1
Sivas Cumhuriyet University, Faculty of Education, Sivas, Türkiye
2
Hacettepe University, Faculty of Education, Ankara, Turkiye
3
Şehit Ebubekir Ekinci Primary School, Ministry of National Education, Sivas, Turkiye
Abstract
The aim of this study is to examine the relationships between health anxiety, intolerance of uncertainty, rumination, and self-compassion through structural equation modeling (SEM) and latent profile analysis (LPA). The study group consists of 471 participants (296 female and 175 male) between the ages of 18 and 75 who were reached by convenience sampling method. Data were collected using the Health Anxiety Inventory (HAI), the Intolerance of Uncertainty Scale Short Form (IUS), the Ruminative Thought Style Scale (RTS), and the Self-compassion Scale (SCS). SPSS AMOS was used for the SEM analysis and MPLUS for the LPA analysis. The SEM results indicate that intolerance of uncertainty was positively associated with health anxiety and negatively associated with self-compassion, while rumination was negatively associated with self-compassion but not directly associated with health anxiety. The mediating role of self-compassion was significant in the relationship between both intolerance of uncertainty and rumination with health anxiety, highlighting the protective role of self-compassion against anxiety. The LPA revealed two latent profiles within the study group. The first latent profile, labeled “lower health anxiety symptoms and higher self-compassion,” included participants with lower levels of health anxiety, intolerance of uncertainty, and rumination, but higher levels of self-compassion. The second latent profile, “higher health anxiety symptoms and lower self-compassion,” comprised individuals with higher levels of health anxiety, intolerance of uncertainty, and rumination, and lower levels of self-compassion. These findings emphasize the importance of self-compassion and effective cognitive coping strategies in mitigating health anxiety, suggesting targeted interventions to enhance self-compassion and manage cognitive processes could be beneficial.
Keywords
health anxiety,intolerance of uncertainty,rumination,self-compassion
How to Cite
Polat, K., Gulden, C., & Cifci, S. (2025). Relationships between health anxiety, intolerance of uncertainty, rumination and self-compassion: A structural equation and latent profile analysis. International Journal of Eurasia Social Sciences, 16(59), 290–313. https://doi.org/10.70736/ijoess.552
📄Abramowitz, J. S., & Braddock, A. E. (2008). Psychological treatment of health anxiety and hypochondriasis: A biopsychosocial approach. Hogrefe & Huber Publishers.
📄Abramowitz, J. S., Deacon, B. J., & Valentiner, D. P. (2007). The Short Health Anxiety Inventory: Psychometric properties and construct validity in a non-clinical sample. Cognitive Therapy and Research, 31(6), 871–883. https://doi.org/10.1007/s10608-006-9058-1
📄Abramowitz, J. S., Schwartz, S. A., & Whiteside, S. P. (2002). A Contemporary conceptual model of hypochondriasis. Mayo Clinic Proceedings, 77(12), 1323–1330. https://doi.org/10.4065/77.12.1323
📄Akın, Ü., Akın, A., & Abacı, R. (2007). Self-compassion Scale: The study of validity, and reliability. H.U. Journal of Education, 33, 1–10.
📄Asmundson, G. J. G., & Fergus, T. A. (2019). The concept of health anxiety. In E. Hedman-Lagerlöf (Ed.), The clinician’s guide to treating health anxiety (pp. 1–18). Academic Press. https://doi.org/10.1016/B978-0-12-811806-1.00001-9
📄Aydemir, Ö., Kirpinar, İ., Sati, T., Uykur, B., & Cengisiz, C. (2013). Reliability and validity of the Turkish version of the Health Anxiety Inventory. Noro Psikiyatri Arsivi, 50(4), 325–331. https://doi.org/10.4274/npa.y6383
📄Boelen, P. A., & Lenferink, L. I. M. (2018). Latent class analysis of indicators of intolerance of uncertainty. Scandinavian Journal of Psychology, 59(3), 243–251. https://doi.org/10.1111/sjop.12440
📄Brinker, J. K., & Dozois, D. J. A. (2009). Ruminative thought style and depressed mood. Journal of Clinical Psychology, 65(1), 1–19. https://doi.org/10.1002/jclp.20542
📄Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43. https://doi.org/10.1016/j.janxdis.2016.02.007
📄Carleton, R. N., Norton, M. A. P. J., & Asmundson, G. J. G. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21(1), 105–117. https://doi.org/10.1016/j.janxdis.2006.03.014
📄Deniz, M. E. (2021). Self-compassion, intolerance of uncertainty, fear of COVID-19, and well-being: A serial mediation investigation. Personality and Individual Differences, 177, 110824. https://doi.org/10.1016/j.paid.2021.110824
📄Fergus, T. A., & Valentiner, D. P. (2011). Intolerance of uncertainty moderates the relationship between catastrophic health appraisals and health anxiety. Cognitive Therapy and Research, 35(6), 560–565. https://doi.org/10.1007/s10608-011-9392-9
📄Fink, P., Ørnbøl, E., Toft, T., Sparle, K. C., Frostholm, L., & Olesen, F. (2004). A new, empirically established hypochondriasis diagnosis. American Journal of Psychiatry, 161(9), 1680–1691. https://doi.org/10.1176/appi.ajp.161.9.1680
📄Fraenkel, J. R., Wallen, N. E., & Huyn, H. H. (2012). How to design and evaluate research in education. The McGraw-Hill Companies.
