Journal of Applied Psychology

Dont Fear the Reaper: Trait Death Anxiety, Mortality

Salience, and Occupational Health
Michael T. Sliter, Robert R. Sinclair, Zhenyu Yuan, and Cynthia D. Mohr
Online First Publication, February 3, 2014. http://dx.doi.org/10.1037/a0035729

CITATION
Sliter, M. T., Sinclair, R. R., Yuan, Z., & Mohr, C. D. (2014, February 3). Dont Fear the
Reaper: Trait Death Anxiety, Mortality Salience, and Occupational Health. Journal of Applied
Psychology. Advance online publication. http://dx.doi.org/10.1037/a0035729

Journal of Applied Psychology

2014, Vol. 99, No. 2, 000

2014 American Psychological Association

0021-9010/14/$12.00 DOI: 10.1037/a0035729

RESEARCH REPORT

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Dont Fear the Reaper: Trait Death Anxiety, Mortality Salience, and
Occupational Health
Michael T. Sliter

Robert R. Sinclair

Indiana University-Purdue University Indianapolis

Clemson University

Zhenyu Yuan

Cynthia D. Mohr

Indiana University-Purdue University Indianapolis

Portland State University

Despite multiple calls for research, there has been little effort to incorporate topics regarding mortality
salience and death anxiety into workplace literature. As such, the goals of the current study were to (a)
examine how trait differences in death anxiety relate to employee occupational health outcomes and (b)
examine how death anxiety might exacerbate the negative effects of mortality salience cues experienced
at work. In Study 1, we examined how death anxiety affected nurses in a multitime point survey. These
results showed that trait death anxiety was associated with increased burnout and reduced engagement
and that death anxiety further exacerbated the relationship between mortality salience cues (e.g., dealing
with injured and dying patients) and burnout. These results were replicated and extended in Study 2,
which examined the impact of death anxiety in firefighters. In this multitime point study, death anxiety
related to burnout, engagement, and absenteeism. The results further showed that death anxiety moderated the relationship between mortality cues and burnout, where people high in trait death anxiety
experience higher levels of burnout as a result of mortality cues than people lower in death anxiety.
Across the 2 studies, despite differences in the methods (e.g., time lag; measures), the effect sizes and
the form of the significant interactions were quite similar. Overall, these results highlight the importance
of understanding death anxiety in the workplace, particularly in occupations where mortality salience
cues are common. We discuss recommendations, such as death education and vocational counseling, and
provide some avenues for future research.
Keywords: death anxiety, mortality salience, burnout, engagement, absenteeism

Mortality is often considered to be the great equalizer everyone dies. Whereas some people can reflect on, and cope with, their
eventual death, other people experience a great deal of anxiety
when contemplating their inevitable demise. This trait, called
death anxiety, can impact people in their day-to-day lives, including their work experiences. Many occupations share characteristics
in which mortality saliencethe recognition and realization of
ones own mortality (Greenberg, Pyszczynski, & Solomon,
1986)is high. This includes jobs where employees are exposed

to the dead and dying (e.g., nurses, emergency medical technicians, morticians), and jobs where employees are in danger of
injury or death themselves (e.g., police, coal miners, military).
Recently, there have been calls for researchers to incorporate
concepts related to mortality into workplace literature, such as
mortality salience/death awareness, death reflection, and death
anxiety (Grant & Wade-Benzoni, 2009; Stein & Cropanzano,
2011). Despite these calls, there remains essentially no research on
death anxiety at work.

Michael T. Sliter, Department of Psychology, Indiana University-Purdue

University Indianapolis; Robert R. Sinclair, Department of Psychology,
Clemson University; Zhenyu Yuan, Department of Psychology, Indiana
University-Purdue University Indianapolis; Cynthia D. Mohr, Department
of Psychology, Portland State University.
Multiple funding sources made this research possible. Portions of this
research were supported by Northwest Health Foundation Grant #14180,
awarded to Portland State University, National Institute for Occupational Safety and Health (NIOSH) Grant T01 OH008435-02, and from
a Clemson University Department of Psychology summer funding

grant, awarded to Robert R. Sinclair. The remainder was supported by

NIOSH Pilot Research Project Training Program of the University of
Cincinnati Education and Research Center Grant #T42/OH008432-06,
awarded to Michael T. Sliter. We gratefully acknowledge the support of
the Oregon Nurses Association, the members of the Oregon Nurse
Retention Project research team, and the City of Cleveland Fire Department for their contributions to this research program.
Correspondence concerning this article should be addressed to Michael
T. Sliter, Indiana University-Purdue University Indianapolis, Department
of Psychology, 402 North Blackford Street, LD126P, Indianapolis, IN
46202. E-mail: msliter@iupui.edu
1

SLITER, SINCLAIR, YUAN, AND MOHR

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One of the many gaps in the empirical literature on death

involves whether employees anxieties and concerns about death
are related to their occupational health outcomes. Our study helps
bridge the gap between the long-standing interest in concepts
related to death in the general field of psychology and occupational
health in jobs where death is salient. In the current research, we
addressed this gap by investigating the occupational health-related
correlates of death anxiety in two occupations where mortality
salience should be highfirefighting and nursing. In Study 1, we
investigated the relationship between death anxiety, burnout, and
engagement in a sample of acute care nurses, an occupation where
employees frequently encounter deaths of those to whom they
provide care. In Study 2, we investigated death anxiety in firefighters, who also may see death among civilians, but, because of
the inherent dangers in their work, also experience potential threats
to their own lives as well as those of their coworkers. In this study,
we replicated the burnout and engagement hypotheses tested in
Study 1 and added absenteeism as an additional expected outcome
of death anxiety. Finally, we examined, across both studies,
whether death anxiety moderates the relationship between mortality cues and employee outcomes.

