The status and influencing factors of death anxiety among Chinese college students under the COVID-19 pandemic: a cross-sectional study

Abstract

Background

To comprehend the current state of death anxiety among Chinese college students during the COVID-19 pandemic, analyze its influencing factors, and provide recommendations for mitigating death anxiety among these students.

Methods

From March to May 2023, utilizing a cluster sampling method, students from three universities in Changzhou, Jiangsu, were selected as research participants. The investigation employed a general information questionnaire, the PTSD Checklist for DSM-5 (PCL-5), the Chinese Version Templer-Death Anxiety Scale (CT-DAS), and the brief version of the Big Five Inventory (BFI-10). Multivariate linear regression analysis was performed to examine the factors influencing death anxiety among Chinese college students during the COVID-19 pandemic.

Results

The total average score of death anxiety among the college students in this study was 44.35 ± 8.21. There was a positive correlation between death anxiety scores and both PTSD symptoms scores and neuroticism (r = 0.134, 0.255, both P < 0.01), and a negative correlation between death anxiety scores and extraversion, agreeableness, conscientiousness, and age (r=-0.135, -0.049, -0.172, -0.093, all P < 0.01). Multivariate linear regression analysis indicated that gender, age, place of origin, COVID-19 infection, PTSD symptoms scores, neuroticism, extraversion, and conscientiousness were significant factors influencing death anxiety among college students (all P < 0.05).

Conclusions

Death anxiety among Chinese college students during the COVID-19 pandemic is relatively high and is associated with gender, age, place of origin, COVID-19 infection, PTSD symptoms scores, and personality traits. Appropriate intervention strategies can be formulated based on these influencing factors.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-025-21477-1.

Background

Since December 2019, the novel coronavirus (COVID-19) has precipitated a global outbreak. The World Health Organization has declared it an international public health emergency of international concern [1]. As an acute public health crisis, the COVID-19 pandemic not only poses a significant threat to human life [2], but has also triggered psychological crises such as anxiety, depression, post-traumatic stress disorder, and sleep disturbances [3–5], significantly disrupting people’s lives, work, and studies.

College students, as a distinct demographic, have experienced severe disruptions in their lives and academic routines due to the sudden onset, contagious nature, widespread prevalence, uncertainty, and harmfulness of the COVID-19 pandemic [6]. They face numerous challenges, including academic pressure, employment stress, and the need for social adaptation, leading to a range of negative psychological reactions, such as varying degrees of anxiety, depression, and fear. Without timely educational guidance and intervention, these conditions could escalate into more severe psychological crises [7–9]. Research indicated that students who had experienced the COVID-19 pandemic were more frequently confronted with issues related to death, which may trigger “COVID-19 Anxiety Syndrome.” The persistent presence of this syndrome can lead to functional impairment and psychological distress, exacerbating severe death anxiety [10]. However, not all individuals who encounter stressful life events will experience significant mental distress. Studies showed that there were differences in how individuals respond to these events, with some being able to effectively cope with the stress, thereby maintaining their mental health [11].

Death anxiety refers to the negative emotional experience triggered by an individual’s anticipation of their own mortality [12]. Since the global outbreak of COVID-19, people have easily accessed information related to the pandemic and death via the internet, increasing their exposure to death reminders, which can heighten death anxiety [13]. Death anxiety is closely related to various mental health issues; individuals with higher levels of death anxiety are more prone to psychological disorders such as depression, anxiety disorders, and obsessive-compulsive disorder, and are more likely to develop post-traumatic stress disorder following crisis events [14]. Some scholars believe that death anxiety accompanies individuals throughout their lives and can significantly affect daily living and functionality, even at an unconscious level [15]. The emergence of death anxiety is considered to result from the interaction of an individual’s internal and external factors [16]. Therefore, internal personality traits and external traumatic experiences might be significant influencing factors.

In summary, college students have not yet formed a correct understanding of life and death, holding misconceptions about these concepts. Due to the COVID-19 pandemic, they have been forced to confront and contemplate death-related issues more frequently, which could lead to intense death anxiety and trigger more severe psychological problems. Therefore, it is vital to enhance the investigation of death anxiety conditions among college students in the context of COVID-19. This study focuses on college students, examining their current state of death anxiety during the COVID-19 pandemic and exploring the influencing factors, including internal personality traits and external traumatic experiences. The aim is to provide references for the early identification of psychological crises in college students and to offer targeted interventions.

