Article

OMEGA—Journal of Death and

Trust in God, Dying

2015, Vol. 72(1) 20–41
! The Author(s) 2015
Forgiveness by God, Reprints and permissions:
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and Death Anxiety DOI: 10.1177/0030222815574697
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Neal Krause1

Abstract
Research on religion and death anxiety has produced many contradictory findings.
These conflicting findings arise, in part, from inadequacies in the measurement of
religion as well as problems with the way the data have been analyzed. The purpose
of the current study is to develop and empirically evaluate a conceptual model that
contains the following core hypotheses: (a) People who go to church more often will
receive more spiritual support from fellow church members (spiritual support is
assistance provided by coreligionists for the explicit purpose of increasing the reli-
gious beliefs and practices of the recipient). (b) Individuals who receive more spiritual
support will be more likely to trust God. (c) Those who trust God more deeply will
be more likely to feel forgiven by Him. (d) People who feel forgiven by God will
experience less death anxiety. Findings from a recent nationwide survey provide
support for each hypothesis.

Keywords
religion, forgiveness, death anxiety

Research on the relationship between religion and death anxiety is over 50 years
old (Feifel, 1959). Since then, a growing number of studies have been conducted
to see if religion helps people cope with knowledge of their own inevitable
demise. Ellis and Wahab (2013) recently reported that as of 2012, 84 studies

1
Department of Health Behavior and Health Education, School of Public Health, University of Michigan,
Ann Arbor, MI, USA
Corresponding Author:
Neal Krause, Department of Health Behavior and Health Education, School of Public Health, University
of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109-2029, USA.
Email: nkrause@umich.edu
Krause 21

that assessed the relationship between some aspect of religion and death anxiety
have appeared in the literature. Unfortunately, these investigators pointed out
that the findings from this research are contradictory. More specifically, four
different conclusions emerge from this body of work: (a) Some studies showed
that involvement in religion lowers feelings of death anxiety. (b) Other studies
indicated that various facets of religion are associated with greater death anxi-
ety. (c) Yet other studies failed to find a statistically significant relationship
between the two. (d) Some researchers reported a curvilinear relationship
between religion and death anxiety whereby people with moderate levels of
religious involvement are at greater risk.
Although several theoretical perspectives have been developed to explain why
religion may help reduce feelings of death anxiety, most researchers subscribe to
Terror Management Theory (TMT; Greenberg, Pyszczynski, & Solomon, 1986).
According to this view, people are deeply troubled by their own inevitable death,
and as a result, they subscribe to culturally developed world views that have
been devised to allay these concerns. Perhaps the most important world views
are provided by religion (Soenke, Landau, & Greenberg, 2012). The basic tenets
of many faith traditions help allay concerns about dying by providing assurance
of life after death and many religions, such as the Christian faith, portray the
afterlife in glowing terms.
So if religion holds out the promise of a good life after death, it is not clear
why some studies show that religion exacerbates a sense of death anxiety or why
other studies show that religion fails to lower feelings of death anxiety. There are
a number of reasons for these unanticipated findings, as Ellis and Wahab (2013)
pointed out. Even so, the purpose of the current study is to address three issues
that deal with the measurement and conceptualization of religion.
The first problem with the literature on religion and death anxiety has to do
with the fact that religion has been assessed in a number of studies with only one
or two measures (Ellis & Wahab, 2013). For example, Lin (2003) focused solely
on the relationship between a single item that assesses the degree of self-rated
religiousness and fear of death. Unfortunately, researchers have known for some
time that religion is a complex multidimensional phenomenon that can be mea-
sured in a number of ways (Fetzer Institute/National Institute on Aging
Working Group, 1999). As a result, a broader array of religion measures are
needed to more adequately depict the way in which involvement in religion may
influence feelings of death anxiety.
The second problem with the literature arises from the fact that, in many
cases, the dimensions of religion that have been examined are more general or
global in nature and do not speak directly to issues involving death. For exam-
ple, some investigators focused solely on the frequency of church attendance
(e.g., Morris & McAdie, 2009). However, attendance at worship services is a
complex phenomenon in its own right that subsumes many different aspects of
religion. For example, when people attend church services, they pray, they listen
22 OMEGA—Journal of Death and Dying 72(1)

to passages that appear in sacred texts, and they interact with their fellow church
members. As a result, it is not clear which aspect(s) of church attendance are
related to feelings of death anxiety. Other researchers relied on scales that assess
intrinsic and extrinsic religiousness, which measure general feelings of religious
commitment (e.g., Ardelt & Koenig, 2006). But once again, it is not clear how
deeper commitment to one’s faith should assuage feelings of death anxiety.
Moreover, faith traditions embrace a wide range of tenets and beliefs and
people may feel more committed to some religious teachings than others. And
the teachings they endorse more fully may not be related to death per se. So if
deeper commitment (i.e., an intrinsic religious motivation) is associated with less
death anxiety, the specific beliefs that individuals are committed to are not
identified, and as a result, the theoretical process remains unclear. In contrast,
other investigators have included measures in their work that assess beliefs about
the nature of the afterlife, which obviously deal more directly with issues invol-
ving death (e.g., Lundh & Radon, 1998). However, people may believe in an
afterlife without necessarily being involved in a formal faith tradition, and as a
result, measures that assess belief in an afterlife may capture the influence of
factors other than religion per se.
The third problem with the literature on religion and death anxiety arises
from the fact that the multiple dimensions that comprise religion are interre-
lated. Instead of comparing and contrasting the effects of different dimensions of
religion on death anxiety in an effort to see which is most important, it makes
more sense to build conceptual models that show how one dimension of religion
leads to another dimension of religion and how both work in concert to influ-
ence feelings of death anxiety. For example, Krause and Bastida (2012) evalu-
ated a conceptual model which shows that perceived contact with deceased loved
ones fosters a stronger sense of religiously based feelings of connectedness with
others, a greater sense of connectedness with others promotes stronger feelings
of gratitude to God, and greater gratitude to God is, in turn, associated with less
death anxiety.
In the discussion that follows, a conceptual model is developed that relates
four different dimensions of religion with death anxiety. Two main themes are
captured in this conceptual scheme. First, the model of religion and death anxi-
ety is socially based. This means that the reason why religion may help people
deal more effectively with death anxiety arises from the social interaction that
takes place in religious institutions. This orientation is consistent with what
sociologists and psychologists have been arguing for over 100 years. For exam-
ple, James Mark Baldwin, an early president of the American Psychological
Association maintained that, “The fact is constantly recognized that religion is
a social phenomena. No man is religious by himself, nor does he choose his god,
nor devise his offering, nor enjoy his blessings along” (Baldwin, 1902, p. 325).
The social aspects of religion are assessed with both formal measures of social
contact (i.e., attendance at worship services) as well as informal interaction with
Krause 23

