Young adults who are especially worried about rejection in their close relationships tend to report a greater fear of death, which in turn is linked to more symptoms of anxiety, depression, and other forms of distress, according to a new study published in Scientific Reports. The findings also suggest that for several types of symptoms, this link depends on whether a person views death as the complete end of their existence or as a transition to another state.
Death anxiety refers to the worry, dread, or apprehension that comes from knowing that human life eventually ends. While it is normal to think about mortality from time to time, many psychologists now view persistent or poorly managed fear of death as a shared factor underlying many different mental health conditions. It can show up as panic or constant worry in anxiety disorders, feelings of hopelessness in depression, repetitive rituals aimed at preventing harm in obsessive-compulsive disorder, or extreme worry about physical sensations in somatic symptom disorders.
These existential concerns often become especially prominent during emerging adulthood, the developmental period spanning the late teens and twenties. As young people build their independent identities and confront major life transitions, they frequently grapple with questions about meaning and mortality, with prior research showing that fear of death tends to peak during a person’s twenties.
How well a young adult copes with the reality of mortality has been linked to their attachment style, which is the characteristic way a person relates to others in close relationships based on their internal sense of self-worth and their trust in other people. Psychologists often categorize adult attachment into four patterns: secure (positive view of both self and others), preoccupied (negative view of self, positive view of others), dismissing (positive view of self, negative view of others), and fearful (negative view of both self and others).
People with a secure attachment style generally manage stress well and turn to loved ones for comfort. In contrast, those with insecure styles rely on less helpful strategies to regulate their emotions, and a 2025 meta-analysis of 18 studies found that adults with higher attachment anxiety or attachment avoidance consistently report a greater fear of death.
Individuals with a preoccupied attachment style tend to experience high attachment anxiety, meaning they are overly sensitive to rejection and abandonment, which can amplify their distress when thinking about death. Those with a dismissing style exhibit high attachment avoidance, meaning they prize extreme independence and suppress their emotional needs, often trying to push thoughts of mortality out of their awareness.
Beyond relationship patterns, how a person fundamentally defines death also shapes how they handle existential fear. In psychology, this belief is called the ontological representation of death, which captures what a person believes happens to their core identity when they die. Some people view death as total annihilation, meaning the absolute and permanent extinction of the self. Others view death as a passage, meaning a transition to another form of existence, whether through a literal afterlife or a symbolic legacy that allows some part of their identity to continue.
The research, led by Alessandro Musetti, an associate professor of dynamic psychology in the Department of Humanities, Social Sciences and Cultural Industries at the University of Parma in Italy, examined how these relational and existential factors work together. Psychologists use the term internalizing symptoms for inward-directed problems such as depression, anxiety, obsessive thoughts, and unexplained physical complaints.
“Death anxiety is increasingly recognized as a factor involved in many forms of psychological distress, including anxiety, depression, obsessive-compulsive symptoms, and somatic complaints,” Musetti told PsyPost. “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.”
To investigate this, the researchers analyzed data from 640 Italian young adults between the ages of 18 and 22, with an average age of about 20.5 years. The sample was predominantly female (83.4 percent) and consisted mostly of students (62.7 percent) or working students (28.8 percent). In terms of religious views, 39.1 percent identified as agnostic, 30.6 percent as atheist, and 30.3 percent as religious believers.
Participants, recruited through social media, completed a series of online questionnaires. To measure attachment styles, the researchers used the Relationship Questionnaire, which asks participants to rate on a 1-to-7 scale how well four short paragraphs describing secure, dismissing, preoccupied, and fearful attachment patterns apply to them. Death anxiety was measured using a 15-item true-or-false questionnaire that included statements like “I am very much afraid to die.”
Participants also completed the Testoni Death Representation Scale, which uses six items rated on a 1-to-5 scale to determine the degree to which a person views death as a passage versus definitive annihilation. Finally, the researchers assessed four types of internalizing mental health symptoms over the prior two weeks: depression, anxiety, somatic symptoms (such as unexplained physical aches and pains), and obsessive-compulsive symptoms (repetitive unpleasant thoughts or urges).
The researchers used a statistical technique called conditional process analysis, which tests whether an indirect pathway between two variables changes depending on a third factor, while controlling for gender. In the initial look at how attachment related to fear of mortality, participants scored an average of 9.31 out of 15 on the death anxiety scale. Higher scores on preoccupied attachment were associated with higher death anxiety, whereas higher scores on dismissing attachment were associated with lower reported death anxiety.
Secure and fearful attachment styles were not linked to death anxiety once all four styles were considered together. The finding for dismissing attachment differs from the 2025 meta-analysis described earlier, which linked attachment avoidance to greater fear of death. The authors suggest that people with a dismissing style may push death-related thoughts out of awareness rather than feel less threatened by mortality.
