Development and validation of Believers’ Death Anxiety Scale: integrating religious dimensions into death anxiety assessment

Abstract

Background and objectives

Death anxiety has traditionally been measured without considering religious beliefs related to death, such as afterlife, the grave, and punishment. The present study was aimed at developing and validating a new scale to address this limitation.

Methods

The study was carried out in four phases and recruited a total of 2250 conveniently selected participants aged 18–59. Believers’ Death Anxiety Scale (BDAS) was developed and validated according to the reputed standards for scale development and validation. Exploratory and confirmatory factor analyses were performed. The convergent validity was established by correlating BDAS with the Depression, Anxiety, and Stress Scale. Discriminant validity was established by correlating BDAS with the Satisfaction with Life Scale. Internal consistency and reliability were assessed through Cronbach’s alpha, item-total, and item-scale correlations.

Results

The BDAS consists of fifteen items distributed across five subscales: worry, terror, despair, avoidance, and thoughts. The BDAS exhibited a strong factor structure, with five distinct factors consistently exceeding acceptable factor loadings. Convergent validity was confirmed through positive correlations with depression, anxiety, and stress, while discriminant validity was demonstrated through a significant inverse correlation with life satisfaction. The scale demonstrated excellent internal consistency and reliability across all phases of testing.

Conclusion

The BDAS emerges as a valuable and innovative instrument for researchers and practitioners seeking to comprehensively assess death anxiety, considering the often-overlooked role of religious dimensions.

Introduction

Death anxiety, also known as thanatophobia, is a terrifying experience [1]. Death anxiety is the extreme fear of death and dying [2, 3] due to actual or perceived threats [4]. It’s a complex emotion [5] and a self-defense mechanism [6] through which an individual may avoid discussing topics related to death [2]. It involves recurring thoughts about death [7–11], worrying about pain, uncertainty, separation from loved ones, and the perceived end of existence after death [8]. Death anxiety is related to fearing death and as well as its impact on one’s life [12]. It is a perceived or imagined threat to one’s existence [13] that is influenced by societal, religious, and cultural factors [8, 14, 15].

Death anxiety is regarded as a specific phobia in the Diagnostic and Statistical Manual of Mental Disorders [16]. Specific phobias are characterized by unreasonable and excessive fear, avoidance behavior, and significant distress or impairment lasting for at least 6 months [16]. Specific phobias may also manifest with physiological reactions such as dizziness, nausea, sweating, a raised heartbeat, stomach pain, or general feelings of anxiety [16]. Death anxiety triggers the protective physiological mechanisms [17]. Physical signs of death anxiety may include shaking, sweating, and difficulty breathing [18]. Death anxiety may also lead to significant psychological challenges [17] including intrusive thoughts about death, avoidance of death-related conversations, social withdrawal [18], poor quality of life [19], sadness, anger, despair, hopelessness [20], worry, fear, threat, restlessness, discomfort, irritation, confusion, pain, fear of the unknown, and fear of loneliness [9, 21, 22], generalized anxiety disorder [23, 24], obsessive–compulsive disorder [25], and various psychiatric illnesses [26].

Scholars have tried to typify death anxiety in diversified ways [27]. Existential death anxiety involves concerns about the meaninglessness of life and the inevitability of death, often associated with philosophical and religious questions about the afterlife [28, 29]. Personal death anxiety is characterized by fear of one’s own death, often linked to concerns about pain and suffering, the loss of loved ones, and the unknown [30]. Predator anxiety arises when unconscious guilt becomes powerful, leading to potential harm to others based on faulty ethical and moral perceptions [28]. Intrinsic death anxiety involves personal fear and apprehension about one’s own mortality, including concerns about the unknown elements of the afterlife [31]. Extrinsic death anxiety relates to worries about the passing away of loved ones or the general fear of dying in society [32]. Fear of dying young, fear of losing loved ones, fear of dying itself, fear of falling from a great height, fear of discovering one’s own death, fear of the dead, and fear of ghosts may also be different varieties of death anxiety [33].