Defining Death Anxiety

Death anxiety (DA), though often discussed in psychological
literature, has rarely been formally defined (Neimeyer & Van
Brunt, 1995). One recently proposed definition is that DA is the
unpleasant emotion resulting from existential concerns that are
provoked on contemplation of the death of the self or others
(Nyatanga & de Vocht, 2006). Most people experience some level
of DA, and, although some people experience abnormal/extreme
amounts, DA is not inherently maladaptive. From an evolutionary
perspective, some level of DA can be adaptive, assisting in the
preservation of life and avoidance of situations likely to result in
injury or death (Tomer, 1992).
Given its specific nature, DA is distinct from general anxiety,
which is characterized by generalized nervousness, apprehension,
and worrying. In one classic review study, Pollak (1979) examined
several studies to assess the overlap between general anxiety and
death anxiety. From these results, Pollak (1979) concluded that
these variables only have moderate overlap, with between 13% and
20% of the variance being common between death anxiety and
generalized anxiety. These findings have since been replicated in
empirical research (see Brown, 2011; Cella & Tross, 1987, as
examples), indicating the relative distinctness of these constructs.
Furthermore, DA is most often conceptualized, and measured,
as a traita relatively stable, enduring characteristicas opposed
to a state. In the short-term (12 months), death anxiety measures
tend to demonstrate similar testretest reliability to other established trait measures (i.e., the Big Five), ranging from .70 to .90
(Neimeyer, 1994; Templer, 1970). In fact, in the short term, some
researchers contend that DA is even more stable than general
anxiety. For example, Rasmussen and colleagues (1998) posited
that the relationship between trait and state anxiety and DA can be
likened to a river. That is, the water at the surface general
anxietyis more influenced by internal and external factors. The
deeper waterDAis less influenced by these factors. Research
has generally supported this river analogy, showing that DA is
more stable than general anxiety and depression. For instance, in

one classic study, Pettigrew and Dawson (1979) found that DA

was stable across time, even after people were exposed to death
cues (e.g., death words). Rasmussen and colleagues (1998) found
that relaxation training and stress management techniques were
effective in reducing state/trait anxiety and depression, but not DA
Finally, Fischer, Gozansky, Kutner, Chomiak, and Kramer (2003)
found that a 1-month curriculum intervention did not decrease
death anxiety in medical students, again pointing toward the relative stability of death anxiety.
In terms of longer term stability, a small, but informative, group
of studies has shown that DA, across 1 year to several years, tends
to be relatively stable. As one example, Kaye and Loscalzo (1998)
conducted a 4-year longitudinal, controlled study in which medical
students either took a death and dying education course (experimental group) or took another elective course (control group).
Across 4 years, with or without the course, there was no change in
the death anxiety of these students, though the program was
successful in altering attitudes toward treating dying patients and
dealing with their families. This study, among others (e.g., Linn,
Moravec, & Zeppa, 1982), supports a trait view of death anxiety;
despite many life changes, and despite exposure to dead and dying
patients, DA remained stable.
There does, however, tend to be a predictable relationship
between age and DA, such that older people tend to report somewhat less DA than younger people (with correlations ranging
from .10 to .30 in cross-sectional studies; Neimeyer, 1988;
Neimeyer & Moore, 1994). These findings are consistent with
socioemotional selectivity theory (SST; Carstensen, Isaacowitz, &
Charles, 1999), which posits that adults awareness of their limited
future time provides motivation to focus on the present, primarily
by maximizing experience of positive emotions and life satisfaction. Indeed, aging tends to be marked by changes in other established, stable traits, including increases in positive affectivity,
agreeableness, conscientiousness, and decreases in negative affectivity and neuroticism (e.g., Donnellan & Lucas, 2008; Soto, John,
Gosling, & Potter, 2011).

Outcomes of DA at Work
Psychologists as early as Freud (1922) recognized the importance of death-related drives in determining human behavior (i.e.,
Thanatos). More recently, organizational psychologists have discussed the potential influence of death awareness for attitudinal
and behavioral outcomes in the workplace (Grant & WadeBenzoni, 2009; Stein & Cropanzano, 2011). To situate DA in
occupational health psychology research, we draw on the conservation of resources (COR) model to develop our hypotheses. COR
theory (Hobfoll, 2001) has provided valuable insights into research
on extreme situations involving significant resource loss (e.g.,
trauma and disaster; Freedy, Saladin, Kilpatrick, Resnick, & Saunders, 1994) and extremely stressful work (e.g., firefighters; Bacharach & Bamberger, 2007).
According to the COR model of stress (Hobfoll, 2001), life is
one of the most salient resources that people are motivated to
protect and foster. Evolutionarily speaking, the loss of life precludes the passing down of an individuals genes. The criticality of
life as a resource with which individuals hold high value has been
well documented in disaster research, which has consistently
shown that the threat of life loss is a strong predictor of severe

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DEATH ANXIETY AT WORK

dysfunctional syndromes (e.g., posttraumatic stress syndrome;