Methods

Study population

The study recruited 10,705 college students from three universities in Changzhou City, China, as research participants between March and May 2023. Participants were eligible if they were (1) 18 years of age or older, (2) enrolled full-time at a university, (3) capable of effective communication without reading impairments, and (4) willing to voluntarily participate in the study. Individuals were excluded if they had (1) a psychiatric disorder, (2) intellectual disabilities, or (3) severe physical health conditions.

Procedure

A cluster random sampling method was used to select three universities in Changzhou City, Jiangsu Province, for participation in this study. College students were instructed to complete the questionnaires via the Wenjuanxing online platform [17]. Participants accessed and completed the questionnaires using the provided links. Initially, 11,000 questionnaires were collected. Incomplete questionnaires were discarded to maintain data integrity, resulting in 10,705 valid questionnaires, yielding an effective response rate of 97.3%.

Instruments

The study utilized the following self-administered instruments for data collection:

General information questionnaire

This self-designed questionnaire collected demographic information, including gender, age, grade, education level, COVID-19 infection status, left-behind experience (this status denotes a minimum six-month parent-child separation wherein parents migrate for employment while children remain in their original residence under non-parental guardianship), role as a student leader, economic status, and place of origin.

PTSD checklist for DSM-5 (PCL-5)

A shortened version of the original 20-item PCL-5 questionnaire was used as a self-report tool to assess the frequency of PTSD symptoms as defined by the DSM-5 over the past month. The scale includes four dimensions: intrusion symptoms, avoidance symptoms, symptoms of negative changes in cognition and mood, and symptoms of hyperarousal. It uses the Likert 5-point scoring method to evaluate the severity of symptoms in patients over the past month, with each item being scored from 0 to 4, which respectively represent “not at all”, “a little bit”, “moderately”, “quite a bit”, and “very severe“ [18]. Higher scores indicate a greater frequency of PTSD symptoms, with a cut-off score of 33 used for positive screening outcomes. This scale was validated among college students, yielding a Cronbach’s α coefficient of 0.940 [19], while the Cronbach’s α coefficient in this study was 0.964.

The Chinese version of the Templer death anxiety scale (CT-DAS)

This scale is the Chinese version adapted by Yang Hong et al. through cross-cultural adaptation of the Death Anxiety Scale (Templer’s Death Anxiety Scale, T-DAS) [20], The scale consists of 15 items, of which 9 items are scored positively, and 6 items (items 2, 3, 5, 6, 7, 15) are scored negatively. This scale uses a 5-level rating scale, with scores ranging from 1 to 5, corresponding to “strongly disagree, disagree, uncertain, agree, and strongly agree. The English version of this scale is provided as a supplementary document (see Additional file 1, translated CT-DAS questionnaire). It encompasses four dimensions: emotional dimension, distress and pain, consciousness of time, and cognitive dimension. The total score, which is the sum of all item scores, represents the level of death anxiety; higher scores indicate greater levels of death anxiety. This scale has been validated among Chinese college students, with a Cronbach’s α coefficient of 0.830 [21], while the Cronbach’s α coefficient in this study was 0.695.

The big five inventory-short version (BFI-10)

The Big Five Inventory-10 (BFI-10) is a brief personality assessment tool developed by Rammstedt and John based on the BFI-44. By selecting two items from each dimension of the BFI-44, they created a scale consisting of 10 items aimed at assessing the five major personality dimensions: Openness, Agreeableness, Neuroticism, Conscientiousness, and Extraversion. This scale utilizes a 5-point Likert scale for responses, ranging from 1 (strongly disagree) to 5 (strongly agree). Each dimension includes one positively scored item and one negatively scored item, with total scores ranging from 2 to 10. Higher scores indicate a stronger inclination towards the corresponding personality trait [22]. In a study involving Chinese populations, the BFI-10 demonstrated good reliability and validity, with Cronbach’s alpha values indicating strong internal consistency. Test-retest reliability was also satisfactory, suggesting that the scale produces stable scores over time [23], while the Cronbach’s α coefficient in this study was 0.864.