Death anxiety may originate from psychopathological factors and religious beliefs. Depression, anxiety, stress, fear of aging, and lesser satisfaction with life have been regarded as predictors of death anxiety [34, 35]. Death anxiety has also been associated with sleep disturbances, aggression [34], generalized anxiety [36], obsessive–compulsive disorder [37], eating disorders [38], post-traumatic stress disorder [39], hypochondriasis [40]. The prevalence of death anxiety exhibits variability based on both cultural and religious factors [41–45]. Disagreement persists regarding the manifestation of death anxiety across diverse cultures and religions [46–48]. Religiousness plays important role in improving quality of life [49] and preventing from various psychosocial issues [50, 51]. Religions exhibit varying degrees of fear of death which is displayed through distinct practices like memorials or rituals [8]. Research comparing non-eastern and eastern participants revealed higher levels of death anxiety in eastern populations such as Kuwait [52], Qatar, Lebanon, Syria, Egypt [53], and Turkey [54] as compared to the United States, Denmark, and Spain. The role of religion in death anxiety has been a subject of extensive research [55]. Earlier investigations consistently demonstrated that individuals less inclined towards religious beliefs reported more severe cases of death anxiety compared to their more religious counterparts [56–61]. Moreover, the concept of death views has been introduced, indicating that the intensity of one’s religious beliefs is reflected in their perspective on death [62]. Empirical evidence from various studies suggests that a strong attachment to God and religion can be associated with a reduction in death anxiety [63–65] and as well as with an increase in death anxiety [66–68] due to the nature and degree of religious beliefs. Religious beliefs within specific faiths provide unique perspectives on death [69]. For instance, Muslims believe that death is inevitable and prepare for it to receive rewards in the afterlife [70, 71], while Hindus anticipate rebirth, decreasing death anxiety [72]. Moreover, intrinsic religiosity, characterized by sincere faith, is often associated with lower death anxiety compared to extrinsic religiosity, where religion serves as a source of comfort and social relationships [32, 73–76].

The earlier scales on death anxiety such as Templer death anxiety scale [18], the multidimensional fear of death scale [77], the Collett–Lester fear of death scale [78], Arabic scale for death anxiety [79], death anxiety inventory [80], death and dying distress scale [81], scale of death anxiety [31], the death anxiety beliefs and behaviors scale [82] were not focused to measure the involvement of religiousness in death anxiety such as religious beliefs on death, dying, grave, and life hereafter. This deficiency in the existing scales on death anxiety has also been demonstrated through a comprehensive meta-analysis including 21 scales [83]. This meta-analysis also acknowledged the statistical shortcomings prevalent in the majority of these death anxiety scales [83]. Another insightful meta-analysis, spanning the years 1980–2007, scrutinized research papers to observe the attributes linked to death anxiety [4]. The outcomes of this meta-analysis revealed that within the literature, death anxiety was associated with defining attributes, namely emotional, cognitive, experiential, developmental, sociocultural shaping, and motivational sources. Additionally, it identified antecedents such as exposure to stressful environments, encounters with unpredictable circumstances, diagnosis of life-threatening illnesses, experiences with life-threatening events, and encounters with death and dying. Furthermore, the meta-analysis illuminated the consequences of death anxiety, encompassing both adaptive and maladaptive presentations [4]. The literature acknowledges that previous scales on death anxiety omitted consideration of religious aspects that could potentially instigate or intensify death anxiety. This recognition highlights the necessity for a more comprehensive and new approach to measuring and understanding death anxiety. The present study, therefore, aimed to develop and validate a new scale for assessing death anxiety, with a specific focus on incorporating religious dimensions alongside the fundamental symptomatology associated with death anxiety.

Method

Development of the Believers’ Death Anxiety Scale (BDAS)