Freedy et al., 1994). Moreover, individuals who experience a
threat of resource loss tend to adopt a defensive strategy to avoid
future resource loss (Hobfoll, 2001). Drawing on COR theory, we
further argue that DAa relatively stable trait that predisposes
individuals to the salience of death and the threat of life loss has
important implications for individual well-being.
Burnout, which refers to the exhaustion of personal resources
after prolonged exposure to work stressors (Pines & Aronson,
1988; Shirom & Melamed, 2006), has often been linked to individual differences (Maslach, Schaufeli, & Leiter, 2001; Swider &
Zimmerman, 2010). However, DA has not received adequate attention in burnout research. We could locate only two studies in
which DA and burnout were examined, both of which suggest that
DA is associated with higher levels of burnout (Mallett, Price, Jurs,
& Slenker, 1991; Melo & Oliver, 2011). DA is usually defined as
a trait reflecting the salience of death to the individuals (Pettigrew
& Dawson, 1979; Rasmussen et al., 1998); individuals high in DA
more frequently experience negative cognitions about death. In
line with the COR theory, such threat of resource loss is a precursor to stress, which can ultimately build up to burnout (Hobfoll &
Freedy, 1993). Moreover, suppressing and avoiding thoughts of
death require large amounts of cognitive and emotional resources
(Arndt, Greenberg, Solomon, Pyszczynski, & Simon, 1997), which
makes demanding jobs even more burdensome. Under such circumstances, the maintenance of current performance levels comes
at the cost of sympathetic activation and increased effort (Hockey,
1993), which will result in burnout if not resolved with adequate
resource replenishment (Hobfoll & Freedy, 1993).
DA may also have important implications for work engagement.
Engagement is an emerging concept that captures the positive state
of mind toward ones work and is characterized by vigor, dedication, and absorption (Schaufeli, Salanova, Gonzlez-Rom, &
Bakker, 2002). Individuals high in DA are prone to resource loss
and general maladjustment (Neimeyer, Wittkowski, & Moser,
2004). Under such circumstances, individuals lack the physical,
emotional, and psychological resources to invest in their job and
may lower work engagement as a result (Hobfoll, 2001; Kahn,
1990). Therefore, we expect DA to be negatively related to work
engagement.
Moreover, individuals might be absent from the workplace in
order to avoid situations that expose them to mortality cues (Grant
& Wade-Benzoni, 2009; Hobfoll, 2001). Considering that DA is
expected to relate to burnout and that burnout can lead to absenteeism (Bakker, Demerouti, de Boer, & Schaufeli, 2003; Neveu,
2007), it follows that burnout would mediate the relationship
between DA and absenteeism. When DA predisposes individuals
to burnout, they respond by withdrawing from the workplace.
Taken altogether, we propose the following:
Hypothesis 1: DA will be related to higher levels of burnout.
Hypothesis 2: DA will be related to lower levels of work
engagement.
Hypothesis 3: DA will be related to higher levels of absenteeism through the mediating mechanism of burnout.

DA as a Moderator in the Relationship Between

Mortality Cues and Outcomes
One important variable that should be considered when discussing DA is the concept of mortality cues. Mortality cues refer to any
external stimuli that serve as a reminder of death, including, but
not limited to, being in danger, being exposed to the injury/death
of others, talking about death, or any other death-related stimuli
(e.g., cemeteries, retirement homes, movies). Many occupations
include frequent mortality cues, some being vicarious (e.g., witnessing the death of others), others being direct (e.g., actually
facing danger). For example, deployed military personnel are often
exposed to war-related danger, injury, or death (Vinokur, Pierce,
Lewandowski-Romps, Hobfoll, & Galea, 2011), and forensic doctors deal with dead bodies as part of their job (van der Ploeg,
Dorresteijn, & Kleber, 2003).
It is worth noting that, although there is a good deal of overlap
between exposure to traumatic events and mortality cues, the terms
are conceptually distinct. Traumatic stressors can be defined as
acute stressors/critical events that cause or pose great threat to the
lives and physical integrity of the self and others (American
Psychiatric Association, 1994). Given this definition, it is clear that
mostif not alltraumatic events should serve as mortality cues,
as any event that poses great threat to the self or others should
serve as a reminder of ones own mortality. However, not all
mortality cues are necessarily traumatic events. As noted above,
any reminder of death, such as a macabre movie (e.g., Harold and
Maude) or being around the aging/older parents or relatives (e.g.,
Goodstein, 1995), should serve as a reminder of death. As such,
mortality cues encompass traumatic events, but can be even
broader (see Grant & Wade-Benzoni, 2009, for a typology of
mortality cues).
In the current study, we investigate mortality cues in two occupations: nurses and firefighters. In these samples, mortality cues
will be experienced as exposure to illness, injury, death, dying, and
other traumatic events. In Study 1, we examined nurses encounter
with death/dying-related events in their work as mortality cues
(French, Lenton, Walters, & Eyles, 2000). In Study 2, we used
exposure to traumatic events, including the death/injury of a victim
and exposure to life-threatening danger, as a measure of mortality
cues among firefighters.
To the extent that life represents a form of salient resources,
threats to ones own life or to the lives of valued others should
result in strain, the long-term effect of which is burnout (Hobfoll,
2001). In other words, these mortality cues represent a class of job
stressors that require additional effort so that individuals can
maintain their performance level (Demerouti, Bakker, Nachreiner,
& Schaufeli, 2001; Hockey, 1993). This is particularly true in the
current samples (i.e., firefighters and nurses). Nurses working to
save a gravely ill patient and firefighters attempting to save victims
of fires cannot easily reduce the resources they devote to job
performance. Over time, this sustained resource overinvestment
will result in chronic resource depletion and, more specifically,
burnout (Demerouti et al., 2001; Hobfoll & Freedy, 1993). Given
the mortality cues in the workplace, individuals might withdraw
from their role performance rather than invest resources into their
job (i.e., engagement). Consistent with the notion that absenteeism
might result from exposure to job stressors (Schaufeli, Bakker, &
van Rhenen, 2009; Sliter, Sliter, Withrow, & Jex, 2012), individ-

