How Does Self-esteem Alleviate Death Anxiety in Youth Populations? The Mediating Role of Security 

How Does Self-esteem Alleviate Death Anxiety in Youth Populations? 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The Mediating Role of Security Jingxian Yu, Ziping Hu, Yongqi Liang, Huan Peng, Na Li, Hanjiao Liu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4735152/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract With the widespread use of the Internet and social media, youth groups are suffering deaths with increasing frequency. Studies have shown that self-esteem and a sense of security can reduce death anxiety, but a detailed explanation of the relationship is still lacking. Therefore, this study aimed to explore the interrelationship and potential pathways of death anxiety, self-esteem, and security in young people. A cross-sectional study was conducted in Shenzhen and Shaoguan, Guangdong Province, China, to collect general data, death anxiety scores, self-esteem scores, and security scores. A total of 623 valid questionnaires were collected from November to May 20232024. The results showed that both self-esteem and a sense of security could significantly predict death anxiety in reverse. Moreover, the sense of security engagement mediated the relationship between self-esteem and death anxiety. Although there is a high level of death anxiety in young people, measures to enhance self-esteem and a sense of security can help alleviate anxiety and promote physical and mental health. Biological sciences/Psychology Health sciences/Health care Death anxiety self-esteem security younger population mediating effects. Figures Figure 1 Figure 2 Figure 3 Introduction In the past few years, the new coronavirus pandemic has caused many deaths and worldwide panic, which has aroused the interest of scholars in various fields. As an important part of the research on death attitude, death anxiety has been paid much attention to 1 , 2 . Death anxiety refers to the individual's fear and worry about death and the ultimate event, which is a universal psychological phenomenon in the human life cycle and is closely related to the individual's physical and mental health 3 . Thanks to the rapid development of Internet technology, global information has gained more abundant dissemination channels. However, the rapid spread of death-related events such as mass infectious disease, serious traffic accidents, and sudden natural disasters has also increased the risk of mortality salience among Internet users 4 . While these messages provide young people who use online social media frequently with topics to interact and discuss, they also help spread the idea that "life is unpredictable". It induces doubt about self-control and anxiety about death in young people 5 , 6 . An individual's level of death anxiety can be affected by many factors such as age, income, level of education, religious beliefs, and life experience 7 , 8 . Studies have shown that prolonged death anxiety can lead to a range of physical and mental health disorders, such as anxiety disorders, depression, obsessive-compulsive disorder, and panic disorder. Even death anxiety triggered by sudden death salience can induce symptoms such as sleep disorders, appetite disorders, and avoidance of social interaction, thus affecting an individual's quality of life 9 , 10 . Moreover, individuals who lack a sense of security from relationships not only compromise effective buffering against death anxiety but also increase the risk of suicidal behaviors 11 . According to terror management theory (TMT), cultural worldviews can manage death-related anxiety by providing individuals with meaning and self-esteem that increases their sense of worth 12 . Self-esteem is a comprehensive evaluation of the degree or importance of self-esteem based on individual values. It is the core of self-cognition and reflects the individual's judgment of his value and ability 13 . Research shows that low self-esteem is closely related to cardiovascular disease, depression, schizophrenia, and other physical and mental diseases 14 . Improving individual self-esteem is beneficial to prosocial attitudes and behavior, which can alleviate death anxiety and reduce the risk of suicide 15 . Security is not only an individual's perception and assessment of the security of their environment, including public order, interpersonal relationships, social support, and resources, but also their feelings of their own physical and psychological stability 16 – 21 . An adequate sense of security can help individuals improve social adaptability, maintain emotional stability, enhance a sense of control, improve and develop self-awareness, and establish close relationships, which is of great significance to relieve the mental and physical condition caused by death anxiety 22 , 23 . Because of inferiority, individuals with low self-esteem levels complete their self-protection through intimacy avoidance, research has shown. That makes it difficult for them to appreciate the love and care given by others, lack of security and ultimately triggers anxiety. However, in groups with higher self-esteem, the phenomenon is reversed 24 . Martin et al. found a significant positive correlation between self-esteem and security 25 . In addition, Belmi's research also reveals the effectiveness of security in reducing death anxiety caused by death salience 26 . However, reviewing the available data, we did not find any reports on the interrelationships and pathways of self-esteem, security, and death anxiety in young people. Youth is an essential time for individuals to explore self-knowledge and social acceptance. At this stage, the self-esteem level and sense of security of young people who are subject to multiple pressures from family, economy, education, and occupation may suffer impacts, the balance of physical and mental health is undermined, and death anxiety increases 27 . Therefore, this study proposes the following hypotheses(Fig. 1): H1. The self-esteem level of the younger populations can predict the degree of death anxiety inversely. H2. The sense of security of the younger populations can predict the degree of death anxiety inversely. H3. There is a positive correlation between the level of self-esteem and the sense of security of the youth group. H4. The sense of security mediates the explanation of the relationship between self-esteem and death anxiety. Methods Survey methodology This project is a cross-sectional study and adopts the questionnaire survey method. To avoid bias due to differences in economic development as much as possible, we chose the cities of Shenzhen and Shaoguan in the Guangdong province of China as representative of developed and less developed regions. In addition to distributing paper questionnaires at primary health facilities and community activity centers at which large numbers of residents can often be reached, we created online electronic questionnaires, which are convenient for web users who wish to participate and provide their opinions and feedback. Participants Firstly, participants aged between 18 and 35 are our target population. Second, considering the differences in culture, policy, and economy, Taiwan, Hong Kong, Macao, and foreign countries' participants will not be included. Thirdly, abnormal intelligence or mental, or suffering from diagnosed mental disorders that make them unable to co-operate with the research workers will not be included. Fourthly, to control bias as much as possible, reporters are expected to have similar health conditions. Therefore, we did not include participants with serious diseases or vital organ dysfunction, such as malignant tumors, heart, liver, and kidney failure. Finally, those with text-reading difficulties who could not understand the questionnaire's content were considered unsuitable subjects. Variables and measurements 1.Basic information sheet General socio-demographic variables captured through participant self-report, including age, gender, ethnicity, home residence, education, occupation, income level, marital status, fertility, health status, religious affiliation, and life education experience. 2.Death Anxiety Scale The Templer Death Anxiety Scale (T-DAS) was developed by Professor Templer 28 , and we used the Chinese version of the Templer Death Anxiety Scale (C-T-DAS) translated by Yang Hong in this study 29 . The scale consists of 15 items, and these questions are split into four dimensions, including Ⅰ. Emotion (items: 1, 3, 5, 10, 13, 14), Ⅱ. Stress and distress (items: 4, 6, 9, 11), Ⅲ. Passage of time (Question items: 8, 12) and Ⅳ. Perception of life and death (questions: 2, 7, 15). This instrument consisted of nine forward-scoring questions and six reverse-scoring questions (items 2, 3, 5, 6, 7, and 15). Participants who answered yes to all the questions got a score of 1, while those who answered no got a score of 0. The scale has a total score of 15, with 7 being the standard threshold for high death anxiety 30 . The Cronbach's alpha for this instrument in this study was 0.726. 3.Self-esteem scale The Self-Esteem Scale (SES) was developed by Rosenberg 31 with the Chinese version has been translated and culturally adapted by Fuyi Ji and Xin Yu 32 . Although a large body of evidence is available, there is still a lack of reliable evidence to support the scale as a multidimensional instrument 33 . Ten things make up the scale: five are associated with "self-denial" and five with "self-affirmation". Rosenberg supports the positive scoring of questions 1, 2, 4, 6, and 7 and the negative scoring of items 3, 5, 8, 9, and 10 on this scale. However, concerning Tian Lu Mei's study, topic item 8 should maintain positive scoring in the Chinese context 34 . This instrument used Likert 4-point scoring, with a score of 1–4 indicating that the participant's attitude ranges from very non-conforming to very conforming. The total score is 10–40, with higher scores representing higher levels of self-esteem in individuals. The Cronbach's alpha (α) for this instrument in this study was 0.850. 