Statistical analysis

Statistical analyses were conducted using SPSS 26.0 software. Quantitative data conforming to a normal distribution were expressed as mean ± standard deviation (). Prior to analysis, we examined the normality, homogeneity of variance, and independence, and the results met the statistical assumptions for t-tests and ANOVA. Comparisons between two groups were conducted using independent samples t-tests, and comparisons among multiple groups were conducted using one-way ANOVA. Post-hoc analyses were conducted using the Bonferroni correction to control for the Type I error rate associated with multiple comparisons. Categorical data were represented as frequencies, and comparisons between groups were made using the chi-square (χ²) test. Pearson correlation analysis was used to explore the relationships between variables, while multiple linear regression analysis was used to analyze influencing factors. A P-value less than 0.05 was considered statistically significant.

Results

General information of the participants

In this study, a total of 10,705 participants were included. The average age of the subjects was 20.20 ± 1.10 years. Among the 10,705 participants, there were 7,131 males (66.6%) and 3,574 females (33.4%); 185 were undergraduates (1.7%) while 10,520 (98.3%) were in junior college programs; 10,445 were of the Han ethnicity (97.6%), and 260 were from minority ethnic groups (2.4%); 2,431 were from urban areas (22.7%), and 8,274 were from rural areas (77.3%); 8,258 had been infected with COVID-19 (77.1%), while 2,447 (22.9%) had not been infected; 3,853 were Single-child family(36.0%), while 6,852 (64.0%) were not; 3,230 had experiences of being left behind in their hometowns (30.2%), whereas 7,475 (69.8%) did not; 2,608 were student leaders (24.4%), while 8,097 (75.6%) were not; there were 5,226 first-year students (48.8%), 4,177 second-year students (39.0%), and 1,302 third-year students (12.2%).

Death anxiety scores

The overall average score for death anxiety among college students in this study was 44.35 ± 8.21, measured using the Chinese version of the death anxiety scale (CT-DAS), which scores each item from 1 to 5, resulting in a total score range from 15 to 75. Among the various dimensions assessed, the Distress and pain exhibited the highest mean item score, while the Emotional dimension had the lowest. See Table 1 for details.

Table 1.

Death anxiety scores of college students (—x ± s)

Scales and their dimensions	Entry	Average score	Item mean score
Emotional dimension	6	16.81 ± 3.97	2.80 ± 0.66
Distress and pain	4	13.06 ± 3.41	3.26 ± 0.85
Consciousness of time	2	5.87 ± 2.16	2.93 ± 1.08
Cognitive dimension	3	8.59 ± 2.94	2.86 ± 0.98
Death anxiety score	15	44.35 ± 8.21	2.95 ± 0.54

Note: The CT-DAS scoring range is from 15 to 75

Comparison of death anxiety scores among college students with different characteristics

The comparison of death anxiety scores among college students with different genders, educational backgrounds, places of origin, COVID-19 infection status, whether they were an only child, whether they had experiences of being left behind, and from different grade levels showed statistically significant differences (all P < 0.05). However, the comparison of death anxiety scores among college students from different ethnic groups and whether they were student leaders or not showed no statistically significant differences (all P > 0.05). See Table 2 for details.

Table 2.

The impact of different demographic characteristics on death anxiety among college students (n = 10705)