The BDAS was developed and validated in the current study. The study was divided into four distinct phases. During the initial phase, we focused on developing the scale and conducting an exploratory factor analysis. A comprehensive literature review was undertaken to identify prevalent existential concerns within various religions concerning death and the afterlife. This involved an examination of beliefs across major religions such as Christianity, Islam, Judaism, Hinduism, and Buddhism, revealing a common thread where death is perceived as the commencement of a new journey, influenced by one’s life deeds [84–86]. The study explored how these religious perspectives on death might induce anxiety. Initially, 19 items were generated, addressing aspects like fear of death, sadness, worries about punishment after death, and perceptions of the afterlife (I don’t want to die, I get sad while thinking of death, I am afraid of dying, Thoughts of death make me worried, I consider death as a horrible experience, I consider death as a painful experience, I am afraid of being punished after death, I feel worried when I think of the punishment I may receive in my grave, The life of grave can be terrifying for me, I don’t consider myself eligible for the mercy of God, I have not spent my life in a way which could lead me to the heaven, I feel myself helpless while thinking of my death, Punishments and rewards from God are predetermined, I avoid life-threatening situations, I am afraid of having a chronic disease, I don’t want to think of death, I usually avoid thoughts of death, I am afraid of dying a slow and painful death., I become confused while I think of death). A panel of five expert psychologists critically assessed these items for face and content validity. Subsequently, based on the panel’s approval, data collection ensued for the EFA. After the EFA, four items were excluded due to poor or cross-factor loadings (I don’t want to die, I consider death as a horrible experience, I consider death as a painful experience, I feel myself helpless while thinking of my death), refining the BDAS to fifteen items distributed across five sub-scales: worry, terror, despair, avoidance, and thoughts. The second phase involved subjecting the scale to confirmatory factor analysis (CFA), resulting in a factor structure consistent with the EFA findings. In the third phase, attention was directed towards establishing the scale’s convergent validity by examining its relationship with depression, anxiety, and stress. Finally, during the fourth phase, the scale’s discriminant validity with life satisfaction was investigated. All these procedures adhered to standard norms for scale development and validation.

Participants

Since people from every age group and gender may develop symptoms of death anxiety [87], the study involved a diversified sample that included people from various age groups. The only inclusion criteria to participate in the study was being an adult (18 years and above) and being able to respond to questionnaires in English. The sequential progression through the four phases involved a total of 2250 participants, 1094 men and 1258 women ranging in age from 18 to 59 years, with a mean age of 26 years. In phase one, there were 552 participants (271 men, 281 women), with ages ranging from 18 to 46 years and an average age of 22 years. Moving on to phase two, the sample consisted of 732 participants (284 men, 448 women) ranging in age from 18 to 59 years, with a mean age of 27. Phase three included 643 participants (246 men and 397 women) ranging in age from 18 to 59 years, with a mean age of 26. Finally, phase four included 323 participants (129 men and 194 women) ranging in age from 18 to 59 years, with a mean age of 28.

The instruments

The BDAS, developed and validated in the current study, consists of fifteen items in English and uses a 5-point Likert scale ranging from “extremely false” to “extremely true.” The scale includes five distinct subscales: worry, terror, despair, avoidance, and thoughts. The BDAS demonstrated strong reliability and validity after four rounds of comprehensive testing. To assess convergent validity, the Depression, Anxiety, and Stress Scale [88] was used in conjunction with the BDAS. Concurrently, the Satisfaction with Life Scale [89] was used to assess the discriminant validity of the BDAS. In addition, a demographic information questionnaire was used to collect important information about the participants’ gender and age.

Procedure

The Departmental Ethics Review Committee at the (blinded) university provided ethical approval for the research protocol. The data collection process was carried out with detailed care, following the principles outlined in the 1964 Helsinki Declaration and its subsequent amendments. Researchers met with potential participants in a variety of settings, including hospitals, clinics, educational institutions, and public offices. Each participant was approached individually, given detailed information about the study’s objectives, and informed consent to participate was obtained. The emphasis was on maintaining the confidentiality of their data. The researchers expressed gratitude to each participant for their invaluable contribution to the study, emphasizing their commitment to ethical and respectful research practices.

Analysis

The collected data was recorded and analyzed with the Statistical Package for Social Sciences (SPSS). The data cleaning procedure included a thorough examination of missing values, unengaged responses, outliers, linearity, homoscedasticity, multicollinearity, skewness, and kurtosis. To determine the reliability and validity of the Believers’ Death Anxiety Scale (BDAS), both exploratory and confirmatory factor analyses were rigorously performed. Additionally, Pearson correlation coefficients and descriptive statistics were calculated to gain insight into the dataset’s relationships and distributional characteristics.

