Spiritual and Religious Beliefs, Behaviors, and Struggles in Relation to Death Anxiety: Evidence from a U.S. Nationwide Probability Sample

Abstract

Death anxiety is associated with adverse psychological and health outcomes, yet findings regarding the role of religiosity and spirituality (R/S) as protective or risk factors remain mixed. Prior research has relied on convenience samples, combined disparate R/S constructs, and rarely tested nonlinear associations. This study examined associations between death anxiety and multiple R/S facets in a nationwide probability sample of 3,010 U.S. adults. Regression models tested associations between R/S predictors and death anxiety and tested moderation by age and chronic illness, controlling for demographics, meaning in life, social support, anxiety, and depression. All belief predictors (afterlife beliefs, R/S centrality, R/S peace, and positive view of God) showed curvilinear inverted U-shaped patterns: strong worldviews, both religious and secular, were linked to lower death anxiety, while ambivalence was associated with the highest death anxiety. Regarding behaviors, Bible reading was linearly protective; however, church attendance and prayer were protective only at threshold levels (multiple times per month and week, respectively). R/S struggles (insecure attachment to God and negative view of God) were consistently detrimental. Age moderated several relationships, with R/S centrality, peace, positive view of God, and prayer becoming increasingly protective in later life, while avoidant attachment to God became more harmful. Chronic illness moderated only positive God views such that benevolent God beliefs became more protective with increasing illness burden. These findings clarify inconsistencies in the existing literature and suggest that clarity in one's worldview may be an important target for intervention.