Image of Death and Attitude Towards Death

Abstract

Mental images play a vital role in cognitive processing and behaviour. The aim of this study was to assess the influence of image of death (positive or negative), and sex on the attitude towards death. A sample of 250 university undergraduates were applied the subscales of the Death Attitude Profile-Revised (DAP-R). Undergraduates with a positive image of death had less Fear of Death (FD) and Death Avoidance (DA), more Escape Acceptance (EA), and higher scores in Neutral Acceptance (NA) than individuals with a negative image of death. The results revealed no significant sex differences in any of the subscales of the Death Attitude Profile-Revised (DAP-R). Further lines of research are proposed.

Full text

______________________________
Author info: Correspondence should be sent to:
Alfredo Campos, University
of Santiago de Compostela. Department of Basic Psychology, 15782 Santiago de
Compostela, Spain, or alfredo.campos@usc.es
North American Journal of Psychology, 2020, Vol. 22, No. 4, 701 -710.
 NAJP
Image of Death and Attitude towards Death
María Esther López-Pérez & Margarita Pino-Juste
University of Vigo
Alfredo Campos
University of Santiago de Compostela
Mental images play a vital role in cognitive processing and behaviour.
The aim of this study was to assess the influence of image of death
(positive or negative), and sex on the attitude towards death. A sample of
250 university undergraduates was administered the subscales of the
Death Attitude Profile-Revised (DAP-R). Undergraduates with a positive
image of death had less Fear of Death (FD) and Death Avoidance (DA),
more Escape Acceptance (EA), and higher scores in Neutral Acceptance
(NA) than individuals with a negative image of death. The results
revealed no significant sex differences in any of the subscales of the
Death Attitude Profile-Revised (DAP-R). Further lines of research are
proposed.
Keywords: Mental imagery, positive mental images, negative mental
images, death attitude.
Mental images play a vital role in cognitive processing and behaviour
(Campos & Campos-Juanatey, 2019, 2020; Pérez-Fabello & Campos,
2017; Pérez-Fabello et al., 2018), and directly affect attitudes,
particularly if images are conceived as beyond the visual, and involve
auditory, gustative, olfactory, and tactile images (Campos & Fuentes,
2016; Campos & Pérez-Fabello, 2005).
Attitudes towards death vary according to the historical period, the
country and culture, ethnicity, sex, education, as well as an array of other
variables that make up a person’s idea of death (Lee, 2009; McGovern &
Barry, 2000). Attitudes towards death are also related to ideology and
religiosity (Castano et al., 2011; Dadfar & Lester, 2017). One of the
variables influencing attitudes towards death is mental imagery, in
particular whether the mental image of death is positive or negative
(Borkovec et al., 2004). López-Pérez et al. (in press) found that, in a
group of teenagers, the individuals who had greater image control had
significantly less Fear of Death (FD), lower scores on the Avoidance of

702 NORTH AMERICAN JOURNAL OF PSYCHOLOGY
Death (DA) scale, and higher scores on the scale of Neutral Acceptance
(NA) than students who had lower image control.
Thus, in a study where half of the participants listened to audio
recordings of descriptions of imagined unpleasant scenarios, and were
instructed to imagine the scenarios, whereas the other half listened to the
same audio recordings of descriptions of imagined unpleasant scenarios,
and were instructed to verbally elaborate on the same information,
emotion was found to be higher in the former than the latter (Holmes &
Matheus, 2005). Recently, a study applying the Death Imagery Scale
measuring five types of imagery: re-enactment, rescue, revenge, reunion,
and remorse to 130 violent death survivors, who sought (and received)
therapeutic treatment at a community health care clinic, found that the
most frequent mental images in violent death survivors were re-
enactment, rescue, and remorse imagery, and all forms of imagery were
associated with post-traumatic stress disorder (Baddeley et al., 2015).
In numerous cases, individuals with extremely negative attitudes
towards death leading to behavioural disorders require treatment to
transform these images and negative attitudes into positive ones (Clark et
al., 2006; Ng et al., 2014; Nilsson et al., 2012; Stopa et al., 2012; Wild et
al., 2008). Negative images are quite common in clinical and non-clinical
populations, but negative images are also characteristic of several mental
disorders (Brewin, 2010). For instance, an absence of positive mental
images and a presence of negative images have been found in depression
severity (WeBlau, 2015). Moreover, mental images influence affective
responses (Deeprose & Holmes, 2010; Holmes et al., 2008), and states of
mood (Deeprose & Holmes, 2010; Holmes et al., 2008).
López-Pérez et al. (2020) applied the Image of Death Scale (IDS;
López-Pérez et al., 2020) to determine if image of death was positive or
negative, and the Death Attitude Profile-Revised (DAP-R) to a sample of
280 adolescents, and found participants with a positive image of death
scored higher on Approach Acceptance, Escape Acceptance, and Neutral
Acceptance, and lower in Fear of Death, and Death Avoidance, than
adolescents with a negative image of death. The aim of this study was to
replicate this study in a sample of adults and contrast the results.
Sex is a variable influencing attitudes towards death (Lee, 2009;
McGovern & Barry, 2000); notwithstanding, the results are inconsistent.
No significant differences between women and men were found in the
description of death, either in the description of positive images or
negative images between the groups of undergraduates (McDonald &
Hilgendorf, 1986). However, in a study on a group of 144 Atlantic
Canadian students who were administered the Multidimensional Fear of
Death Scale (MFODS), women exhibited more Fear for Significant
Others and Fear of the Death (Power & Smith, 2008).