4.Scurity Questionnaire The Security Questionnaire (SQ), developed by Cong and An Lijuan, consists of 16 items and contains two factors that address interpersonal security (items: 1, 3, 6, 8, 10, 12, 15, 16) and certainty of control (items: 2, 4, 5, 7, 9, 11, 13, 14) 35 . This questionnaire is scored on a Likert 5-point scale, with 1–5 representing very much in agreement, mostly in agreement, not sure, mostly not in agreement, and very much not in agreement, respectively. On a total score of 16–80, higher scores represent more adequate security for the individual. The Cronbach's alpha (α) for this instrument in this study was 0.885. Statistical analysis The two researchers independently used Excel to collate all the data collected and eliminate duplicates, incomplete information, and overseas responses (The screening process: Fig. 2). After screening, the data were all imported to SPSS26. Any doubts encountered during the data screening process were resolved by consulting the raw data and through duo consultation. At first, we tested for common method bias through factor analyses. Next, reliability analyses on the measurement instruments were utilized to test the reliability of the instruments. Thirdly, independent-sample t-tests and one-way ANOVA were used to assess participants' differences in demographic variables. Fourthly, we evaluated correlations between SES scores, C-T-DAS scores, and SQ scores using Pearson's test. Lastly, we tested for mediation effects on the relationship between SES, C-T-DAS, and SQ using macro model 4 of the PROCESS program developed by Hayes because of the program's ability to complete multivariate stratified regression analyses 36 . We set the bootstrap confidence interval (CI) to 95% and set it to evaluate 5000 bootstrap samples simultaneously. For this project, all statistical tests were two-sided, and differences were considered statistically significant at P < 0.05. Ethical approval The project strictly adhered to the Declaration of Helsinki and its amendments and was approved by the ethics committee of the author's institution (No. KY-2024-026-01) 37 . Before confirming enrolment, all individuals received guidance from a uniformly trained surveyor to read and sign the informed consent form on the front page of the questionnaire. The researchers have provided face-to-face or email responses to subjects' inquiries on all pertinent ethical matters. Participants had the right to ask questions or withdraw freely during the study. Upon completion of the survey, all recovered information will be consolidated into a password-protected Excel file, paper questionnaires will be stored in an opaque sealed document bag, and electronic questionnaires will be kept in a password-protected electronic folder. All information acquired in this project will be used as evidence for scientific research only. Results From November 2023 to May 2024, 704 responses were collected for this project. After screening out overage, duplicates, incomplete information, completion time <120 seconds, and overseas questionnaires, 623 questionnaires were returned, with a validity rate of 88%. Common method bias test In this study, all data were collected via participant self-report, which may introduce common method bias. To test the level of bias, we conducted an exploratory factor analysis of all univariate unrotated items included in the scales by Harman's one-way test 38 . ≥40% of the explanatory variables for the factor with the maximum share was evidence of common method bias 39 . After statistical analyses, eight factors with eigenvalues greater than 1 were identified. However, the maximum share among them was 21.7% of the explanatory variables. Therefore, there was no significant common method bias in this study. Participant characteristics The average age of the participants was 23.6 years old and consisted of 194 (31.1%) males and 429 (68.9%) females. Minority participants numbered 27 (4.3%). 471 respondents had a bachelor's or college degree, which accounted for the largest share at 75.6%. Student participants totaled 293 (47%). Non-student participants totaled 413, and the most popular occupations among them were light manual labor such as Office Clerk and High-Tech Industry. The total number of participants who self-reported having a healthy physical condition consisted of 341 participants, which is more than half of the total number. Detailed socio-demographic characteristics of the participants are shown in Table 1. Descriptive statistics and correlation analysis of variables After statistical analyses, we obtained the following information: first, self-esteem strongly negatively correlated with death anxiety and its three dimensions, including "emotion" "time awareness" and "cognition"; second, security showed a significant negative correlation with death anxiety and its four factors; finally, self-esteem demonstrated a significant positive correlation with security and its two factors, including relationship security and certainty of control. The details are shown in Table 2. Table 2:Descriptive statistics and correlation analysis of the variables and their dimensions.(*Indicates a strong correlation between two variables) Variables M SD 1 2 3 4 5 6 7 8 9 1.Death Anxiety 9.90 3.041 1 2.Emotional 3.37 1.687 0.853 * 1 3.Stress and Pain 3.28 0.913 0.639 * 0.390 * 1 4.Time Awareness 1.43 0.709 0.630 * 0.399 * 0.345 * 1 5.Cognition 1.91 1.010 0.566 * 0.264 * 0.124 * 0.216 * 1 6.Self-Esteem 27.96 5.086 -0.186 * -0.130 * 0.006 -0.165 * -0.232 * 1 7.Security 47.290 11.314 -0.380 * -0.350 * -0.198 * -0.378 * -0.116 * 0.530 * 1 8.Relationship Security 24.530 6.202 -0.272 * -0.283 * -0.108 * -0.289 * -0.045 0.537 * 0.929 * 1 9.Certainty and Control 22.750 5.892 -0.444 * -0.373 * -0.266 * -0.421 * -0.176 * 0.452 * 0.932 * 0.750 * 1 Mediation effect test After correlation analyses, significant relationships between the variables were confirmed, so the project met the statistical requirements for conducting mediation effect analyses. We used model 4 of the Process program to perform a mediation effects test, treating self-esteem as the independent variable, death anxiety as the dependent variable, and security as the mediating variable. Reviewing the available information and also referring to the evidence of intergroup differences obtained through socio-demographic surveys, gender, age, occupation, income, and health status were considered as control variables included in the mediation model 8 , 40 . Statistical results showed that self-esteem was able to significantly alleviate death anxiety in the youth group through the feeling of security (Effect:0.124, P0.05). Thus, security plays a fully mediating role in the relationship between self-esteem and death anxiety in the youth group. The results of the significance analysis of the mediating effect appear in Table 3, and the relationships and paths of action between the variables are shown in Figure 3. In addition, the effects of each control variable on the mediating and independent variables can be found in Annex 1. Table 3:Associations of death anxiety, self-esteem, and security in the young people: an examination of mediating effects. Item Path Effect SE t p LLCI ULCI Direct Effect Self-Esteem→Death Anxiety 0.005 0.028 0.193 0.847 -0.049 0.060 Indirect effect Self-Esteem→Security 1.207 0.082 14.663 0.000 1.045 1.369 Security→Death Anxiety -0.102 0.012 -8.648 0.000 -0.126 -0.079 Total effect Self-Esteem→Security→Death Anxiety -0.118 0.025 -4.651 0.000 -0.168 -0.068 Discussion This project aimed to investigate the interrelationships between death anxiety, self-esteem, and security in a youth group, as well as to explore what role security plays in the influence of self-esteem on death anxiety. Using questionnaires from participants in two cities, we observed that both self-esteem and security in the youth population inversely predicted individuals' death anxiety and that self-esteem was significantly positively associated with security. Furthermore, this study provides evidence for potential ways in which feelings of safety mediate the association between self-esteem and death anxiety. Overall, the youth population had higher mortality anxiety, with a mean score of 9.9(SD: 3.041), and showed a tendency to decline with age, which was consistent with Chopik's findings 41 . In youth, individuals often go through the process of moving from their parents' home into college dorms and leaving campus to live alone. Thus, changes in death anxiety in young people may be related to the breakdown of family-centered intimacy and the re-establishment of individual-centered intimacy. Having a self-centered social network (intimacy) can help individuals regulate their emotions and gain a sense of meaning and value in life, thereby reducing anxiety and fear of death 42 . In addition, we also found that the unemployed (and possibly college students) showed remarkable levels of death anxiety. This may be because they lack the satisfaction of the need for self-transcendence that a sense of meaning from a long-term career provides. Also, the phenomenon may be more positive after experiencing life trauma or death highlights 43 . Self-esteem inversely predicts death anxiety, and adequate self-esteem alleviates death anxiety. Terror management theory assumes that humans, influenced by a unique awareness of the fragility of life and the inevitability of death, will, out