fellow church members (i.e., spiritual support). The second main theme involves
the specific religiously oriented beliefs that arise from this social contact and are
proposed to reduce feelings of death anxiety. Trust in God and feeling forgiven
by God figure prominently in this respect. This appears to be the first time that
the relationships among spiritual support, trust in God, and forgiveness by God
have been examined in studies on death anxiety.

Religious Involvement, Forgiveness by God, and Death

Anxiety
Figure 1 contains the conceptual model that was evaluated in this study. Two
steps were taken to simplify the presentation of this conceptual scheme. First,
the elements of the measurement model (i.e., the observed indicators and mea-
surement error terms) are not depicted graphically even though a full measure-
ment model was evaluated when this conceptual model was estimated
empirically. Second, the relationships among the latent constructs in Figure 1
were estimated after the effects of age, sex, education, race, and marital status
were controlled statistically (i.e., treated as exogenous variables).
All of the paths among the latent constructs were estimated in the analyses
presented below (i.e., a fully saturated model was evaluated). However, the
theoretical process that this conceptual scheme was designed to capture is
depicted in the following core hypotheses: (a) People who go to church more
often receive more spiritual support from the individuals who worship there

Figure 1. A conceptual model of trust in God, forgiveness by God, and death anxiety.
24 OMEGA—Journal of Death and Dying 72(1)

(spiritual support is assistance that is provided by coreligionists for the explicit

purpose of increasing the religious beliefs and practices of the recipient). (b)
Individuals who receive more spiritual support from fellow church members
will be more likely to trust God. (c) Those who trust God more deeply will be
more likely to feel forgiven by Him. (d) People who feel they have been forgiven
by God will experience less death anxiety. The theoretical rationale for each of
these relationships is provided below.

Church Attendance and Spiritual Support

The conceptual model that was developed for this study is inherently social in
nature. This emphasis is justified because scholars have been arguing for over
100 years that the essence of religion may be found in the relationships that are
formed among individuals who share a common faith (Baldwin, 1902; Graham
& Haidt, 2010). Consistent with this view, the process that is depicted in Figure 1
begins with the relationship between two key aspects of congregational life:
church attendance and spiritual support.
There are three reasons why more frequent church attendance should be
associated with receiving more spiritual support. The first reason is straightfor-
ward. In order for an individual to receive spiritual support, they must obviously
come into contact with potential support providers. Attending worship services
more frequently provides the necessary context for this contact to take place.
Second, in order for a supportive relationship to arise, support providers and
support recipients must have contact on a fairly regular basis. Once again,
regular attendance at worship services provides the context for developing and
maintaining supportive relationships. Third, as Roberts (2007) argued, faith
becomes more alive and more meaningful when it is shared with others:

The church is a society of people who have undertaken the struggle to love one
another with a spiritual love. We teach one another, week in and week out . . . We
cultivate ourselves and one another in the consciousness of a calling to perfect
fellowship. (p. 91)

If fellow church members subscribe to these teachings, then more frequent con-
tact during worship services with like-minded others should provide a greater
opportunity to put these religious teachings into practice through the exchange
of spiritual support.

Church Attendance, Spiritual Support, and Trust in God

The nature of the afterlife is shrouded in mystery. In fact, it is not possible to
empirically verify that there is an afterlife in the first place. As a result, people
must take religious teachings on the nature and existence of the afterlife on faith.
Krause 25

Put another way, people must trust that the word of God about the afterlife that
appears in sacred texts is valid and accurate. It is for this reason that trust of
God is contained in Figure 1.
An important issue that emerges at this juncture has to do with how this sense
of trust in God is developed and maintained in the first place. If the core
assumption in this study about the social basis of religion is accurate, then the
genesis and maintenance of trust in God should be found in key aspects of
congregational life. As shown in Figure 1, it is proposed that trust in God
arises from the interplay between attendance at worship services and spiritual
support.
Messages involving the importance of trusting God are often embedded in a
number of aspects of formal worship services, including sermons, hymns, and
congregational prayers. It follows from this that more frequent attendance at
worship services should be associated with greater trust in God. This view is
consistent with the theory of religion that was developed by Stark and Finke
(2000). These investigators maintained that confidence in religious principles
increases to the extent that people participate in religious rituals, such as worship
services.
Another important source of trust in God may be found in the informal
spiritual support that is exchanged among fellow church members. Evidence
that religious teachings are maintained and reinforced through social processes
is found in Berger’s (1967) classic treatise on religion. He maintained that reli-
gious precepts are socially constructed and socially maintained. Berger (1967)
went on to point out that this informal reinforcement of religious teachings is
not a one-time affair. Instead, he maintains that people continuously reinforce
and reconstruct basic religious beliefs. This view is also consistent with another
proposition that is found in Stark and Finke’s (2000) theory of religion. These
investigators argued that a person’s confidence in religious teachings and prin-
ciples increases to the extent that fellow church members express confidence in
them. Based on these insights, it is predicted in Figure 1 that people who receive
more spiritual support from fellow church members will have greater trust in
God.

