The study recruited 200 participants aged 60 and older, with a mean age of 69.79 years and a standard deviation of 7.19 years, using stratified proportional random sampling between May and July 2025. Each participant completed standardized questionnaires measuring three constructs: death anxiety, hope, and perceived social support. The research team, which also included Kosar Hoseini of Mazandaran University of Medical Sciences and Shahab Papi of Lorestan University of Medical Sciences, then analyzed the data using multiple linear regression and structural equation modeling, running the analyses in SPSS 24 and AMOS 24 with a significance threshold of p less than 0.05. The work was approved by the Research Ethics Committee of Mazandaran University of Medical Sciences and conducted in accordance with the Declaration of Helsinki.

Death anxiety, sometimes called thanatophobia, is far more than a fleeting worry about mortality. In older adults it has been linked to diminished quality of life, sleep disturbance, and heightened psychological distress. As people confront chronic illness, bereavement, and the narrowing of their remaining time horizon, thoughts of death can shift from abstract philosophy to concrete preoccupation. Psychologists have long noted that this anxiety is not distributed evenly: some elders face the end of life with equanimity while others are gripped by dread. Understanding what buffers that dread has therefore become a central question in geriatric mental health research.

Perceived social support, the subjective sense that one is loved, valued, and can count on others, has repeatedly emerged as a protective factor in this literature. But the Iranian team noticed a gap: while the association between support and death anxiety had been documented, the underlying mechanisms remained underexplored. Knowing that support correlates with lower anxiety tells clinicians little about where to intervene. If the relationship is direct, then simply increasing contact might suffice. If it is indirect, flowing through some intermediate psychological state, then that intermediate state becomes the real therapeutic target. The researchers hypothesized that hope, defined in the tradition of positive psychology as goal-directed thinking combining the will to pursue goals with the perceived ability to find pathways toward them, might be that crucial link.

The structural equation modeling results were striking in their clarity. Perceived social support strongly and positively predicted hope, with a standardized coefficient of 0.72 and a p-value of 0.001, indicating that elders who felt well supported reported substantially higher levels of hopeful thinking. Hope, in turn, strongly and negatively predicted death anxiety, with a standardized coefficient of negative 0.62, also at p equal to 0.001. In other words, the more hopeful the participants were, the less death anxiety they reported. These two paths together traced a coherent psychological pipeline from social connection to reduced existential distress.

The most revealing result, however, was what did not appear. The direct path from perceived social support to death anxiety was statistically negligible, with a standardized coefficient of just 0.021 and a p-value of 0.886, nowhere near significance. When the researchers bootstrapped the indirect effect, the pathway running from support through hope to death anxiety, it was significant, with a standardized coefficient of negative 0.45 and a 95 percent confidence interval spanning negative 0.70 to negative 0.21. Taken together, this pattern is consistent with full mediation: social support appears to lower death anxiety only insofar as it first builds hope. Remove hope from the model, and the protective association between support and death anxiety essentially vanishes.

For readers unfamiliar with the statistics, full mediation is a demanding standard. It does not merely show that hope plays some role alongside other mechanisms; it suggests that hope carries essentially all of the effect. The bootstrapping procedure used to test the indirect effect is considered robust because it resamples the data thousands of times to estimate the confidence interval of the mediated pathway, avoiding the distributional assumptions that can plague smaller samples. The large standardized coefficients involved, 0.72 for support predicting hope and negative 0.62 for hope predicting anxiety, are unusually strong for psychological research, where effect sizes of this magnitude are rare. That strength lends credibility to the mediation model, though it also raises questions the cross-sectional design cannot answer.

That design limitation deserves emphasis. Because all measurements were taken at a single point in time, the study can establish patterns of association but not causal direction. It is theoretically possible, for instance, that hopeful people are better at eliciting support from others, or that low death anxiety frees cognitive resources that make hopeful goal pursuit easier, creating feedback loops rather than a one-way pipeline. The authors themselves are explicit on this point, calling for future longitudinal or intervention studies to test whether deliberately cultivating hope actually reduces death anxiety over time. Only randomized trials that boost hope and track anxiety prospectively can confirm the causal chain the model implies.

Even with those caveats, the practical implications are compelling. If hope is the conduit through which social support eases existential fear, then interventions should aim at both ends of the pipeline. Strengthening social networks, through family engagement, community programs, senior centers, and regular contact with caregivers, may build the reservoir of perceived support from which hope draws. Meanwhile, hope-focused psychological interventions, such as those derived from hope therapy, goal-setting frameworks, and meaning-centered approaches used in palliative care, could directly amplify the mediating mechanism. The findings align with a broader movement in geriatric mental health that treats positive psychological resources not as luxuries but as active ingredients in resilience against mortality-related distress.

The study also carries a quiet message for families and clinicians who care for aging loved ones. Companionship matters, but the research suggests its deepest value may lie in what it makes psychologically possible: a sense that the future still holds attainable goals and navigable paths. An older adult surrounded by supportive relationships but without hope may remain vulnerable to death anxiety, while one whose hope is nurtured, whether through relationships, purpose, or structured therapy, may approach life’s final chapter with markedly less dread. As populations worldwide age rapidly, translating this insight into scalable programs for fostering hope among elders could become a meaningful public health priority. The open-access study, published on 29 September 2026 with no external funding, offers a testable roadmap for that effort, and the next phase of research will determine whether hope can be deliberately planted and grown where fear once took root.

Subject of Research: The mediating role of hope in the relationship between perceived social support and death anxiety in older adults

Article Title: Hope as a mediator in the relationship between social support and death anxiety in older adults

Article References: Zoleikani, Z., Hoseini, K., Papi, S., & Jorbonyan, A. (2026). Hope as a mediator in the relationship between social support and death anxiety in older adults. Discover Mental Health. https://doi.org/10.1007/s44192-026-00608-z

Image Credits: AI Generated

DOI: 10.1007/s44192-026-00608-z

Keywords: death anxiety, hope, social support, older adults, aging, mental health, positive psychology, structural equation modeling, gerontology, mediation analysis, psychological well-being, anxiety