The validation of the Persian death anxiety scale in cardiac outpatients: A psychometric and clinical study

Death anxiety is a common psychological concern among individuals with serious health conditions, including cardiovascular diseases. Reliable assessment of this construct requires culturally adapted and validated instruments. This cross-sectional psychometric study aimed to examine the validity and reliability of the Persian version of the Death Anxiety Scale among cardiac outpatients. A total of 272 participants completed the Persian version of the scale. Psychometric evaluation included face and content validity, item analysis, confirmatory factor analysis (CFA), and assessments of convergent and discriminant validity. The items demonstrated adequate variability and approximately normal distribution, with item-total correlations mostly above 0.50. A minimal floor effect (3 %) and no ceiling effect were observed. CFA supported a three-factor structure, Ambiguity, Exposure, and Agony, with acceptable to good fit indices (CFI = 0.922, RMSEA = 0.063). Factor loadings ranged from 0.446 to 0.868, and composite reliability values exceeded 0.70 for all factors. Both convergent and discriminant validity were confirmed. Internal consistency was satisfactory, with Cronbach's alpha ranging from 0.752 to 0.888 and McDonald's omega from 0.766 to 0.890. Overall, the Persian version of the Death Anxiety Scale demonstrated sound validity and reliability, supporting its use for the assessment of death anxiety and the development of psychological interventions in cardiac populations.