📄Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
📄Karatepe, H. T., Yavuz, F. K., & Turkcan, A. (2013). Validity and reliability of the Turkish version of the Ruminative Thought Style Questionnaire. Bulletin of Clinical Psychopharmacology, 23(3), 231–241. https://doi.org/10.5455/bcp.20121130122311
📄Kraemer, K. M., O’Bryan, E. M., & McLeish, A. C. (2016). Intolerance of uncertainty as a mediator of the relationship between mindfulness and health anxiety. Mindfulness, 7(4), 859–865. https://doi.org/10.1007/s12671-016-0524-x
📄Lo, Y., Mendell, N. R., & Rubin, D. B. (2001). Testing the number of components in a normal mixture. Biometrika, 88(3), 767–778. https://doi.org/10.1093/biomet/88.3.767
📄Lovas, D. A., & Barsky, A. J. (2010). Mindfulness-based cognitive therapy for hypochondriasis, or severe health anxiety: A pilot study. Journal of Anxiety Disorders, 24(8), 931–935. https://doi.org/10.1016/j.janxdis.2010.06.019
📄Marcus, D. K., Hughes, K. T., & Arnau, R. C. (2008). Health anxiety, rumination, and negative affect: A mediational analysis. Journal of Psychosomatic Research, 64(5), 495–501. https://doi.org/10.1016/j.jpsychores.2008.02.004
📄McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49(3), 186–193. https://doi.org/10.1016/j.brat.2010.12.006
📄McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027–1035. https://doi.org/10.1016/j.jpsychires.2011.03.006
📄Muse, K., McManus, F., Hackmann, A., Williams, M., & Williams, M. (2010). Intrusive imagery in severe health anxiety: Prevalence, nature and links with memories and maintenance cycles. Behaviour Research and Therapy, 48(8), 792–798. https://doi.org/10.1016/j.brat.2010.05.008
📄Neff, K. D. (2003). The development and validation of a scale to measure self-compassion. Self and Identity, 2(3), 223–250. https://doi.org/10.1080/15298860309027
📄Neff, K. D., & Dahm, K. A. (2015). Self-compassion: What it is, what it does, and how it relates to mindfulness. In B. D. Ostafin, M. D. Robinson, & B. P. Meier (Eds.), Handbook of mindfulness and self-regulation. Springer. https://doi.org/10.1007/978-1-4939-2263-5_10
📄Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582. https://doi.org/10.1037/0021-843X.100.4.569
📄Odou, N., & Brinker, J. (2014). Exploring the relationship between rumination, self-compassion, and mood. Self and Identity, 13(4), 449–459. https://doi.org/10.1080/15298868.2013.840332
📄Partovi Pirooz,L., Jomehri,F., Seadatee Shamir,A., & Hasani, J.(2022). Structural model of health anxiety based on intolerance of uncertainty and anxiety sensitivity with mediating therole of rumination in college students. Journal of Adolescent and Youth Psychological Studies, 3(2), 126-132. https://doi.org/10.61838/kman.jayps.3.2.21
📄
📄Poluch, M., Feingold-Link, J., Papanagnou, D., Kilpatrick, J., Ziring, D., & Ankam, N. (2022). Intolerance of uncertainty and self-compassion in medical students: Is there a relationship and why should we care? Journal of Medical Education and Curricular Development, 9. https://doi.org/10.1177/23821205221077063
📄Raes, F. (2010). Rumination and worry as mediators of the relationship between self-compassion and depression and anxiety. Personality and Individual Differences, 48(6), 757–761. https://doi.org/10.1016/j.paid.2010.01.023
