Structural Explanation of Health Anxiety Based on Childhood Trauma: The Mediating Role of Anxiety Sensitivity and Cognitive Avoidance in Women Attending Healthcare Centers
Keywords:
Childhood trauma, Anxiety sensitivity, Cognitive avoidance, Health anxietyAbstract
Objective: This study aimed to structurally explain health anxiety based on childhood trauma by examining the mediating roles of anxiety sensitivity and cognitive avoidance in women attending healthcare centers.
Methods and Materials: This descriptive-correlational study was conducted using structural equation modeling. The statistical population included women aged 18 to 50 years who attended healthcare centers in districts 1 to 3 of Tehran during winter 2025–2026. A total of 400 participants were selected through convenience sampling. Data were collected using the short form of the Childhood Trauma Questionnaire, the Anxiety Sensitivity Index, the Cognitive Avoidance Questionnaire, and the Health Anxiety Inventory. Data analysis was performed using SPSS version 28 and Amos version 24. Pearson correlation coefficients, structural equation modeling, and bootstrap analysis were used to examine direct and indirect effects.
Findings: The results indicated that the proposed model had an acceptable fit to the data, with fit indices supporting the adequacy of the structural model (RMSEA=0.044, CFI=0.932, SRMR=0.049, χ²/df=1.88). Childhood trauma had a positive and significant direct effect on health anxiety (β=0.317, p<0.001). Anxiety sensitivity (β=0.231, p<0.001) and cognitive avoidance (β=0.218, p<0.001) also showed positive and significant direct effects on health anxiety. In addition, childhood trauma had positive and significant direct effects on anxiety sensitivity (β=0.175, p<0.001) and cognitive avoidance (β=0.121, p<0.001). Bootstrap results further demonstrated that anxiety sensitivity (β=0.040, p<0.001) and cognitive avoidance (β=0.026, p<0.001) significantly mediated the relationship between childhood trauma and health anxiety. The total indirect effect was also significant (β=0.066, p<0.001), indicating partial mediation.
Conclusion: The findings suggest that childhood traumatic experiences contribute to health anxiety both directly and indirectly through increased anxiety sensitivity and cognitive avoidance. Therefore, psychological interventions targeting maladaptive interpretations of bodily sensations and cognitive avoidance strategies may help prevent and reduce health anxiety among women with a history of childhood trauma.
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