Trust in God and Forgiveness by God

Being forgiven by God is the linchpin in Figure 1 because it bridges the dimen-
sions of religion that have been discussed so far with feelings of death anxiety.
However, before discussing why forgiveness by God may help reduce feelings of
death anxiety, it is important to reflect on how people come to believe they are
forgiven by God in the first place.
As with many other aspects of religious life, there is no way to empirically
confirm that people have been forgiven by God. Instead, people must seek
assurance that they have been forgiven through indirect means, such as
26 OMEGA—Journal of Death and Dying 72(1)

teachings in sacred texts. Sacred texts, like the Christian Bible, typically convey
three messages that are relevant here. First, sacred texts repeatedly indicate that
God is aware of the fallible nature of all human beings. Second, sacred texts
state that even though all people have shortcomings, God wants what is best for
the individuals He created. Third, because God cares for all people, He is willing
to forgive them for their transgressions. In fact, research by Lundberg (2010)
reveals that every major faith tradition in the world endorses each of these
precepts. However, because there is no empirical verification of these religious
teachings, belief in them rests on trust in God. It is for this reason that it is
proposed in Figure 1 that people who trust in God are more likely to feel they
have been forgiven by Him. There do not appear to be any studies in the
literature that empirically evaluate the relationship between trusting in God
and feeling forgiven by God. One contribution of the current study arises
from the fact that an attempt is made to see if the two are associated.

Forgiveness by God and Death Anxiety

There are two reasons why forgiveness by God should be associated with lower
feelings of death anxiety. The first is straightforward. If people believe they have
not been forgiven by God, then they should be more likely to believe they will be
punished by God for their transgressions in the next life. And if people believe
that punishment awaits them after death, then they should experience more
death anxiety.
The second reason why feeling forgiven by God may lower feelings of death
anxiety may be found by returning to TMT. Greenberg, Solomon, and
Pyszczynski (1997) argued that self-esteem is a core tenet in TMT. According
to this view, a strong sense of self-esteem arises and is maintained by displaying
the attributes, behaviors, and achievements that are embedded in world views
that have been developed to help people cope with their pending demise. By
fulfilling the roles that are specified in these world views, people believe they are
valued members of the universe who are worthy of the good things that the next
life presumably provides.
Greenberg et al. (1997) specifically mentioned that religion is an especially
important source of these world views, but they fall short in their discussion of
precisely how this important function is performed by the various faith tradi-
tions. This is especially true when the fallible aspects of human nature are taken
into account. Because people inevitably fail to always fulfill the roles that are
embedded in religious world views, it is not clear how they are still able to
maintain the strong sense of self-worth that is needed to offset their fear of
dying. If anything, their inevitable transgressions should serve to heighten
death anxiety. Research by Barna (2002) provides a point of departure for
showing why this may be so. He reports the results of six nationwide surveys
which suggest that between 68% and 73% of all adults believe that God is the
Krause 27

all-knowing all-powerful creator of the universe. Kirkpatrick (2005) identified

the psychological implications of these beliefs. He argued that if people view
God as all-knowing, then He will be aware of their shortcomings. And if God is
all-powerful, then He is fully capable of extracting revenge and punishing people
for their transgressions. Kirpatrick (2005) went on to argue that these realiza-
tions are likely to produce considerable anxiety and fear. Although Kirkpatrick
(2005) did not discuss self-esteem specifically, it is not hard to see why the
consequences of believing in an all-knowing and all-powerful God are likely
to diminish a person’s sense of self-esteem.
A central premise in the current study is that feeling forgiven by God is the
key to resolving the dilemma that is created by the need to live up to religious
teachings and the failure to do so on every occasion. When people fail to live up
to the tenets of their faith, they may experience feelings of guilt. This is impor-
tant because research reveals that guilt is associated with diminished feelings of
self-worth (Strelan, 2007). However, research further reveals that forgiveness can
help bolster feelings of self-worth that have been eroded by guilt that arises from
a transgression (Strelan, 2007). It follows from this that people who feel they
have been forgiven by God are less likely to experience strong feelings of death
anxiety because the forgiveness they have received helps restore and bolster
feelings of self-worth that are needed to offset concerns about death.

Aging, Religion, and Death Anxiety

As the discussion in the next section will reveal, the participants in the current
study are age 50 and older. Consequently, it is important to discuss why it is
important to focus on the relationship between religion and death anxiety in a
sample that comprises middle-aged and older individuals. Insight into this issue
may be found by turning to two patterns of findings that have emerged from the
literature.
Findings from the first group of studies suggest that the fear of death begins
to taper off during midlife and does not decline further as people go through late
life (e.g., Cicirelli, 2002). Initially, these data may be somewhat difficult to under-
stand because older adults are closer to death than younger adults and older
people are more likely to experience acute and chronic health conditions that
may hasten their demise.
Findings from a second group of studies indicate that people who are cur-
rently older tend to be more deeply involved in religion than individuals who are
presently younger (see Krause, 2008, for a review of this research). Many
researchers argue that these findings suggest that people tend to become more
religious as they grow older.
Taken together, these two bodies of research suggest that greater involvement
in religion may promote less fear of death in late life. This is in fact what some
studies indicate (e.g., Cicirelli, 2002). However, as Krause (2008) points out,
28 OMEGA—Journal of Death and Dying 72(1)

many researchers rely on crude measures of religious involvement, such as the

frequency of church attendance. Consequently, it makes sense to reexamine the
relationship between religion and death anxiety in samples of middle-aged and
older adults with more sophisticated measures of religious involvement. One
goal of the current study is to address this issue.

