Systematic review of instruments for assessing positive attitudes toward death in adults from the general non-clinical population

Research on death-related attitudes has traditionally focused on death anxiety and fear, whereas positive attitudes toward death, including forms of acceptance, meaning-making, and an integrative orientation toward mortality, have received less attention. Evidence on measures of these positive attitudes remains fragmented, especially regarding conceptual foundations and psychometric properties. The aim of this review is to analyse the psychometric properties of instruments designed to measure positive attitudes toward death in the general adult population. To reach this aim, Web of Science, EBSCOhost, Scopus and PubMed were searched from September 1 to October 31, 2025. Peer-reviewed studies were included if they developed, adapted, or validated instruments in general populations. Study quality was assessed using the Newcastle–Ottawa Scale, and instrument adequacy was evaluated according to eight standards-based criteria. Of 320 records identified, 27 met the inclusion criteria, comprising 36 psychometric evaluations across 12 instruments. Instrument quality was mostly acceptable or good, with differences in methodology, empirical trajectory, and linguistic or cultural adaptations. One recently developed instrument showed the strongest validity and reliability evidence, whereas established measures stood out for broader validation across populations. The revised instruments support the specific assessment of positive attitudes toward death, but comparability and applied use remain limited by conceptual fragmentation, scarce normative data, uneven cross-cultural validation, and limited evidence on temporal stability and sensitivity to change. Future research should strengthen conceptual integration, psychometric standardization, and culturally sensitive validation. The review followed PRISMA guidelines and was registered in PROSPERO.