Results

Reliability

The BDAS demonstrated high reliability across the 4 phases which is evident through Cronbach’s alpha (Table 1; α = 0.857, 0.772, 0.851, & 0.847) and the mean scores calculated for the 4 phases (Fig. 1). Cronbach’s alpha for the 5 sub-scales of the BDAS also projected high reliability ranging from 0.611 to 0.911 across the 4 phases. The item-total correlations (ranging from 0.308 to 0.682 with p < 0.01) and item-scale correlations (0.792 to 0.941 with p < 0.01) of the items of the BDAS demonstrated a high degree of internal consistency (Table 2).

Table 1.

Descriptive statistics, reliability, and data accuracy (N = 2250)

Variable	N	Items	α	M	SD	%	Range		Skewness	Kurtosis
							Potential	Actual
Phase 1 (EFA)	552
Death anxiety		15	0.857	52.698	10.738	70.26	15–75	20–71	−0.645	−0.136
Worry		3	0.847	10.308	3.449	68.72	3–15	3–15	−0.495	−0.980
Terror		3	0.895	12.082	3.174	80.54	3–15	3–15	−1.405	1.085
Despair		3	0.746	9.538	2.997	63.59	3–15	3–15	−0.137	−0.757
Avoidance		3	0.911	11.237	3.169	74.92	3–15	3–15	−1.059	0.140
Thought		3	0.902	9.533	3.666	63.55	3–15	3–15	−0.252	−1.107
Phase 2 (CFA)	732
Death Anxiety		15	0.810	56.062	8.201	74.74	15–75	31–75	−0.337	−0.239
Worry		3	0.772	11.654	2.861	77.69	3–15	3–15	−1.076	0.571
Terror		3	0.684	13.216	1.763	88.10	3–15	8–15	−0.850	0.085
Despair		3	0.697	10.015	3.067	66.76	3–15	3–15	−0.172	−0.946
Avoidance		3	0.713	11.907	2.425	79.38	3–15	4–15	−0.954	0.574
Thought		3	0.886	9.269	3.576	61.79	3–15	3–15	−0.118	−1.145
Phase 3 (CV)	643
Death Anxiety		15	0.851	57.720	9.196	76.960	15–75	31–75	−0.367	−0.526
Worry		3	0.807	11.751	2.825	78.341	3–15	3–15	−1.126	0.728
Terror		3	0.712	13.263	1.690	88.419	3–15	8–15	−0.829	0.124
Despair		3	0.758	10.278	3.049	68.523	3–15	3–15	−0.307	−0.828
Avoidance		3	0.718	11.882	2.441	79.212	3–15	4–15	−0.956	0.606
Thought		3	0.856	10.546	3.273	70.306	3–15	3–15	−0.441	−0.851
Depression		14	0.896	21.789	9.052	51.877	0–42	1–42	−0.241	−0.155
Anxiety		14	0.884	22.457	9.209	53.470	0–42	0–42	−0.371	−0.068
Stress		14	0.868	22.275	8.140	53.036	0–42	0–42	−0.196	0.117
Phase 4 (DV)	323
Death Anxiety		15	0.847	54.455	10.888	72.607	15–75	15–74	−0.637	0.648
Worry		3	0.797	11.084	3.322	73.891	3–15	3–15	−0.912	−0.047
Terror		3	0.782	12.669	2.629	84.458	3–15	3–15	−1.555	2.463
Despair		3	0.768	9.836	3.210	65.573	3–15	3–15	−0.255	−0.862
Avoidance		3	0.611	11.285	2.939	75.232	3–15	3–15	−0.821	0.267
Thought		3	0.779	9.582	3.558	63.880	3–15	3–15	−0.173	−1.078
Satisfaction with life		5	0.761	22.384	6.002	63.954	5–35	5–35	−0.422	−0.520

N = number of participants; α = Cronbach’s alpha; M = mean; SD = standard deviation

Fig. 1.

Mean scores of death anxiety across the 4 phases of the study

Table 2.

