Relationship between Death Anxiety and Resilience in Grade Four Liver Disease Patients: Mediating Role of Attachment to God

Document Type : Original Article

Authors

1 Department of Psychology, Payame Noor University, Kaboodarhang, Iran

2 Department of Psychology, Sciences and Research, Branch,Islamic Azad University,fars, Shiraz, Iran

3 Department of Psychology, Garmsar Branch, Islamic Azad University, Garmsar, Iran

4 Department of Psychology, Tehran Branch, Islamic Azad University, Science and Research Branch, Tehran, Iran

Abstract

Background: Today, the global focus is shifting toward non-communicable and chronic illnesses, such as non-alcoholic fatty liver disease.  
 
Objectives: This study aimed to explore the impact of attachment to God as a mediator in the relationship between death anxiety and resilience among grade four liver disease patients.
 
Methods: The present study was part of descriptive-correlational research and used cross-sectional research methods and structural equation modeling. The statistical population of this study included all grade four liver disease patients in Imam Khomeini Hospital, Tehran, Iran, between from August to October 2023. The statistical sample included 211 grade four liver disease patients selected through purposive sampling. Research tools included the Death Anxiety Scale, the Connor-Davidson Resilience Scale, and the Attachment to God Inventory. SPSS software (version 27) was used to perform descriptive statistics, and SmartPLS software (version 4) was used to conduct path analysis between variables.
 
Results: The findings of the present study showed that death anxiety had a significant negative impact on resilience (β=-0.516, P<0.001). Similarly, death anxiety significantly and negatively impacted attachment to God (β=-0.636, P<0.001). However, attachment to God, as a mediating variable, did not significantly impact resilience (β=0.111, P=0.101).
 
Conclusion: The results indicated that having a connection to God can lower death anxiety in grade four liver disease patients. Additionally, the study found that as death anxiety increases in grade four liver disease patients, their level of resilience and attachment to God decreases.  

Keywords


Acknowledgments: We extend our gratitude to the entire team at Imam Khomeini Hospital in Tehran, as well as to the grade four liver disease patients who participated in this research. Approval for this study was granted by the Ethical Committee at Islamic Azad University, Garmsar Branch, Garmsar, Iran (IR.IAU.GARMSAR.REC. 1402. 215).

 

Availability of data and materials:  The data used in the research can be requested from the author before or after the publication of the study.

 

Conflicts of interest: The researchers verify that the study was conducted free from any commercial or financial conflicts of interest. 

 

Consent for publication: The signed Consent to Publish send to the Publisher to permission of the Authors to publish the Work.

 

Ethics approval and consent to participate:  Approval for this study was granted by the Ethical Committee at Islamic Azad University, Garmsar Branch, Garmsar, Iran (IR.IAU.GARMSAR.REC. 1402. 215). The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.

 

Financial disclosure: This research did not receive any financial backing from external entities.

 

Author contributions: F. A.Z.: Contributed to the conception of the work, revising the draft, approving the final version of the manuscript, and agreeing on all aspects of the work; S. T.; M. G. and S. T. : Contributed to the data analysis and interpretation, critical revision, and approval of the final version of the manuscript; S. B.B.; F. A.Z. and R.K: Contributed to acquiring data, drafting the manuscript, and approving the final version; M. G. and S. T.: Contributed to the conception and design of the study, critical revision, and approval of the manuscript's final version; F. A.Z. and R.K.: Contributed to the conception and design of the study, data interpretation, drafting of the manuscript and critical revision, and approval of final version.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Tapper, E.B. and N.D. Parikh, Diagnosis and management of cirrhosis and its complications: a review. Jama, 2023. 329(18): p. 1589-1602.
https://doi.org/10.1001/jama.2023.5997
PMid:37159031 PMCid:PMC10843851
 
2. Tian, S., et al., Identifying optimal candidates for autologous peripheral blood stem cell therapy in patients with decompensated liver cirrhosis: a prognostic scoring system. Stem Cell Research & Therapy, 2024. 15(1): p. 8.
https://doi.org/10.1186/s13287-023-03622-y
PMid:38167085 PMCid:PMC10763677  
 
3. Shafiezadeh, R., et al., The effect of Trachyspermum ammi on functional dyspepsia, severity liver steatosis and liver enzymes in patients with nonalcoholic fatty liver disease: A double blind randomized clinical trial. 2019.  
 