Lopez-Perez, Pino-Juste, & Campos IMAGE OF DEATH 703
Moreover, Wong et al.’s (1994) comparison of 100 young adults
(mean age = 23.3 years), 100 middle-aged adults (mean age = 41.8
years), and 100 elderly adults (mean age = 72.9 years) found sex
significantly related to the scores on certain subscales of the Death
Attitude Profile-Revised (DAP-R; Wong et al., 1994): Approach
Acceptance (AA), Death Avoidance (DA), and Escape Acceptance (EA).
Wong et al. (1994) found women were significantly more accepting of
life after death and significantly more accepting of death as an escape
from life than men. In contrast, men tended to avoid all thoughts of death
more than women. No differences were found between women and men
on the Neutral Acceptance (NA), or the Fear of Death (FD) subscales.
López-Pérez et al. (2020) found in a group of adolescents that women
scored higher than men on the Fear of Death (FD) Subscale, and the
Escape Acceptance (EA) Subscale. However, no significant differences
were found between women and men on the other subscales of the Death
Attitude Profile-Revised (DAP-R): Approach Acceptance (AA), Death
Avoidance (DA), or Neutral Acceptance (NA).
Thus, the aim of this study was to determine if a person’s image of
death (positive or negative) and sex influenced the attitude towards death.
The hypothesis was that an adult’s image of death (positive or negative)
and sex would significantly influence attitudes towards death. The
independent variables were image of death and sex, and the dependent
variables were the subscales of the Death Attitude Profile-Revised (DAP-
R): Approach Acceptance (AA), Fear of Death (FD), Death Avoidance
(DA), Escape Acceptance (EA), and Neutral Acceptance (NA). The
authors contend that in the present climate of COVID-19, it is a topic of
current interest. If the hypothesis is confirmed, it will entail a major
advance for clinical practice.
METHOD
Participants
A group of 250 third and fourth-year science and humanities
undergraduates from the University of Vigo (201 women and 49 men,
mean age 22.03 years, standard deviation 2.38, range 19 to 28 years)
participated in this study.
Instruments
The Death Attitude Profile-Revised (DAP-R), a version of the Death
Attitude Profile (DAP, Gesser et al., 1988), which is a multidimensional
measure of attitudes towards death developed by Wong et al. (1994), was
administered. The scale consists of 32 items scored on a Likert type scale
ranging from 1 = strongly disagree to 7 = strongly agree. The subscales
are: Fear of Death (FD), Death Avoidance (DA), Neutral Acceptance

704 NORTH AMERICAN JOURNAL OF PSYCHOLOGY
(NA), Approach Acceptance (AA), and Escape Acceptance (EA). Wong
et al (1994) obtained a Cronbach’s alpha for Approach Acceptance (AA)
of .97, an alpha for Fear of Death (FD) of .86, an alpha for Death
Avoidance (DA) of .88, the alpha for Escape Acceptance (EA) was .84,
and the alpha for Neutral Acceptance (NA) was .65. The test had no
completion time limit.
The Image of Death Scale (IDS; López-Pérez et al., 2020) is a Likert
type scale with only one item: “If you had to describe your image of
death, Would you say it is positive (rest, absence of pain, etc.), or
negative (loss of life, family, etc.)?”. Responses were on 6-point scale
where 1 = Very negative, 2 = Fairly negative, 3 = Negative, 4 = Positive,
5 = Fairly positive, 6 = Very positive.
Procedure
Participants were administered in their usual classrooms the Death
Attitude Profile-Revised (DAP-R; Wong et al., 1994), and the Image of
Death Scale (IDS; López-Pérez et al., 2020). Test instructions were given
and the order of test presentation was counterbalanced. All
undergraduates freely volunteered to participate in the study and were not
rewarded. Informed consent was obtained, and participants were
guaranteed their data would remain anonymous and confidential. The
tests were administered in the students’ usual classrooms in groups of
approximately 20 undergraduates during school hours. The instructions
given to participants were the instructions for the tests. The study was
approved by the Ethics Committee of the University of Santiago de
Compostela and complied with the Declaration of Helsinki 2013.
Having gathered the data, participants were classified as either
Positive image of death for scores 4 or higher on the Image of Death
Scale (IDS; López-Pérez et al., 2020), or Negative image of death for
scores below 4 on the Image of Death Scale (IDS; López-Pérez et al.,
2020).
Data Analysis
Cronbach’s Alpha was used to evaluate the reliability of the subscales
of the Death Attitude Profile-Revised (DAP-R; Wong et al., 1994). In
order to analyse the influence of Image of Death and sex on each of the
subscales of the Death Attitude Profile-Revised (DAP-R), a 2 (Image of
Death) x 2 (Sex) Multivariate Analysis of Variance (MANOVA) was
performed. The dependent variables were the subscales of the Death
Attitude Profile-Revised (DAP-R): Approach Acceptance (AA), Fear of
Death (FD), Death Avoidance (DA), Escape Acceptance (EA), and
Neutral Acceptance (NA). The statistical data analyses were performed
using the SPSS 22.0 software program.

