Spiritual Well-Being, Perceived Social Support, and Death Anxiety Among Primigravid Women: A Cross-Sectional Study

Background/Objectives: Pregnancy may involve psychological and existential concerns, particularly for women experiencing pregnancy for the first time. This study examined the relationships among spiritual well-being, perceived social support, and death anxiety in primigravid women and explored the cross-sectional indirect association through perceived social support. Methods: This cross-sectional study included 390 primigravid women attending an antenatal outpatient clinic in northern Türkiye. Data were collected using the Three-Factor Spiritual Well-Being Scale, Multidimensional Scale of Perceived Social Support, and Death Anxiety Scale. Pearson correlation, hierarchical multiple regression, and an exploratory cross-sectional indirect association analysis using PROCESS Model 4 with 5000 bootstrap samples were performed. Results: Spiritual well-being was positively correlated with perceived social support (r = 0.495, p < 0.001) and negatively correlated with death anxiety (r = -0.554, p < 0.001). Perceived social support was also negatively correlated with death anxiety (r = -0.522, p < 0.001). After adjustment for the prespecified covariates, spiritual well-being (β = -0.152, p < 0.001) and perceived social support (β = -0.145, p < 0.001) remained negatively associated with death anxiety. A statistically significant adjusted indirect association was observed in the specified cross-sectional model (B = -0.91, 95% percentile bootstrap CI [-1.44, -0.44]). Conclusions: Higher spiritual well-being and perceived social support were associated with lower death anxiety among primigravid women. A statistically significant adjusted cross-sectional indirect association between spiritual well-being and death anxiety through perceived social support was also observed; however, this finding does not establish mediation, temporal ordering, or causality.