Mediating Effect of Religious Belief on Death Anxiety in Chinese Adolescents: A Cross-Sectional Study

Background: Since death anxiety is a potential risk for adolescent suicide, it is important to identify the related factors for promoting positive life attitudes and suicide prevention in high school students in Macao. For this aim, we assessed the level of death anxiety of the adolescents with Chinese ethnicity and explored its socio-demographic correlations. Methods: A cross-sectional survey was conducted on 2,687 adolescents aged 14 years or above, recruited from ten high schools in Macao during June 2015. A self-administrated questionnaire was distributed to the participants and was completed autonomously and anonymously. Results: Our findings indicated the average death anxiety score of high school adolescents in Macao was within the general norm of 4.5 to 7.0 (6.97, SD=3.13). Female adolescents (t=-7.914, P<0.001) who studied in senior secondary school (t=-3.952, P<0.001) had participated in life and death education (t=-2.275, P=0.023) with religious belief (t=-2.451, P=0.014) and attended school with religious background (t=-3.42, P=0.001) reported significant differences in death anxiety. Furthermore, weak mediating effect of religious belief (OR=0.04, P=0.042) and school attendance with religious background (OR=0.06, P=0.004) were found to be effective in reducing death anxiety in these adolescents. Conclusion: This is the first study to examine death anxiety of Chinese adolescents. Our findings suggest the need to pay attention on the effect of religious belief and cultural considerations for designing life and death education in Chinese adolescents.