Methods
Sample
The data for this study come from an ongoing nationwide survey of Whites and
African Americans. Altogether, five waves of interviews have been conducted.
The study population for the baseline survey was defined as all household resi-
dents who self-identified as either Black or White, noninstitutionalized, English-
speaking, and at least 66 years of age. Geographically, the study population was
restricted to all eligible persons residing in the coterminous United States (i.e.,
residents of Alaska and Hawaii were excluded). The study population was
restricted to currently practicing Christians, individuals who were Christian in
the past but no longer practice any religion, and people who were not affiliated
with any faith at any point in their lifetime. This study was designed to explore a
range of issues involving religion. As a result, individuals who practice a faith
other than Christianity were excluded because it would be too difficult to devise
a comprehensive battery of religion measures that would be suitable for indivi-
duals of all faiths. The three groups were not selected so that they could
be compared and contrasted. Instead, the goal was to be able to clearly and
cleanly assess the relationship between one faith tradition and health-related
outcomes.
The sampling frame consisted of all eligible persons contained in the bene-
ficiary list maintained by the Centers for Medicare and Medicaid Services. A
five-step process was used to draw the sample from the Centers for Medicare and
Medicaid Services Files (see Krause, 2002a, for a detailed discussion of these
steps).
The baseline survey took place in 2001. The data collection for all waves of
interviews was conducted by Harris Interactive (New York). A total of 1,500
interviews were completed, face-to-face, in the homes of the study participants.
African Americans were oversampled so that sufficient statistical power would
be available to assess racial cultural differences in religion. The overall response
rate for the baseline survey was 62%. The Wave 2 survey was conducted in 2004.
A total of 1,024 study participants were reinterviewed successfully. The reinter-
view rate was 80%. A third wave of interviews was completed in 2007. A total of
969 older study participants were reinterviewed successfully (reinterview rate
was 75%). Wave 4 was completed in 2008. A total of 718 older study partici-
pants were reinterviewed successfully (reinterview rate ¼ 88%).
Krause 29

A fifth wave of interviews was completed in June, 2013. However, the sam-
pling strategy for this round of interviews was complex. By the time the Wave 5
interviews were conducted, only 229 study participants were reinterviewed suc-
cessfully. Many former study participants experienced significant health pro-
blems that were associated with their advanced age (M ¼ 83.2 years).
Moreover, a number of former study participants died (N ¼ 611). So in order
to have sufficient statistical power to conduct meaningful analyses, the following
two-part sampling strategy was employed. First, we reinterviewed as many of
the original study participants as possible (N ¼ 229). Second, this group was
supplemented with a new sample of individuals who had not participated in
the study previously (N ¼ 1,306). In the process of fielding the sample of new
study participants, we lowered the age for eligibility from 66 to 50. This was
done in order to make it possible to evaluate issues involving religious involve-
ment in midlife, which is not the focus of the current study. The reinterview rate
for prior study participants was 63%. The response rate for people in the new
supplementary sample was 45%.
There are clear differences between the old and new samples at Wave 5 (e.g.,
the old sample comprises people who are obviously older). But the upshot of the
sampling plan was to derive a sample that is representative of U.S. adults age 50
and over when the old and new samples are combined.
The sample of individuals who had not participated previously in the study
was obtained in the following manner. Based on the data in the 2010 Census, 50
geographic areas (i.e., Census tracts) were selected to proportionally represent
the population age 50 and over who were either White or African American. All
households within each Census tract were enumerated. One eligible person per
household was selected at random to participate in the study.
Altogether, a total of 1,535 individuals participated in the Wave 5 inter-
views. The analyses presented below are based on the Wave 5 data only
because this was the first time that questions on trust in God were adminis-
tered. Recall that spiritual support is contained in the conceptual model for
this study. When the questionnaire for this study was being developed, the
members of the research team felt it did not make sense to ask questions about
receiving spiritual support from fellow church members if study participants
either never attend worship services or if they go to church only one or two
times a year. Consequently, 381 participants with low rates of church attenders
were excluded from the analyses presented below, resulting in a sample size of
1,154. The Full Information Maximum Likelihood (FIML) procedure was
handle item nonresponse (Enders, 2010).
Preliminary analysis revealed that the average age of the participants in the
pooled study sample was 63.4 years (SD ¼ 11.7 years), 35.9% were men, 43.1%
were married at the time of the Wave 5 survey, 61.1% self-identified as White,
and the average level of educational attainment was 13.1 years of schooling
(SD ¼ 2.3 years).
30 OMEGA—Journal of Death and Dying 72(1)

Measures
Table 1 contains the indicators that were used to assess the core constructs in
Figure 1. The procedures that were used to code these items are provided in the
footnotes of this table.

Church attendance. A single item was taken from research by the Fetzer Institute/
National Institute Working Group (1999) to measure how often study partici-
pants attend worship services. A high score denotes more frequent church atten-
dance. This item is scored in the following manner (coding in parenthesis): never
(1), less than once a year (2), about once or twice a year (3), several times a year
(4), about once a month (5), 2 to 3 times a month (6), nearly every week (7), every
week (8), and several times a week (9). The mean of this ordinal measure is 6.7
(SD ¼ 1.7).

Table 1. Core Study Measures.

1. Church attendance
How often do you attend religious services?
2. Spiritual support
A. Not counting Bible study groups, prayer groups, or church services, how often
does someone in your congregation share their own religious experiences with you?
B. How often does someone in your congregation help you find solutions to your
problems in the Bible?
C. How often do the examples set by others in your congregation help you lead a
better religious life?
D. How often does someone in your congregation help you to know God better?
E. How often does someone in your congregation help you live according to your
religious beliefs?
3. Trust in God
A. I trust God completely.
B. I believe that God will never let me down.
C. I know that God will ultimately do what is best for me.
D. I know God will never give me more than I can handle.
E. I trust God because He has always been right there for me in the past.
4. Forgiveness by God
A. I have done some things that even God may not forgive
B. I believe God forgives me for the things I have done wrong.
5. Death anxiety
A. I find it hard to face up to the fact that I will die.
B. Thinking about death makes me feel uneasy.
C. I do not feel prepared to face my own death.
D. I am disturbed by the shortness of life.
Krause 31

Spiritual support. Five indicators that were developed by Krause (2002b) were
used to assess spiritual support. A high score stands for study participants
who received spiritual support from fellow church members more often. The
spiritual support items are scored in the following manner: never (1), once in a
while (2), fairly often (3), and very often (4). The mean spiritual support value is
13.0 (SD ¼ 4.2).

Trust in God. Based on the procedures described by Krause (2002b), the following
item development strategy was devised to create new measures of trust in God.
First, 41 open-ended in-depth interviews were conducted in order to see how the
typical individual thinks about things like trust in God. Following this, the main
themes that emerged from these interviews were used to draft closed-ended item
stems. Once a preliminary set of measures were in place, 40 cognitive interviews
were conducted with a new sample of study participants. Cognitive interviews
involve presenting study participants with newly developed closed-ended items
that are followed by a series of open-ended probes. The probes were designed to
determine if the item was understood in the intended manner and if there are
better ways to phrase the question stems. Following this, the indicators were
revised and evaluated with standard pilot testing procedures.
The procedures that are described above were used to craft five items that
assess trust in God. A high score stands for greater trust in God. The items that
assess trust in God are scored in the following manner: strongly disagree (1),
disagree (2), agree (3), and strongly agree (4). The mean is 18.1 (SD ¼ 2.6).

