Analysis: The relationship between death anxiety in patients with chronic illness and fear of the illness recurring or progressing is important to understand
Approximately one in three people globally is affected by a chronic physical illness. Living with chronic illness brings many challenges and burdens, including financial pressure, medication adherence, deterioration of quality of life, inability to work and the need for symptom control. Mentally, these burdens can leave chronic illness patients at a higher risk of depression and anxiety, with those perceiving their illness as severe reporting lower self-esteem, life satisfaction and psychological wellbeing.
A common psychological concern in chronic illness patients is the fear that their illness will recur or progress. Up to 70% of cancer survivors have been shown to express concerns relating to fear of illness recurrence, with these fears having been found to contribute to higher anxiety, depression, rumination and distress.
From TEDxRochester, Dr Fahad Saeed on what dying patients taught him about the fear of death
Existential concerns are central to these fears. Having interviewed 30 breast cancer survivors, researchers found differences between the concerns raised by those with low fear of cancer recurrence and those with high fear of cancer recurrence. The former mentioned practical concerns such as treatment, disruptions to family life and finances, while the latter spoke fearfully about death, the dying process and the impact that their potential death would have on those around them.
Death-related fears also seem relevant to recurrence and progression concerns in illnesses other than cancer. For instance, death anxiety has been identified as one of the seven most predominant fears associated with fear of illness progression in cardiac patients. Amongst other illnesses, such as coronary heart disease, stroke and diabetes, death-related concerns also seem to underline fear or recurrence or progression. Patients report heightened awareness of mortality and expressing concerns as to how their family would be affected by their death.
Until now, the extent to which both constructs are related has remained unclear. New research, conducted in a collaboration between the University of Sydney and University College Cork, has examined the relationship between death anxiety and fear of recurrence or progression in those affected by chronic illness.
From PsychAlive, Dr. Robert Firestone on how people deal with existential issues and death anxiety
Looking at findings from 15 existing studies, researchers found a large, positive relationship to exist between death anxiety and fear of illness recurrence or progression. The relationship was stronger for those affected by cancer than for those affected by other chronic illnesses, such as respiratory disease, rheumatoid arthritis, or diabetes. This indicates that as one's death anxiety increases, they become more fearful about their illness recurring or progressing.
In addition, death anxiety was as strongly related to fear of illness progression as it was to fear of illness recurrence, suggesting it is a shared existential concern that underpins both. This finding is important as it helps to reshape how we think about the relationship between fear of illness recurrence or progression and death anxiety. Rather than looking at them as separate constructs that overlap with death anxiety, these findings suggest that both fear of recurrence and fear of progression may be viewed as manifestations of individuals’ broader challenge of confronting mortality.
Clinically, these findings are important as they suggest that by targeting death anxiety, clinical psychologists may be able to reduce individuals’ fear or recurrence or progression and enhance their overall mental health. Though death anxiety can predict poor mental health outcomes and mental disorders (such as anxiety, obsessive-compulsive disorder symptomology and specific phobias), it has been shown to be effectively reduced through cognitive behaviour therapy-style interventions.
By reducing patients' death anxiety, clinicians may help to improve their overall mental health
This new research points to the importance of considering death anxiety for clinical psychologists when working with chronic illness patients. By reducing patients' death anxiety, through cognitively challenging clients’ maladaptive beliefs about death or by gradually exposing them to death related stimuli, clinicians may help to improve their overall mental health. Fear of recurrence or progression has been shown to have significant impacts on mental health, quality of life and wellbeing, so alleviating this may produce a wide range of psychological benefits for people with chronic illnesses.
Given the large relationship observed in this study between death anxiety and fear of recurrence or progression, efforts to alleviate this may potentially benefit from specifically addressing fears of death. Whether this rings true, or not, remains a question for future clinical research to answer; one which may have profound benefits for the wellbeing of those living with chronic illness.
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