Project	n (%)	Mean ± SD	F/t	P	Hedge’s g
Gender			-15.210	0.000	-0.313
Male	7131 (66.6)	43.50 ± 8.09
Female	3574 (33.4)	46.04 ± 8.20
Education			-2.720	0.007	-0.202
Undergraduate	185 (1.7)	42.72 ± 8.06
Junior college	10,520 (98.3)	44.38 ± 8.21
Nationality			0.372	0.710	0.023
Han ethnicity	10,445 (97.6)	44.35 ± 8.20
Minority ethnic groups	260 (2.4)	44.16 ± 8.59
Places of origin			-4.739	0.000	-0.113
Urban	2431 (22.7)	43.63 ± 8.58
Rural	8274 (77.3)	44.56 ± 8.09
Infected with COVID-19			4.292	0.000	0.099
Yes	8258 (77.1)	44.53 ± 8.23
No	2447 (22.9)	43.72 ± 8.11
Single-child family			-3.535	0.000	-0.072
Yes	3853 (36.0)	43.97 ± 8.49
No	6852 (64.0)	44.56 ± 8.05
Left-behind experience			3.357	0.001	0.071
Yes	3230 (30.2)	44.75 ± 8.03
No	7475 (69.8)	44.17 ± 8.29
Student cadre			0.230	0.818	0.005
Yes	2608 (24.4)	44.38 ± 8.38
No	8097 (75.6)	44.34 ± 8.16
Grade			25.956	0.000
Freshman year	5226 (48.8)	44.92 ± 8.15			0.126b
Sophomore year	4177 (39.0)	43.89 ± 8.18a			0.045c
Junior year	1302 (12.2)	43.52 ± 8.40a			0.171d

Note: ^a: compared to freshman year, P < 0.05; SD: standard deviation.^b: Freshman year vs. Sophomore year; ^c: Sophomore year v Junior year; ^d: Freshman year vs. Junior year

Pearson correlation analysis revealed that death anxiety scores were positively correlated with PTSD symptoms scores and Neuroticism (r = 0.134, 0.255, both P < 0.01). Conversely, death anxiety scores were negatively correlated with Extraversion, Agreeableness, Conscientiousness, and Age (r = -0.135, -0.049, -0.172, -0.093, all P < 0.01). See Table 3 for details.

Table 3.

Correlation analysis of death anxiety, post-traumatic stress disorder, personality traits, and age among college students ( r )

Project	Death anxiety
PTSD symptoms scores	0.134**
Neuroticism	0.255**
Extraversion	-0.135**
Openness to Experience	-0.016
Agreeableness	-0.049**
Conscientiousness	-0.172**
Age	-0.093**

Note:^*: P < 0.05;^**: P < 0.01

Multiple linear regression analysis of death anxiety among college students

Using death anxiety scores as the dependent variable, factors with statistical significance from the univariate analysis (gender, educational background, place of origin, COVID-19 infection status, single-child status, left-behind experience, and grade), along with age, PTSD symptoms scores, neuroticism, extraversion, agreeableness, and conscientiousness scores that are correlated with death anxiety, were utilized as independent variables for multiple linear regression analysis. The results revealed that factors such as gender, age, place of origin, COVID-19 infection, PTSD symptoms scores, neuroticism, extraversion, and conscientiousness scores are significant predictors of death anxiety among college students (all P < 0.05). See Table 4 for variable assignments and Table 5 for regression analysis details.

Table 4.

Variable assignment methods

Variables	Assignment Methods
Gender	1 = Male, 2 = Female
Age	Raw value input
Places of origin	1 = urban, 2 = rural
Infected with COVID-19	1 = Yes, 2 = No
PTSD symptoms scores	Raw value input
Neuroticism	Raw value input
Extraversion	Raw value input
Conscientiousness	Raw value input

Table 5.

The Multivariate Linear regression analysis of death anxiety among college students

Variables	B	SE	β	t	P
Gender	2.210	0.162	0.127	13.616	0.000
Age	-0.495	0.068	-0.067	-7.248	0.000
Places of origin	0.782	0.180	0.040	4.350	0.000
Infected with COVID-19	-0.633	0.180	-0.032	-3.523	0.000
PTSD symptoms scores	0.063	0.007	0.089	9.297	0.000
Neuroticism	1.119	0.063	0.180	17.693	0.000
Extraversion	-0.312	0.051	-0.059	-6.123	0.000
Conscientiousness	-0.396	0.058	-0.069	-6.824	0.000
Constant	48.337	1.606	/	30.101	0.000