of self-protective defensive instincts, gain self-esteem through the creation and maintenance of their cultural worldviews and the pursuit of beliefs that satisfy them, to achieve anxiety buffering and alleviate terror 44 . In addition, the anxiety buffering hypothesis also suggests that under conditions of death salience, if individuals can strengthen their sense of self-worth, both death anxiety and defense reactions will subsequently decrease 45 . Conversely, if this mechanism is weakened, individuals require more defenses against vulnerability and death anxiety. It was found that the bilateral insulae of subjects with higher self-esteem showed reduced activation to death-related stimuli, whereas the bilateral ventral lateral prefrontal and medial orbitofrontal cortex of participants with low self-esteem showed enhanced activation to death-related stimuli, a phenomenon that may reflect the anxiety-buffering effect of self-esteem in the brain 46 . Yang et al.'s investigation of patients with advanced cancer has also shown that self-esteem is a protective factor against death anxiety 47 . The sense of security includes not only the sense of security of the surroundings but also the sense of psychological security, which plays an important role in an individual's death anxiety. Exposure to traumatic events, such as natural disasters and terrorist activities, may lead to an increase in individual security concerns and a decrease in the sense of security. Moreover, Mahat-Shamir et al have found that rather than talking face-to-face with witnesses, when we are exposed through the media to horrific accounts of traumatic events because we cannot verify or refute them, there could be more serious concerns about the security situation 48 . These worries may disrupt a person's anxiety buffers, trigger doubts about self-efficacy, and exacerbate death anxiety. Enhancing an individual's psychological security has a positive effect on relieving the threat of death salience and restraining death anxiety. The results of Belmi's experiment show that although there is a gender difference in the response of individuals to the significance of death, when men and women feel that they have higher power, all of them showed the enhancement of personal value and psychological security, which provided a certain degree of death anxiety protection 26 . As a mediator variable, sense of security can completely mediate the relationship between self-esteem and death anxiety. Low self-esteem induces psychosocial vulnerability, leading to the onset of insecurity and impairing mental health. As a result, individuals with low self-esteem show a higher risk of psychological disorders after a serious threatening event such as a death salience 49 . In contrast, individuals with high self-esteem often show less concern about feeling safe, which helps them to avoid experiencing death anxiety. Experiments by Miller et al. showed that divers with high self-esteem and high self-efficacy did not experience a significant rise in death anxiety after experiencing a death salience due to having sufficient certainty about possible safety issues 50 . In addition to this, positive attitudes towards the search for measures to maintain a sense of safety mitigated the effects of death anxiety on individuals with high self-esteem. Courtney's observation that after experiencing a death salience triggered by a large pandemic disease, such as COVID-19, the Terrorism Management Model of Health activates the defensive function of self-esteem to prompt protective strategies, i.e., self-esteem promotes the individual's ability to actively acquire effective strategies to cope with the health threats, maintains the individual's sense of security, and resists death anxiety 51 . As the only species in this world that has a concept of death, the anxiety people feel about the unpredictable inevitability of death is death anxiety. It can manifest itself in denial of death, fear of one's death and the death of others, dramatic reactions to death salience, and avoidance of interactions with the dying 52 . There is now a large body of evidence that death anxiety is significantly associated with depression, obsessive-compulsive disorder, generalized anxiety, eating disorders, muscle dysmorphia, and other physical and mental health problems 9,53 , 54 . In the past few years, the global pandemic of COVID-19, which is highly contagious and has a high mortality rate, has led to the dissemination of a large amount of uncertain information through the media, resulting in death salience and triggering a threat to people's sense of security and severe death anxiety 1,4,55 , 56 , 57 . In modern times, thanks to the rapid development of technology, a large number of traumatic events have been disseminated via the Internet and news media to create death salience, inevitably triggering a sense of security threat as the most active users of social media, death anxiety among young people seems unavoidable 5 , 58 . Therefore, exploring the protective role of self-esteem and a sense of security is important for preventing and alleviating death anxiety and concomitant physical and mental disorders and for promoting the overall health of the youth population. Limitation Although we controlled for the risk of bias as much as possible, this study still has several limitations. First, we considered factors such as gender, age, and occupation as covariates, yet a further number of factors were not adequately considered. To ensure the accuracy of the findings, other variables, such as Internet use and Engel's coefficient, should be more tightly controlled in future work. Secondly, considering the potential impact of the economic development level on the cultural environment, Shenzhen and Shaoguan were chosen as representatives in this study, but all sample data came from Guangdong Province. The problem may be solved if possible, future studies can consider collecting information and increasing sample size from different regions. Finally, as a cross-sectional study, our findings do not allow us to infer a necessary association between exposure (i.e., self-esteem and security) and outcome (i.e., death anxiety). Further research is needed to design systematic and scientific experiments to expose the mechanism of action of this effect. Conclusion Through a questionnaire survey in two representative cities, we found that the current level of death anxiety among young people is at a high level. Self-esteem and a sense of security can predict the performance of death anxiety in reverse, and a sense of security can completely mediate the effect of self-esteem on death anxiety. Given the strong positive correlation between self-esteem and a sense of security, providing measures to increase self-esteem and a sense of security for youth groups is important for alleviating their death anxiety and promoting their physical and mental health. And, in follow-up work, we will explore the potential categories of death anxiety in young people based on their different manifestations and determine the effectiveness of protective factors in alleviating different categories of death anxiety. Declarations Author Contribution: Jingxian Yu is responsible for conceptualization and surveys; Ziping Hu is responsible for surveys and data curation;Yongqi Liang is responsible for formal analysis; Huan Peng and Na Li are responsible for surveys; Hanjiao Liu is responsible for project administration.*These authors contributed equally to this work. Competing Interests The authors declare no competing interests. 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World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. Jama 310 , 2191-2194, doi:10.1001/jama.2013.281053 (2013). Harman, H. H. Modern factor analysis. Journal of the American Statistical Association 56 (1960). Hair, J. F., Anderson, R. E., Tatham, R. L. & Black, W. C. Multivariate Data Analysis, 5th Ed. all publications (1998). Rayatpisheh, F., Torabizadeh, C., Najafi Kalyani, M. & Farsi, Z. Relationship between resilience and death anxiety of the older adults during the coronavirus disease 2019 (COVID-19) pandemic. BMC Geriatr 23 , 367, doi:10.1186/s12877-023-04086-8 (2023). Chopik, W. J. Death across the lifespan: Age differences in death-related thoughts and anxiety. Death Stud 41 , 69-77, doi:10.1080/07481187.2016.1206997 (2017). Xiao, Z., Zhao, Y., Zheng, Y., Bao, Y. & Zhang, C. The Effect of Group Identification on Death Anxiety: The Chain Mediation Role of Close Relationships and Self-Esteem. Int J Environ Res Public Health 19 , doi:10.3390/ijerph191610179 (2022). Xu, M., Dust, S. B. & Liu, S. COVID-19 and the great resignation: The role of death anxiety, need for meaningful work, and task significance. J Appl Psychol 108 , 1790-1811, doi:10.1037/apl0001102 (2023). Solomon, S., Greenberg, J. & Pyszczynski, T. in Advances in Experimental Social Psychology Vol. 24 (ed Mark P. Zanna) 93-159 (Academic Press, 1991). Greenberg, J. et al. Effects of Self-Esteem on Vulnerability-Denying Defensive Distortions: Further Evidence of an Anxiety-Buffering Function of Self-Esteem. Journal of Experimental Social Psychology 29 , 229-251, doi:https://doi.org/10.1006/jesp.1993.1010 (1993). Klackl, J., Jonas, E. & Kronbichler, M. Existential neuroscience: self-esteem moderates neuronal responses to mortality-related stimuli. Soc Cogn Affect Neurosci 9 , 1754-1761, doi:10.1093/scan/nst167 (2014). Hong, Y. et al. Death anxiety among advanced cancer patients: a cross-sectional survey. Support Care Cancer 30 , 3531-3539, doi:10.1007/s00520-022-06795-z (2022). Mahat-Shamir, M. et al. Concern and death anxiety during an ongoing terror wave: The moderating role of direct vs. indirect exposure. Death Stud 42 , 