Exploratory factor analysis, item-total and item-scale correlations (Phase 1; n = 552)

Item no	Item	Factor structure					Ext	Item-total correlation	Item-scale correlation
		F1	F2	F3	F4	F5			F1	F2	F3	F4	F5
1	I get sad while thinking of death	0.798	0.129	0.068	0.196	0.210	0.741	0.665**	0.861**
2	I am afraid of dying	0.846	0.117	0.064	0.114	0.183	0.780	0.638**	0.891**
3	Thoughts of death make me worried	0.831	0.105	0.099	0.152	0.221	0.783	0.669**	0.876**
4	I am afraid of being punished after death	0.116	0.898	0.052	0.192	−0.029	0.860	0.552**		0.924**
5	I feel worried when I think of the punishment I may receive in my grave	099	0.913	0.092	0.196	−0.013	0.891	0.572**		0.940**
6	The life of grave can be terrifying for me	0.131	0.810	0.132	0.182	0.166	0.751	0.627**		0.864**
7	I don’t consider myself eligible for the mercy of God	0.157	0.148	0.792	−0.173	−0.065	0.708	0.308**			0.830**
8	I have not spent my life in a way which could lead me to the heaven	0.044	0.120	0.834	0.056	0.096	0.724	0.421**			0.825**
9	Punishments and rewards from God are predetermined	0.013	−0.015	0.798	0.083	0.010	0.644	0.321**			0.792**
10	I avoid life-threatening situations	0.204	0.108	−0.018	0.851	0.251	0.840	0.651**				0.903**
11	I am afraid of having a chronic disease	0.154	0.253	0.017	0.868	0.192	0.879	0.682**				0.941**
12	I am afraid of dying a slow and painful death	0.155	0.329	−0.006	0.827	0.167	0.845	0.679**				0.921**
13	I don’t want to think of death	0.231	0.056	0.020	0.110	0.895	0.870	0.628**					0.927**
14	I usually avoid thoughts of death	0.152	0.009	0.039	0.253	0.874	0.853	0.630**					0.922**
15	I become confused while I think of death	0.255	0.054	−0.002	0.206	0.830	0.799	0.641**					0.894**

Extraction was performed using the maximum-likelihood extraction technique with varimax rotation. The assumption checks indicate that the data collected for the questionnaire meet the necessary criteria for further analysis. The Bartlett’s Test of Sphericity yielded a significant result (χ² = 5248.928, df = 105, p < 0.001), indicating correlation among the variables. The KMO Measure of Sampling Adequacy yielded an overall value of 0.810, suggesting the sample size is appropriate for analysis. Average variance explained was 79.788

Factor structure is bold

F1 = worry; F2 = terror; F3 = despair; F4 = avoidance; F5 = thoughts; Ext. = extraction/communalities

* Correlation is significant at the 0.05 level (2-tailed)

** Correlation is significant at the 0.01 level (2-tailed)

Exploratory factor analysis (EFA)

The EFA was carried out in phase 1 by employing maximum likelihood extraction technique with varimax rotation. The data gathered from 552 respondents were deemed adequate for further analysis based on the Kaiser–Meyer–Olkin’s values (KMO) [90] and the Bartlett’s sphericity test (BTS) [91] (KMO: 0.810; BTS: χ² = 5248.928, df = 105, p < 0.001). As part of the EFA process, we excluded 4 items due to their insufficient validity (item extraction values less than 0.4). The EFA of the BDAS revealed 5 factors consisting of 15 items. The average variance extracted was 79.788. All items had communalities ranging from 0.644 to 0.682 (Table 2), meeting acceptable (> 0.4) criterion [92]. The factor loadings of the EFA ranged from 0.792 to 0.913 (Table 2). The 5 factors extracted from the EFA included worry (items 1–3), terror (items 4–6), despair (items 7–9), avoidance (items 10–12), and thoughts (items 13–15).

Confirmatory factor analysis (CFA)

