Presenting a Structural Relationship Model of Death Anxiety and Hypochondriacal Thoughts with Illness Perception in Older Adults: Examining the Mediating Role of Health-Promoting Behaviors
Keywords:
Death anxiety, illness perception, health-promoting behaviors, hypochondriacal thoughts, older adultsAbstract
This study was conducted with the aim of presenting a structural relationship model between death anxiety and hypochondriacal thoughts with illness perception in older adults, and examining the mediating role of health-promoting behaviors. The statistical population consisted of older adults in the city of Khoy, who were selected using a convenience sampling method. Data were collected using Templer’s Death Anxiety Scale, Evans’ Hypochondriacal Thoughts Questionnaire, Broadbent’s Illness Perception Questionnaire, and Walker’s Health-Promoting Lifestyle Profile, and were analyzed using structural equation modeling in SPSS-22 and Smart PLS software. The results indicated that death anxiety (path coefficient = 0.42, p < 0.001) and hypochondriacal thoughts (path coefficient = 0.38, p < 0.01) had a direct and significant effect on illness perception. Furthermore, health-promoting behaviors, as a mediating variable, moderated the relationship between death anxiety (indirect effect = 0.19, p < 0.05) and hypochondriacal thoughts (indirect effect = 0.22, p < 0.01) with illness perception. The proposed model demonstrated a good fit (NFI = 0.960 and SRMR = 0.058) and explained 65% of the variance in illness perception. The findings of this study emphasize the importance of considering psychological factors such as death anxiety and hypochondriacal thoughts in older adults and suggest that strengthening health-promoting behaviors can improve illness perception and quality of life in this population. The results of this study can provide a basis for designing psychological interventions and health promotion programs for older adults.
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References
1. World Health O. Promoting health through the life-course2021.
2. Kyriazis M. Aging as time-related dysfunction: A perspective. Frontiers in Medicine. 2020;7:371. doi: 10.3389/fmed.2020.00371.
3. Hagg S, Jylhava J, Wang Y, Xu H, Metzner C, Annetorp M. Age, frailty, and comorbidity as prognostic factors for short-term outcomes in patients with coronavirus disease 2019 in geriatric care. Journal of the American Medical Directors Association. 2020;21(11):1555-9.
4. Hamehzadeh E, Davoudi H, Heydari H, editors. Lived Perceptions of Older Adults About Physical Health: A Phenomenological Study2024.
5. Petrie KJ, Weinman J. Patients' perceptions of their illness. The Lancet. 2012.
6. Barghi Irani Z. The Causal Relationship Among Illness Perception, Medication Adherence, and Quality of Life in Older Adults with Parkinson's Disease. Clinical Psychology and Personality. 2014;12(1):51-60.
7. Mokhtarinejad U, Mirzaeian B, Hasanzadeh R. Comparing the Effectiveness of Schema Therapy and Acceptance and Commitment Therapy on Illness Perception and Worry in Patients with Illness Anxiety Disorder. Advances in Cognitive Sciences. 2020;22(3):58-67.
8. Iverach L, Menzies G, Menzies R. Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clinical Psychology Review. 2016;34(7):580-93.
9. American Psychiatric A. Diagnostic and Statistical Manual of Mental Disorders, Text Revision. 5th ed: American Psychiatric Association; 2022.
10. Neimeyer RA. Death Anxiety Handbook: Research, Instrumentation, and Application: Taylor and Francis; 2015.
11. Momeni K, Radmehr F, Sanjabi A. The Role of Cognitive Fusion, Social Support, and Aging Perception in Predicting Death Anxiety. Journal of Psychiatric Nursing. 2019;7(2):57-64.
12. Dehghanpouri H, Ebrahimi S, Chavoshi SR. The Effect of Death Anxiety on Psychological Distress in Older Adult Nature Tourists with Mindfulness as a Mediator. Social Work Quarterly. 2021;10(3):15-26.