195-203, doi:10.1080/07481187.2017.1334010 (2018). Brown, G. W., Harris, T. O. & Craig, T. K. J. Exploration of the influence of insecure attachment and parental maltreatment on the incidence and course of adult clinical depression. Psychol Med 49 , 1025-1032, doi:10.1017/s0033291718001721 (2019). Miller, G., Taubman, O. & Ben, A. Scuba diving risk taking - A terror management theory perspective. JOURNAL OF SPORT & EXERCISE PSYCHOLOGY 26 , 269-282, doi:10.1123/jsep.26.2.269 (2004). Courtney, E. P., Goldenberg, J. L. & Boyd, P. The contagion of mortality: A terror management health model for pandemics. Br J Soc Psychol 59 , 607-617, doi:10.1111/bjso.12392 (2020). Nyatunga, B. Towards a definition of death anxiety. Int J Palliat Nurs 12 , 410-413, doi:10.12968/ijpn.2006.12.9.21868 (2006). Menzies, R. E., Sharpe, L. & Dar-Nimrod, I. The relationship between death anxiety and severity of mental illnesses. Br J Clin Psychol 58 , 452-467, doi:10.1111/bjc.12229 (2019). Menzies, R. E., Sharpe, L., Richmond, B. & Cunningham, M. L. "Life's too short to be small": An experimental exploration of the relationship between death anxiety and muscle dysmorphia symptoms. Body Image 44 , 43-52, doi:10.1016/j.bodyim.2022.11.006 (2023). Andrei, A. M., Webb, R. & Enea, V. Health anxiety, death anxiety and coronaphobia: Predictors of postpartum depression symptomatology during the COVID-19 pandemic. Midwifery 124 , 103747, doi:10.1016/j.midw.2023.103747 (2023). Martínez-López, J., Lázaro-Pérez, C. & Gómez-Galán, J. Death Anxiety in Social Workers as a Consequence of the COVID-19 Pandemic. Behav Sci (Basel) 11 , doi:10.3390/bs11050061 (2021). Lee, S. A., Jobe, M. C., Mathis, A. A. & Gibbons, J. A. Incremental validity of coronaphobia: Coronavirus anxiety explains depression, generalized anxiety, and death anxiety. J Anxiety Disord 74 , 102268, doi:10.1016/j.janxdis.2020.102268 (2020). Krawczyk, K. et al. Quantifying Online News Media Coverage of the COVID-19 Pandemic: Text Mining Study and Resource. J Med Internet Res 23 , e28253, doi:10.2196/28253 (2021). Table 1 Table 1 is available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files SupplementaryInformation.docx Supplementary information files Annex 1：The effect of control variables on the dependant and mediating variables in the mediation model constructed from self-esteem, death anxiety, and security. 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College of Guangzhou University of Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ziping","middleName":"","lastName":"Hu","suffix":""},{"id":335987719,"identity":"d40d34d1-0861-49cb-92a3-418fd1053f99","order_by":2,"name":"Yongqi Liang","email":"","orcid":"","institution":"Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine.","correspondingAuthor":false,"prefix":"","firstName":"Yongqi","middleName":"","lastName":"Liang","suffix":""},{"id":335987722,"identity":"5ae49890-f567-45b0-8fc1-abf8fa85b1ed","order_by":3,"name":"Huan Peng","email":"","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Peng","suffix":""},{"id":335987724,"identity":"6d110c15-3d57-4f09-b167-2462ae9d50b1","order_by":4,"name":"Na Li","email":"","orcid":"","institution":"Fujian University of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Na","middleName":"","lastName":"Li","suffix":""},{"id":335987726,"identity":"aff19aa9-2fcf-4e99-8cc9-24072381f97e","order_by":5,"name":"Hanjiao Liu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYBACefn3Dw58MLCRs29vIFKLYUMO48EZBWnGBjwHiLXmQA7zYY4PhxMNJBKI1MHYcPbAYQaDtARzyccbbzDU2EQT1MLO2JdwuMDAJs9ydlqxBcOxtNwGgrY0MxgcnmGQVsxwO8dMgrHhMGEtDMeAWngMDic23DxDrJYzPBAtG27wEKnFcAZbwkGgw4wle4B+SSDGL/ISzIc/fPhjI8fPfnjjjQ81NkQ4DAkQHzVIWkjVMQpGwSgYBSMDAADqEETKiFCzfgAAAABJRU5ErkJggg==","orcid":"","institution":"Shenzhen Hospital of Integrated Traditional Chinese and Western Medicine.","correspondingAuthor":true,"prefix":"","firstName":"Hanjiao","middleName":"","lastName":"Liu","suffix":""}],"badges":[],"createdAt":"2024-07-13 12:36:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4735152/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4735152/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62051217,"identity":"71fb2d51-cef7-4684-a703-afc7754d1488","added_by":"auto","created_at":"2024-08-08 17:31:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26777,"visible":true,"origin":"","legend":"\u003cp\u003eHypothetical modeling of the relationship between death anxiety, self-esteem, and security.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4735152/v1/7b85fbe26e82700a2972109e.png"},{"id":62051218,"identity":"0b3b66a1-da6e-4f6c-826a-8a27873f7680","added_by":"auto","created_at":"2024-08-08 17:31:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":32102,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart for invalid questionnaires exclusion\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4735152/v1/622ee35d2ef9f379118c69a6.png"},{"id":62051220,"identity":"c223daef-82bb-40c8-90b8-23fe8679110f","added_by":"auto","created_at":"2024-08-08 17:31:34","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":71100,"visible":true,"origin":"","legend":"\u003cp\u003ePathways and effect sizes of the mediation model\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4735152/v1/7d2e651ee211d5a677203b4a.png"},{"id":74215592,"identity":"a26d57dd-1955-4bc9-8e24-0f59ee51ff53","added_by":"auto","created_at":"2025-01-20 05:39:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":920188,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4735152/v1/5f4d5ff4-5dee-4eee-beb4-6de43aef776c.pdf"},{"id":62051529,"identity":"8329c074-e927-4bb6-9b25-934b2db33c89","added_by":"auto","created_at":"2024-08-08 17:39:34","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23437,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSupplementary information files\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAnnex 1：The effect of control variables on the dependant and mediating variables in the mediation model constructed from self-esteem, death anxiety, and security.\u003c/p\u003e","description":"","filename":"SupplementaryInformation.docx","url":"https://assets-eu.researchsquare.com/files/rs-4735152/v1/f68aede543e544c3131f32ec.docx"},{"id":62051222,"identity":"f5b2a64f-04c1-4dd9-9d10-3e245e1416cc","added_by":"auto","created_at":"2024-08-08 17:31:34","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":29990,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-4735152/v1/567132ad4b0c77e6ea7511ff.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"How Does Self-esteem Alleviate Death Anxiety in Youth Populations? The Mediating Role of Security ","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn the past few years, the new coronavirus pandemic has caused many deaths and worldwide panic, which has aroused the interest of scholars in various fields. As an important part of the research on death attitude, death anxiety has been paid much attention to\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Death anxiety refers to the individual\u0026apos;s fear and worry about death and the ultimate event, which is a universal psychological phenomenon in the human life cycle and is closely related to the individual\u0026apos;s physical and mental health\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThanks to the rapid development of Internet technology, global information has gained more abundant dissemination channels. However, the rapid spread of death-related events such as mass infectious disease, serious traffic accidents, and sudden natural disasters has also increased the risk of mortality salience among Internet users\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e. While these messages provide young people who use online social media frequently with topics to interact and discuss, they also help spread the idea that \u0026quot;life is unpredictable\u0026quot;. It induces doubt about self-control and anxiety about death in young people\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAn individual\u0026apos;s level of death anxiety can be affected by many factors such as age, income, level of education, religious beliefs, and life experience\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e. Studies have shown that prolonged death anxiety can lead to a range of physical and mental health disorders, such as anxiety disorders, depression, obsessive-compulsive disorder, and panic disorder. Even death anxiety triggered by sudden death salience can induce symptoms such as sleep disorders, appetite disorders, and avoidance of social interaction, thus affecting an individual\u0026apos;s quality of life\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. Moreover, individuals who lack a sense of security from relationships not only compromise effective buffering against death anxiety but also increase the risk of suicidal behaviors\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAccording to terror management theory (TMT), cultural worldviews can manage death-related anxiety by providing individuals with meaning and self-esteem that increases their sense of worth\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. Self-esteem is a comprehensive evaluation of the degree or importance of self-esteem based on individual values. It is the core of self-cognition and reflects the individual\u0026apos;s judgment of his value and ability\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e. Research shows that low self-esteem is closely related to cardiovascular disease, depression, schizophrenia, and other physical and mental diseases\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Improving individual self-esteem is beneficial to prosocial attitudes and behavior, which can alleviate death anxiety