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Death Anxiety, Social Support Among Persons Living With HIV, AIDS in Nigeria


Nigeria has a population of almost 204 million. Of those, 3.1% of adults, or 3.5 million, are living with HIV. The accompanying death anxiety of people living with HIV and AIDS has not been studied in depth.

Nigeria has a population of almost 204 million.1 Of those, 3.1% of adults, or 3.5 million, are living with HIV.2 Antiretroviral treatment has led to longer life expectancy, but the accompanying death anxiety of people living with HIV and AIDS (PLWHA) has not been studied in depth as it relates to social support and the emotion regulation functions of cognitive reappraisal and expressive suppression

Wanting a multidimensional view of death anxiety for PLWHA, investigators from the Psychology and Social Work departments at the University of Nigeria in Nsukka looked into this relationship, because previous studies have only evaluated social support and emotion regulation as independent factors of death anxiety.2

The group of outpatients they interviewed (N = 186) in July and August 2017 were in the care of the HIV/AIDS unit at a tertiary healthcare institution in southeastern Nigeria. Their mean age was 34.16, and 56.5% were women. All data on death anxiety, social support, and emotion regulation were self-reported. To qualify for the study, patients could not be on antipsychotic medications or be seeing or hearing impaired.

Expressive suppression consists of “top-down, conscious control of reflexive behavioral expression of emotion (eg, stifling laughter or crying, or maintaining a neutral facial expression to hide emotions),"3 and it was shown to be especially influential in that it mediated the actions of friends and significant others who were offering social support to PLWHA dealing with death anxiety. However, the effect was more apparent on the internal thoughts of the patients: Their death anxiety was reduced in regard to death acceptance and thoughts, but not externally generated death anxiety or finality, the more support they received.

Cognitive reappraisal involves using our thoughts and words to “reframe or reinterpret the meaning of a stimulus or situation in order to up- or down-regulate the emotions,”4 and it was positively correlated with expressive suppression in the present study. Higher levels of cognitive reappraisal were linked to higher levels of familial support.

The authors determined that “social support from family, friends, and significant others was negatively associated with death anxiety. Supportive individuals may be helpful in guiding people with death anxiety to generate positive interpretations of their situation.”

They caution that because their investigation was conducted using only patients in Nigeria that their results may not be generalizable to other populations dealing with death anxiety. Therefore, they recommend additional investigation into the social support networks of PLWHA; specifically, how they help to increase death acceptance and reduce negative death thoughts via expressive suppression.


1. Nigeria population. Worldometer website. worldometers.info/world-population/nigeria-population/. Updated and accessed January 9, 2020.

2. Chukwuorji JBC, Uzuegbu CN, Chukwu CV, Ifeagwazi CM, Ugwu C. Social support serves emotion regulation function in death anxiety among people living with HIV/AIDS [published online December 31, 2019]. S Afr J Psychol. doi: 10.1177/0081246319894700.

3. Expressive suppression and executive functioning. The University of Utah College of Social & Behavioral Science Department of Psychology website. psych.utah.edu/graduate/clinical-neuropsychology-program/neuropsych_exec-function.php. Updated July 8, 2019. Accessed January 9, 2020.

4. Emotion regulation and social anxiety disorder. ScienceDirect website. sciencedirect.com/topics/psychology/cognitive-reappraisal. Accessed January 10, 2020.

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