Lopez-Perez, Pino-Juste, & Campos IMAGE OF DEATH 705
RESULTS
The first step was to assess the reliability of the Death Attitude
Profile-Revised subscales (DAP-R; Wong et al., 1994). The Cronbach’s
alpha for Approach Acceptance (AA) was .89, the alpha for Fear of
Death (FD) was .85, the alpha for Death Avoidance (DA) was .91, the
alpha for Escape Acceptance (EA) was .83, the alpha for Neutral
Acceptance (NA) was .72, and the alpha for the Test total of the (DAP-R)
was .85.
MANOVA was performed to determine if Image of Death (positive
or negative) and Sex influenced the scores on the subscales of the Death
Attitude Profile-Revised (DAP-R): Approach Acceptance (AA), Fear of
Death (FD), Death Avoidance (DA), Escape Acceptance (EA), and
Neutral Acceptance (NA). The means and standard deviations of the
groups are shown in Table 1. Results of the MANOVA revealed
significant differences in the scores of different subscales of the Death
Table 1 Means & Standard Deviations (in Brackets) of the Scales of
AttitudeTowards Death (AA, FD, DA, EA, NA) According to the Image
of Death (IDS) & Sex
Subscales IDS Sex Total
DAP-R Positive Negative Men Women M
AA 2.49
2.49 2.61 2.46 2.49
(1.29)
(1.20) (1.25) (1.21) (1.22)
FD 3.34
4.37 3.48 4.26 4.11
(1.30)
(1.39) (1.28) (1.43) (1.44)
DA 3.33
4.32 3.49 4.22 4.07
(1.43)
(1.64) (1.57) (1.63) (1.64)
EA 3.49
2.93 3.26 3.02 3.07
(1.50)
(1.45) (1.36) (1.50) (1.48)
NA 5.99
5.22 5.47 5.40 5.42
(0.62)
(0.90) (0.93) (0.89) (0.90)
Note: IDS = Image of Death Scale; AA =Approach Acceptance; FD =Fear of Death; DA
= Death Avoidance; EA=Escape Acceptance; NA=Neutral Acceptance
Attitude Profile-Revised (DAP-R): Approach Acceptance (AA), Fear of
Death (FD), Death Avoidance (DA), Escape Acceptance (EA), and
Neutral Acceptance (NA), between participants with a positive image
and with a negative image of death, Wilks’ Lambda =.88, F(5, 240) =
6.37, p < .001, η
p
2
= .12, power = 1.
The univariate analysis showed significant differences between the
scores of participants with a positive image of death and those with a
negative image of death on the subscales of the Death Attitude Profile-
Revised (DAP-R): Fear of Death (FD), Death Avoidance (DA), Escape
Acceptance (EA), and Neutral Acceptance (NA), with the exception of
Approach Acceptance (AA). Undergraduates with a positive image of