and reduce the risk of suicide\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eSecurity is not only an individual\u0026apos;s perception and assessment of the security of their environment, including public order, interpersonal relationships, social support, and resources, but also their feelings of their own physical and psychological stability\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. An adequate sense of security can help individuals improve social adaptability, maintain emotional stability, enhance a sense of control, improve and develop self-awareness, and establish close relationships, which is of great significance to relieve the mental and physical condition caused by death anxiety\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBecause of inferiority, individuals with low self-esteem levels complete their self-protection through intimacy avoidance, research has shown. That makes it difficult for them to appreciate the love and care given by others, lack of security and ultimately triggers anxiety. However, in groups with higher self-esteem, the phenomenon is reversed\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eMartin et al. found a significant positive correlation between self-esteem and security\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. In addition, Belmi\u0026apos;s research also reveals the effectiveness of security in reducing death anxiety caused by death salience\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. However, reviewing the available data, we did not find any reports on the interrelationships and pathways of self-esteem, security, and death anxiety in young people.\u003c/p\u003e\n\u003cp\u003eYouth is an essential time for individuals to explore self-knowledge and social acceptance. At this stage, the self-esteem level and sense of security of young people who are subject to multiple pressures from family, economy, education, and occupation may suffer impacts, the balance of physical and mental health is undermined, and death anxiety increases\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. Therefore, this study proposes the following hypotheses(Fig.\u0026nbsp;1):\u003c/p\u003e\n\u003cp\u003eH1. The self-esteem level of the younger populations can predict the degree of death anxiety inversely.\u003c/p\u003e\n\u003cp\u003eH2. The sense of security of the younger populations can predict the degree of death anxiety inversely.\u003c/p\u003e\n\u003cp\u003eH3. There is a positive correlation between the level of self-esteem and the sense of security of the youth group.\u003c/p\u003e\n\u003cp\u003eH4. The sense of security mediates the explanation of the relationship between self-esteem and death anxiety.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eSurvey methodology\u003c/h2\u003e \u003cp\u003eThis project is a cross-sectional study and adopts the questionnaire survey method. To avoid bias due to differences in economic development as much as possible, we chose the cities of Shenzhen and Shaoguan in the Guangdong province of China as representative of developed and less developed regions. In addition to distributing paper questionnaires at primary health facilities and community activity centers at which large numbers of residents can often be reached, we created online electronic questionnaires, which are convenient for web users who wish to participate and provide their opinions and feedback.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eFirstly, participants aged between 18 and 35 are our target population. Second, considering the differences in culture, policy, and economy, Taiwan, Hong Kong, Macao, and foreign countries' participants will not be included. Thirdly, abnormal intelligence or mental, or suffering from diagnosed mental disorders that make them unable to co-operate with the research workers will not be included. Fourthly, to control bias as much as possible, reporters are expected to have similar health conditions. Therefore, we did not include participants with serious diseases or vital organ dysfunction, such as malignant tumors, heart, liver, and kidney failure. Finally, those with text-reading difficulties who could not understand the questionnaire's content were considered unsuitable subjects.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eVariables and measurements\u003c/h2\u003e \u003cp\u003e1.Basic information sheet\u003c/p\u003e \u003cp\u003eGeneral socio-demographic variables captured through participant self-report, including age, gender, ethnicity, home residence, education, occupation, income level, marital status, fertility, health status, religious affiliation, and life education experience.\u003c/p\u003e \u003cp\u003e2.Death Anxiety Scale\u003c/p\u003e \u003cp\u003eThe Templer Death Anxiety Scale (T-DAS) was developed by Professor Templer \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e, and we used the Chinese version of the Templer Death Anxiety Scale (C-T-DAS) translated by Yang Hong in this study \u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e. The scale consists of 15 items, and these questions are split into four dimensions, including Ⅰ. Emotion (items: 1, 3, 5, 10, 13, 14), Ⅱ. Stress and distress (items: 4, 6, 9, 11), Ⅲ. Passage of time (Question items: 8, 12) and Ⅳ. Perception of life and death (questions: 2, 7, 15). This instrument consisted of nine forward-scoring questions and six reverse-scoring questions (items 2, 3, 5, 6, 7, and 15). Participants who answered yes to all the questions got a score of 1, while those who answered no got a score of 0. The scale has a total score of 15, with 7 being the standard threshold for high death anxiety \u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. The Cronbach's alpha for this instrument in this study was 0.726.\u003c/p\u003e \u003cp\u003e3.Self-esteem scale\u003c/p\u003e \u003cp\u003eThe Self-Esteem Scale (SES) was developed by Rosenberg \u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e with the Chinese version has been translated and culturally adapted by Fuyi Ji and Xin Yu \u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e. Although a large body of evidence is available, there is still a lack of reliable evidence to support the scale as a multidimensional instrument \u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e. Ten things make up the scale: five are associated with \"self-denial\" and five with \"self-affirmation\". Rosenberg supports the positive scoring of questions 1, 2, 4, 6, and 7 and the negative scoring of items 3, 5, 8, 9, and 10 on this scale. However, concerning Tian Lu Mei's study, topic item 8 should maintain positive scoring in the Chinese context \u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e. This instrument used Likert 4-point scoring, with a score of 1\u0026ndash;4 indicating that the participant's attitude ranges from very non-conforming to very conforming. The total score is 10\u0026ndash;40, with higher scores representing higher levels of self-esteem in individuals. The Cronbach's alpha (α) for this instrument in this study was 0.850.\u003c/p\u003e \u003cp\u003e4.Scurity Questionnaire\u003c/p\u003e \u003cp\u003eThe Security Questionnaire (SQ), developed by Cong and An Lijuan, consists of 16 items and contains two factors that address interpersonal security (items: 1, 3, 6, 8, 10, 12, 15, 16) and certainty of control (items: 2, 4, 5, 7, 9, 11, 13, 14) \u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e. This questionnaire is scored on a Likert 5-point scale, with 1\u0026ndash;5 representing very much in agreement, mostly in agreement, not sure, mostly not in agreement, and very much not in agreement, respectively. On a total score of 16\u0026ndash;80, higher scores represent more adequate security for the individual. The Cronbach's alpha (α) for this instrument in this study was 0.885.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe two researchers independently used Excel to collate all the data collected and eliminate duplicates, incomplete information, and overseas responses (The screening process: Fig.\u0026nbsp;2). After screening, the data were all imported to SPSS26. Any doubts encountered during the data screening process were resolved by consulting the raw data and through duo consultation.\u003c/p\u003e \u003cp\u003eAt first, we tested for common method bias through factor analyses. Next, reliability analyses on the measurement instruments were utilized to test the reliability of the instruments. Thirdly, independent-sample t-tests and one-way ANOVA were used to assess participants' differences in demographic variables. Fourthly, we evaluated correlations between SES scores, C-T-DAS scores, and SQ scores using Pearson's test. Lastly, we tested for mediation effects on the relationship between SES, C-T-DAS, and SQ using macro model 4 of the PROCESS program developed by Hayes because of the program's ability to complete multivariate stratified regression analyses \u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e. We set the bootstrap confidence interval (CI) to 95% and set it to evaluate 5000 bootstrap samples simultaneously. For this project, all statistical tests were two-sided, and differences were considered statistically significant at P\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe project strictly adhered to the Declaration of Helsinki and its amendments and was approved by the ethics committee of the author\u0026apos;s institution (No. KY-2024-026-01)\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e37\u003c/sup\u003e. Before confirming enrolment, all individuals received guidance from a uniformly trained surveyor to read and sign the informed consent form on the front page of the questionnaire. The researchers have provided face-to-face or email responses to subjects\u0026apos; inquiries on all pertinent ethical matters. Participants had the right to ask questions or withdraw freely during the study. Upon completion of the survey, all recovered information will be consolidated into a password-protected Excel file, paper questionnaires will be stored in an opaque sealed document bag, and electronic questionnaires will be kept in a password-protected electronic folder. All information acquired in this project will be used as evidence for scientific research only.