Structural Model of the Relationship Between Metacognitive Beliefs and Psychological Well-Being: The Mediating Role of Health Anxiety in Women with Cancer
Keywords:
Metacognitive beliefs, Health anxiety, Psychological well-being, Women with cancer, CancerAbstract
This study aimed to examine a structural model of the relationship between metacognitive beliefs and psychological well-being through the mediating role of health anxiety in women with cancer. This fundamental study employed a descriptive-correlational design based on structural equation modeling. The statistical population consisted of women with cancer attending Hashemi Rafsanjani Specialized Hospital and Esmaeilzadeh Specialized Clinic in Tehran between May and December 2025. Following convenience sampling, data collection, and screening, 360 participants were included in the final analysis. Data were collected using the 18-item Ryff Psychological Well-Being Scale, the 30-item short form of the Wells and Cartwright-Hatton Metacognitions Questionnaire, and the 18-item short form of the Health Anxiety Inventory. Pearson correlation coefficients and structural equation modeling were performed using SPSS version 27 and AMOS, while bootstrapping was applied to test the indirect effect of metacognitive beliefs on psychological well-being through health anxiety. Metacognitive beliefs were positively and significantly associated with health anxiety (r=0.28, p<0.001) and negatively and significantly associated with psychological well-being (r=-0.36, p<0.001). Health anxiety was also negatively related to psychological well-being (r=-0.43, p<0.001). The structural model demonstrated satisfactory fit (CMIN/df=2.49, RMSEA=0.064, CFI=0.919, IFI=0.923, GFI=0.904) and explained 27% of the variance in psychological well-being. Metacognitive beliefs had a significant negative direct effect on psychological well-being (β=-0.463, p<0.001) and a significant positive effect on health anxiety (β=0.427, p<0.001). Health anxiety, in turn, exerted a significant negative effect on psychological well-being (β=-0.221, p<0.001). Bootstrapping confirmed a significant indirect effect of metacognitive beliefs on psychological well-being through health anxiety (β=-0.0943, p=0.005, 95% CI [-0.1265, -0.0632]), supporting the mediating role of health anxiety. Maladaptive metacognitive beliefs may reduce psychological well-being in women with cancer both directly and indirectly by increasing health anxiety. Accordingly, psychological interventions targeting maladaptive metacognitive beliefs and health-related anxiety may contribute to improving psychological well-being and adaptation among women experiencing cancer
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