Death Anxiety and Proximal Defense Strategies Among Female College Students During the First Wave of the COVID-19 Pandemic

Background: During the COVID-19 pandemic, young adults, including college students, had the lowest rates of compliance with public health recommendations aimed at reducing the spread of the virus. The COVID-19 pandemic likely heightened awareness of mortality and had the potential to increase individuals’ death anxiety. Terror Management Theory and the Terror Management Health Model have both demonstrated that individuals cope with conscious thoughts of death by engaging in a) health-promoting behaviors (e.g., masking) or b) patterns of thoughts or behaviors that facilitate avoidance (e.g., drinking to cope). Examining how female college students cope with death anxiety in the context of COVID-19 may yield findings that can inform public health efforts. Purpose: The current study examined the association between death anxiety, avoidance of death anxiety, mask use, and alcohol use frequency during the first wave of the COVID-19 pandemic. The association between these variables were examined longitudinally in a sample of female college students who used alcohol. Methods: A sample of 157 female college students completed a baseline survey that occurred prior to the outbreak of the COVID-19 pandemic and included measures of death anxiety, avoidance of death anxiety, and alcohol use frequency. Participants completed a follow-up assessment during the first wave of the COVID-19 pandemic and reported their mask use, as well as levels of death anxiety, avoidance of death anxiety, and alcohol use frequency. Cross-lagged panel modeling was used to examine whether baseline death anxiety predicted mask use and alcohol use frequency at follow-up. Findings: This study found that 1) baseline death anxiety did not predict follow-up mask use either directly or indirectly (through avoidance of death anxiety) and 2) baseline death anxiety also did not predict alcohol use frequency at follow-up directly or indirectly (through avoidance of death anxiety). Relatively strong correlations were observed among the independent variables, which could have decreased the ability to detect the hypothesized associations. A series of post hoc analyses were conducted to further elucidate the association between key variables of the study’s primary model. The results of these additional analyses did not yield results supporting the hypothesized associations. Descriptive and exploratory analyses revealed that alcohol use frequency decreased in the study sample from baseline (pre-COVID-19) to follow-up (first wave of the COVID-19 pandemic). Furthermore, racial/ethnic group differences were observed in mask use, such that white women in the sample reported more frequent use of masks as compared to women who identified as Hispanic/Latinx. Conclusions: Participants in the current study did not report an increase in death anxiety from baseline (pre-COVID-19 pandemic) to follow-up (first wave of the COVID-19 pandemic). The absence of this expected increase in death anxiety raised questions about the applicability of the theorized model as well as the measurement approach that was employed within the context of the COVID-19 pandemic. Nevertheless, it is also possible that young adult women experienced less-than-expected concerns regarding death during the COVID-19 pandemic because they were not members of an age group identified as having a heightened risk for hospitalization or death as a result of COVID-19.