Volume 23, Issue 1 (Apr - May 2019)                   J Qazvin Univ Med Sci 2019, 23(1): 14-25 | Back to browse issues page


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Soleimani M A, Zarabadi-Pour S, Pahlevan Sharif S, Motalebi S A. The Relationship Between Death Anxiety and Self-esteem in Patients With Acute Myocardial Infarction. J Qazvin Univ Med Sci. 2019; 23 (1) :14-25
URL: http://journal.qums.ac.ir/article-1-2789-en.html
1- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
2- Department of Taylor’s Business, Taylor’s University Malaysia Subang Jaya, Selangor, Malaysia.
3- Social Determinants of Health Research Center, Qazvin University of Medical Sciences, Qazvin, Iran. , ammotalebi@yahoo.com
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1. Introduction
ardiovascular diseases are the leading cause of death worldwide [4]. High mortality and multiple complications of heart disease, especially in the middle age, can affect all aspects of a person's life [7]. Many patients experience psychological complications such as depression and anxiety, in addition to physical symptoms [8]. Death anxiety (DA) is one of the worst and threatening psychological complications. Those with DA face this problem even after the completion of treatment [11].
DA refers to the fear of death. It is an unpleasant feeling caused by thinking about their own or others’ death [13]. According to the terror management theory, self-esteem is one of the factors affecting DA [20]. Self-esteem is a concept that refers to a person’s sense of self-worth based on the cultural beliefs of the person [21]. Self-esteem is an essential factor against the fear of impending death [23].
Considering that the psychological problems of patients with heart problems and reducing their anxiety is an important part of their nursing and therapeutic care, this study aimed to determine the relationship between DA and self-esteem in people with acute myocardial infarction (MI).
2. Materials and methods
This descriptive correlational study was conducted on 216 patients with acute MI. They were selected using convenience sampling method from those patients hospitalized in the Cardiac Unit of Bu-Ali Sina Hospital in Qazvin, Iran, in 2016. The inclusion criteria were a diagnosis of acute MI (transmural MI in any region of the heart), the experience of the acute phase of the disease, no history of stroke or heart disease, hospitalization for at least 24 hours, and with stable vital signs and cardiac hemodynamic condition.
Those with psychological diseases such as depression and anxiety (according to their report and used medications) were excluded from the study. For surveying the participants, this study used a demographic form, Templer’s Death Anxiety Scale, and Rosenberg self-esteem. To measure the perceived social and religious support, the participants rated their perceived social and religious support on a scale from 0 (lowest) to 10 (highest).
The collected data were analyzed using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (the Pearson correction test and multiple regression analysis) to examine the correlation between DA and self-esteem and to determine the predictive power of DA and self-esteem. The significance level was set at 0.05.
3. Results
The participants had a Mean±SD age of 60.25±10.58 years (range:30-96 y). Based on the results, the Mean±SD scores of DA and self-esteem scores were 44.95±11.62 and 12.48±2.04, respectively. The Pearson correction test results showed a significant positive relationship between DA and self-esteem in the samples, and with increasing self-esteem, their DA also increased (95% CI: 0.089-1.675, b=0.882). The results of multiple regression analysis showed that DA had a significant negative correlation with low and moderate economic status (P=‌0.001) and age (95%CI: 0.069, -0.456, b=-0.263), and religious beliefs of patients (95% CI:-0.242, -2.612, b=-0.263).
4. Conclusion
The patients with higher self-esteem reported higher DA level. However, self-esteem is not the only factor that affects DA and other personal and social factors that significantly contribute to this association. Further studies in different population groups are recommended to confirm our study results.

Ethical Considerations
Compliance with ethical guidelines

Participants were ensured that their information was kept confidentially. Before collecting the data, all participants signed written consent form. The present study was approved by the Ethics Committee of Qazvin University of Medical Sciences, Qazvin, Iran “QUMS.REC.1394.11”.
Funding
This article was extracted from a research project that was supported financially by Qazvin University of Medical Sciences.
Authors' contributions
Conceptualization, validation: Mohammad Ali Soleimani; Methodology: Mohammad Ali Soleimani, Simin Zarabadi-Pour, Saeed Pahlevan Sharif; Formal analysis: Saeed Pahlevan Sharif; Investigation, resources and draft preparation, Mohammad Ali Soleimani, Simin Zarabadi, Seyedeh Ameneh Motalebi; Editing: Mohammad Ali Soleimani, Seyedeh Ameneh Motalebi; Supervision, and project administration: Mohammad Ali Soleimani, Seyedeh Ameneh Motalebi.
Conflicts of interest
There are no conflicts of interest related to this article.
Acknowledgements
We would like to thank all the patients who participated in this study, as well as the nurses of cardiology ward of Bu Ali Sina hospital, Qazvin. We also extend our gratitude to the Qazvin University of Medical Sciences for providing the research grant.

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Type of Study: Research | Subject: Community Medicine

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