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eFrom November 2023 to May 2024, 704 responses were collected for this project. After screening out overage, duplicates, incomplete information, completion time \u0026lt;120 seconds, and overseas questionnaires, 623 questionnaires were returned, with a validity rate of 88%.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCommon method bias test\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn this study, all data were collected via participant self-report, which may introduce common method bias. To test the level of bias, we conducted an exploratory factor analysis of all univariate unrotated items included in the scales by Harman\u0026apos;s one-way test\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e38\u003c/sup\u003e.\u0026nbsp;\u0026ge;40% of the explanatory variables for the factor with the maximum share was evidence of common method bias\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e39\u003c/sup\u003e. After statistical analyses, eight factors with eigenvalues greater than 1 were identified. However, the maximum share among them was 21.7% of the explanatory variables. Therefore, there was no significant common method bias in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eParticipant characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe average age of the participants was 23.6 years old and consisted of 194 (31.1%) males and 429 (68.9%) females. Minority participants numbered 27 (4.3%). 471 respondents had a bachelor\u0026apos;s or college degree, which accounted for the largest share at 75.6%. Student participants totaled 293 (47%). Non-student participants totaled 413, and the most popular occupations among them were light manual labor such as Office Clerk and High-Tech Industry. The total number of participants who self-reported having a healthy physical condition consisted of 341 participants, which is more than half of the total number. Detailed socio-demographic characteristics of the participants are shown in Table 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDescriptive statistics and correlation analysis of variables\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter statistical analyses, we obtained the following information: first, self-esteem strongly negatively correlated with death anxiety and its three dimensions, including \u0026quot;emotion\u0026quot; \u0026quot;time awareness\u0026quot; and \u0026quot;cognition\u0026quot;; second, security showed a significant negative correlation with death anxiety and its four factors; finally, self-esteem demonstrated a significant positive correlation with security and its two factors, including relationship security and certainty of control. The details are shown in Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2:Descriptive statistics and correlation analysis of the variables and their dimensions.(*Indicates a strong correlation between two variables)\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"635\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.936708860759495%\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e\u003cstrong\u003eM\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u003cstrong\u003e7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u003cstrong\u003e9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.936708860759495%\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.Death Anxiety\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e9.90\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e3.041\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.936708860759495%\"\u003e\n \u003cp\u003e\u003cstrong\u003e2.Emotional\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e3.37\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e1.687\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.853 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.936708860759495%\"\u003e\n \u003cp\u003e\u003cstrong\u003e3.Stress and Pain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e3.28\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e0.913\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.639 \u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.390\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.936708860759495%\"\u003e\n \u003cp\u003e\u003cstrong\u003e4.Time Awareness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e1.43\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e0.709\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.630\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.399\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.345\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.936708860759495%\"\u003e\n \u003cp\u003e\u003cstrong\u003e5.Cognition\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e1.91\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e1.010\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.566\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.264\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.124\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.216\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.936708860759495%\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.Self-Esteem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e27.96\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e5.086\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.186\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.130\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.006\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.165\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.232\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.936708860759495%\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.Security\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e47.290\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e11.314\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.380\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.350\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.198\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.378\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.116\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.530\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.936708860759495%\"\u003e\n \u003cp\u003e\u003cstrong\u003e8.Relationship Security\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e24.530\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e6.202\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.272\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.283\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.108\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.289\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.045\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.537\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.929\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"19.936708860759495%\"\u003e\n \u003cp\u003e\u003cstrong\u003e9.Certainty and Control\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"6.962025316455696%\"\u003e\n \u003cp\u003e22.750\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e5.892\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.444\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.373\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.266\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.421\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e-0.176\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.452\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.932\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.2784810126582276%\"\u003e\n \u003cp\u003e0.750\u003csup\u003e*\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.436708860759493%\"\u003e\n \u003cp\u003e1\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eMediation effect test\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAfter correlation analyses, significant relationships between the variables were confirmed, so the project met the statistical requirements for conducting mediation effect analyses. We used model 4 of the Process program to perform a mediation effects test, treating self-esteem as the independent variable, death anxiety as the dependent variable, and security as the mediating variable. Reviewing the available information and also referring to the evidence of intergroup differences obtained through socio-demographic surveys, gender, age, occupation, income, and health status were considered as control variables included in the mediation model\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e8\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e40\u003c/sup\u003e. Statistical results showed that self-esteem was able to significantly alleviate death anxiety in the youth group through the feeling of security (Effect:0.124, P\u0026lt;0.05), but the direct effect of self-esteem on death anxiety was not significant (Effect:0.005, P\u0026gt;0.05). Thus, security plays a fully mediating role in the relationship between self-esteem and death anxiety in the youth group. The results of the significance analysis of the mediating effect appear in Table 3, and the relationships and paths of action between the variables are shown in Figure 3. In addition, the effects of each control variable on the mediating and independent variables can be found in Annex 1.