706 NORTH AMERICAN JOURNAL OF PSYCHOLOGY
death (M = 3.34, SD = 1.30) had less Fear of Death (FD) than
undergraduates with a negative image of death (M = 4.37, SD = 1.39),
and this difference was significant, F(1, 244) = 8.07, p = .005, η
p
2
= .03,
power = .81.
Individuals with a positive image of death (M = 3.33, SD = 1.43) had
less Death Avoidance (DA) than individuals with a negative image of
death (M = 4.32, SD = 1.64), and this difference was significant, F(1,
244) = 7.79, p = .006, η
p
2
= .03, power = 0.79. Undergraduates with a
positive image of death scored higher on Escape Acceptance (EA) (M =
3.49, SD = 1.50) than undergraduates with a negative image of death (M
= 2.93, SD = 1.45), and this difference was significant, F(1, 244) = 5.98,
p = .01, , η
p
2
= .02, power = .68. Finally, individuals with a positive
image of death scored higher on Neutral Acceptance (NA) (M = 5.99, SD
= 0.62) than individuals with a negative image of death (M = 5.22, SD =
0.90), and the difference was significant, F(1, 244) = 24.42, p < .001, η
p
2
= .09, power = 1. No significant difference was observed in Approach
Acceptance (AA), between university undergraduates with a positive
image of death and those with a negative image of death, F(1, 244) =
0.04, p = .84, η
p
2
= .01, power = .06.
The next step was to analyse significant differences between women
and men in the scores of the subscales of the Death Attitude Profile-
Revised (DAP-R): Approach Acceptance (AA), Fear of Death (FD),
Death Avoidance (DA), Escape Acceptance (EA), and Neutral
Acceptance (NA). The results of the MANOVA revealed no significant
differences between women and men in any of the subscales, Wilks’
Lambda = .96, F(5, 240) = 1.78, p = .12, η
p
2
= .04, power = .61. The
interaction between both variables, Image of Death and Sex was not
significant, Wilks’ Lambda = .97, F(5, 244) = 1.59, p = .16, η
p
2
= .03,
power = .55.
DISCUSSION
The Cronbach’s alphas in the study ranged from .72, for the Neutral
Acceptance (NA) subscale, to .91 for Death Avoidance (DA). These
alphas are considered by George and Mallery (2003) to be “acceptable”
and “excellent.” Moreover, significant differences were found between
participants with a positive image and those with a negative image of
death, on certain subscales of the Death Attitude Profile-Revised (DAP-
R): Fear of Death (FD), Death Avoidance (DA), Escape Acceptance
(EA), and Neutral Acceptance (NA). Undergraduates with a positive
image of death had less Fear of Death (FD), and less Death Avoidance
(DA), but more Escape Acceptance (EA), and scored higher in Neutral
Acceptance (NA) than individuals with a negative image of death. These
results corroborated the work of López-Pérez et al. (2020), except for the
Approach Acceptance (AA) subscale, which in López-Pérez’ et al.

Lopez-Perez, Pino-Juste, & Campos IMAGE OF DEATH 707
(2020) study participants with a positive image of death scored higher on
Approach Acceptance (AA), than individuals with a negative image of
death. In this study, no significant differences were found between both
groups in the Approach Acceptance subscale (AA). It is worth noting that
adolescents participated in the study of López-Pérez et al., whereas the
participants in the present study were university undergraduates.
In this study, no significant differences were found between women
and men in the scores of the subscales of the Death Attitude Profile-
Revised (DAP-R): Approach Acceptance (AA), Fear of Death (FD),
Death Avoidance (DA), Escape Acceptance (EA), and Neutral
Acceptance (NA). This result corroborated other studies in observing no
significant differences between women and men: McDonald and
Hilgendorf (1986) found no significant differences between women and
men in descriptions of death in a group of undergraduate students, in
neither positive, nor negative images. Wong et al. (1994) found no
differences between women and men on the Neutral Acceptance (NA),
and the Fear of Death (FD), subscales, and López-Pérez et al. (2020)
found no significant differences between women and men in certain
subscales of the Death Attitude Profile-Revised (DAP-R): Approach
Acceptance (AA), Death Avoidance (DA), and Neutral Acceptance
(NA). However, the results of the present study disagree with the
findings of studies reporting significant differences in certain attitudes
towards death between women and men: Power and Smith (2008) found
women had more Fear for Significant Others and Fear of the dead than
men, and López-Pérez et al. (2020) found women scored higher than men
on the Fear of Death (FD) scale, and the Escape Acceptance (EA) scale
in a group of adolescents.
The influence of a positive or negative image of death on attitudes to
death has rarely been examined. The few studies mentioned in the
literature suggest image has an influence, but the results are inconsistent,
which underscores the need for further studies to measure the influence
of age, ethnicity, culture, and sex using the same test of attitudes to death.
The results of comparisons between women and men in attitude towards
death are inconsistent, which highlights the need for research to elucidate
this relationship and determine the influence of culture and age. In this
study no significant sex differences were found between women and
men, which may be due to the lack of sex parity in the sample. It would
be interesting to replicate this study with sex parity.
The data of the present study were gathered prior to the COVID-19
pandemic, and it would be most interesting to collect data from the same
individuals, or individuals of a similar age group and socioeconomic
characteristic to evaluate the effects of COVID-19 on attitudes towards
death. As throughout the pandemic everybody has experienced the death

708 NORTH AMERICAN JOURNAL OF PSYCHOLOGY
of a loved one at some time, as well as being personally exposed to the
fear of death itself, it would seem reasonable to believe the COVID-19
pandemic has had an impact on attitudes to death.
The authors foresee these results will have a significant impact on the
practical application of clinical psychology since negative images of
death can be modified and converted into positive ones. The resulting
change in attitudes towards death will reduce anxiety towards death and
enhance a person’s well-being.
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