Death Anxiety Scale

Abstract

The Death Anxiety Scale (DAS), developed by Donald I. Templer in 1970, represents one of the foundational and most extensively utilized psychometric instruments in thanatology and clinical psychology. Designed to quantify an individual’s conscious dread, apprehension, and maladaptive attitudes toward death and dying, the DAS was constructed to address the psychometric deficiencies of earlier, unstandardized measures. The instrument consists of 15 self-report items administered via a dichotomous (True/False) response format. While originally conceptualized and scored as a unidimensional assessment yielding a single composite score ranging from 0 to 15, subsequent structural and psychometric investigations, notably by Lonetto and Templer (1986), identified four underlying dimensions: personal and emotional reactions to death, concerns regarding physical dissolution and alteration, acute awareness of the passage of time, and apprehensions surrounding pain, suffering, and terminal illness.

Psychometrically, the DAS demonstrates robust properties across diverse clinical and non-clinical cohorts. Initial validation established an internal consistency reliability coefficient (Kuder-Richardson Formula 20) of .76 and a three-week test-retest reliability coefficient of .83 among community college participants. Construct and discriminant validity were confirmed through known-groups comparisons—wherein psychiatric inpatients exhibiting pronounced death-related distress scored significantly higher than matched controls (11.62 vs. 6.77)—and through differential correlations with general anxiety inventories. Specifically, the DAS correlated substantially with Boyar’s Fear of Death Scale (r = .74) while demonstrating modest associations with generalized anxiety measures from the Minnesota Multiphasic Personality Inventory (MMPI), including the Taylor Manifest Anxiety Scale (r = .39), the Welsh Anxiety Scale (r = .36), and the Welsh Anxiety Index (r = .18). Over five decades of empirical application, the scale has been translated into more than ten languages, facilitating cross-cultural investigations in palliative medicine, geriatric psychiatry, psycho-oncology, and existential psychology.

Keywords

Death Anxiety Scale, Donald Templer, thanatology, fear of death, existential psychology, psychometrics, terror management theory, end-of-life distress, anxiety measurement, palliative care psychology

Authors

The Death Anxiety Scale was formulated and psychometrically standardized by Donald I. Templer, Ph.D. (1938–present). During the development and initial validation of the DAS, Dr. Templer was affiliated with the Western State Hospital in Hopkinsville, Kentucky, and subsequently served as a prominent faculty member in clinical psychology at the California School of Professional Psychology (CSPP) at Alliant International University in Fresno, California.

Dr. Templer is recognized internationally as a pioneer in empirical thanatology. Throughout his academic career, he authored and co-authored over two hundred peer-reviewed publications covering clinical neuropsychology, psychometrics, affective disorders, and the existential dimensions of mortality. His foundational work in the late 1960s and early 1970s transformed death anxiety from an abstract philosophical and psychoanalytic construct into an operationally definable, empirically verifiable psychological variable. Later psychometric expansions of his work were conducted in close collaboration with Richard Lonetto, Ph.D., of the University of Guelph, culminating in seminal monographs that examined the multi-factorial architecture of mortality awareness across the human lifespan.

Purpose

The primary purpose of the Death Anxiety Scale is to systematically assess and quantify conscious fear, cognitive dread, and affective distress linked to death, dying, and terminal vulnerability. Prior to the publication of Templer’s instrument in 1970, empirical investigations into death attitudes were severely constrained by the absence of psychometrically sound, standardized self-report instruments. Existing indices were largely projective, highly subjective, idiosyncratic to individual research laboratories, or plagued by low reliability and unknown construct validity. Templer conceptualized the DAS to establish an objective, rapidly administrable, and statistically standardized inventory capable of measuring the broad spectrum of mortality-related concerns across clinical populations, academic cohorts, and community samples.

In clinical practice, the DAS serves several diagnostic and therapeutic functions:

• Palliative and End-of-Life Care: Healthcare clinicians, medical social workers, and hospice psychologists utilize the instrument to screen terminally ill patients for severe existential distress, facilitating targeted psychological interventions such as dignity therapy, meaning-centered psychotherapy, or specialized palliative psychiatric support.
• Psycho-Oncology and Chronic Disease Management: Patients receiving life-threatening medical diagnoses (e.g., advanced malignant neoplasms, congestive heart failure, severe cardiovascular pathology) frequently experience acute existential crises. The DAS aids clinicians in distinguishing normative, non-pathological mortality awareness from debilitating, treatment-interfering thanatophobia.
• Geriatric Assessment: Psychologists working in long-term care facilities and geriatric outpatient clinics employ the scale to explore the complex relationship between aging, cognitive decline, institutionalization, and fears of physical dissolution.
• Psychotherapy for Anxiety and Depressive Disorders: Clinicians operating within existential, psychodynamic, and cognitive-behavioral paradigms utilize the scale to uncover underlying death-related cognitive schemas that may fuel panic disorder, health anxiety (hypochondriasis), obsessive-compulsive themes, or severe depressive episodes.