SLITER, SINCLAIR, YUAN, AND MOHR

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uals might be absent from the workplace to avoid encountering

mortality cues and their associated negative outcomes (Biron &
Bamberger, 2012).
In addition to main effects of mortality cues on occupational
health-related outcomes, we further contend that DA may moderate the relationships between mortality cues and outcomes (i.e.,
burnout, engagement, and absenteeism). Individuals who are
higher in anxiety are more sensitive to the negative effects of
stressors such as interpersonal conflict (Fox, Spector, & Miles,
2001), pain (Moosbrugger & Schermelleh-Engel, 1991), and
trauma (Feldner, Lewis, Leen-Feldner, Schnurr, & Zvolensky,
2006). Extending the sensitizing effect to mortality cues suggests
that individuals who have higher levels of DA are more sensitive
to, and therefore will have more adverse reactions to, mortality
cues. COR theory suggests these people are more likely to perceive
mortality cues as threats to their well-being, experience stress, and
deploy resources to cope with the threats, the long-term result of
which is resource depletion and, more specifically, burnout (Hobfoll, 2001). In a similar vein, being sensitive to mortality cues in
the workplace, people high in DA are more ready to lower their
engagement level. Moreover, those who are more often concerned
with death are more inclined to be absent from work as a protective
strategy.
Hypothesis 4: DA will moderate the relationship between
exposure to mortality cues and outcomes (burnout, engagement, absenteeism), such that the relationship between mortality cues and its outcomes will be stronger for people who
are high in DA and weaker for those who are low in DA.

Study 1
The primariy purpose of Study 1 was to provide initial support
for our hypotheses in an occupational group that frequently experiences cues of mortality: nurses. Nurses experience these cues
through dealing with injured, sick, dying, or dead patients quite
frequently, and DA could have a relatively strong impact in this
occupation.

Method
Participants and procedure. The data for Study 1 came from
a data set focused on nurses work experiences and retention. All
participants were full-time acute care nurses from a professional
organization representing nurses in the Pacific northwestern region
of the United States. Participants were recruited from professional
nursing conferences and conventions, newsletters, and through
word-of-mouth. The varied recruitment methods prevent us from
calculating an exact response rate. However, a total of 620 nurses
expressed initial interest in participating in the study (by registering to participate at a project website), 438 (71%) of whom
completed the first survey in the data collection. The data set used
ultimately consisted of three waves of survey data. Participants
completed the Time 1 and Time 2 surveys approximately 9 months
apart in 2008 2009. Participants could choose to complete either
an online or a mailed hard-copy survey (with a postage-paid return
envelope). Then, participants completed a third web-based survey
in summer 2012 (Time 3). Incentives were provided for each
survey completed ($15 at Time 1 and $10 at Times 2 and 3). Time

1 and Time 2 participants also were entered in raffles for $50 gift
cards.
The final sample (matched across Times 1, 2, and 3) consisted
of 162 female Registered Nurses. The majority of the sample was
Caucasian (93%), with an average age of 42.46 (SD 10.29), and
an average of 17.95 years of experience as nurses (SD 12.04).
Most participants worked in a hospital or acute care setting, and
approximately 49% had at least a bachelors degree in the field of
nursing. Most participants (68%) worked the day shift and worked
approximately 35 hr per week.
Measures. For all nontrait measures, participants were asked
to use the past month as a time frame.
Mortality salience cues (Time 1). Mortality salience cues
were assessed using a shortened version the Death and Dying
subscale of the Expanded Nurses Stressors Scale (ENSS; French et
al., 2000). The scale consisted of five items ( .78) that assessed
experiences in which a nurse is exposed to the death and dying of
patients. Example items include A patient in my care died unexpectedly and I watched a patient suffer. Items were rated on a
frequency scale, ranging from 1 (never) to 5 (very often).
Burnout (Time 2). Burnout was measured using the ShiromMelamed Burnout Measure (Shirom & Melamed, 2006). This
scale consists of 14 items that measure three dimensions of burnout: physical fatigue (six items), cognitive weariness (five items),
and emotional exhaustion (three items). Items were rated on a
frequency scale, where 1 never and 5 always. A composite
measure of the 14 items ( .94) was used for the purposes of this
study.
Engagement (Time 2). Work engagement was measured using the short version of the Utrecht Work Engagement Scale
(UWES; Schaufeli, Bakker, & Salanova, 2006) during the Time 2
data collection. This scale consists of nine items that measure three
related dimensions of engagement: vigor (three items), dedication
(three items), and absorption (three items). All items were rated
along a 5-point Likert scale ranging from 1 (strongly disagree) to
5 (strongly agree). We tested our hypotheses with a composite
measure of engagement ( .92).
Trait DA (Time 3). DA was assessed using the shortened
version of the Revised DA Scale (RDAS; Thorson & Powell,
1992). This scale consisted of nine items and measured three
interrelated facets of DA: anxieties over not being (The total
isolation of death is frightening to me), fear of pain and helplessness (The pain involved in dying frightens me), and life after
death and decomposition (The subject of life after death troubles
me greatly). As recommended by the authors of the scale, a
composite score was used ( .77).
It is important to note here that our design is somewhat unconventional in the sense that the DA measure was obtained after all
of the other measures. However, because this is a trait-based
measure that would be expected to be reasonably stable over time,
this should not be problematic. Additionally, because of the sizable
gap between the first two waves of survey collection and Time 3,
it is unlikely that correlates of DA with measures obtained at
earlier time points reflect methodological artifacts such as common method biases.
Control variables. As exposure to mortality cues, over time,
could potentially relate to DA, occupational tenure was controlled
for in all analyses. Additionally, negative affectivity (NA) has
been shown to be strongly related to generalized anxiety (with

