A Quasi-Experimental Study of a Community-Based Training Program to Reduce Death-Related Existential Anxiety Among Rural Elderly Women in Nineveh, Iraq
DOI:
https://doi.org/10.64529/qfhq8173Keywords:
Existential anxiety, Death-related anxiety, Elderly women, Rural areas, Psychosocial Interventions, Geriatric Mental Health, Quasi-ExperimentAbstract
Existential anxiety related to death can be a significant psychological problem among older adults, especially women living in rural settings where access to mental health support may be limited. The study examined the potential effectiveness of community-based training programs in reducing existential anxiety related to death among elderly women in rural Nineveh, Iraq. A quasi-experimental pre-test/post-test design with an unequal control group was used. The study involved 25 women aged 60-70 years, selected through purposive sampling, with 14 assigned to the intervention group and 11 to the control group. The intervention consisted of 10 sessions delivered over two weeks. Outcome assessments were conducted using the 36-item Existential Death Anxiety Scale developed by the researchers for this population. The intervention group showed a much greater decrease in anxiety scores than the control group (mean reduction = 38.64 vs. 4.18; t = 9.83, p < 0.05), and in-group analysis also showed a significant pre-post reduction in the intervention group (pre-test mean = 142.86; post-test mean = 104.22; t = 11.59, p < 0.05). These findings suggest that the program may help reduce existential anxiety related to death among rural elderly women. However, the results should be interpreted with caution due to the small, non-random sample, the use of geographically separated groups, and the absence of follow-up assessments. Larger, more rigorous studies are needed to confirm the effectiveness and long-term impact of interventions.
References
Beller, J. (2023). Loneliness and mortality: The moderating effect of positive affect. Applied Psychology: Health and Well-Being, 15(1), 49–65. https://doi.org/10.1111/aphw.12354
Cronbach, L. J. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16(3), 297–334. https://doi.org/10.1007/BF02310555
Donaldson, S. I., Dollwet, M., & Rao, M. A. (2015). Happiness, excellence, and optimal human functioning revisited: Examining the peer-reviewed literature linked to positive psychology. The Journal of Positive Psychology, 10(3), 185–195. https://doi.org/10.1080/17439760.2014.943801
Greenberg, J., Solomon, S., & Pyszczynski, T. (1997). Terror management theory of self-esteem and cultural worldviews: Empirical assessments and conceptual refinements. Advances in Experimental Social Psychology, 29, 61–139. https://doi.org/10.1016/S0065-2601(08)60016-7
Heidary, M., Heshmati, R., & Hayes, J. (2023). Effect of group logotherapy on anxiety about death and existential loneliness in patients with advanced cancer: A randomized controlled trial. Cancer Nursing, 46(1), E21–E30. https://doi.org/10.1097/NCC.0000000000001086
Hussain, B., Mirza, M., Baines, R., Burns, L., Stevens, S., Asthana, S., & Chatterjee, A. (2023). Loneliness and social networks of older adults in rural communities: A narrative synthesis systematic review. Frontiers in Public Health, 11, Article 1113864. https://doi.org/10.3389/fpubh.2023.1113864
Juhl, J., Routledge, C., Arndt, J., Sedikides, C., & Wildschut, T. (2010). Fighting the future with the past: Nostalgia buffers existential threat. Journal of Research in Personality, 44(3), 309–314. https://doi.org/10.1016/j.jrp.2010.02.004
Kellehear, A., & Garrido, M. (2023). Existential aging and dying: A scoping review. Archives of Gerontology and Geriatrics, 104, Article 104798. https://doi.org/10.1016/j.archger.2022.104798
Khodabakhshi-Koolaee, A. (2022). Living with death anxiety: Challenges of older adults during the COVID-19 quarantine period. OMEGA—Journal of Death and Dying, 85(3), 640–656. https://doi.org/10.1177/00302228211065960
Lu, J., Yang, Y., Chen, H., Ma, H., & Tan, Y. (2024). Effects of different psychosocial interventions on death anxiety in patients: A network meta-analysis of randomized controlled trials. Frontiers in Psychology, 15, Article 1362127. https://doi.org/10.3389/fpsyg.2024.1362127
Lyke, J. (2013). Associations among aspects of meaning in life and death anxiety in young adults. Death Studies, 37(5), 471–482. https://doi.org/10.1080/07481187.2011.649939
Menzies, R. E., Zuccala, M., Sharpe, L., & Dar-Nimrod, I. (2018). The effects of psychosocial interventions on death anxiety: A meta-analysis and systematic review of randomized controlled trials. Journal of Anxiety Disorders, 59, 64–73. https://doi.org/10.1016/j.janxdis.2018.09.004
Morrish, N., Choudhury, S., & Medina-Lara, A. (2023). What works in interventions targeting loneliness: A systematic review of intervention characteristics. BMC Public Health, 23, Article 2245. https://doi.org/10.1186/s12889-023-17097-2
Routledge, C., & Juhl, J. (2010). When death thoughts lead to death fears: Mortality salience increases death anxiety for individuals who lack meaning in life. Cognition & Emotion, 24(5), 848–854. https://doi.org/10.1080/02699930902847144
Williams, T., Lakhani, A., & Spelten, E. (2022). Interventions to reduce loneliness and social isolation in rural settings: A mixed-methods review. Journal of Rural Studies, 90, 76–92. https://doi.org/10.1016/j.jrurstud.2022.02.001
Wisman, A., Heflick, N., & Goldenberg, J. L. (2015). The great escape: The role of self-esteem and self-related cognition in terror management. Journal of Experimental Social Psychology, 60, 121–132. https://doi.org/10.1016/j.jesp.2015.05.002
Wong, P. T. P. (2007). Meaning management theory and death acceptance. In A. Tomer, G. T. Eliason, & P. T. P. Wong (Eds.), Existential and spiritual issues in death attitudes (pp. 65–87). Lawrence Erlbaum Associates. https://doi.org/10.4324/9780203809679-10
World Health Organization. (2023). Mental health of older adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults
World Health Organization. (2025a, October 8). Mental health of older adults. https://www.who.int/news-room/fact-sheets/detail/mental-health-of-older-adults
World Health Organization. (2025b). Reducing social isolation and loneliness among older people. https://www.who.int/activities/reducing-social-isolation-and-loneliness-among-older-people
Yalom, I. D. (1980). Existential psychotherapy. Basic Books.
Younis, M. S., & Lafta, R. K. (2021). The plight of women in Iraq: Gender disparity, violence, and mental health. International Journal of Social Psychiatry, 67(8), 977–983. https://doi.org/10.1177/00207640211003602
Zhang, J., Peng, J., Gao, P., Huang, H., Cao, Y., Zheng, L., & Miao, D. (2019). Relationship between meaning in life and death anxiety in the elderly: Self-esteem as a mediator. BMC Geriatrics, 19, Article 308. https://doi.org/10.1186/s12877-019-1316-7
Zhou, J., Wu, B., Su, L., & Ma, X. (2024). The influence of tai chi on the death anxiety of elderly people living alone: The chain mediating effect of social support and psychological capital. Frontiers in Psychology, 14, Article 1303524. https://doi.org/10.3389/fpsyg.2023.1303524
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