In empirical research, the DAS remains a standard benchmark tool. It has been extensively deployed to test hypotheses derived from Terror Management Theory (TMT), investigate the psychological mechanisms of religious coping, evaluate the impact of educational thanatology interventions on healthcare professionals (such as nursing and medical students), and measure cross-cultural variations in attitudes toward mortality across diverse demographic strata.

Psychological Construct

The psychological construct evaluated by the DAS is death anxiety, broadly defined as a multi-determined negative emotional state characterized by apprehension, cognitive dread, and physiological arousal triggered by the anticipation of one’s own mortality or the cessation of biological existence. Rather than viewing the fear of death as an isolated phobic symptom, modern psychometrics conceptualizes death anxiety as a pervasive existential vulnerability intertwined with personality organization, self-esteem, defensive coping mechanisms, and affective stability.

Although Templer constructed the original 15-item inventory to yield a singular composite score representing an overarching construct of death anxiety, comprehensive factor-analytic studies—most notably conducted by Lonetto and Templer (1986)—revealed that the construct comprises four distinct, interrelated psychological domains:

1. Intellectual and Personal Emotional Reactions to Death

This dimension encompasses an individual’s conscious cognitive appraisal of mortality and the accompanying subjective emotional turbulence. It captures the direct admission of fear regarding one’s ultimate annihilation, the degree to which thoughts of mortality intrude upon daily cognitive processing, and the emotional equilibrium maintained during interpersonal dialogues about dying. Items such as “I am very much afraid to die” (Item 1) and “The thought of death seldom enters my mind” (Item 2, reverse-scored) represent this conscious affective-cognitive nexus. High endorsement within this domain reflects acute existential unease, poor cognitive habituation to mortality, and a relative failure of baseline repression mechanisms.

2. Concern About Physical Change and Somatic Dissolution

This subconstruct reflects somatic vulnerability, bodily integrity fears, and revulsion toward corporeal decomposition. Humans exhibit profound distress not only regarding the cessation of consciousness but also toward the visceral realities of physical breakdown, medical invasion, and dead tissue. Items tapping into this dimension include apprehension regarding surgical procedures (“I dread to think about having to have an operation”, Item 4) and revulsion toward biological remains (“The sight of a dead body is gruesome to me”, Item 14). This factor closely mirrors the evolutionary disgust response and somatic threat detection systems that protect organisms from biological hazards.

3. Awareness of and Concern About the Passage of Time

Rooted deeply in existential philosophy, this component addresses subjective temporality, the relentless progression of time, and the acute realization of the finitude of human lifespan. Time awareness evokes death anxiety because every passing chronological increment brings the individual closer to non-existence. This dimension is primarily captured by Item 8 (“I am often distressed by the way time flies so very rapidly”) and Item 12 (“I often think about how short life really is”). Endorsement of these items signals an ongoing existential hyper-vigilance regarding lost opportunities, unfulfilled aspirations, and the unstoppable march of personal aging.

4. Pain, Suffering, and the Stress of Terminal Illness

Often differentiated conceptually from the metaphysical fear of non-existence, this dimension captures the fear of the process of dying. Individuals frequently report that their primary distress centers on prolonged physiological agony, debilitating disease processes, loss of autonomy, and catastrophic physical decompensation. Items such as “I am not particularly afraid of getting cancer” (Item 6, reverse-scored), “I fear dying a painful death” (Item 9), and “I am really scared of having a heart attack” (Item 11) assess this anticipation of acute physical pain and terminal distress. In palliative and oncology contexts, elevations in this specific domain often signal a need for detailed medical psychoeducation concerning symptom control and modern analgesic management.

Theoretical Framework

The construction and clinical interpretation of the Death Anxiety Scale are informed by several overlapping theoretical traditions within clinical psychology, psychodynamics, and existential philosophy.