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DEATH ANXIETY AT WORK

relationship was plotted (see Figure 1) and, consistent with our

predictions, burnout was higher for those high in DA (simple
slope .34, p .001) than those low in DA (simple slope .07,
ns). Next, we tested this relationship with engagement as an
outcome and did not find a significant interaction term. As such,
Hypothesis 4 was partially supported, showing that people who are
high in DA are more sensitive to the negative effects associated
with mortality cues in terms of burnout, but not engagement.

approximately 62% of the variance overlapping; Jolly, Dyck,

Kramer, & Wherry, 1994), which is a covariate of DA. To ensure
that the effects of DA on burnout and engagement are not confounded with the effects of generalized anxiety, we controlled for
NA. NA was assessed using the 10-item ( .89) NA portion of
the Positive and Negative Affect Schedule (PANAS; Watson,
Clark, & Tellegen, 1988). Finally, it is possible that effects associated with mortality cues may be attributable to general job
demands rather than specifically to mortality cues; therefore, we
controlled for two types of job demands. Quantitative job demands
were assessed with the nine-item ( .87) Expanded Nursing
Stress Scale (French et al., 2000). Example items include I
worked too many hours in a shift and Patient acuity was too
high. Qualitative job demands were assessed using a four-item
scale ( .80) created for the purposes of this study. Example
items include The demands for work quality made upon me were
unreasonable.

Study 2
The first goal of Study 2 was to replicate the results of Study 1
using a different occupational groupfirefighters. For nurses,
most mortality cues concern the lives of their patients, whereas
these cues, in firefighters, involve both exposure to the injury and
death of others and threats to their own lives. In addition to
differences in mortality cues, there are significant gender differences across these two samples, where nurses are primarily women
(entirely women, in our sample) and firefighters are primarily men
(entirely men, in our sample). Next, we sought to replicate our
Study 1 findings using full versions of all measures (as opposed to
the abridged measures used in Study 1, which includes an additional dimension of the DA scale). Additionally, we measured DA
concurrently at the first time point to determine whether measurement order was an issue with Study 1. Showing similar DA effects
when it is administered at different time points relative to the other
measures helps strengthen our confidence in the generalizability of
our findings and in the trait-based nature of DA. Lastly, we wanted
to link DA to an objective measure of absenteeism, which was
available in the firefighters.

Results
Descriptive statistics and correlations among all variables are
provided in Table 1. Hierarchical moderated multiple regression
was used to test the hypotheses. In the first step, we entered the
control variables. In the second step, we entered the predictor and
moderator variables. In the third step, we entered a cross-product
of the predictor and moderator variables. Before computing this
cross-product term, we standardized all variables in order to reduce
interpretation issues associated with multicollinearity (Cohen, Cohen, West, & Aiken, 2003). Finally, we examined the change in R2
from Step 2 to Step 3 to determine whether there was a significant
effect of the moderating variable. Regression results are reported
in Table 2.
Hypotheses 1, that DA will relate positively with burnout, was
supported ( .20, p .01). Hypothesis 2, that DA will related
negatively to engagement, was supported ( .21, p .01).
These results indicate that nurses who report higher levels of DA
are more likely to display symptoms of burnout and less likely to
report high levels of work engagement.
Hypothesis 4 examined the moderating effect of trait DA in the
relationship between mortality salience cues and each outcome
(burnout and engagement). The significant interaction term (
.21, p .01) explained 4% additional variance in burnout, above
and beyond occupational tenure, mortality cues, and DA. This

Method
Participants and procedure. Firefighters from a major midwestern city participated in a grant-funded, two-wave survey study
designed to assess utilization of coping strategies. Participants
were recruited through direct contact by the researchers, and
through working with the Chief, who sent out a letter of support for
the study. Participants were sent hard-copy surveys (with an online
option), which consisted of several measures as part of the larger
study. The time points were spaced 3 months apart, and participants received $20 and $25 incentives for their participation for
each time point. A total of 128 usable surveys were returned for

Table 1
Descriptive Statistics and Correlations Among All Variables in Nurses
Measure
1.
2.
3.
4.
5.
6.
7.
8.

Tenure (T1)
NA (T3)
Qual demands (T2)
Quant demands (T2)
Mortality cues (T1)
Death anxiety (T3)
Burnout (T2)
Engagement (T2)

SD

17.95
1.64
2.15
3.00
2.10
2.55
2.57
3.41

12.04
.55
.75
.88
.80
.70
.80
.77

.01
.01
.17
.07
.14
.11
.16

2
.89
.07
.12
.12
.08
.06
.09

.80
.65
.22
.18
.31
.28

.87
.28
.22
.39
.24

.10
.25
.10

.77
.30
.31

.94
.66

.92

Note. n 162; r values .13 are significant at the .05 level; r values .18 are significant at the .01 level. TI data collected at Time 1; T2 data
collected at Time 2; NA negative affect; Qual Quality; Quant Quantity. Italicized values indicate internal consistency, where applicable. Dashes
indicate that internal consistency is not relevant.