Note: R² = 0.105, Adjusted R² = 0.105

Discussion

Current status of death anxiety among college students

The results indicate that the average death anxiety score among college students is 44.35 ± 8.21, surpassing the high anxiety threshold, with 89.9% exhibiting high anxiety. This suggests heightened death anxiety among college students during the COVID-19 pandemic, aligning with Zhang Linlin et al.’s findings on patients recovering from COVID-19 [24]. The results of Table 2 indicated that there were significant differences in death anxiety scores based on characteristics such as gender, educational background, place of origin, COVID-19 infection status, whether they were an only child, and whether they had experienced being left behind (all P < 0.05). This suggested that these factors may influence the level of death anxiety. Specifically, the highest scores were in the distress and pain dimension, indicating that college students were experiencing significant feelings of discomfort and unease related to thoughts of death. This may encompass fears about illness, the impact of death on their lives, and anxiety about the suffering that accompanies loss. Several factors may contribute to this. Primarily, the timing of this study during the ongoing COVID-19 pandemic, with most subjects having been infected by the virus. This may lead to varying levels of negative emotions [25]. The ease of accessing information about the pandemic and death via the internet likely increases exposure to environments that remind individuals of death, potentially raising death anxiety. Furthermore, this might also be related to the participants’ age—the average age in this study was 20.20 ± 1.10 years. A negative correlation between age and death anxiety was observed. Other studies have suggested that death anxiety peaks around the age of 20 [26]. Given the widespread state of death anxiety among college students, addressing this issue is particularly important. Research indicates that interventions such as Acceptance and Commitment Therapy (ACT) have shown good effectiveness in dealing with anxiety disorders, especially during such challenging times [27]. Additionally, other interventions like mindfulness-based stress reduction, cognitive-behavioral therapy (CBT), and peer support programs have also proven effective in alleviating anxiety symptoms [28]. Therefore, future interventions should target high-risk groups, such as women, younger students, students from rural areas, and those who have been infected with COVID-19. Potential strategies include group psychological counseling, cognitive-behavioral interventions, ACT, and other supportive measures, all aimed at effectively reducing death anxiety. Furthermore, in addition to implementing these interventions, it is essential to conduct an in-depth analysis of the various factors influencing death anxiety among college students to develop more targeted solutions.

Factors influencing death anxiety among college students

The findings suggest that gender significantly affects death anxiety among college students. As shown in Table 2, with females generally experiencing higher levels compared to males. This is consistent with several domestic and international studies [29, 30]. This may be attributed to physiological factors in women, where estrogen can affect the central nervous system and consequently emotions during certain periods. A decrease in estrogen levels can lead to feelings of depression and anxiety [31]. Additionally, women tend to have greater emotional sensitivity, with richer and more delicate feelings, making them more sensitive to death and more prone to anxiety when facing stressors such as the COVID-19 pandemic. In contrast, men may approach emotions more rationally and be less affected by external influences [32].

This study reveals that age significantly affects death anxiety among college students. As shown in Table 3, with a negative correlation between age and death anxiety; younger students exhibit higher death anxiety. This aligns with previous research [33] and is higher compared to studies on elderly populations within the country using the same questionnaire. For instance, Liu Youqin’s study found the death anxiety score among the elderly to be 40.55 ± 8.72 [34]. One possible reason is the lack of death education in China [35], which results in most students not having a proper understanding of life and death, leading to misconceptions [36].

The results of this study indicate that the place of origin significantly influences death anxiety among college students. As shown in Table 2, with students from rural areas exhibiting higher levels of death anxiety compared to their urban counterparts. This suggests that students from rural backgrounds are more sensitive to death anxiety. In this study, the majority of rural students were either left-behind children or from families with multiple children. Research has shown that college students with experiences of being left behind often face adverse family conditions such as familial conflicts and lack of functional family support, which affects their psychological adaptability [37], leading to higher levels of negative emotions [38]. Furthermore, compared to families with an only child, families with multiple children often provide less support and protection [39]. Therefore, during the COVID-19 pandemic, rural students, in comparison to urban students, have fewer protective factors and more risk factors, resulting in a lower level of psychological resilience [40]. This might contribute to an increase in their death anxiety.

The results of this study reveal that having been infected with COVID-19 is a significant factor influencing death anxiety among college students. As shown in Table 2, students who have previously been infected with COVID-19 exhibit higher levels of death anxiety compared to those who have not been infected. This could be attributed to the fact that post-infection, even in the recovery phase, many individuals continue to experience uncomfortable symptoms [41]. The risk of developing mental health disorders significantly increases during the recovery phase for COVID-19 survivors, with an incidence rate of mental illness reaching 18.1%, severely impacting individuals’ quality of life and adding to the societal burden of disease [42]. Additionally, patients recovering from COVID-19 may have concerns and fears about the virus mutating or their condition re-worsening. The prolonged state of worry and fear fosters negative emotions, which in turn can heighten fears [43].