1. Existential Philosophy and Thanatological Theory

The primary philosophical scaffolding of the DAS stems from existential psychiatry and philosophy, notably articulated by thinkers such as Søren Kierkegaard, Martin Heidegger, Paul Tillich, and later synthesized clinically by Irvin Yalom (1980) and Rollo May. Within existential theory, death is viewed as the ultimate “boundary situation” or ultimate concern. Human existence is characterized by an inescapable tension between the desire to exist and the absolute inevitability of biological extinction. Yalom posited that death anxiety is a ubiquitous human experience, constantly present beneath conscious awareness. When defensive structures (such as beliefs in personal specialness or belief in an ultimate rescuer) crack under the weight of illness, aging, or crisis, death anxiety floods conscious awareness, requiring conscious coping or resulting in neurotic symptomatology. Templer operationalized this boundary condition, providing empirical means to measure how conscious mortality concerns break through daily psychological defenses.

2. Psychodynamic Perspectives and Defense Mechanisms

Early psychoanalytic theory, initiated by Sigmund Freud in Thoughts for the Times on War and Death (1915), suggested that the unconscious does not believe in its own death and that conscious fear of death is secondary to castration anxiety or unresolved guilt. However, later psychodynamic and ego-psychological theorists revised this stance, recognizing death anxiety as a primary emotional driver. The DAS is conceptually anchored in the idea that individuals maintain varying levels of defensive repression and denial. The reverse-keyed items of the DAS (e.g., “The thought of death never bothers me”, Item 7) directly operationalize massive psychological denial. In this framework, moderate scores reflect normative human apprehension balanced by adaptive defense mechanisms, whereas extremely low scores often suggest rigid, maladaptive denial, and extremely high scores indicate a collapse of coping mechanisms.

3. Terror Management Theory (TMT)

Although Terror Management Theory was articulated by Jeff Greenberg, Sheldon Solomon, and Tom Pyszczynski in the late 1980s—well after the DAS was published—the scale served as an essential foundational measurement tool that stimulated TMT’s empirical validation. TMT posits that human beings possess sophisticated cognitive capabilities that make them uniquely aware of their inevitable mortality, which conflicts with an instinctive biological drive for self-preservation, generating potentially paralyzing terror. To buffer against this dread, humans construct and adhere to cultural worldviews that imbue life with meaning, value, and symbolic immortality, alongside striving for self-esteem. The DAS captures variations in how effectively an individual’s cultural and psychological anxiety buffers are functioning; elevations on the DAS signify that mortality salience has pierced the individual’s defensive cultural armor.

Validity

Extensive empirical investigations have established the validity of the Death Anxiety Scale across multiple methodological approaches, establishing its construct, convergent, discriminant, and criterion-related validity.

Face Validity

Templer (1970) initially generated a pool of 40 potential items derived from clinical literature, existential writings, and clinical interviews. To ensure rigorous face validity, this preliminary pool was subjected to independent evaluation by seven panel judges: one licensed clinical psychologist, two advanced doctoral students in clinical psychology, and four psychiatric state hospital chaplains. Items were evaluated for their direct relevance to death-related distress, linguistic clarity, and psychological distinctiveness. Nine items failed to achieve unanimous consensus regarding their direct representation of death anxiety and were systematically removed, leaving 31 candidate items for empirical psychometric screening.

Construct and Criterion-Related Validity

To substantiate construct validity, Templer (1970) executed two classic empirical projects:

• Known-Groups Validation: Templer administered the DAS to a clinical group of 21 psychiatric hospital patients who had spontaneously expressed pronounced, severe death-related distress during clinical intake interviews and psychiatric treatment. Their scores were contrasted against a carefully matched control group of 21 psychiatric patients with identical psychiatric diagnoses, biological sex, and approximate age, but who exhibited no prominent mortality concerns. The high-death-anxiety cohort achieved a mean DAS score of 11.62 (SD = 2.22), whereas the control cohort demonstrated a mean score of 6.77 (SD = 3.25). This difference was statistically significant (t = 5.78, p < .001), corroborating the scale’s sensitivity in discerning clinically meaningful existential distress.
• Item-Total Biserial Correlations: In the 31-item prototype, point-biserial correlation coefficients were computed between each item and the total score. Sixteen items that failed to reach statistical significance across replication samples were eliminated, resulting in the final, optimized 15-item inventory.

Convergent Validity

Convergent validity was evaluated by correlating the DAS with Boyar’s Fear of Death Scale (FODS; Boyar, 1964), the preeminent existing measure of death dread at the time, among 77 undergraduate university students. The resulting Pearson correlation coefficient was highly robust (r = .74, p < .001), demonstrating excellent shared construct variance between the two independently designed inventories.