SLITER, SINCLAIR, YUAN, AND MOHR

Table 2
Moderating Effect of Death Anxiety in Firefighter and Nurses

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Nurses
Variable

Step 1

Tenure
NA
Work demands
Mortality cues
Death anxiety
Mortality Anxiety
R2
R2

.14
.07
.40

Tenure
NA
Work demands
Mortality cues
Death anxiety
Mortality Anxiety
R2
R2

.21
.06
.30

.16
.16

.12
.12

Step 2

Firefighters
Step 3

DV: Burnout
.11
.14
.07
.08

.32
.32
.16
.14
.16
.11
.19
.21
.25
.05
.04
DV: Engagement
.18
.20
.10
.06
.25
.25
.02
.02
.19
.16
.13
.16
.18
.03
.02
DV: Absenteeism

Tenure
NA
Work demands
Mortality cues
Death anxiety
Mortality Anxiety
R2
R2

Step 1

Step 2

Step 3

.06
.14
.03

.06
.11
.06
.02
.52

.01
.01

.27
.26

.05
.05
.06
.03
.58
.20
.31
.04

.27
.01
.07

.05
.05
.00
.05
.01

.00
.00

.31
.01
.06
.20
.29
.14
.08
.02
.07
.00
.13
.21
.08
.08

.30
.06
.07
.19
.33
.14
.17
.02
.02
.11
.02
.14
.24
.12
.09
.01

Note. Beta weights provided are in their standardized form. DV dependent variable; NA negative affect.

p .05. p .01.

Time 1 and Time 2, resulting in a response rate of 23%. The final

group of participants were all male with an average age of 47.11
(SD 6.26). The majority were Caucasian (79%) and had worked
as a firefighter for an average of 20.9 years (SD 6.91).
Measures.
Mortality salience cues (Time 1). We assessed mortality salience cues using a traumatic stressors scale developed specifically
for firefighters by Allen (1995). The scale assesses 17 acutely
stressful events ( .85), with examples including An event that
placed YOU in danger of death or great injury and The mutilation and/or death of an adult. Respondents are asked to report how
often each event has occurred, ranging from 1 (never) to 5 (extremely often).
Trait DA (Time 1). DA was assessed using the full 25-item
( .85) version of the RDAS (Thorson & Powell, 1992), which
included the control, pain, and afterlife concerns facet (I will
leave careful instructions about how things should be done after I
am gone), which was omitted in Study 1. Items were again rated on
a 5-point agreement scale.
Burnout (Time 2). Burnout was assessed using the Burnout
Measure (Pines & Aronson, 1988). The Burnout Measure consists
of three subscales, each with seven items, assessing physical,
emotional, and mental exhaustion. Items were rated using a 7-point
frequency Likert scale, where 1 never and 7 always. For the
purposes of this study, a composite measure of burnout was used
( .87).

Engagement (Time 2). Work engagement was measured using the full 17-item ( .91) UWES (Schaufeli & Bakker, 2003).
Absenteeism. Data on absenteeism was obtained directly from
management of the fire department. Archival records data on absenteeism (i.e., the number of days missed) were provided for each of the
128 participants. Two months of this data were released following
Time 1 data collection, and it was matched to the employee survey
data.
Control variables. Tenure and NA were again controlled for in
all analyses. NA was again measured using the 10-item ( .88) NA
portion of the PANAS at Time 1. Work demands were also controlled
for, though a different archival measure was used as a proxy for
demands in Study 2. The number of dispatches was used as an
assessment of demands, where a dispatch is defined as any occasion
in which a fire unit is sent to an emergency (including fires, medical,
car accidents, false alarms, etc.). The month preceding Time 1 data
collection was used so that the reference point for the mortality cues
measure (i.e., the past month) would be consistent with this assessment of demands (M 59.4, SD 9.42; roughly six calls per 24-hr
shift). As a higher number of dispatches could potentially relate to the
outcomes variables, dispatches were controlled for.

Results
Descriptive statistics and correlations among all variables are
provided in Table 3. The same hierarchical regression procedures

DEATH ANXIETY AT WORK

term ( .20, p .01) explained an additional 4% of the variance

in burnout. This interaction was graphed (see Figure 2), and the
relationship was as predicted. That is, the relationship between
mortality cues and burnout was stronger for those high in DA
(simple slope .30, p .01) than those low in DA (simple
slope .19, ns). Once again, the shape of the interaction was
consistent with our predictions. In further examining Hypothesis 4,
DA did not significantly moderate the relations between mortality
cues and engagement or absenteeism.

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Discussion

Figure 1. Moderating effect of trait death anxiety in the relationship

between mortality cues and burnout in nurses.

were used to test the main effect and moderation hypothesis, and
these results are presented in Table 2. Hypotheses 1, that DA
would relate positively with burnout, was supported ( .53, p
.001). Hypothesis 2, that DA would related negatively to engagement, was also supported ( .25, p .01). Consistent with our
Study 1 findings about nurses, these results indicate that firefighters with higher DA report more burnout symptoms and less work
engagement.
Hypothesis 3, that DA would be related to absenteeism through
burnout, was assessed through bootstrapping (N 1,000; Preacher
& Hayes, 2008). Unbiased 95% confidence intervals were also
estimated. The indirect effect of DA on absenteeism through
burnout was significant ( .27; 95% CI [.04, .63]), providing
support for Hypothesis 3.
Hypothesis 4 examined the moderating effect of trait DA in the
relationship between traumatic events at work (exposure to death
cues) and each outcome (burnout, engagement, and absenteeism).
When examining burnout as an outcome, the significant interaction