This study has found that the PTSD symptoms scores significantly impact death anxiety among college students. As shown in Table 3, with a positive correlation between PTSD symptoms scores and death anxiety. This indicates that higher PTSD symptoms scores may lead to increased death anxiety, consistent with previous research findings [44]. The reason behind this might be that individuals who experience traumatic public health emergencies are prone to psychological conditions like anxiety, depression, and sleep disorders, and might even develop PTSD [45]. The core symptoms of PTSD, including flashbacks or re-experiencing, heightened alertness, and avoidance, share comorbidity with the heightened vigilance characterized by fears and concerns about death that define death anxiety [46].

In this study, within the Big Five personality traits, death anxiety was positively correlated with neuroticism and negatively correlated with extraversion, agreeableness, conscientiousness, and age. Through multivariate linear regression analysis, it was determined that neuroticism could positively predict death anxiety, while extraversion and conscientiousness could negatively predict it. Other factors did not have predictive power for death anxiety. This indicates that neuroticism, extraversion, and conscientiousness are influential factors for death anxiety among college students, especially neuroticism, which plays a major role in predicting death anxiety. The reason might be that college students with high levels of neuroticism have poor emotional regulation abilities and are more likely to experience negative emotions such as anger, anxiety, and depression, along with a strong sense of insecurity. During the COVID-19 pandemic, those with high neuroticism reacted more intensely to external stimuli than others, potentially increasing their death anxiety and leading to extreme or adverse emotional responses [47]. Students with stronger extraversion tend to be more enthusiastic, confident, and adept at social interactions, allowing them to receive more support and adopt positive coping strategies during negative events [48]. Individuals with high conscientiousness can create a happy atmosphere, generate positive life events, experience more positive emotions and fewer negative emotions, and are more likely to receive positive feedback from others, which is conducive to their psychological health [49]. Additionally, this study found no correlation between openness and death anxiety, which means there is no clear linear relationship between the two variables. This may be attributed to individuals with high openness generally possessing greater cognitive flexibility, curiosity, and intellectual engagement. These traits enable them to adapt more readily and resiliently when facing stress, allowing them to actively confront death anxiety, explore its meaning, and thereby reduce their fear. Furthermore, highly open individuals are more inclined to seek help and support, which enhances their psychological resilience. As a result, they may demonstrate a greater capacity to resist stress and anxiety [50]. Although agreeableness showed a low correlation with death anxiety, further linear regression analysis did not reveal significant predictive power. This may be related to the gentle and social nature of agreeable individuals, who tend to rely more on external support rather than managing their internal emotions when facing death anxiety [51]. However, future research should investigate other factors, such as neuroticism and resilience, which may offer additional insights into the psychological mechanisms behind death anxiety. Specifically, neuroticism may heighten sensitivity to death anxiety, while resilience might act as a protective factor, reducing the impact of stressful experiences like the COVID-19 pandemic on death anxiety.

Limitations

While this study provides valuable insights into the impact of the COVID-19 pandemic on death anxiety among college students in China, several limitations must be acknowledged.

For self-reported data, the study relied on self-reported questionnaires, which may introduce biases such as memory errors and social desirability effects, leading to the underreporting of sensitive issues like death anxiety and PTSD symptoms. Although future research could incorporate clinical assessments or interviews to enhance accuracy and reliability, these methods were not feasible in the current study due to resource constraints and the limitations of the sample size. Incorporating these approaches in future research would provide a more comprehensive understanding of death anxiety and other related psychological factors.

For geographic limitations, the sample was drawn from only three universities in Changzhou City, Jiangsu Province. This geographic focus may limit the generalizability of the findings, as cultural differences, economic conditions, and varying pandemic prevention measures across regions can significantly influence college students’ psychological states. Future research should aim to include a broader range of geographical locations and cultural backgrounds to enhance representativeness.

