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Death Studies
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SINGLE- VERSUS
MULTI-ITEM SCALES
IN MEASURING DEATH
ANXIETY
AHMED M. ABDEL-KHALEK
Version of record first published: 11 Nov
2010.

To cite this article: AHMED M. ABDEL-KHALEK (1998): SINGLE- VERSUS

MULTI-ITEM SCALES IN MEASURING DEATH ANXIETY, Death Studies, 22:8,
763-772

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SINGLE- VERSUS MULTI-ITEM SCA LES IN

MEASURING DEATH A NXIETY
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AHMED M. A BDEL-KHA LEK

Alexandria University, Egypt, and Kuwait University, Kuwait

T he author investigated the reliab ility and concur rent validity of a L ikert - type
single -item test ask ing f or a self - rating of death anxie ty in tw o A rab ic countries :
E g ypt and K uw ait . A total of 1,439 participants w ere divided into 9 m ale and
f emale sub sam ples and w ere tested by a single item of death anxi ety , along w ith
three psychometric multi - item instrum ents ( i .e ., T empler’ s D eath A nxiety S cale ,
T horson and P ow ell’ s R evised D eath A nx iety S cale , and the A rab ic S cale of D eath
A nxiety ) . T he single - and m ulti -item scales had high reliab ilities . A ll of the thir-
teen correlations b etw een the single -item and the m ulti - item scales of death anxie ty
am ong m en and w omen w ere statisticall y signi® cant ( p , .001) and positive . T hey
ranged f rom .30 to .66 , w ith a median of .51 . I t w as concluded that single -item
assessment can be reliable across time ( test ± retest 5 .82) and that it correlates mod-
erately w ith m ulti -item instrum ents .

The purpose of the study was to construct a one-item measure of

death anxiety that would be useful for research when the partici-
pant time available to the researcher is very limited. It also has a
possible clinical use and research use for situations in which the
clinician or researcher does not wish to overwhelm the patient or
participant with a barrage of death anxiety-fraught items.
Interest in the psychological aspects of death has been growing
over the past several years. Death anxiety is one of the central
subjects in thanatology. Considerable research has focused on the
psychological factors associated with fears of death, including age,

R eceiv ed 14 O ctob er 1996 ; a ccep ted 27 M arch 1997.

A ddress corresp on dence to A hm ed M . A bd el-K ha lek , D ep art m ent of P sy ch ology ,
C olleg e of A rt s, K uw a it U niv ersit y , P .O. Box 23558, Sa fa t 13096, K u w ait.

Dea th Stu dies, 22 : 763± 772, 1998

C op yrig ht Ó 1998 T ay lor & F ra ncis
0748-11 87 / 98 $12.00 1 .00 763
 764 A . M . A bdel -K hale k

