Cross-cultural validity of the Death Reflection Scale during the COVID-19 pandemic

Christina Ramsenthaler; Klaus Baumann; Arndt Büssing; Gerhild Becker

doi:10.3389/fpsyg.2022.957177

Cross-cultural validity of the Death Reflection Scale during the COVID-19 pandemic

Front Psychol. 2022 Aug 3:13:957177. doi: 10.3389/fpsyg.2022.957177. eCollection 2022.

Authors

Christina Ramsenthaler^{1

2

3}, Klaus Baumann^{4

5}, Arndt Büssing^{5

6}, Gerhild Becker⁷

Affiliations

¹ School of Health Professions, Institute of Health Sciences, Zurich University of Applied Sciences, Winterthur, Switzerland.
² Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, United Kingdom.
³ Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, United Kingdom.
⁴ Caritas Science and Christian Social Work, Faculty of Theology, University of Freiburg, Freiburg im Breisgau, Germany.
⁵ IUNCTUS - Competence Center for Christian Spirituality, Philosophical-Theological Academy, Münster, Germany.
⁶ Chair of Quality of Life, Spirituality and Coping, Faculty of Health, Witten/Herdecke University, Herdecke, Germany.
⁷ Clinic for Palliative Medicine, University Medical Center Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.

Abstract

Background: The global COVID-19 pandemic confronts people with their fragility, vulnerability, and mortality. To date, scales to measure death awareness mainly focus on the anxiety-provoking aspect of mortality cues. This study aims to cross-culturally adapt and validate the Death Reflection Scale (DRS), a scale for measuring positive, growth-oriented cognitions of life reflection and prosocial behavior following confrontation with the finiteness of life.

Materials and methods: The Death Reflection Scale was translated and adapted in a multi-step process to the German language. In this anonymous, cross-sectional, online survey at a large university in Germany, students, healthcare professionals (HCP) and other staff completed the DRS alongside comparison measures. Multi-group confirmatory factor analysis was used to assess configural, metric, and scalar measurement equivalence across four age and occupational groups. Convergent/divergent validity testing was done via Spearman correlations.

Results: 1,703 participants provided data for a response rate of ∼5%. 24% of respondents were HCP, 22% students. Confirmatory factor analysis showed a higher-order structure of the DRS with a strong general factor and the originally proposed five subscales (CFI 0.945, SRMR 0.045, RMSEA 0.055). Multi-group CFA showed partial metric equivalence across age groups and partial scalar invariance across occupational groups. Non-invariant scales were the Motivation to live, Putting life into perspective, and Legacy subscales. In the convergent validity testing, two hypotheses were fully confirmed, two partially and four were not confirmed. Experiencing a propensity for increased contemplation and life reflection during the pandemic together with spirituality showed correlations of moderate to large size to the DRS and its subscales (Spearman's rho ranging from 0.31 to 0.52).

Conclusion: Further conceptual work for death awareness to explore the construct's stability in different population groups needs to be undertaken. However, the DRS can be mostly used to assess positive and growth-oriented aspects of death awareness and death reflection which may be an important avenue when developing counseling and support interventions for groups experiencing a high burden during the pandemic.

Keywords: COVID-19 pandemic; cross-cultural validity; death awareness; death reflection; life satisfaction; measurement invariance.