📄Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(5), 843–853. https://doi.org/10.1017/S0033291702005822
📄Sansom-Daly, U. M., Bryant, R. A., Cohn, R. J., & Wakefield, C. E. (2014). Imagining the future in health anxiety: The impact of rumination on the specificity of illness-related memory and future thinking. Anxiety, Stress, & Coping, 27(5), 587–600. https://doi.org/10.1080/10615806.2014.880111
📄Sansom-Daly, U. M., Bryant, R. A., Cohn, R. J., & Wakefield, C. E. (2016). Rumination and self-defining memories in the context of health concerns. Memory, 24(7), 939–948. https://doi.org/10.1080/09658211.2015.1059860
📄Sarıçam, H., Erguvan, F. M., Akın, A., & Akça, M. Ş. (2014). The Turkish short version of the Intolerance of Uncertainty (IUS-12) Scale: The study of validity and reliability. Route Educational and Social Science Journal, 1(3), 148–148. https://doi.org/10.17121/ressjournal.109
📄Satici, B., Saricali, M., Satici, S.A., & Griffits, M.D. (2022) Intolerance of Uncertainty and Mental Wellbeing: Serial Mediation by Rumination and Fear of COVID-19. International Journal of Mental Health and Addiction, 20, 2731–2742. https://doi.org/10.1007/s11469-020-00305-0
📄Sirois, F. M., Molnar, D. S., & Hirsch, J. K. (2015). Self-compassion, stress, and coping in the context of chronic illness. Self and Identity, 14(3), 334–347. https://doi.org/10.1080/15298868.2014.996249
📄Smith, J. M., & Alloy, L. B. (2009). A roadmap to rumination: A review of the definition, assessment, and conceptualization of this multifaceted construct. Clinical Psychology Review, 29(2), 116–128. https://doi.org/10.1016/j.cpr.2008.10.003
📄Stephens, H. F. (2016). A latent profile analysis of rumination: An examination of trait affect and socio-emotional associations [Doctoral dissertation, Florida State University]. FSU Research Repository. http://purl.flvc.org/fsu/fd/FSU_SUMMER2017_Stephens_fsu_0071E_13242
📄Tabachnick, B. G., & Fidell, L. S. (2014). Using multivariate statistics (6th ed.). Pearson.
📄Tamres, L. K., Janicki, D., & Helgeson, V. S. (2002). Sex differences in coping behavior: a meta-analytic review and an examination of relative coping. Personality and Social Psychology Review, 6(1), 2–30. https://doi.org/10.1207/S15327957PSPR0601_1
📄Taylor, S. (2004). Understanding and treating health anxiety: A cognitive-behavioral approach. Cognitive and Behavioral Practice, 11(1), 112–123. https://doi.org/10.1016/S1077-7229(04)80015-4
📄Ullrich-French, S., & Cox, A. E. (2020). The use of latent profiles to explore the multi-dimensionality of self-compassion. Mindfulness, 11(6), 1483–1499. https://doi.org/10.1007/s12671-020-01365-y
📄Warwick, H. M. C., & Salkovskis, P. M. (2001). Cognitive-behavioral treatment of hypochondriasis. In V. Starcevic & D. R. Lipsitt (Eds.), Hypochondriasis: Modern perspectives on an ancient malady. Oxford University Press.
📄Wolfradt, U., Oemler, M., Braun, K., & Klement, A. (2014). Health anxiety and habitual rumination: The mediating effect of serenity. Personality and Individual Differences, 71, 130–134. https://doi.org/10.1016/j.paid.2014.07.030
📄Yalçın, İ., Boysan, M., Eşkisu, M., & Çam, Z. (2024). Health anxiety model of cyberchondria, fears, obsessions, sleep quality, and negative affect during COVID-19. Current Psychology, 43(9), 8502–8519. https://doi.org/10.1007/s12144-022-02987-2