4. Badvath, D., A. safali Miriyala, and P.V.K. Kuricheti, ONBLR: An effective optimized ensemble ML approach for classifying liver cirrhosis disease. Biomedical Signal Processing and Control, 2024. 89: p. 105882.
https://doi.org/10.1016/j.bspc.2023.105882  
 
5. Arafa, A., et al., Fatty Liver Index as a proxy for non-alcoholic fatty liver disease and the risk of stroke and coronary heart disease: The Suita Study. Journal of Stroke and Cerebrovascular Diseases, 2024. 33(1): p. 107495. doi: 10.1016/j.jstrokecerebrovasdis.2023.107495 .(PubMed: 34304083).
https://doi.org/10.1016/j.jstrokecerebrovasdis.2023.107495
PMid:38000108  
 
6. Perveen, N., et al., Quality of life, psychological stress and death anxiety among liver and renal transplant recipients. Stress, 2019. 1(31): p. 21.  
 
7. Al Boukhary, R., et al., The effect of gratitude on death anxiety is fully mediated by optimism in Lebanese adults following the 2023 earthquake. BMC psychology, 2024. 12(1): p. 2. . doi: 10.1186/s40359-023-01509-4 .(PubMed: 38167169).
https://doi.org/10.1186/s40359-023-01509-4
PMid:38167169 PMCid:PMC10759689  
 
8. Sharma, P., et al., Death Anxiety among Elderly People: Role of Gender, Spirituality and Mental Health. Indian Journal of Gerontology, 2019. 33(3).  
 
9. Bala, R. and S. Maheshwari, Death anxiety and death depression among elderly. International Journal of Psychiatric Nursing, 2019. 5(1): p. 55-59. 10.5958/2395-180X.2019.00012.4
https://doi.org/10.5958/2395-180X.2019.00012.4  
 
10. Azizi, M., M. Tajrobehkar, and S. Purehsan, Predicting Self-Control Based On Attachment To God Mediated Coping Styles In Patients With Diabetes. 2023.  
 
11. Kh N, H.A., Agha Mohammadi V, Savadpoor M, Jafari M., The Relationship between God Attachment and Attitude toward Death in Elderly People of Ardabil in 2019. Journal of Health and Care., 2020. 22(2): p. 168-75. 10.52547/jhc.22.2.168
https://doi.org/10.52547/jhc.22.2.168  
 
12. Tung, E.S., et al., Attachment to God as mediator of the relationship between God Representations and mental health. Journal of Spirituality in Mental Health, 2018. 20(2): p. 95-113.
https://doi.org/10.1080/19349637.2017.1396197  
 
13. Saki, S.S., et al., Relationship of attachment styles to god and depression with death anxiety as a mediator among women with breast cancer. Relig Health, 2020. 7: p. 1-11.  
 
14. Kiani, L., et al., The Relationship between Resilience and Post Traumatic Growth in Patients on Hemodialysis. Health Psychology, 2020. 8(32): p. 93-104.  
 
15. Daneshvarinasab A, M.S., Saleh M. , The Relationship between Social Support and Social Resilience of Flood-Affected Women (Case Study: Delgan City). Social psychological studies of women, 2021. 2(19): p. 50-7.  
 
16. Hasani, F., et al., The effectiveness of compassion-focused therapy on sexual satisfaction, emotional regulation, and resilience in nurses with burnt marriage syndrome. IJRN, 2021. 7(3): p. 52-64. .  
 
