buffers are weakened. However, doubts about replicability and methodological rigor have grown. We conducted a multivariate three-level meta-analysis examining mortality salience effects on clinically relevant outcomes, synthesizing 61 outcomes from 22 randomized controlled trials (N = 2571). Results showed a moderate pooled effect (g = 0.49, 95% CI [0.20, 0.79]), with significant moderation by DSM-5 symptom type, delay presence, and study location. Publication bias was evaluated using multilevel Egger's tests, the three-parameter selection model, and both p-curve and z-curve. P-curve indicated evidential value and moderate-to-high power, whereas z-curve suggested inflated discovery rates and low replicability. Overall, findings point to the need for stronger transparency and methodological checks, whereas the substantial heterogeneity in outcome measures and considerable flexibility in interpretation raise concerns about the robustness of TMT research.