sex, religion, race, culture, occupation, familial resemblance, per-

sonality, mental ability, subjective life expectancy, addiction,
suicide, psychopathology, physical health, and disease
( Kastenbaum, 1987 ; Lester, 1990 ; Lonetto & Templer, 1986 ; Nei-
meyer & Van Brunt, 1995) .
On the other hand, death anxiety has di€ erent theoretical, con-
ceptual, and methodological aspects ( Lonetto & Templer, 1986 ;
Neimeyer, 1994) . Of these, the measurement of death anxiety is
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among the most important ( Lester & Templer, 1992± 1993) . There
have been di€ erent e€ orts to develop and validate scales and ques-
tionnaires that can be useful in assessing the various aspects of the
concept. More than a quarter of a century has passed since
Templer ( 1970) constructed the Death Anxiety Scale ( DAS) . It
has since become the most widely used psychometric instrument in
this area. From the 1960s onward, numerous assessment scales
have emerged ( see, e.g., Collett & Lester, 1969 ; Conte, Weiner, &
Plutchik, 1982 ; Hoelter, 1979 ; Lester, 1990 ; Little® eld & Fleming,
1984± 1985 ; Robbins, 1990± 1991 ; Templer, 1970 ; Thorson &
Powell, 1992) , with several studies focusing on their psychometric
properties. However, little attention has been given to scale devel-
opment outside English-speaking countries. Two of these e€ orts
involve my construction of a preliminary Arabic Scale of Death
Anxiety ( Abdel-Khalek, 1987) , and the translation of Templer’ s
( 1970) DAS into Arabic. Subsequently, a number of studies were
carried out using Templer’ s scale in four Arabic countries : Egypt,
Lebanon, Saudi Arabia, and Kuwait ( Abdel-Khalek, 1986, 1991,
1997a, 1997b ; Abdel-Khalek, Beshai, & Templer, 1993 ; Abdel-
Khalek & Omar, 1988 ; Beshai & Templer, 1978) .
There is now a large body of research suggesting the multidi-
mensionality of the death anxiety construct ( Little® eld & Fleming,
1984± 1985 ; Neimeyer & Van Brunt, 1995) . Nevertheless, there has
been no agreement on the main subfactors of death anxiety. The
vast majority of the multidimensional scales su€ er from unre-
plicability of factors. Livneh ( 1985) , for example, reported a 5-
cluster solution, which did not support the 4-scale factors of the
Fear of Death Scale advocated by its authors ( Collett & Lester,
1969) . Likewise, there is a lack of agreement about the number of
factors extracted from the unidimensional scales of death anxiety
like the DAS ( Lonetto & Templer, 1986) . This inconsistency is not
 M easuring D eath A nxiety 765

surprising, with published scales comprising as many as 83 items,

and as many as 8 dimensions.
On the other extreme, a number of authors have followed the
direct approach ; that is, to ask for a self-rating of fear of death.
The subject responded to a single item such as : ``How much do
you fear death ?’’ or responded to the statement : ``I am afraid of
death’’ by selecting an appropriate value on a Likert-type scale
( Bengtson, Cuellar, & Ragan, 1977 ; Holmes & Anderson, 1980 ;
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Kalish, 1986 ; Thorson, Horacek, & Kara, 1987) . However, with

the exception of Holmes and Anderson’ s study, few articles have
addressed the convergent validity of single-item measures. They
simply use it as a measuring tool, with no attention to its validity
or reliability. Measuring death anxiety by a single item may have
di€ erent advantages including minimizing the subjective distress
associated with longer questionnaires, and easy incorporation into
large-scale community surveys.
The present study was undertaken to investigate both the test±
retest reliability and concurrent validity of a Likert-type single
item asking for a self-rating of death anxiety. Inasmuch as the vast
majority of death anxiety research has been conducted in predomi-
nantly English-speaking countries, the aim of the present study was
to probe the accuracy of assessing death anxiety by a single item in
two non-English-speaking countries : Egypt and Kuwait.

Method

P articipants
The sample consisted of 1,439 Arabic undergraduates recruited
from di€ erent faculties in Alexandria University in Egypt and
Kuwait University in Kuwait. According to the scales used, there
were nine subsamples : four Egyptian and ® ve Kuwaiti. The Egyp-
tian sample was composed of 719 participants ( 358 men and 361
women) . Their ages ranged between 19 and 22 years. The Kuwaiti
sample consisted of 720 participants ( 254 men, and 466 women) .
Their ages ranged from 20 to 25 years.
Participants were volunteers, who were informed that they could
decline participation in the experiment if they opted for that. The
 766 A . M . A bdel -K hale k

participants were assured of the complete con® dentiality of their

answers.

M easures

The Single Item to Measure Fear of Death

The participant was requested to respond to the following state-
ment : ``I am afraid of death.’’ He or she had to respond on a
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7-point Likert format indicating a single point from strongly disagree

to strongly agree .

The Death Anxiety Scale (DAS ; Templer, 1970)

I translated the 15 true± false DAS items into Arabic, and the
translation was carefully revised by 2 bilingual specialists. The
correlation between the English original form of the DAS and its
Arabic version was .87 ( n 5 43) , which is considered a satisfactory
level. Test± retest reliability and factorial validity of the DAS
administered to Egyptian participants were adequately demon-
strated ( Abdel-Khalek, 1986) .