Despite multiple calls for research incorporating DA and mortality cues into workplace literature (e.g., Grant & Wade-Benzoni,
2009; Stein & Cropanzano, 2011), no studies (to our knowledge)
have done so. The current study was a first step toward understanding how trait DA can directly impact workplace outcomes,
and how DA could exacerbate the relationship between exposure
to workplace mortality cues (traumatic workplace events) and
employee outcomes.
Using both nurses and firefighters occupations for which mortality cues are highthe results supported the notion that DA can
have a direct, negative impact on employees. Indeed, across both
studies, DA related to higher levels of burnout, and lower levels of
engagement. As a trait component that consistently exposes individuals to concerns about the loss of life, DA might build up to
burnout. Consistent with COR theory (Hobfoll, 2001), individuals
high in DA withdraw from their role performance by decreasing
their levels of engagement. It is important to note that Study 2 was
a relatively strong replication. There were many differences in
measures (abridged vs. full measures) and study design (8-month
vs. 3-month lag time; measure of DA at a different time point;
sample size). Despite this, the means of many variables (e.g., DA;
mortality cues) were similar across studies, as were the effect sizes
and patterns of the interactions. Moreover, the simple slopes
showed the exact same pattern as Study 1, and the specific slope
values differed by less than .10 between Study 1 and Study 2.
Additionally, in firefighters, DA related to higher levels of
absenteeism, and this relationship was mediated by burnout. The
mediating effect of burnout is consistent with the contention of the
COR theory that individuals often respond to stress by adopting a
defensive posture (Hobfoll, 2001). The detrimental effect of DA

Table 3
Descriptive Statistics and Correlations Among All Variables in Firefighters
Measure
1.
2.
3.
4.
5.
6.
7.
8.

Tenure (T1)
NA (T1)
Demands (T1)
Mortality cues (T1)
Death anxiety (T1)
Burnout (T2)
Engagement (T2)
Absenteeism (T2)

SD

20.91
1.51
59.4
2.33
2.52
2.95
3.50
1.29

6.91
0.39
9.42
0.39
0.55
0.77
0.51
1.32

.18
.08
.12
.01
.03
.28
.01

2
.88
.03
.03
.06
.13
.06
.05

.23
.04
.09
.07
.02

.85
.22
.15
.10
.17

.85
.53
.23
.23

.87
.36
.30

.91
.19

Note. n 128; r values .17 are significant at the .05 level; r values .22 are significant at the .01 level. Cronbachs alpha is shown along the diagonal
where applicable. T1 data collected at Time 1; NA negative affect; T2 data collected at Time 2. Italicized values indicate internal consistency, where
applicable. Dashes indicate that internal consistency is not relevant.

SLITER, SINCLAIR, YUAN, AND MOHR

plausible explanation is that 2 months of absenteeism data were

not suitably sensitive enough to detect a relationship between
mortality cues and absenteeism (see Bamberger & Biron, 2007, for
an explanation of the benefits of longer periods of data collection
for absenteeism).

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Practical Implications

Figure 2. Moderating effect of trait death anxiety in the relationship

between mortality cues and burnout in firefighters.

on employee well-being (i.e., burnout) can further translate into

undesirable work-related outcomes (i.e., increased absenteeism).
We also investigated how DA might moderate the relationship
between mortality cues (e.g., traumatic stressors) and employee
outcomes. First, mortality cues directly related to burnout (in
nurses) and absenteeism (in firefighters). In terms of the interactions, the results showed some support for our hypotheses. DA was
shown to exacerbate the relationship between exposure to mortality cues and burnout (but not engagement or absenteeism) in both
nurses and firefighters with very similar effect sizes across samples. That is, people who are high in DA are more sensitive to the
mortality cues and may be more vulnerable to burnout, consistent
with the loss spiral of resources (Hobfoll, 2001). As other personal
qualities that have been demonstrated to be important coping
resources (e.g., resilience and humor; Hobfoll, 2001), DA might
represent the opposite current and future resource loss (i.e.,
burnout) at the trigger of death-related cues.
Interestingly, after controlling for NA and tenure, mortality cues
did not have a significant association with absenteeism. This
finding may be indicative of a so-called macho or masculinity
culture that has been shown to manifest in firefighting and other
similar occupations (e.g., Hall, Hockey, Robinson, 2007). In this
type of culture, firefighters are not supposed to react badly to
mortality cues, and are even socially encouraged to make light of
these situations, such as through the use of dark/gallows humor
(e.g., Sliter, Kale, & Yuan, 2013). As such, it may be that being
absent as a result of exposure to mortality cues is a violation of
these cultural norms, and may be less likely to occur. This finding
could also be demonstrating a more typical absenteeism culture, in
which there may be either permissive or rigid norms for absenteeism (e.g., Bamberger & Biron, 2007). Given the often dangerous
nature of firefighting, it is likely that the absence culture is rigid,
discouraging the use of time off for psychological reasons. A final

