Prevalence and Correlates of Death Anxiety Among Frontline Healthcare Workers: A Cross-Sectional Study

Background Frontline healthcare workers face repeated exposure to death, critical illness, and patient suffering. This chronic exposure contributes to death anxiety, defined as persistent fear and dread related to dying and death. Unaddressed death anxiety affects mental health, empathy, clinical decision-making, job satisfaction, and staff retention. Despite its relevance, Indian data on death anxiety among public-sector healthcare workers remain limited, particularly after the COVID-19 pandemic. Understanding its prevalence and associated factors is essential for designing targeted mental health interventions and occupational health policies.

Objective: To estimate the prevalence of death anxiety and identify its sociodemographic and occupational correlates among frontline healthcare workers in public health facilities.

Methods:  A cross-sectional study was conducted from January to August 2025 among doctors, nurses, and paramedical staff working in emergency departments, intensive care units, and inpatient wards of public health facilities in Bhopal, Madhya Pradesh. Participants with at least six months of clinical experience were recruited through consecutive sampling. A total of 50 participants were included. Data were collected using a pre-tested sociodemographic and occupational proforma and Templer’s Death Anxiety Scale, Hindi/English version. The scale has 15 items scored as True=1 and False=0, with a total score range of 0–15. Scores of 11 and above were classified as high death anxiety, 7–10 as moderate, and 0–6 as low. Ethical approval was obtained from the Institutional Ethics Committee, and written informed consent was taken from all participants. Data were entered in MS Excel and analyzed using SPSS version 26. Prevalence was expressed as percentage with 95% confidence interval. Associations were tested using Chi-square test and Fisher’s exact test where applicable. A p-value <0>

Results: The study included 50 participants with a mean age of 32.4±6.8 years. Females comprised 60% of the sample, and males 40%. Nurses accounted for 48% of participants, followed by doctors at 34% and paramedical staff at 18%. Nearly 44% of participants were posted in ICU or emergency departments, and 56% worked in general wards. Regarding work experience, 56% had less than five years of experience, while 44% had five years or more. The prevalence of high death anxiety was 44% (22/50), moderate death anxiety was 36% (18/50), and low death anxiety was 20% (10/50). High death anxiety was more common among females, with 16 of 30 females (53.3%) scoring in the high range compared to 6 of 20 males (30.0%). This difference was statistically significant (χ²=4.17, p=0.04). Similarly, participants posted in ICU or emergency departments reported higher rates of high death anxiety, 12 of 22 (54.5%), compared to 10 of 28 (35.7%) in general wards, though this did not reach statistical significance (p=0.18). Participants with less than five years of experience had a higher prevalence of high death anxiety at 15 of 28 (53.6%) compared to 7 of 22 (31.8%) among those with five or more years of experience (p=0.12). No significant association was observed between age group and death anxiety levels.

Conclusion: Death anxiety is prevalent among frontline healthcare workers, affecting nearly two-fifths of the study population. It is significantly higher among female staff. The findings highlight the need for routine mental health screening, confidential counseling services, and institutional support mechanisms such as peer debriefing and workload management to address death anxiety and safeguard healthcare worker well-being.