\u003c/p\u003e\n\u003cp\u003eTable 3:Associations of death anxiety, self-esteem, and security in the young people: an examination of mediating effects.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.241057542768274%\"\u003e\n \u003cp\u003e\u003cstrong\u003eItem\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8149300155521%\"\u003e\n \u003cp\u003e\u003cstrong\u003ePath\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.553654743390357%\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.020217729393469%\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.776049766718507%\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.9315707620528775%\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.864696734059098%\"\u003e\n \u003cp\u003e\u003cstrong\u003eLLCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.797822706065318%\"\u003e\n \u003cp\u003e\u003cstrong\u003eULCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.241057542768274%\"\u003e\n \u003cp\u003e\u003cstrong\u003eDirect Effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8149300155521%\"\u003e\n \u003cp\u003eSelf-Esteem\u0026rarr;Death Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.553654743390357%\"\u003e\n \u003cp\u003e0.005\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.020217729393469%\"\u003e\n \u003cp\u003e0.028\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.776049766718507%\"\u003e\n \u003cp\u003e0.193\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.9315707620528775%\"\u003e\n \u003cp\u003e0.847\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.864696734059098%\"\u003e\n \u003cp\u003e-0.049\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.797822706065318%\"\u003e\n \u003cp\u003e0.060\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.241057542768274%\" rowspan=\"2\"\u003e\n \u003cp\u003e\u003cstrong\u003eIndirect effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8149300155521%\"\u003e\n \u003cp\u003eSelf-Esteem\u0026rarr;Security\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.553654743390357%\"\u003e\n \u003cp\u003e1.207\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.020217729393469%\"\u003e\n \u003cp\u003e0.082\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.776049766718507%\"\u003e\n \u003cp\u003e14.663\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.9315707620528775%\"\u003e\n \u003cp\u003e0.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.864696734059098%\"\u003e\n \u003cp\u003e1.045\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.797822706065318%\"\u003e\n \u003cp\u003e1.369\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"38.71559633027523%\"\u003e\n \u003cp\u003eSecurity\u0026rarr;Death Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.091743119266056%\"\u003e\n \u003cp\u003e-0.102\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.642201834862385%\"\u003e\n \u003cp\u003e0.012\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.174311926605505%\"\u003e\n \u003cp\u003e-8.648\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.357798165137615%\"\u003e\n \u003cp\u003e0.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"10.458715596330276%\"\u003e\n \u003cp\u003e-0.126\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.559633027522937%\"\u003e\n \u003cp\u003e-0.079\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"15.241057542768274%\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal effect\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"32.8149300155521%\"\u003e\n \u003cp\u003eSelf-Esteem\u0026rarr;Security\u0026rarr;Death Anxiety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.553654743390357%\"\u003e\n \u003cp\u003e-0.118\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.020217729393469%\"\u003e\n \u003cp\u003e0.025\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.776049766718507%\"\u003e\n \u003cp\u003e-4.651\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"7.9315707620528775%\"\u003e\n \u003cp\u003e0.000\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"8.864696734059098%\"\u003e\n \u003cp\u003e-0.168\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.797822706065318%\"\u003e\n \u003cp\u003e-0.068\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis project aimed to investigate the interrelationships between death anxiety, self-esteem, and security in a youth group, as well as to explore what role security plays in the influence of self-esteem on death anxiety. Using questionnaires from participants in two cities, we observed that both self-esteem and security in the youth population inversely predicted individuals\u0026apos; death anxiety and that self-esteem was significantly positively associated with security. Furthermore, this study provides evidence for potential ways in which feelings of safety mediate the association between self-esteem and death anxiety.\u003c/p\u003e\n\u003cp\u003eOverall, the youth population had higher mortality anxiety, with a mean score of 9.9(SD: 3.041), and showed a tendency to decline with age, which was consistent with Chopik\u0026apos;s findings\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e41\u003c/sup\u003e. In youth, individuals often go through the process of moving from their parents\u0026apos; home into college dorms and leaving campus to live alone. Thus, changes in death anxiety in young people may be related to the breakdown of family-centered intimacy and the re-establishment of individual-centered intimacy. Having a self-centered social network (intimacy) can help individuals regulate their emotions and gain a sense of meaning and value in life, thereby reducing anxiety and fear of death\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e42\u003c/sup\u003e. In addition, we also found that the unemployed (and possibly college students) showed remarkable levels of death anxiety. This may be because they lack the satisfaction of the need for self-transcendence that a sense of meaning from a long-term career provides. Also, the phenomenon may be more positive after experiencing life trauma or death highlights\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e43\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eSelf-esteem inversely predicts death anxiety, and adequate self-esteem alleviates death anxiety. Terror management theory assumes that humans, influenced by a unique awareness of the fragility of life and the inevitability of death, will, out of self-protective defensive instincts, gain self-esteem through the creation and maintenance of their cultural worldviews and the pursuit of beliefs that satisfy them, to achieve anxiety buffering and alleviate terror\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e44\u003c/sup\u003e. In addition, the anxiety buffering hypothesis also suggests that under conditions of death salience, if individuals can strengthen their sense of self-worth, both death anxiety and defense reactions will subsequently decrease\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e45\u003c/sup\u003e. Conversely, if this mechanism is weakened, individuals require more defenses against vulnerability and death anxiety. It was found that the bilateral insulae of subjects with higher self-esteem showed reduced activation to death-related stimuli, whereas the bilateral ventral lateral prefrontal and medial orbitofrontal cortex of participants with low self-esteem showed enhanced activation to death-related stimuli, a phenomenon that may reflect the anxiety-buffering effect of self-esteem in the brain\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e46\u003c/sup\u003e. Yang et al.\u0026apos;s investigation of patients with advanced cancer has also shown that self-esteem is a protective factor against death anxiety\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e47\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe sense of security includes not only the sense of security of the surroundings but also the sense of psychological security, which plays an important role in an individual\u0026apos;s death anxiety. Exposure to traumatic events, such as natural disasters and terrorist activities, may lead to an increase in individual security concerns and a decrease in the sense of security. Moreover, Mahat-Shamir et al have found that rather than talking face-to-face with witnesses, when we are exposed through the media to horrific accounts of traumatic events because we cannot verify or refute them, there could be more serious concerns about the security situation\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e48\u003c/sup\u003e. These worries may disrupt a person\u0026apos;s anxiety buffers, trigger doubts about self-efficacy, and exacerbate death anxiety. Enhancing an individual\u0026apos;s psychological security has a positive effect on relieving the threat of death salience and restraining death anxiety. The results of Belmi\u0026apos;s experiment show that although there is a gender difference in the response of individuals to the significance of death, when men and women feel that they have higher power, all of them showed the enhancement of personal value and psychological security, which provided a certain degree of death anxiety protection\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e26\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAs a mediator variable, sense of security can completely mediate the relationship between self-esteem and death anxiety.