The Revised Death Anxiety Scale (RDAS ; Thorson & Powell ,

1992)
This scale consists of 25 items, to which the participant responds
on a 5-point Likert-type scale. The RDAS consists of Thorson and
Powell’ s ( 1992) revision of the Nehrke ( 1973) scale, which, in turn,
consists mainly of a combination of Templer’ s ( 1970) and Boyar’ s
( 1964) scales. I translated the RDAS, and the resultant version was
thoroughly scrutinized by 3 bilingual psychologists as well as 2
bilingual linguists.

The Arabic Scale of Death Anxiety (ASDA )

This scale was designed in Arabic by Abdel-Khalek ( 1987) . It
consists of 83 yes/ no questions. At ® rst, Arabic undergraduate and
postgraduate students of psychology in Alexandria University,
Egypt ( n 5 160) were requested to write questions to help in assess-
ing death anxiety. The outcome was a large number of items.
These items were subjected to editing, rephrasing, splitting the
compound items, and deleting repeated and irrelevant items.
 M easuring D eath A nxiety 767

Then, referees were requested to review the items. Face validity

and reliability were fairly demonstrated. Correlation between the
ASDA and Templer’ s DAS was .61 for men ( n 5 126) and .61 for
women ( n 5 132) , indicating acceptable concurrent validity of the
ASDA. More recently, the present writer thoroughly scrutinized
the items of the ASDA, and constructed a short version containing
20-Likert type format items. The scale has good internal consis-
tency, stability, and face validity. Concurrent and convergent
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validity were also high. Four factors were disclosed : fear of dead
corpses and tombs, fear of afterdeath, fear of fatal diseases, and
thoughts of death.

P rocedure
All participants ( n 5 1,439) responded to the single item denoting
death anxiety. In addition to this measure, the ® rst Egyptian
group ( n 5 461) was tested by the RDAS, whereas the second
Egyptian group ( n 5 258) was tested by the ASDA. The ® rst
Kuwaiti group ( n 5 271) was tested by the RDAS, whereas the
second ( n 5 292) and the third ( n 5 157) were tested on the DAS.
Testing was carried out during the regular classroom periods and
in the regular setting ( i.e., in a group-testing situation) . Each
session contained a small group.
Test± retest reliability was assessed for the single-item measure,
DAS, and ASDA. Samples in the test± retest study were chosen
according to their availability. The interval was 1 week.

Results

Table 1 shows the reliabilities of the single item as well as the three
psychometric inventories. All of the coefficients are either accept-
able or high.
Product-moment correlation coefficients were computed
between scores on the single item and the DAS, RDAS, and
ASDA. Table 2 presents the correlations.
Examination of Table 2 reveals that all of the thirteen corre-
lations between the single-item and the three multi-item psycho-
metric instruments to assess death anxiety are positive and
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768
TA BLE 1 Reliability Coefficients of the Single-Item and the Three Psychometric Death Anxiety Inventories

Men Women Men and women

Scale Nationality Method n r1 1 n r1 1 n r1 1 Reference

Single item Egyptian Retest Ð Ð Ð Ð 38 .82 Abdel-Khalek, 1987

DAS Egyptian Alpha 103 .70 105 .67 208 .71 Abdel-Khalek, 1997a
DAS Egyptian Retest 44 .70 56 .73 Ð Ð Abdel-Khalek, 1986
DAS Kuwaiti Alpha 122 .76 169 .80 274 .79 Abdel-Khalek, 1997b
RDAS Egyptian Alpha 232 .81 242 .80 461 .81 Unpublished
RDAS Kuwaiti Alpha 274 .77 Abdel-Khalek, 1997b
RDAS Kuwaiti Alpha 294 .85 Thorson et al., in press
ASDA Egyptian Retest 38 .92 Abdel-Khalek, 1987
ASDA Egyptian Split-half 47 .92 50 .94 97 .93 Abdel-Khalek, 1987
N o te. T h e in terv al b etw een test an d retest w a s 1 w eek . DA S 5 Dea th A nx iet y S ca le ; R DA S 5 R ev ised Deat h A nx iety S ca le ;
A S DA 5 A ra bic Sca le of D ea th A nx iety.
 M easuring D eath A nxiety 769