Forgiveness by God. As shown in Table 1, two items that come from research by
Krause (2002b) were used to assess whether study participants feel they have
been forgiven by God. The first item was scored in the following manner:
strongly agree (1), agree (2), uncertain (3), disagree (4), and strongly disagree
(5). The second indicator was scored in the following manner: strongly disagree
(1), disagree (2), uncertain (3), agree (4), and strongly agree (5). A high score
denotes greater feelings of being forgiven by God. Summing the two indicators
produced a brief composite with a mean of 8.5 and a standard deviation of 1.5.
The bivariate correlation between the two measures of forgiveness by God is
.242 (p < .001).

Death Anxiety
A number of researchers assess death anxiety with complex, multidimensional
scales, such as the Mutidimensional Fear of Death Scale (Hoelter, 1979), which
captures distinct ways in which death anxiety is manifest (e.g., fear of the dying
process and fear of being destroyed). In contrast to this comprehensive
approach, four indicators were used in the current study to measure death
anxiety. These items were taken from scales that are in the literature (see
32 OMEGA—Journal of Death and Dying 72(1)

Neimeyer, 1994, for a discussion of these measures). The indicators in this uni-
dimensional scale assess more general or global fear of death as a whole. These
items are coded so that a high score reflects more anxiety about dying. The death
anxiety items are scored in the following manner: strongly disagree (1), disagree
(2), agree (3), and strongly agree (4). The mean of the brief composite that was
developed by summing the scores on these items is 8.6 (SD ¼ 2.7).

Demographic control variables. Recall that the relationships among the core study
measures were assessed after the effects of age, sex, education, marital status,
and race were controlled statistically for. Age and education were coded con-
tinuously in years. In contrast, sex (1 ¼ men; 0 ¼ women), race (1 ¼ White;
0 ¼ Black), and marital status (1¼ presently married; 0 ¼ otherwise) were scored
in a binary format.

Results
The findings from this study are presented below in three sections. Some tech-
nical issues involving the estimation of the study model are discussed in the first
section. Following this, data on the psychometric properties of the multiple item
constructs are presented in the second section. The final section contains the
substantive findings that were derived from estimating the study model.

Model Estimation Issues

The model depicted in Figure 1 was evaluated with the maximum likelihood
estimator in Version 8.80 of the LISREL statistical software program (du Toit &
du Toit, 2001). Use of this estimator is based on the assumption that the
observed indicators have a multivariate normal distribution. Preliminary tests
(not shown here) revealed that this assumption had been violated in the current
study. Although there are a number of ways to deal with departures from multi-
variate normality, the straightforward approach that is discussed by du Toit and
du Toit (2001) was followed here. These investigators report that departures
from multivariate normality can be handled by converting raw scores of the
observed indicators to normal scores prior to estimating the model (du Toit &
du Toit, 2001, p. 143). Based on these insights, the analyses presented below
were performed with observed indicators that were normalized.
Because the FIML procedure was used to deal with item nonresponse, the
LISREL software program provides only two goodness-of-fit measures. The first
is the full information maximum likelihood chi-square value (365.542 with
170 degrees of freedom, p < .000). Unfortunately, this statistic substantially
underestimates the fit of the model to the data when samples are large, such
as the sample in the current study (see Fornell & Larcker, 1981; Joreskog, 1969).
Better insight into the fit of the model to the data is provided by the second
Krause 33

goodness-of-fit measure—the root mean square error of approximation. The

root mean square error of approximation value for the model in Figure 1 is
.032. Although there is some debate about the best cut point for determining an
adequate fit of the model to the data, most investigators would agree that values
below .05 indicate a good fit to the data (Hu & Bentler, 1999).

Psychometric Properties of the Multiple Item Measures

The factor loadings and measurement error terms that were derived from esti-
mating the study model are provided in Table 2. These coefficients provide

Table 2. Measurement Error Parameter Estimates for Multiple Item Study Measures
(N ¼ 1,154).

Construct Factor loadinga Measurement errorb

1. Spiritual support
A. Others share religious experiencesc .798 .363
B. Find solutions to problems in Bible .787 .381
C. Lead a better religious life .780 .392
D. Help you know God better .846 .285
E. Live according to religious beliefs .829 .313
2. Trust in God
A. Trust God completely .847 .283
B. God never lets me down .908 .176
C. God will do what is best .875 .234
D. Never give more than I can handle .823 .322
E. He has always been there .876 .232
3. Forgiveness by God
A. Done things God would not forgive .430 .815
B. Feel forgiven by God .703 .505
4. Death anxiety
A. Hard to face up to death .834 .305
B. Death makes me uneasy .858 .265
C. Not prepared for death .844 .288
D. Disturbed by shortness of life .773 .403
a
Factor loadings are from the completely standardized solution. The first-listed item for each latent
construct was fixed at 1.0 in the unstandardized solution.
b
Measurement error terms are from the completely standardized solution. All factor loadings and mea-
surement error terms are significant at the .001 level.
c
Item content is paraphrased for the purpose of identification. See Table 1 for the complete text of each
indicator.
34 OMEGA—Journal of Death and Dying 72(1)