The second phase involved 732 participants. CFA was conducted on the 15 items to test a structure based on 5 factors (Fig. 2). The factor loadings were statistically significant (p < 0.01) and ranged from 0.560 to 0.884 (Table 3). The average variance extracted was 0.726, demonstrating adequate convergence. A heterotrait–monotrait ratio of 1 suggested good discriminant validity. The reliability was excellent (Cronbach’s alpha = 0.810, McDonald’s omega = 0.811). The CFA model demonstrated good fit according to several fit indices such as Comparative Fit Index (CFI): 0.958; Tucker–Lewis Index (TLI): 0.945; Bentler–Bonett Non-normed Fit Index (NNFI): 0.945; Bentler–Bonett Normed Fit Index (NFI): 0.937; Parsimony Normed Fit Index (PNFI): 0.714; Bollen’s Relative Fit Index (RFI): 0.918; Bollen’s Incremental Fit Index (IFI): 0.958; Relative Noncentrality Index (RNI): 0.958; Information Criteria: Log-likelihood: −14,623.554, Number of free parameters: 55, Akaike (AIC): 29,357.108, Bayesian (BIC): 29,609.876, Sample-size adjusted Bayesian (SSABIC): 29,435.233; Root mean square error of approximation (RMSEA): 0.051; RMSEA 90% CI lower bound: 0.043; RMSEA 90% CI upper bound: 0.059; RMSEA p value: 0.412; Standardized root mean square residual (SRMR): 0.046; Hoelter’s critical N (α = 0.05): 323.044; Hoelter’s critical N (α = 0.01): 356.075; Goodness of fit index (GFI): 0.996; McDonald fit index (MFI): 0.902; Expected cross-validation index (ECVI): 0.467; Kaiser–Meyer–Olkin (KMO) Test: Overall KMO: 0.768; KMO for individual indicators ranged from 0.700 to 0.865; Bartlett’s Test of Sphericity: χ² = 3668.597, df = 105, p < 0.001; R-Squared: Explained variance (R²) for each factor ranged from 0.431 to 0.726. A higher order factor analysis (Fig. 3) revealed that the higher latent variable (death anxiety) is reflected more through worry and avoidance as compared to terror, despair, and thoughts.

Fig. 2.

Confirmatory factor analysis (Phase 2; n = 732)

Table 3.

Confirmatory factor analysis (Phase 2; n = 732)

Factor	Item	Factor loadings				Residual variances
		Estimate	SE	z	p	Estimate	SE	z	p
Worry	DA1	0.773	0.038	22.287	<0.001	0.403	0.039	12.558	<0.001
	DA2	0.768	0.042	22.004	<0.001	0.410	0.046	12.591	<0.001
	DA3	0.761	0.037	21.788	<0.001	0.422	0.037	12.956	<0.001
Terror	DA4	0.676	0.027	16.927	<0.001	0.543	0.020	12.798	<0.001
	DA5	0.749	0.029	18.236	<0.001	0.439	0.022	9.551	<0.001
	DA6	0.574	0.036	13.757	<0.001	0.671	0.033	14.941	<0.001
Despair	DA7	0.788	0.060	18.333	<0.001	0.379	0.102	7.368	<0.001
	DA8	0.642	0.051	15.301	<0.001	0.588	0.066	12.963	<0.001
	DA9	0.560	0.051	13.963	<0.001	0.686	0.069	15.900	<0.001
Avoidance	DA10	0.600	0.041	14.865	<0.001	0.641	0.045	14.897	<0.001
	DA11	0.781	0.042	19.834	<0.001	0.390	0.049	8.968	<0.001
	DA12	0.652	0.037	16.881	<0.001	0.575	0.037	14.328	<0.001
Thoughts	DA13	0.884	0.041	28.719	<0.001	0.218	0.040	9.821	<0.001
	DA14	0.866	0.042	27.881	<0.001	0.250	0.041	11.098	<0.001
	DA15	0.798	0.041	24.892	<0.001	0.364	0.040	14.795	<0.001

Extraction was performed using the maximum-likelihood extraction technique with no rotation. Average variance extracted was 0.726

Chi-square test: Baseline model: χ² = 3702.541, df = 105, Factor model: χ² = 231.570, df = 80, p < 0.001; Additional Fit Measures: Comparative Fit Index (CFI): 0.958; Tucker–Lewis Index (TLI): 0.945; Bentler–Bonett Non-normed Fit Index (NNFI): 0.945; Bentler–Bonett Normed Fit Index (NFI): 0.937; Parsimony Normed Fit Index (PNFI): 0.714; Bollen’s Relative Fit Index (RFI): 0.918; Bollen’s Incremental Fit Index (IFI): 0.958; Relative Noncentrality Index (RNI): 0.958; Information Criteria: Log-likelihood: −14,623.554, Number of free parameters: 55, Akaike (AIC): 29,357.108, Bayesian (BIC): 29,609.876, Sample-size adjusted Bayesian (SSABIC): 29,435.233; Root mean square error of approximation (RMSEA): 0.051; RMSEA 90% CI lower bound: 0.043; RMSEA 90% CI upper bound: 0.059; RMSEA p value: 0.412; Standardized root mean square residual (SRMR): 0.046; Hoelter’s critical N (α = 0.05): 323.044; Hoelter’s critical N (α = 0.01): 356.075; Goodness of fit index (GFI): 0.996; McDonald fit index (MFI): 0.902; Expected cross-validation index (ECVI): 0.467; Kaiser–Meyer–Olkin (KMO) Test: Overall KMO: 0.768; KMO for individual indicators ranged from 0.700 to 0.865; Bartlett’s Test of Sphericity: χ² = 3668.597, df = 105, p < 0.001; R-Squared: Explained variance (R²) for each factor ranged from 0.431 to 0.726