\u0026nbsp;Low self-esteem induces psychosocial vulnerability, leading to the onset of insecurity and impairing mental health. As a result, individuals with low self-esteem show a higher risk of psychological disorders after a serious threatening event such as a death salience\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e49\u003c/sup\u003e. In contrast, individuals with high self-esteem often show less concern about feeling safe, which helps them to avoid experiencing death anxiety. Experiments by Miller et al. showed that divers with high self-esteem and high self-efficacy did not experience a significant rise in death anxiety after experiencing a death salience due to having sufficient certainty about possible safety issues\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e50\u003c/sup\u003e. In addition to this, positive attitudes towards the search for measures to maintain a sense of safety mitigated the effects of death anxiety on individuals with high self-esteem. Courtney\u0026apos;s observation that after experiencing a death salience triggered by a large pandemic disease, such as COVID-19, the Terrorism Management Model of Health activates the defensive function of self-esteem to prompt protective strategies, i.e., self-esteem promotes the individual\u0026apos;s ability to actively acquire effective strategies to cope with the health threats, maintains the individual\u0026apos;s sense of security, and resists death anxiety\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e51\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eAs the only species in this world that has a concept of death, the anxiety people feel about the unpredictable inevitability of death is death anxiety. It can manifest itself in denial of death, fear of one\u0026apos;s death and the death of others, dramatic reactions to death salience, and avoidance of interactions with the dying\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e52\u003c/sup\u003e. There is now a large body of evidence that death anxiety is significantly associated with depression, obsessive-compulsive disorder, generalized anxiety, eating disorders, muscle dysmorphia, and other physical and mental health problems\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e9,53\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e54\u003c/sup\u003e. In the past few years, the global pandemic of COVID-19, which is highly contagious and has a high mortality rate, has led to the dissemination of a large amount of uncertain information through the media, resulting in death salience and triggering a threat to people\u0026apos;s sense of security and severe death anxiety\u003csup\u003e\u0026nbsp;\u003c/sup\u003e\u003csup\u003e1,4,55\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e56\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e57\u003c/sup\u003e\u003csup\u003e.\u003c/sup\u003e In modern times, thanks to the rapid development of technology, a large number of traumatic events have been disseminated via the Internet and news media to create death salience, inevitably triggering a sense of security threat as the most active users of social media, death anxiety among young people seems unavoidable\u003csup\u003e5\u003c/sup\u003e\u003csup\u003e,\u003c/sup\u003e\u003csup\u003e58\u003c/sup\u003e. Therefore, exploring the protective role of self-esteem and a sense of security is important for preventing and alleviating death anxiety and concomitant physical and mental disorders and for promoting the overall health of the youth population.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLimitation\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAlthough we controlled for the risk of bias as much as possible, this study still has several limitations. First, we considered factors such as gender, age, and occupation as covariates, yet a further number of factors were not adequately considered. To ensure the accuracy of the findings, other variables, such as Internet use and Engel\u0026apos;s coefficient, should be more tightly controlled in future work. Secondly, considering the potential impact of the economic development level on the cultural environment, Shenzhen and Shaoguan were chosen as representatives in this study, but all sample data came from Guangdong Province. The problem may be solved if possible, future studies can consider collecting information and increasing sample size from different regions. Finally, as a cross-sectional study, our findings do not allow us to infer a necessary association between exposure (i.e., self-esteem and security) and outcome (i.e., death anxiety). Further research is needed to design systematic and scientific experiments to expose the mechanism of action of this effect.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThrough a questionnaire survey in two representative cities, we found that the current level of death anxiety among young people is at a high level. Self-esteem and a sense of security can predict the performance of death anxiety in reverse, and a sense of security can completely mediate the effect of self-esteem on death anxiety. Given the strong positive correlation between self-esteem and a sense of security, providing measures to increase self-esteem and a sense of security for youth groups is important for alleviating their death anxiety and promoting their physical and mental health. And, in follow-up work, we will explore the potential categories of death anxiety in young people based on their different manifestations and determine the effectiveness of protective factors in alleviating different categories of death anxiety.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor Contribution:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eJingxian Yu is responsible for conceptualization and surveys; Ziping Hu is responsible for surveys and data curation;Yongqi Liang is responsible for formal analysis; Huan Peng and Na Li are responsible for surveys; Hanjiao Liu is responsible for project administration.*These authors contributed equally to this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003cstrong\u003e：\u003c/strong\u003eDatasets used and/or analysed in the current study can be obtained from the corresponding authors upon reasonable request. Contact: [email protected].\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLi, X. \u0026amp; He, Y. Research on the death psychology among Chinese during and after the COVID-19 pandemic. \u003cem\u003eSci Rep\u003c/em\u003e \u003cstrong\u003e14\u003c/strong\u003e, 3005, doi:10.1038/s41598-024-53673-1 (2024).\u003c/li\u003e\n\u003cli\u003eHe, Y. \u0026amp; Li, T. Death Attitudes and Death Anxiety Among Medical Interns After the 2020 Outbreak of the Novel Coronavirus. \u003cem\u003eFront Psychol\u003c/em\u003e \u003cstrong\u003e13\u003c/strong\u003e, 698546, doi:10.3389/fpsyg.2022.698546 (2022).\u003c/li\u003e\n\u003cli\u003eMcDonald, R. T. \u0026amp; Hilgendorf, W. A. 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Incremental validity of coronaphobia: Coronavirus anxiety explains depression, generalized anxiety, and death anxiety. \u003cem\u003eJ Anxiety Disord\u003c/em\u003e \u003cstrong\u003e74\u003c/strong\u003e, 102268, doi:10.1016/j.janxdis.2020.102268 (2020).\u003c/li\u003e\n\u003cli\u003eKrawczyk, K.\u003cem\u003e et al.\u003c/em\u003e Quantifying Online News Media Coverage of the COVID-19 Pandemic: Text Mining Study and Resource. \u003cem\u003eJ Med Internet Res\u003c/em\u003e\u003cstrong\u003e23\u003c/strong\u003e, e28253, doi:10.2196/28253 (2021).\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Table 1","content":"\u003cp\u003eTable 1 is available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Death anxiety, self-esteem, security, younger population, mediating effects.","lastPublishedDoi":"10.21203/rs.3.rs-4735152/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4735152/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eWith the widespread use of the Internet and social media, youth groups are suffering deaths with increasing frequency. Studies have shown that self-esteem and a sense of security can reduce death anxiety, but a detailed explanation of the relationship is still lacking. Therefore, this study aimed to explore the interrelationship and potential pathways of death anxiety, self-esteem, and security in young people. A cross-sectional study was conducted in Shenzhen and Shaoguan, Guangdong Province, China, to collect general data, death anxiety scores, self-esteem scores, and security scores. A total of 623 valid questionnaires were collected from November to May 20232024. The results showed that both self-esteem and a sense of security could significantly predict death anxiety in reverse. Moreover, the sense of security engagement mediated the relationship between self-esteem and death anxiety. Although there is a high level of death anxiety in young people, measures to enhance self-esteem and a sense of security can help alleviate anxiety and promote physical and mental health.\u003c/p\u003e","manuscriptTitle":"How Does Self-esteem Alleviate Death Anxiety in Youth Populations? The Mediating Role of Security ","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-08-08 17:31:29","doi":"10.21203/rs.3.rs-4735152/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"802a1ff2-a37e-4a75-851e-561a900c2cf1","owner":[],"postedDate":"August 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":35582513,"name":"Biological sciences/Psychology"},{"id":35582514,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2025-01-20T05:38:59+00:00","versionOfRecord":[],"versionCreatedAt":"2024-08-08 17:31:29","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4735152","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4735152","identity":"rs-4735152","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}