information about the reliability of the multiple item study measures. However,
researchers have yet to reach a consensus on the cut point for determining
whether the magnitude of a factor loading is acceptable. Widaman (2012) sug-
gests that items with standardized factor loadings in excess of .600 tend to have
good reliability. The data in Table 2 reveal that only one coefficient was below
.700. Even so, this coefficient (.430), which is associated with being forgiven by
God, was retained. Eliminating this item would have left only one observed
indicator to assess forgiveness by God. When latent constructs are assessed
with only one item, researchers must assume that indicator contains no measure-
ment error. This assumption is frequently untenable in psychosocial research.
This issue aside, the overall magnitude of the standardized factor loadings sug-
gests that the reliability of the multiple-item constructs is acceptable.
Although the factor loadings and measurement error terms that are asso-
ciated with the observed indicators provide useful information about the relia-
bility of each item, it would be helpful to know something about the reliability
for the scales as a whole. It is possible to compute these reliability estimates with
a formula provided by DeShon (1998). This procedure is based on the factor
loadings and measurement error terms. Applying the procedures described by
DeShon (1998) to these data in Table 2 yields the following reliability estimates
for the multiple item constructs in Figure 1: spiritual support (.904), trust in God
(.938), and death anxiety (.895).
Fornell and Larcker (1981) provide an alternative way of gauging the psycho-
metric properties of study measures. They recommend researchers compute the
average variance extracted (AVE) in a multiple item measure. The AVE reflects
the amount of variance in a set of measures that is captured by the latent
construct in relation to the amount of variance that is due to measurement
error. They recommend that AVE values exceed .50. The following AVE
values were observed for the multiple item study measures: spiritual support
(.653), trust in God (.746), and death anxiety (.685). The only measure to fall
below the cutoff of .50 was forgiveness by God (.340). However, Fornell and
Larcker (1981) point out that the AVE is a conservative measure and that a
researcher may conclude that a construct is adequate even though the AVE
estimate is below .50.

Substantive Findings
Table 3 contains the estimates of the relationships among the latent constructs in
the study model. Taken as a whole, these findings tend to support the theoretical
rationale that was developed earlier. The results reveal that people who go
to church more often report receiving more spiritual support from their fellow
church members (b ¼ .277; p < .001). Moreover, the data indicate that indivi-
duals who go to church more often (b ¼ .128; p < .001) and people who receive
more spiritual support (b ¼ .322; p < .001) are more likely to have greater trust
Krause 35

Table 3. Trust in God, Forgiveness by God, and Death Anxiety (N ¼ 1,154).

Dependent variables

Church Spiritual Trust in Forgiveness Death

Independent attendance support God by God anxiety

Age .143***a .146*** .056* .006 .120***

(.021)b (.009) (.002) (.001) (.007)
Sex .020 .028 .027 .069 .064*
(.071) (.044) (.027) (.077) (.090)
Education .011 .048 .050 .104*** .027
(.008) (.016) (.010) (.024) (.008)
Race .057 .201*** .169*** .075*** .074*
(.195) (.307) (.164) (.082) (.102)
Marital Status .136*** .003 .018 .100** .006
(.461) (.005) (.017) (.108) (.009)
Church Attendance .277*** .128*** .084* .046
(.123) (.036) (.027) (.018)
Spiritual Support .322*** .087 .028
(.205) (.062) (.025)
Trust in God .519*** .015
(.585) (.021)
Forgiveness by God .325***
(.407)
Multiple R2 .037 .137 .204 .347 .152
a
Standardized regression coefficient.
b
Metric (unstandardized) regression coefficient.
*p < .05. ** p < .01. *** p < .001.

in God. The findings further suggest that study participants who have more trust
in God are more likely to believe that God has forgiven them for the transgres-
sions they have committed (b ¼ .519; p < .001). The findings further reveal that
people who feel they have been forgiven by God tend to have lower levels of
death anxiety (b ¼ .325; p < .001).
It is possible to further refine the theoretical insights in this study by turning
to the indirect and total effects that operate through the study model. A simple
example will help clarify the meaning of these terms. According to the ratio-
nale that was provided earlier, trust in God is associated with feeling forgiven
by God and forgiveness by God is, in turn, associated with lower death anxi-
ety. If this turns out to be the case, then the findings would reveal that trust in
36 OMEGA—Journal of Death and Dying 72(1)

God exerts an indirect effect on death anxiety that operates through feeling
forgiven by God. When this indirect effect is added to the direct effect of trust
in God on death anxiety, the resulting total effect provides a more compre-
hensive view of the relationship between trust in God and death anxiety.
Breaking down the relationship between study measures into direct, indirect,
and total effects is often called the “decomposition of effects” in the literature
(Alwin, 1988).
Based on this logic, the relationship between three pairs of measures will be
decomposed in order to sharpen the theoretical perspective that has been devel-
oped in this study. The first decomposition involves the example that was pro-
vided above (i.e., the relationship between trust in God and death anxiety). The
data in Table 3 reveal that the direct effect of trust in God on death anxiety is not
statistically significant (b ¼ .015; ns). However, further analysis (not shown in
Table 3) reveals that the indirect effect of trust in God on death anxiety that
operates through feeling forgiving by God is statistically significant (b ¼ .168;
p < .001). Summing the direct and indirect effects shows that the total effect of
trust in God on death anxiety is also statistically significant (.105 + .168 ¼
.183; p < .001; not shown in Table 3). Viewed in more substantive terms, this
decomposition of effects suggests that, within the confines of the study model,
trust in God is associated with lower levels of death anxiety primarily because
people who place their trust in God are more likely to feel they have been
forgiven by Him.
The second decomposition has to do with the relationship between church
attendance and death anxiety. Recall that findings from other studies suggest
that more frequent church attendance is associated with less death anxiety
(Morris & McAdie, 2009). Initially, the findings in Table 3 appear to be at
odds with these findings because the data suggest that the direct effect of
church attendance on death anxiety is not statistically significant (b ¼ .046;
ns). However, a different picture emerges from the data when the indirect and
total effects that operate through the study model are taken into account. More
specifically, these additional analyses (not shown in Table 3) indicate that the
indirect effect of church attendance on death anxiety that operates through the
other variables in the study model is statistically significant (b ¼ .083; p < .001).
Summing the direct and indirect effects produces a total effect that is more in line
with the findings that have been reported by other investigators (.046 + .083
¼ .129; p < .001). This decomposition of effects underscores importance of one
of the criticisms of the literature that was raised earlier in this study. Earlier,
studies that focus solely on the relationship between church attendance and
death anxiety were faulted because they fail to show why the two are related.
By tracing the indirect effects of church attendance that operate through spiri-
tual support, trust in God, and forgiveness by God, the findings from the current
study provide more insight into why church attendance might allay feelings of
death anxiety.
Krause 37

