A new study published in Scientific Reports suggests that young adults who fret about rejection in close relationships also tend to fear death more, and that this death anxiety is linked to higher levels of anxiety, depression and other distress. The researchers say the connection depends on whether individuals view death as the end of existence or as a transition to another form of life or continuity.
Death anxiety refers to the worry and dread surrounding the end of human life. While it is normal to contemplate mortality occasionally, psychologists increasingly see persistent fear of death as a shared underpinning of various mental health conditions, including anxiety disorders, depression and obsessive-compulsive or somatic symptom disorders.
The focus on mortality tends to intensify during emerging adulthood, the period in the late teens and twenties when people forge independent identities and face major life transitions. Previous work has shown fear of death tends to peak in a person’s twenties.
Attachment style — the habitual pattern with which a person relates to others in close relationships — also appears to shape how young adults cope with mortality. Four attachment patterns are commonly described: secure (positive views of self and others), preoccupied (negative self-view, positive view of others), dismissing (positive self-view, negative view of others), and fearful (negative views of both self and others).
Individuals with a secure attachment style generally cope well under stress and seek comfort from loved ones, while those with insecure styles may rely on less-effective emotional regulation strategies. A 2025 meta-analysis of 18 studies linked higher attachment anxiety or avoidance with greater fear of death.
Beyond relationship patterns, how a person conceives of death also matters. The ontological representation of death captures whether someone believes death annihilates the self or signifies a passage to another form of existence, whether literal or symbolic through a lasting legacy.
The Italian researchers, led by associate professor Alessandro Musetti of the University of Parma, explored how these relational and existential factors interact to influence internalising symptoms such as depression, anxiety, obsessive-compulsive symptoms and somatic complaints. Internalising symptoms describe inward-directed problems including depressed mood and anxious rumination.
“Death anxiety is increasingly recognised as a factor involved in many forms of psychological distress, including anxiety, depression, obsessive-compulsive symptoms, and somatic complaints,” Musetti said. “However, we still know relatively little about why some people are more vulnerable to death anxiety than others, and why death anxiety seems to affect some individuals more strongly. We wanted to integrate attachment theory with existential psychology by examining whether attachment styles are linked to internalizing symptoms through death anxiety, and whether this process depends on how people fundamentally represent death, either as total annihilation or as a form of passage or continuity.”
The study drew on data from 640 Italian young adults aged 18 to 22, with an average age of about 20.5 years. The sample was predominantly female (83.4%) and mostly students or working students (62.7% and 28.8%, respectively). Religious affiliation was diverse: 39.1% identified as agnostic, 30.6% as atheist, and 30.3% as religious believers.
Participants were recruited via social media and completed a suite of online questionnaires to assess attachment styles (the Relationship Questionnaire), death anxiety (a 15-item true-or-false measure including “I am very much afraid to die”), the Testoni Death Representation Scale (rating whether death is a passage or annihilation), and four categories of internalising symptoms over the preceding fortnight: depression, anxiety, somatic symptoms and obsessive-compulsive symptoms.
Using conditional process analysis and controlling for gender, the researchers first mapped how attachment related to fear of mortality. They found an average death anxiety score of 9.31 out of 15. Higher attachment anxiety (preoccupied style) correlated with greater death anxiety, while higher attachment avoidance (dismissing style) correlated with lower death anxiety. Secure and fearful attachment styles did not show a link when all four styles were considered together.
Crucially, the impact of death anxiety on mental health varied with people’s beliefs about death. Death anxiety predicted worse anxiety, obsessive-compulsive symptoms and somatic symptoms only among those who viewed death as total annihilation; for those who saw death as a passage, higher death anxiety did not correspond to elevated levels of these three symptom types.
Among annihilation-believing participants, a preoccupied attachment style was indirectly associated with greater anxiety, obsessive-compulsive and somatic symptoms via heightened death anxiety. By contrast, a dismissing attachment style showed a negative indirect association with these symptoms through lower death anxiety, though the authors cautioned that this should not be interpreted as a sign of overall psychological health, noting that dismissing attachment was also directly linked to higher somatic symptoms in other analyses.
Depression followed a different pattern. Whether death was viewed as annihilation or as a passage did not alter the link between death anxiety and depressive symptoms. Instead, preoccupied attachment was indirectly linked to greater depressive symptoms through death anxiety across the board, while preoccupied and fearful attachments were directly associated with worse symptoms across all four mental health domains. Secure attachment, conversely, was directly associated with lower depression and anxiety.
“Our findings suggest that psychological distress is influenced not only by how people relate to others, but also by how they make sense of their own mortality,” Musetti explained. “At the same time, the way people understand death appears to matter: when death is experienced as the complete end of personal existence, death anxiety seems more strongly connected to several forms of psychological distress.”
He also noted a surprising aspect of the results: “One finding that surprised us was that the ontological representation of death mattered for anxiety, obsessive-compulsive, and somatic symptoms, but not for depressive symptoms,” adding that depression may be connected to existential concerns through somewhat different mechanisms than other forms of distress.
The researchers say the findings fit with previous PsyPost-covered work suggesting death anxiety and feelings of relational disconnection help explain how attachment anxiety relates to problematic social media use. They also align with earlier research indicating existential anxiety can illuminate links between lower meaning in life and greater depressive symptoms among different populations.
Musetti cautioned that, while statistically significant, the effects were modest in magnitude, a common feature of research into complex psychological phenomena. He stressed that attachment style or death anxiety alone do not determine mental health outcomes, and that existential concerns are only one piece of a broader puzzle involving relationships, emotional regulation, personality and social context.
A key limitation is the cross-sectional design, which cannot establish causality. The sample’s composition — predominantly young Italian women, largely students — limits generalisability to men, older adults and other cultural or religious backgrounds. Participants were recruited non-randomly, and the study relied on brief self-report measures rather than clinical interviews, with some scales showing only modest reliability.
The authors advocate longitudinal research to clarify causal pathways and recommend that clinicians consider the potential value of integrating relationship-focused approaches with existential or meaning-making therapies for young adults who exhibit a preoccupied attachment style and view death as annihilation, provided such interventions respect the individual’s worldview.
“Our findings point to the importance of examining these relationships over time to better understand how attachment, death anxiety, and psychological symptoms influence one another,” Musetti added. “We are also interested in whether similar processes operate across different age groups and cultural contexts, since beliefs about death are deeply shaped by culture and life experience.”
The study was titled “Adult Attachment, Death Anxiety, Representation of Death, and Depression, Anxiety, Obsessive-compulsive, and Somatic Symptoms in Emerging Adulthood: A Moderated Mediation Model,” and is attributed to Alessandro Musetti, Andrea Zagaria, Vittorio Lenzo, Gianluca Santoro and Adriano Schimmenti.