Our findings could potentially have important practical implications in both stress management interventions in jobs in which
mortality cues are frequently experienced as well as in career
choice and selection. As DA has been shown to be relatively
resistant to change (e.g., Rasmussen et al., 1998), assessment of
this construct could potentially inform career choice. That is, DA
could be assessed by career counselors, who may be able to rule
out certain occupations for people who are high in DA. This
counseling can begin as early as secondary school or college, or
extend even into higher levels of education after a person has
chosen a given career path. For example, career counseling for
nurses and doctors could focus on choices between different professional specializations where death is more (e.g., oncology) or
less (e.g., rehabilitation) likely to be frequently encountered.
However, for many employees, feelings about death may not be
salient until after they encounter it on the job. Even in jobs where
mortality cues are high, employees might not personally encounter
death until they have worked for several months or even years, and
hence mortality cues and DA would not interact (e.g., such as with
firefighters in a small, suburban firehouse). Thus, vocational counseling programs should be supplemented with well-designed, onthe-job death education programs. The well-designed is especially important, as many programs have been shown to have very
small or no effects on DA. As Mooney (2005) put it, Attempts to
reduce death anxiety through educational programs have resulted
in a substantial volume of literature. However, this impressive
quantity of research has not been matched by its quality (p. 427).
Given the trait-based nature of DA, an effective death education
program has to be long-term, relatively intensive, and contain
reflection and examination of attitudes rather than dictation of how
to reduce DA (Mooney, 2005).

Limitations and Future Directions

Though the current study has several strengths (e.g., multiple
time points, two unique, interesting samples), it is not without
limitations. Most of the variables of interest were measured using
self-report measures, which assess self-perceptions that might be
inaccurate or biased due to the method of collection (Podsakoff,
Mackenzie, Lee, & Podsakoff, 2003). Though we took steps to
reduce this bias, such as measuring the predictor and outcomes at
different time points, we cannot completely rule out these effects.
It is important to note, however, that some researchers (e.g.,
Spector, 2006) have argued that common method variance-related
biases are an overstated problem, and the variables in the current
study are likely best assessed using self-report.
Second, due to the relatively low response rate for the firefighter
sample and the imperfectly calculated response rate for the nurses
(due to recruitment method), there is the possibility that sample
bias impacted the results. That is, perhaps more veteran employees
who experienced higher levels of DA and mortality cues were

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DEATH ANXIETY AT WORK

more motivated to participate in the study, and would therefore

skew the results. However, we do not believe this is the case for
several reasons. First, both studies were part of larger, grantfunded research projects with different espoused purposes than an
investigation of mortality cues and DA. As such, differing levels of
the study variables should not have motivated (or discouraged)
participation. Second, specific to the firefighter sample, we were
more likely to recruit veteran firefighters simply due to the characteristics of the sample population. That is, in that fire department, there is a very low retirement and hire rate (partially due to
economic concerns, which are faced by many major cities). Our
older sample, therefore, represented the veteran nature of that
department and not a sample bias (where only a very small portion
of firefighters have fewer than 10 years of experience). A final
indicator that sample bias was not a major concern in the study was
that, despite different occupations and different recruitment methods, the resultsincluding directions, effective sizes, and interaction formswere very similar across studies. These findings demonstrate the strength of the generalizability of these findings and
that sample bias, within each study, is unlikely to have had a
substantial influence on the findings.
Finally, the occupations we studied experience higher levels of
mortality cues than many others. Working in these occupations for
many years may have shaped trait levels of DA, where some
employees may have been more likely to become anxious about
death due to exposure. As such, exposure to events might have
shaped the trait, which, in turn, exacerbates symptoms of future
exposure. We controlled for occupational tenure in both groups,
given that length of time working in the occupation is a viable
proxy for exposure to mortality cues in that occupation. Given the
relatively high tenure in both samples (18 years for nurses, and 20
years for firefighters), it may be that we assessed the survivors
of DA. That is, people who have remained in the organizations,
even those with high DA, may have developed coping skills that
enable them to remain in the occupation. People who could not
cope with mortality cues may have washed out of their
respective occupations early. It may be that DA has an even
more profound effect on new employees in the organization, a
group that was undersampled in the current study. As such, our
findings may only be a conservative test of the true relationship
of DA in the workplace. All this points to the need for more
longitudinal research on DA at work; understanding how this
trait can change due to exposure to work-related mortality cues,
as well as how people learn to cope with mortality cues, is
important in terms of occupational health outcomes.
In terms of other future research directions, we focused on DA
in the current study. However, Grant and Wade-Benzoni (2009)
proposed that death reflection could be another, more adaptive,
process by which workplace mortality cues might affect employees. As such, future research could investigate this process, starting
with development of a scale for death reflection. Along these lines,
it would be valuable to investigate both DA and death reflection
across age groups, which is particularly important given the aging
workforce. Indeed, as people age, death becomes more salient
(Neimeyer, 1988), and this may impact levels of DA and death
reflection, which may impact employee outcomes.
Additionally, particularly in Study 2, our mortality cue measure
focused on traumatic events. As mentioned earlier, most (if not all)
traumatic events are mortality cues, but not all mortality cues are

traumatic events. As such, distinguishing the effects of traumatic

versus nontraumatic mortality cues would give a clearer picture of
how these cues function from a more holistic sense, and guidance
can be found in Grant and Wade-Benzonis (2009) typology of
mortality cues. Finally, we investigated in the current study the
outcomes of DA in two job types (nurses and firefighters) that
expose employees to a high frequency of mortality cues. As such,
future research could potentially investigate the impact of DA in
other jobs, including both jobs in which mortality cues are common and jobs in which these cues may not be present (e.g., office
workers). It is possible, and has even been proposed (Grant &
Wade-Benzoni, 2009), that DA can impact employees regardless
of occupation, and this is a ripe area for further understanding the
consequences of this interesting individual difference.

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Received May 28, 2013

Revision received November 20, 2013
Accepted November 25, 2013

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