The third decomposition of effects has to do with the relationship between

spiritual support and death anxiety. The data in Table 3 initially seem to
suggest that spiritual support is not associated with feelings of death anxiety
(b ¼ .028; ns). However, this finding appears to be inconsistent with social con-
structionist views of religion (e.g., Berger, 1967), which maintain that religious
beliefs arise from and are reinforced by interaction with like-minded others. An
examination of the indirect and total effects of spiritual support on death anxiety
tends to bring the findings from the current study in line with the social construc-
tionist perspective. Additional analyses (not shown in Table 3) indicate that the
indirect effect of spiritual support on death anxiety that operates through trust in
God and forgiveness by God is statistically significant (b ¼ .087; p < .001).
When the direct and indirect effects are summed, the resulting total effect
(b ¼ .115; p < .001; not shown in Table 3) suggests that individuals who receive
more spiritual support from their fellow church members tend to experience less
death anxiety.

Supplementary Analysis
The AVE estimates that were provided earlier are also useful because they can
be used in conjunction with the estimate of the amount of variance that is
explained in the relationship between two constructs to provide an estimate of
discriminant validity (Fornell & Larcker, 1981, p. 46). As the measure of trust
in God is new, it would be helpful to provide an estimate of the discriminant
validity of this index. This will be accomplished by applying the formula given
by Fornell and Larcker (1981) to the relationship between the frequency of
church attendance and trust in God. The correlation between the two latent
constructs is .226 (not shown in Table 3). Fornell and Larcker (1981) suggest
that if the AVE value is greater than the squared correlation between the two
measures the requirements for discriminant validity have been satisfied. Recall
that the AVE for the trust in God measure is .746. This is substantially larger
than the squared value of the correlation between church attendance and trust
in God. This analysis suggests that there is some evidence for the discriminant
validity of the new trust in God measure.
Because the death anxiety measure that is used in this study is brief and has
not appeared elsewhere in its current form, it is also helpful to provide evidence
of the discriminant validity of this construct as well. This will be accomplished
by focuses on the relationship between forgiveness by God and death anxiety.
The squared correlation between the two latent constructs is .037 (not shown in
Table 3). The AVE value for the death anxiety measure that was reported earlier
is .685, which is once again larger than the amount of variance that is explained
in the relationship between forgiveness by God and death anxiety.
Consequently, evidence for the discriminant validity of the death anxiety mea-
sure is provided by these analyses.
38 OMEGA—Journal of Death and Dying 72(1)

Discussion
Many studies that examine the relationship between religion and death anxiety
focus on one or two measures of religion and typically evaluate only the direct
effects of these measures on the fear of death. The purpose of the current study
was to pursue a different strategy that involved creating a conceptual model to
assess the interplay among multiple dimensions of religion and death anxiety.
Data from a recent nationwide survey provide support for the following core
relationships in this conceptual scheme: Individuals who attend worship services
more often tend to receive more spiritual support from fellow church members,
people who get more spiritual support tend to have greater trust in God, those
who trust God more are more likely to feel they have been forgiven by God, and
people who feel God has forgiven them tend to experience less death anxiety.
Further analysis of the indirect and total effects that operate through the study
model helped to sharpen the theoretical conclusions that can be drawn from this
model. For example, the data suggest that greater trust in God is associated with
less death anxiety, but this relationship is due solely to fact that people who trust
in God are more likely to feel they have been forgiven by God and this forgive-
ness is, in turn, associated with less death anxiety.
Even though the findings from the current study provide some potentially
useful insights into the relationship between religious involvement and death
anxiety, a considerable amount of work remains to be done. Forgiveness by
God was assessed with only two indicators in the current study. However, the
process leading to the belief that one has been forgiven by God is likely to
involve more than is assessed by these items. For example, a study by Krause
and Hayward (2013) that was conducted with data provided by older Mexican
Americans provides some insight into the finer nuances of this process. These
investigators found that performing acts of contrition in order to earn God’s
forgiveness is associated with lower death anxiety among members of this ethnic
group. Acts of contrition involve things like asking for God’s forgiveness, pro-
mising God that the transgression will not be repeated, and providing restitution
for a transgression whenever possible. Research is needed to find out if these
findings can be generalized beyond older Mexican Americans. Another possibi-
lity is found in a study by McConnell and Dixon (2012). These researchers argue
that people who feel they have been forgiven by God are more likely to forgive
themselves. Perhaps people who are more likely to forgive themselves are, in
turn, less likely to experience death anxiety.
In addition to pursuing new issues in research on death anxiety, researchers
should also address the limitations in the current study. It is important to briefly
discuss two shortcomings here. First, the data for this study are cross-sectional,
and as a result, the temporal ordering among the constructs in the study model
was based on theoretical considerations alone. Consequently, other investigators
might propose other legitimate causal orderings among the study constructs. For
example, the model in Figure 1 specifies that people with greater trust in God are
Krause 39

more likely to be forgiven by God, but it could just as easily be argued that
people who feel they have been forgiven by God are subsequently more likely to
trust Him. This as well as other causal assumptions in the study model must be
more rigorously assessed with data that have been gathered at more than one
point in time. Second, researchers should use more sophisticated, multidimen-
sional measures to assess death anxiety rather than the four brief global mea-
sures of death anxiety that were used in the current study.
As research on death anxiety has revealed, many people are deeply concerned
about their eventual demise (Neimeyer, 1994). Religion is uniquely positioned to
ease concerns associated with death because it deals directly with issues like
forgiveness and because it holds out the promise of life after death for those
who remain faithful to the teachings of the church. Yet research on religion and
death anxiety is not fully developed. Hopefully, the strategy that was implemen-
ted in the current study will encourage other researchers to delve more deeply
into the complex processes that link religion with feelings of death anxiety.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research,
authorship, and/or publication of this article.

Funding
The author(s) disclosed receipt of the following financial support for the research, author-
ship, and/or publication of this article: This research was supported by grants from the
John Templeton Foundation and the National Institute on Aging (RO1 AG014749).