Discriminant Validity

A critical psychometric hurdle in thanatology is proving that a death anxiety scale measures a distinct, domain-specific construct rather than shared, generalized negative affectivity, neuroticism, or manifest trait anxiety. Templer (1970) administered the DAS alongside three recognized anxiety metrics embedded in the Minnesota Multiphasic Personality Inventory (MMPI): the Taylor Manifest Anxiety Scale (MAS), the Welsh Anxiety Scale (A), and the Welsh Anxiety Index (AI). The intercorrelations between the DAS and these generalized anxiety indices were modest:

• DAS with Taylor Manifest Anxiety Scale: r = .39
• DAS with Welsh Anxiety Scale: r = .36
• DAS with Welsh Anxiety Index: r = .18

Because these general anxiety indices correlated far higher with one another (typically r > .80) than they did with the DAS, and because the DAS-Boyar correlation (r = .74) substantially exceeded the DAS’s associations with generalized anxiety, Templer established that the DAS possesses exceptional discriminant validity. It quantifies death anxiety specifically, rather than capturing non-specific trait emotionality or general neurotic distress.

Reliability

The Death Anxiety Scale has demonstrated acceptable to strong reliability indices across a wide array of experimental, clinical, and epidemiological investigations over several decades.

Internal Consistency

In Templer’s (1970) original psychometric investigation, the internal consistency of the 15-item instrument was calculated utilizing the Kuder-Richardson Formula 20 (KR-20), the mathematically appropriate metric for dichotomously scored scales. The KR-20 coefficient was established at .76. In subsequent psychometric studies across collegiate, adult, and geriatric samples, internal consistency estimates (KR-20 and Cronbach’s alpha) have generally ranged between .65 and .83. While slightly below the stringent .80 benchmark in certain isolated homogeneous samples—partially due to the scale’s short length (15 items) and multi-factorial structure—the internal consistency remains thoroughly adequate for descriptive, group-level, and exploratory clinical screening.

Test-Retest Reliability

Temporal stability was originally demonstrated by administering the scale to a cohort of 31 community college students on two occasions separated by a three-week interval. The test-retest correlation coefficient was calculated at r = .83 (p < .001), indicating high temporal stability of conscious death attitudes over time in the absence of major existential trauma or life transitions. Subsequent stability evaluations over two- to four-week intervals have consistently replicated test-retest coefficients exceeding .80, indicating that while death anxiety can fluctuate in response to acute crises, baseline conscious attitudes remain relatively stable across non-clinical life phases.

Factor Analysis

Although Donald Templer deliberately formatted the DAS as a unidimensional instrument to yield a single total score representing gross death anxiety, subsequent psychometricians conducted Exploratory Factor Analyses (EFA) and Confirmatory Factor Analyses (CFA) that challenged the unidimensional assumption, demonstrating a multi-dimensional factor architecture.

Lonetto and Templer (1986) Four-Factor Model

The most widely accepted and replicated factor structure was established by Richard Lonetto and Donald Templer (1986). Subjecting diverse samples of college students, normal adults, and elderly populations to principal components analysis with varimax rotation, they consistently identified four robust components accounting for approximately 40% to 50% of the total variance:

• Factor I: Cognitive and Emotional Reactions (or Intellectual Dread): Captures conscious fear of dying and intrusive thoughts of death. Prominently loaded by Item 1 (“I am very much afraid to die”), Item 2 (“The thought of death seldom enters my mind” [negative loading]), Item 3 (“It doesn’t make me nervous when people talk about death” [negative loading]), and Item 5 (“I am not at all afraid to die” [negative loading]).
• Factor II: Somatic and Physical Alteration: Captures physical vulnerability and bodily destruction. Strongly loaded by Item 4 (“I dread to think about having to have an operation”) and Item 14 (“The sight of a dead body is gruesome to me”).
• Factor III: Awareness of Time: Reflects the passage of time and existential finitude. Dominated by Item 8 (“I am often distressed by the way time flies so very rapidly”) and Item 12 (“I often think about how short life really is”).
• Factor IV: Pain and Illness: Focuses on terminal morbidity and disease processes. Anchored by Item 6 (“I am not particularly afraid of getting cancer” [negative loading]), Item 9 (“I fear dying a painful death”), and Item 11 (“I am really scared of having a heart attack”).

Subsequent Factor Replications and CFA Debates

Independent researchers, such as McMordie (1979), Devins (1979), and Saggino and Kline (1996), confirmed that a single-factor solution provides a sub-optimal fit when evaluated against modern structural equation modeling criteria. While confirmatory factor analyses frequently confirm the superiority of a four-factor or hierarchical higher-order factor model over a strict unidimensional model, psychometric consensus supports the continued clinical use of the overall composite score, provided clinicians recognize that specific item clusters may account for unique symptom profiles in specialized populations (such as oncology patients disproportionately elevating the Pain and Illness factor).