17. Bülbüloğlu, S. and B. Demir, The effect of perceived social support on psychological resilience in liver transplant patients receiving immunosuppression therapy. Transplant Immunology, 2021. 69: p. 101475.
https://doi.org/10.1016/j.trim.2021.101475
PMid:34600070  
 
18. Luo, Y., et al., Reflection in the context of the epidemic: does death anxiety have a positive impact? The role of self-improvement and mental resilience. Frontiers in Psychology, 2022. 13: p. 804635.
https://doi.org/10.3389/fpsyg.2022.804635
PMid:35401317 PMCid:PMC8985700  
 
19. Chang, X., et al., Impact of rumination on sleep quality among patients with non‑alcoholic fatty liver disease: a moderated mediation model of anxiety symptoms and resilience. BMC psychiatry, 2023. 23(1): p. 84.).
https://doi.org/10.1186/s12888-023-04572-8
PMid:36732707 PMCid:PMC9893673  
 
20. Beaujean, A.A., Latent variable models: An introduction to factor, path, and structural equation analysis. 2016.  
 
21. Lester, D., D.I. Templer, and A. Abdel-Khalek, A cross-cultural comparison of death anxiety: A brief note. OMEGA-Journal of Death and Dying, 2007. 54(3): p. 255-260.
https://doi.org/10.2190/W644-8645-6685-358V
PMid:17847957  
 
22. Poordad, S. and K. Momeni, Death anxiety and its relationship with social support and gratitude in older adults. Iranian Journal of Ageing, 2019. 14(1): p. 26-39.  
 
23. Connor, K.M. and J.R. Davidson, Development of a new resilience scale: The Connor‐Davidson resilience scale (CD‐RISC). Depression and anxiety, 2003. 18(2): p. 76-82.
https://doi.org/10.1002/da.10113
PMid:12964174  
 
24. Nemati, S., et al., The Relationship between religious coping strategy, resiliency and marital satisfaction. Journal of Modern Psychological Researches, 2019. 14(53): p. 317-331.  
 
25. Keyhani, M., et al., Internal consistency and confirmatory factor analysis of the Connor-Davidson Resilience Scale (CD-RISC) among nursing female. Iranian journal of medical education, 2015. 14(10): p. 857-865.  
 
26. Beck, R. and A. McDonald, Attachment to God: The Attachment to God Inventory, tests of working model correspondence, and an exploration of faith group differences. Journal of psychology and theology, 2004. 32(2): p. 92-103.
https://doi.org/10.1177/009164710403200202  
 
27. Pirzadeh, H., The Relationship between God Attachment Styles with Tendency to Drugs among Students. Journal of Family Relations Studies, 2021. 1(1): p. 4-12. https://doi.org/10.22098/jhrs.2022.8456.1001  
 
28. Mohammadzadeh, A. and M. Oraki, Attachment to God as a predictor of death distress among Muslims. Current Psychology, 2020. 39(6): p. 2314-2319.
https://doi.org/10.1007/s12144-018-9934-3  
 
29. Jordan, K.D., K.L. Niehus, and A.M. Feinstein, Insecure attachment to God and interpersonal conflict. Religions, 2021. 12(9): p. 739.
https://doi.org/10.3390/rel12090739  
 
30. Marin, S., The Relationship between Religiosity and Implicit vs. Explicit DEATH Anxiety. 2019.  
 
31. Njus, D.M. and A. Scharmer, Evidence that God attachment makes a unique contribution to psychological well-being. The International Journal for the Psychology of Religion, 2020. 30(3): p. 178-201. https://digitalworks.union.edu/theses/2324
https://doi.org/10.1080/10508619.2020.1723296  
 
32. Pandya, A.-k. and T. Kathuria, Death anxiety, religiosity and culture: Implications for therapeutic process and future research. Religions, 2021. 12(1): p. 61.
https://doi.org/10.3390/rel12010061  
 
33. Hong, Y., et al., Death anxiety among advanced cancer patients: a cross-sectional survey. Supportive Care in Cancer, 2022: p. 1-9  
 
34. Feng, Y., et al., Exploring the relationship between spiritual well-being and death anxiety in patients with gynecological cancer: a cross-section study. BMC Palliative Care, 2021. 20: p. 1-10
https://doi.org/10.1186/s12904-021-00778-3
PMid:34074283 PMCid:PMC8170730