References
Alwin, D. (1988). Structural equation modeling in research on human development and
aging. In K. W. Schaie, R. T. Campbell, W. Meredith & S. C. Rawlinngs (Eds.),
Methodological issues in aging research (pp. 71–170). New York, NY: Springer.
Ardelt, M., & Koenig, C. S. (2006). The role of religion for hospice patients and relatively
healthy older adults. Research on Aging, 28, 184–215.
Baldwin, J. M. (1902). Fragments in philosophy and science of being: Collected essays and
addresses. New York, NY: Charles Scribner’s Sons.
Barna, G. (2002). The state of the church 2002. Ventura, CA: Issachar Resources.
Berger, P. L. (1967). The sacred canopy: Elements of a sociological theory. New York, NY:
Doubleday.
Cicirelli, V. G. (2002). Fear of death among older adults: Predictions from Terror
Management Theory. Journal of Gerontology: Psychological Sciences, 57B,
P358–P366.
DeShon, R. P. (1998). A cautionary note on measurement error correlations in structural
equation models. Psychological Methods, 3, 412–423.
du Toit, M., & du Toit, S. (2001). Interactive LISREL: User’s guide. Lincolnwood, IL:
Scientific Software International.
40 OMEGA—Journal of Death and Dying 72(1)

Ellis, L., & Wahab, E. A. (2013). Religiosity and fear of death: A theory-oriented review
of the empirical literature. Review of Religious Research, 55, 149–189.
Enders, C. C. (2010). Applied missing data analysis. New York, NY: Guilford.
Fetzer Institute/National Institute on Aging Working Group. (1999). Multidimensional
measurement of religiousness/spirituality for use in health research. Kalamazoo, MI:
John E. Fetzer Institute.
Feifel, H. (1959). The meaning of death. New York, NY: McGraw Hill.
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unob-
served variables and measurement error. Journal of Marketing Research, 18, 39–50.
Graham, J., & Haidt, J. (2010). Beyond beliefs: Religions bind individuals to moral
communities. Personality and Social Psychology Review, 14, 140–150.
Greenberg, J., Pyszczynski, T., & Solomon, S. (1986). The causes and consequences of a
need for self-esteem: A terror management theory. In R. F. Baumeister (Ed.), Public
self and private self (pp. 189–212). New York, NY: Springer-Verlag.
Greenberg, J., Solomon, S., & Pyszczynski, T. (1997). Terror Management Theory of self-
esteem and cultural worldviews: Empirical assessments and conceptual refinements.
Advances in Experimental Social Psychology, 29, 61–139.
Hoelter, J. W. (1979). Multidimensional treatment of fear of death. Journal of Consulting
and Clinical Psychology, 47, 996–999.
Hu, L., & Bentler, P. M. (1999). Cutoff points for fit indices in covariance structure ana-
lysis: Conventional criteria versus new alternatives. Psychological Methods, 1, 130–149.
Joreskog, K. G. (1969). A general approach to confirmatory maximum likelihood factor
analysis. Psychometrika, 34, 183–202.
Kirkpatrick, L. A. (2005). Attachment, evolution, and the psychology of religion. New
York, NY: Guilford.
Krause, N. (2002a). Church-based social support and health in old age: Exploring vari-
ations by race. Journal of Gerontology: Social Sciences, 57B, S332–S347.
Krause, N. (2002b). A comprehensive strategy for developing closed-ended survey items
for use in studies of older adults. Journal of Gerontology: Social Sciences, 57B,
S263–S274.
Krause, N. (2008). Aging in the church. How social relationships affect health. West
Conshohocken, PA: Templeton Foundation Press.
Krause, N., & Bastida, E. (2012). Contact with the dead, religion, and death anxiety
among older Mexican Americans. Death Studies, 36, 932–948.
Krause, N., & Hayward, R. D. (2013). Acts of contrition, forgiveness by God, and death
anxiety among older Mexican Americans. International Journal for the Psychology of
Religion, 25, 57–73.
Lin, A. H. (2003). Factors related to attitudes toward death among American and
Chinese older adults. Omega: Journal of Death and Dying, 47, 3–23.
Lundberg, G. D. (2010). Unifying truths of the world’s religions. New Fairfield, CT:
Heavenlight Press.
Lundh, L. G., & Radon, V. (1998). Death anxiety as a function of belief in an afterlife: A
comparison between a questionnaire measure and Stroop measure of death anxiety.
Personality and Individual Differences, 25, 487–494.
McConnell, J. M., & Dixon, D. N. (2012). Perceived forgiveness from God and self-
forgiveness. Journal of Psychology and Christianity, 31, 31–39.
Krause 41

Morris, G. J., & McAdie, T. (2009). Are personality, well-being, and death anxiety related
to religious affiliation?. Mental Health, Religion & Culture, 12, 115–120.
Neimeyer, R. A. (1994). Death anxiety handbook: Research instrumentation, and applica-
tion. New York, NY: Taylor & Francis.
Roberts, R. C. (2007). Spiritual emotions: A psychology of Christian virtues. Grand
Rapids, MI: William B. Eerdmans.
Soenke, M., Landau, M. J., & Greenberg, J. (2012). Sacred armor: Religion’s role as
buffer against the anxieties of life and the fear of death. In K. I. Pargament (Ed.), APA
handbook of psychology, religion, and spirituality (pp. 105–122). Washington, DC:
American Psychological Association.
Stark, R., & Finke, R. (2000). Acts of faith: Explaining the human side of religion.
Berkeley, CA: University of California Press.
Strelan, P. (2007). Who forgives others, themselves, and situations? The roles of narcis-
sism, guilt, self-esteem, and agreeableness. Personality and Individual Differences, 42,
259–269.
Widaman, K. F. (2012). Exploratory factor analysis and confirmatory factor analysis.
In H. Cooper (Ed.), APA handbook of research methods in psychology (Vol. 3,
pp. 361–389). Washington, DC: American Psychological Association.

Author Biography
Neal Krause, PhD, is the Marshall H. Becker Collegiate Professor in the
Department of Health Behavior and Health Education at the University of
Michigan School of Public Health. His research focuses on religion and
health. An emphasis is placed in this work on the health-related benefits of
support that is provided by religious others.