Fig. 3.

Higher order factor analysis (Phase 2; n = 732)

Convergent validity

In the third phase involving 643 participants, the BDAS was assessed with the Depression, Anxiety and Stress Scale, under the expectation that the results from both assessments would exhibit a significant positive correlation. The findings (Table 4) revealed strong positive correlations of BDAS with depression (r = 0.363, p < 0.01), anxiety (r = 0.409, p < 0.01), and stress (r = 0.353, p < 0.01), establishing the convergent validity of the BDAS.

Table 4.

Correlations

	Death anxiety	Worry	Terror	Despair	Avoidance	Thought
Death anxiety		0.683**	0.514**	0.599**	0.623**	0.558**
Worry			0.264**	0.263**	0.379**	0.154**
Terror				0.230**	0.282**	0.086*
Despair					0.225**	0.04
Avoidance						0.116**
Depression	0.363**	0.170**	00.073	0.366**	0.260**	0.300**
Anxiety	0.409**	0.214**	0.082*	0.348**	0.296**	0.377**
Stress	0.353**	0.198**	0.083*	0.299**	0.274**	0.294**
Satisfaction with life	−0.953**	−0.689**	−0.590**	−0.574**	−0.716**	−0.729**

* Correlation is significant at the 0.05 level (2-tailed)

** Correlation is significant at the 0.01 level (2-tailed)

Discriminant validity

In the fourth phase involving 323 participants, the BDAS was assessed with the Satisfaction with Life Scale, under the expectation that the results from both assessments would exhibit a significant inverse correlation. The findings (Table 4) revealed strong inverse correlation between BDAS and satisfaction with life (r = −0.953, p < 0.01), establishing the discriminant validity of the BDAS.

Discussion

Traditional measures on death anxiety lacked the capacity to account for the role of religious beliefs in death anxiety, including those about the afterlife, the grave, and death itself [4]. There is evidence in the literature that the current death anxiety scales are inadequate, and most of these scales also have statistical flaws [83]. Consequently, the purpose of this research was to develop and validate a new death anxiety scale that takes religious factors into account in addition to the traditional symptoms of death anxiety.

The Believers’ Death Anxiety Scale (BDAS) was developed and validated in the present study. The scale was tested through face validity, exploratory factor analysis, confirmatory factor analysis, convergent validity, discriminant validity, homogeneity, test–retest reliability, item-scale, and item-total correlations. BDAS was found to be a highly reliable and valid instrument revealing five sub-scales namely worry, terror, despair, avoidance, and thoughts about death. Each of these sub-scales has three items. The sub-scale ‘worry’ evaluates fear, worry, and sadness related to death (I get sad while thinking of death, I am afraid of dying, Thoughts of death make me worried). The sub-scale ‘avoidance’ measures avoidance of death related threatening situations and diseases (I avoid life-threatening situations, I am afraid of having a chronic disease, I am afraid of dying a slow and painful death). The sub-scale ‘thoughts’ related to the recurring thoughts about death (I don’t want to think of death, I usually avoid thoughts of death, I become confused while I think of death) are related to the general symptoms of death anxiety. The sub-scale ‘terror’ (I am afraid of being punished after death, I feel worried when I think of the punishment I may receive in my grave, The life of grave can be terrifying for me) and the sub-scale ‘despair’ (I don’t consider myself eligible for the mercy of God, I have not spent my life in a way which could lead me to the heaven, Punishments and rewards from God are predetermined) incorporate religious beliefs associated with death anxiety, specifically focusing on the role of religious beliefs in death anxiety such as punishment after death, punishment in grave, terror in grave, disappointment in the mercy of God, regret of a sinful life that may cause problems in the life hereafter, and destiny. The statistical procedures implied to validate the BDAS also affirm the validity of these religious beliefs in death anxiety.