13. Turan GB, Polat HT. The effects of illness perception on death anxiety and satisfaction with life in patients with advanced gastrointestinal cancer. Palliative and Supportive Care. 2024;22(2):360-6.
14. Semerci Cakmak V, Seven A, Sonmez Sari E. Death anxiety and death literacy among Turkish patients with chronic diseases: a cross-sectional study. BMC Psychiatry. 2025;25(1):299.
15. Jeon SY, Chung SS, Rho JO. Study on health anxiety issues, health-promoting behavior, and quality of life of middle-aged women in Jeonbuk area. Journal of Nutrition and Health. 2020;53(6):613-28.
16. Motlagh Z, Mazloomy Mahmoodabad SS, Momayyezi M. Study of health-promotion behaviors among university of medical science students. Zahedan Journal of Research in Medical Sciences. 2011;13:29-34.
17. Sallis JF. Role of built environments in physical activity. 2012.
18. Langlois F, Vu TT, Chasse K, Dupuis G, Kergoat MJ, Bherer L. Benefits of physical exercise training on cognition and quality of life in frail older adults. Journals of Gerontology Series B: Psychological Sciences and Social Sciences. 2013;68(3):400-4.
19. Satija A. Plant-based dietary patterns and mortality. JAMA Internal Medicine. 2017.
20. Park HC, Oh J. Factors affecting health-promoting behaviors in patients with cardiovascular disease. Healthcare: MDPI; 2021. p. 60.
21. Foroughan M, Mohammadi Shahbalaghi F. Older Adults' Perceptions of Healthy Lifestyle: A Qualitative Study. Salmand: Iranian Journal of Ageing. 2015;10(4):132-9.
22. Zhong J, Li X, Zhou Y, Dai H, Zhang D, Chen H, et al. Relationships between health personality and death anxiety: mediating role of death coping self-efficacy among Chinese clinical medical freshmen. BMC Palliative Care. 2025;24(1):86.
23. Bakhshi N, Pashang S, Jafari N, Ghorban Shiroudi S. A Model of Psychological Well-Being in Older Adults Based on Life Expectancy with Death Anxiety as a Mediator. Iranian Journal of Health Education and Health Promotion. 2020;8(3):283-93.
24. Dennison L. Does digital health intervention improve lifestyle? Health Psychology Review. 2013.
25. Schoen C. Health care in the two Americas: The Commonwealth Fund; 2013.
26. Buysse DJ. Sleep health: Can we define it? Does it matter? Sleep. 2014.
27. Hirshkowitz M. National Sleep Foundation's sleep time duration recommendations. Sleep Health. 2015.
28. Jha P. 21st-century hazards of smoking and benefits of cessation. New England Journal of Medicine. 2013.
29. Health USDo, Human S. The Health Consequences of Smoking: 50 Years of Progress2014.
30. Sheikholeslami R, Omranian M, editors. The Relationship Between Social Support and Psychological Well-Being in Older Adults: The Mediating Role of Death Anxiety. International Conference on Psychology, Educational Sciences, and Lifestyle; 2020.
31. Veys-Karami H, Barzegar Bafroei M, Yousefvand L. The Relationship Between Religious Orientation and Death Anxiety in Older Adults: The Mediating Role of Aging Perception and Spiritual Health. Aging Psychology. 2017;3(4):281-91.
32. Majidi S, Balurchi Fard F, Esmaeili R, Zolghadr Z. The Relationship Between Death Anxiety, Quality of Life, and Self-Care Ability in Older Adults with Chronic Obstructive Pulmonary Disease Referred to Masih Daneshvari Hospital in Tehran in 2018. Nafas. 2019;6(1).
33. Mammen G, Faulkner G. Physical activity and the prevention of depression. American Journal of Preventive Medicine. 2013.
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Copyright (c) 2026 Faezeh Eskandarzadeh , Shayan Maleki , Rezvan Morsali , Mina Najafi (Author); Masoud Ghorbanalipour
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