TA BLE 2 Correlation Between the Single Statement and Three Psychometric

Instruments of Death Anxiety Among Five Samples

Sample Psychometric Correlation with

and gender N instrument the single item

Egyptian ( 1) RDAS
Men 232 .32**
Women 229 .30**
Men and women 461 .31**
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Egyptian ( 2) ASDA
Men 126 .50**
Women 132 .34**
Men and women 258 .42**
Kuwaiti ( 1) RDAS
Men 115 .50**
Women 156 .55**
Men and women 271 .54**
Kuwaiti ( 2) DAS
Men 123 .66**
Women 169 .60**
Men and women 292 .63**
Kuwaiti ( 3) DAS
Men and women 157 .66**

Mdn. .51**
N o te . R DA S 5 R ev ised Dea th A n xiety Sca le ; A S DA 5 A ra bic Sca le of Dea th A n xiety ;
D A S 5 D ea th A nx iety S ca le.
** p , .001.

statistically signi® cant ( p , .001) . The correlations ranged from .30

to .66, with a median of .51.

Discussion

By and large, when multi-item psychometric instruments of death

anxiety were administered along with a single item or a simple
statement asking about death anxiety, there was a common
variance between the two kinds of assessing devices. Correlations
were statistically signi® cant and positive. The median of the corre-
lations between the single- and multi-item scales was about .5.
Thus, on average, single-item rating and multi-item scales share
 770 A . M . A bdel -K hale k

25% of their variance. The present ® nding is congruent, in general,

with the result of Holmes and Anderson ( 1980) . They used the
three death anxiety scales of Templer, Boyar, and Nelson along
with a single item. The correlations between the three psycho-
metric instruments and the single item were .57, .62, and .55
respectively, with a median of .57. They concluded that ``the
present results raise the possibility that it may be more efficient and
equally valid simply to ask a person to rate his own fear of death
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( p. 1342) .’’ In the light of the present correlations, it may be said

that the same possibility in Holmes and Anderson’ s ( 1980) conclu-
sion applies to the present result even though it was carried out on
di€ erent participants drawn from two countries of di€ erent culture,
language, and circumstances.
The reliability of the multi-item psychometric instruments of
death anxiety vis-aÁ -vis the single item ranged from .67 to .94 for
the multi-item scales and .82 for the single item. Thus, the reli-
ability of the single statement lies in the boundaries of the multi-
item psychometric tools. However, most types of reliability cannot
be applied to the single item, such as the alternate form, split-half,
and alpha reliability, though the test± retest method can be used.
The main result of the present study suggests that single-item
assessments can be reliable across time, and that they correlate
moderately with multi-item instruments. Therefore, the single-item
measure has moderate emergent validity. Although the single-item
scale is not psychometrically superior to the multi-item scales, the
present ® ndings also provide no evidence that the single-item
measure is de® cient relative to the larger inventories, at least in
terms of their reliability. However, it remains possible that multi-
item scales may have advantages in other respects, such as assessing
a broader range and complexity of death attitudes ( Neimeyer &
Van Brunt, 1995) .
Further research would be useful in the following directions : ( a)
computing the correlation of the single-item rating with both the
overall scores on multidimensional scales and the subscales from
these instruments ; ( b) using the multi-item scales along with the
single-item measure with the same sample, and comparing the
intercorrelations of the multi-item scales and the intercorrelations
of the single- and multi-item scales ; and ( c) studying the predictive
validity of the single-item rating ( i.e., how it predicts outcomes
 M easuring D eath A nxiety 771

known to be related to death anxiety, such as suicide, subjective

life expectancy, and psychopathology) . These are questions for
further investigation.

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