Instrument / Measurement Tool

• Instrument Name: Death Anxiety Scale (DAS)
• Original Author: Donald I. Templer, Ph.D.
• Publication Date: 1970
• Construct Assessed: Conscious death anxiety, fear of dying, and existential distress
• Administration Format: Paper-and-pencil self-report inventory or digital computerized assessment
• Target Population: Adolescents and adults (ages 16 to 90+) across clinical, research, and non-clinical settings
• Item Count: 15 items
• Response Scale: Dichotomous format: True / False
• Completion Time: Approximately 3 to 5 minutes
• Scoring Protocol:
  • One point is awarded for each response keyed toward death anxiety.
  • Items keyed “True”: 1, 4, 8, 9, 10, 11, 12, 13, 14
  • Items keyed “False” (Reverse-scored): 2, 3, 5, 6, 7, 15
  • Total Score Range: 0 to 15
• Score Interpretation Guidelines:
  • 0 to 4: Low death anxiety. May reflect genuine existential equilibrium, advanced self-actualization, or strong psychological denial/repression.
  • 5 to 7: Normative/average death anxiety. Represents the standard range for healthy community and collegiate samples (typical normative mean falls between 6.0 and 7.0; SD ≈ 3.0).
  • 8 to 11: Elevated death anxiety. Indicates marked conscious preoccupation with mortality, somatic vulnerability, or existential stress.
  • 12 to 15: Severe/clinical death anxiety. Represents debilitating existential distress, commonly observed in acute psychiatric populations, individuals undergoing severe health crises, or untreated panic/phobic disorders.

Permissions & Fee and Test Year

The Death Anxiety Scale was formally published in 1970 in the Journal of General Psychology. Under contemporary academic standards, the instrument is widely treated as an open-access, public-domain psychometric scale for empirical academic research and non-profit clinical screening. Dr. Templer published the complete 15-item inventory alongside its exact scoring key in his seminal 1970 article to promote empirical thanatological inquiry without commercial gatekeeping or paywalls.

Researchers and mental health practitioners planning to use the DAS within institutional research, clinical trials, or hospital settings do not typically require a paid commercial license. However, standard academic ethics dictate that full formal citation be granted to the original 1970 publication. For commercial applications, software integration into proprietary electronic health records (EHR) platforms, or for-profit clinical diagnostic systems, appropriate copyright verification through the Taylor & Francis publishing group (the current publisher of the Journal of General Psychology) or Dr. Templer’s estate is recommended.

References

• Boyar, J. I. (1964). The construction and partial validation of a scale for the measurement of the fear of death (Unpublished doctoral dissertation). University of Rochester, Rochester, NY.
• Devins, G. M. (1979). Death anxiety and depression in medical patients: A structural equation approach. Journal of Consulting and Clinical Psychology, 47(4), 798–801. https://doi.org/10.1037/0022-006X.47.4.798
• Greenberg, J., Pyszczynski, T., & Solomon, S. (1986). The causes and consequences of a need for self-esteem: A terror management theory. In R. F. Baumeister (Ed.), Public Self and Private Self (pp. 189–212). Springer. https://doi.org/10.1007/978-1-4613-9564-5_10
• Lester, D., & Templer, D. I. (1993). Death anxiety scales: A dialogue. Omega: Journal of Death and Dying, 26(4), 239–253. https://doi.org/10.2190/R16E-PDK5-V6AU-9B8T
• Lonetto, R., & Templer, D. I. (1986). Death anxiety. Hemisphere Publishing Corporation.
• McMordie, W. R. (1979). Improving measurement of death anxiety. Psychological Reports, 44(3), 975–980. https://doi.org/10.2466/pr0.1979.44.3.975
• Saggino, A., & Kline, P. (1996). Item factor analysis of the Italian version of the Death Anxiety Scale. Journal of Clinical Psychology, 52(3), 329–333. https://doi.org/10.1080/00221309.1970.9920634
• Templer, D. I., & Ruff, C. F. (1971). Death Anxiety Scale means, standard deviations, and embedding. Psychological Reports, 29(1), 174–174. https://doi.org/10.2466/pr0.1971.29.1.174
• White, W., & Handal, P. J. (1991). The relationship between death anxiety and mental health/distress. Omega: Journal of Death and Dying, 22(1), 13–24. https://doi.org/10.2190/GE35-CG4P-Y789-58W1
• Yalom, I. D. (1980). Existential psychotherapy. Basic Books.

13. Items of the Scale (Questionnaire)