Death anxiety has been linked to several emotional expressions such as angst, distress, dread, panic, terror, and worriment. Death anxiety, in psychological literature, is proposed to be more a premeditated emotional reaction rather than an immediate response to explicit dangers. Death is typically viewed as a future rather than an immediate matter. The primary focus of research on death anxiety is on trait levels, which involve measuring the overall fear individuals have towards different aspects of death. Thanatologists also distinguish between self-death and other-death and between dying and death [86]. Death anxiety, without involving religious beliefs, would relate to the unknown aspects of death, such as the loss of conscious experience and worldly possessions and achievements. However, the religious perspective on death significantly alters the nature and intensity of death anxiety. All major religions believe humans are immortal and have spirits that may return to a divine realm. This contradicts materialist cynicism about an afterlife. In Christianity, Islam, and Judaism, the soul is responsible for earthly deeds. Hinduism seeks union with the Universal Soul (Brahman) through the eternal atman. Buddhism, unlike other major religions, rejects souls and sees people as transient combinations of five aggregates. All religions believe the spirit goes to paradise, hell, rebirth, or the Divine after death. Christianity, Islam, and Judaism emphasize the soul’s importance over the body by envisioning a spiritual resurrection during a final judgment. God breathes life into the body, which is temporary. Teachings emphasize life’s purpose as preparation for the immaterial world, which affects the soul’s fate after death. Good and bad seeds are believed to be harvested in the afterlife. Many religions believe the soul is judged and sent to heaven or hell after death. In Hinduism and Buddhism, Yama, the dead god, evaluates the soul. Yama, unlike the Christian Satan, administers Hindu and Buddhist justice based on karma. The major world religions emphasize the afterlife and the consequences of one’s actions [84–86].

The BDAS is the first ever scale on death anxiety that incorporates religious correlates into death anxiety research. This innovative instrument adds to the literature and advances psychological assessment. The BDAS’s careful incorporation of religious dimensions allows for a comprehensive death anxiety assessment tailored to religious people. This innovative approach allows researchers to measure death anxiety in respondents whose beliefs and worldviews are shaped by their religion. Researchers using the BDAS to assess religious beliefs related death anxiety can expect higher accuracy and validity.

Limitations and suggestions

The current study included 2250 participants, aged between 18 and 59, with a mean age of 26 years. While the scale development process is not adversely affected by this mean age, it is recommended that future researchers consider incorporating respondents across balanced age groups. Translating the BDAS into other languages would also prove beneficial for researchers from diverse cultural backgrounds.

Conclusion

The present study successfully addressed the limitations of existing death anxiety scales by developing and validating the Believers’ Death Anxiety Scale (BDAS). The BDAS uniquely incorporates religious dimensions into the assessment of death anxiety. The BDAS, consisting of fifteen items across five subscales (worry, terror, despair, avoidance, and thoughts), demonstrated strong reliability and validity through rigorous testing, including exploratory and confirmatory factor analyses, convergent and discriminant validity assessments, and internal consistency evaluations. The incorporation of religious beliefs in the scale allows for a more specific understanding of death anxiety. The BDAS involves aspects related to punishment after death, punishment in the grave, terror in the grave, disappointment in the mercy of God, regret of a sinful life, and perceptions of destiny. This innovative approach addresses the shortcomings of previous scales that overlooked the role of religious factors in death anxiety. The BDAS emerges as a valuable tool for researchers and practitioners seeking a comprehensive assessment of death anxiety, particularly in individuals whose beliefs are influenced by their religious worldview.

Author contributions

Conception and study design—WH. Acquisition, analysis, and interpretation of data—WH. Drafting and critical revision of manuscript—WH, AA, KT, and HJ. Approval of final submission draft—WH, AA, KT, and HJ.

Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Data availability

The datasets used and/or analysed during the current study available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethical approval was granted by the departmental review committee at COMSATS University Code CUI-ISB/HUM/ERC-CPA/2023–61. Informed consent was obtained from the participants. All the procedures performed in this study were in accordance with the 1964 Helsinki declaration and its later amendments.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.