When looking at how death anxiety connected to mental health, the researchers found that a participant’s view of death played a moderating role for three of the four symptom categories. Death anxiety was linked to worse anxiety, obsessive-compulsive, and somatic symptoms, but only among young adults who strongly viewed death as total annihilation. For participants who viewed death as a passage to another state of existence, higher death anxiety was not linked to higher levels of these three symptom types.
Consequently, the indirect pathways linking attachment styles to these three symptoms operated only among those holding annihilation beliefs. For young adults who believed death is the complete end of existence, having a preoccupied attachment style was indirectly linked to greater anxiety, obsessive-compulsive, and somatic symptoms through heightened death anxiety.
Among those same annihilation-believing participants, by contrast, a dismissing attachment style had a negative indirect association with anxiety, obsessive-compulsive, and somatic symptoms because these individuals reported lower death anxiety. However, the authors caution against interpreting a dismissing attachment style as psychologically healthy. When looking at direct relationships outside of the death anxiety pathway, dismissing attachment was directly linked to higher levels of unexplained somatic symptoms, which the authors suggest may indicate that suppressing emotions and relationship needs can contribute to physical complaints even when conscious fear of death is kept at bay.
Depression followed a different pattern than the other three mental health domains. Whether a participant viewed death as total annihilation or as a passage did not alter the link between death anxiety and depressive symptoms. Instead, preoccupied attachment was indirectly associated with greater depressive symptoms through increased death anxiety across the board, regardless of what the person believed happens after death. Additionally, preoccupied and fearful attachment styles were directly linked to worse symptoms in all four mental health categories, while secure attachment 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.”
“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,” Musetti noted. “This suggests that depression may be connected to existential concerns through somewhat different mechanisms than other forms of psychological distress.”
The findings are consistent with research by Musetti and colleagues covered by PsyPost in 2025, which found that death anxiety and feelings of relational disconnectedness helped explain the link between attachment anxiety and problematic social media use. Both studies indicate that fear of mortality helps explain how insecure attachment is linked to psychological difficulties, though the earlier study focused on problematic social media habits across a wide adult age range while the new research examined internalizing mental health symptoms in young adults.
The depression results also align with a study covered by PsyPost in 2023, which examined broader existential anxiety and meaning in life among adult mental health professionals rather than death anxiety and attachment styles in emerging adults, and similarly found that existential anxiety helped explain the link between lower meaning in life and more severe depressive symptoms.
Musetti pointed out that the statistical relationships uncovered in the study should be kept in perspective. “The effects were statistically significant but generally modest in magnitude, which is common when studying complex psychological phenomena,” he said. “We are not suggesting that attachment style or death anxiety alone determine mental health outcomes. Rather, our findings indicate that existential concerns may be one piece of a broader psychological puzzle that includes relational experiences, emotional regulation, personality, and social context.”
As with all research, there are some caveats to consider when interpreting these findings. Because all the survey data were collected at a single point in time, the study cannot establish cause and effect. While psychological theory suggests that attachment patterns develop early and shape later fears and symptoms, it is also possible that experiencing depression or anxiety makes a young person feel more insecure in their relationships or more frightened of dying.
“A key caveat is that this was a cross-sectional study,” Musetti emphasized. “The findings identify associations that are consistent with a theoretically grounded model, but longitudinal research is needed to clarify causal pathways. Additionally, representing death as a passage should not be interpreted simply as being religious. The construct we studied concerns a person’s fundamental understanding of what happens to the self after death and cannot be reduced to religious affiliation alone.”
There are a few other limitations to keep in mind. Over 83 percent of the participants were young Italian women, and most were students, meaning the results may not generalize equally to men, older adults, or people from different cultural and religious backgrounds where views on death and the afterlife differ. Participants were recruited through social media and word of mouth rather than randomly selected, and the authors note that mediation analyses based on a single time point can overstate indirect pathways. In addition, the researchers relied on brief self-report screening tools rather than clinical interviews, and the two-item measures for depression and somatic symptoms showed only modest internal consistency.
Future studies could track diverse groups of young people over several years to confirm the order in which attachment insecurities, existential beliefs, and mental health symptoms develop. The authors suggest, though this was not tested, that clinicians working with young adults who have a preoccupied attachment style and view death as total annihilation might combine relationship-focused therapy with existential approaches that help build a sense of meaning and continuity, as long as such approaches respect a person’s own worldview.
“One important next step is to examine these relationships longitudinally to better understand how attachment, death anxiety, and psychological symptoms influence one another over time,” Musetti added. “We are also interested in studying 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, “Adult Attachment, Death Anxiety, Representation of Death, and Depression, Anxiety, Obsessive-compulsive, and Somatic Symptoms in Emerging Adulthood: A Moderated Mediation Model,” was authored by Alessandro Musetti, Andrea Zagaria, Vittorio Lenzo, Gianluca Santoro, and Adriano Schimmenti.
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