For population demographics, the sample exhibited gender imbalances, with 66.6% of participants being male and 33.4% female. This disparity may limit the generalizability of our findings, particularly if there are significant differences in death anxiety between genders. Additionally, only 2.4% of participants identified as belonging to minority ethnic groups, with 97.6% identifying as Han ethnicity. Given that the Han population comprises over 91% of China’s total population, this lack of ethnic diversity may restrict the applicability of our findings to other Chinese ethnic groups. Future research should include a more balanced gender representation and a diverse sample to better understand death anxiety across different demographics.

For COVID-19 infection status, a significant proportion of participants (77.1%) reported having been infected with COVID-19, which may skew the findings regarding death anxiety. Although a separate analysis was conducted based on infection status, further investigation into the nuanced impact of personal COVID-19 experiences on anxiety levels is warranted. For statistical significance of variables, the study analyzed factors such as single-child households and student leadership roles, yet these variables did not show statistical significance in the regression analysis. This does not diminish their potential relevance; further exploration of these factors in future studies is recommended to fully understand their impact on death anxiety.

For limited predictive power, the R² value of the regression model suggested that its ability to explain death anxiety is relatively low. This indicates that other factors influencing death anxiety may not have been captured in this study. While we acknowledge the poor R² value, it is important to note that future research could enhance the predictive power of the model by incorporating additional variables, such as socioeconomic status, coping mechanisms, and mental health history. Furthermore, the inclusion of personality traits (e.g., neuroticism, resilience) and situational factors, along with potential interactions between these variables, may help to better explain death anxiety. These factors were not included in the current model due to limitations in the study’s design and scope, but their inclusion in future studies could significantly improve the model’s explanatory power.

Despite these limitations, the findings of this study are significant for understanding the status and influencing factors of death anxiety among college students during the COVID-19 pandemic. We encourage future research to address these limitations and deepen our understanding of this important issue.

Conclusions

In summary, this study indicates that the COVID-19 pandemic has significantly increased levels of death anxiety among college students. This anxiety is positively correlated with post-traumatic stress disorder (PTSD) and neuroticism, while negatively correlated with extraversion, agreeableness, conscientiousness, and age. Key factors influencing death anxiety include gender, age, place of origin, infection status, and PTSD scores. Therefore, future interventions should focus on high-risk groups, such as women, younger students, those from rural areas, and individuals who have contracted COVID-19. To effectively alleviate death anxiety, interventions like Acceptance and Commitment Therapy (ACT), group counseling, and cognitive-behavioral strategies can provide essential support for students. These approaches can significantly reduce death anxiety and enhance their overall psychological well-being.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Abbreviations

BFI-10

The Big Five Inventory-Short Version

CT-DAS

The Chinese Version of the Templer Death Anxiety Scale

PCL-5

PTSD Checklist for DSM-5

PTSD

Post-traumatic stress disorder

Author contributions

Tingye Gao and Xugui Sun supervised the entire research process, designed the study, provided critical revisions, and ensured the accuracy of the final manuscript. Guangjian Li and Zhou Wang analyzed data, and wrote manuscript. Shouzhi Wu, Yaping Kon, and Jie Zhou participated in the research design, and contributed to data interpretation. Xin Gao, Junli Sun, Peng Li and Fengda Wu collected the data. All authors participated in discussions, reviewed, and approved the final version of the manuscript.

Funding

This study was funded by Technology Project of the Changzhou Municipal Health Commission (No.: ZD202355), Major Project on Humanities and Social Sciences Research in Universities of Anhui Province (No.: 2023AH040235), Quality Engineering Teaching and Research Project of Anhui Province (No.: 2022jyxm1691), and Anhui Provincial Colleges and Universities Scientific Research Project (No.: 2024AH053454).

Data availability

No datasets were generated or analysed during the current study.

Declarations

Ethics approval and consent to participate

The ethics committee of Changzhou Dean Hospital approved all procedures. All methods were carried out comply with the ethical standards of Changzhou Dean Hospital, as well as the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from every participant and parents, or their legal guardians of minors involved in this study. The study received ethical approval from the Institutional Review Board of Changzhou Dean Hospital (Ethics Number: CZDALL-2023-009). Informed consent was obtained from all participants.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.