The Relationship Between Basic Psychological Needs and Health Promoting Behaviors with Health Anxiety in Older Women: The Mediating Role of Resilience

Old age seems to be one of the most crucial stages of human life during which individuals encounter a wide range of changes, particularly in the realm of physical and psychological health. Health anxiety, especially in older adults, can have undesirable effects, making it important to examine the factors influencing this variable. Therefore, this study aimed to investigate the relationship between basic psychological needs (BPNs) and health-promoting behaviors (HPBs) with health anxiety in older adults, through the mediating role of resilience. This was a correlational study, of path analysis type. The statistical population of this research included all older women residing in Tabriz, Iran in the spring of 2023, among whom 220 individuals were selected as the sample using convenience sampling method. The measurement tools included the Connor and Davidson’s Resilience Scale, BPNs Questionnaire, HPBs Questionnaire, and Health Anxiety Questionnaire. The collected data were analyzed using Pearson’s correlation coefficient in SPSS-23 software and path analysis in LISREL 8.8 software. The results indicated that BPNs (autonomy, competence, and relatedness) have a negative relationship with health anxiety in older women; HPBs (nutrition, physical activity, health responsibility, stress management, interpersonal relationships, and spiritual growth) have a negative relationship with health anxiety in older women. resilience had a negative relationship with health anxiety in older women. Moreover, BPNs were related to health anxiety in older women through resilience, as well as HPBs were related to health anxiety in older women through resilience. Therefore, it can be concluded that increasing resilience in older adults and fulfilling BPNs along with educating HPBs can prevent the increase of health anxiety.
EXTENDED ABSTRACT
 Introduction
Studies have shown that health anxiety increases with age. Various variables have been examined in the literature to predict health anxiety in older adults, among which basic psychological needs (BPNs) and health-promoting behaviors (HPBs) seem to be among the most important ones. Research indicates a negative relationship between the satisfaction of BPNs and anxiety. HPBs are among the best ways for individuals to maintain and control their health and alleviate their anxiety. Previous studies have investigated the relationship between the above-mentioned variables in older adults, but few have examined how this relationship operates. Various variables may mediate the relationship between BPNs, HPBs, and health anxiety in older adults, with one such variable being resilience. In older adults, resilience may directly relate to HPBs and inversely relate to health anxiety. Given that older adults constitute one of the largest age groups in Iran and health anxiety is a significant concern for these individuals, identifying factors influencing it appears to be crucial. Therefore, the aim of the present study was to examine the relationship between BPNs and HPBs with health anxiety through the mediating role of resilience.
Method
This was a correlational study, of path analysis type. The statistical population comprised all older women residing in Tabriz, Iran in the spring of 2023, among whom a sample of 220 older women was selected through convenience sampling. Inclusion criteria were (1) aged 60 years and above, (2) ability to read and write, and (3) willingness to participate in the study. Exclusion criteria included (1) withdrawal from the study, (2) incomplete questionnaire responses, and (3) diagnosis of psychiatric disorders or use of psychiatric medications within the past year. Participants completed the Salkovskis et al.’s Health Anxiety Inventory (HAI-18), Walker et al.’s Health Promoting Lifestyle Profile II (HPLP-II), the La Guardia et al.’s Basic Psychological Needs Scale (BPNS), and the Connor & Davidson’s Resilience Scale (CD-RISC). To gather necessary data, the researcher visited different parks across Tabriz on six occasions, introduced themselves, explained the study’s purpose to older adults, and provided guidance on completing the questionnaires to ensure their informed participation. Subsequently, eligible older individuals were provided with the questionnaires. After data collection, descriptive statistics and Pearson’s correlation analysis were performed in SPSS-23. Path analysis was then employed to examine the relationships between variables and to test the hypothesized model in Lisrel 8.8 software.
Results
Before conducting data analysis, it was determined that the distribution of scores for all variables was normal, and the results showed no correlation between errors and no collinearity among variables. Hypothesis testing was approached by examining model fit. Therefore, to evaluate the hypothesized model, path analysis was utilized. The results of Pearson’s correlation test indicated that BPNs had a negative relationship with older women’s health anxiety. HPBs had a negative relationship with older women’s health anxiety. Resilience had a negative relationship with older women’s health anxiety. The results of path analysis indicated that BPNs indirectly related to older women’s health anxiety through the mediating role of resilience, and HPBs indirectly related to older women’s health anxiety through the mediating role of resilience. The goodness-of-fit indices for the model were as follows: X²=19623.36, df= 9012, X²/df= 2.17, CFI=.92, GFI=.94, AGFI=.92, RMSEA=.063, indicating a satisfactory model fit. the final model can be seen in Figure 1.
The results from the Sobel test revealed significant mediating roles of resilience in various relationships. Specifically, resilience was found to mediate the relationship between responsibility and health anxiety (Z= -1.26, P<.01), physical activity  and health anxiety (Z= -1.26, P<.01), nutrition and health anxiety (Z=-2.03, P<.01), flourishing and health anxiety (Z= -1.60, P<.01), support and health anxiety (Z= -1.84, P<.01), stress managment and health anxiety (Z= -1.70, P<.01), autonomy and health anxiety (Z = -2.42, P< .01), competence and health anxiety (Z= -2.00, P<.01), and relatedness and health anxiety (Z=-2.10, P<.01). These findings underscore the significant role of resilience in moderating the relationship of various factors with health anxiety among the older women.
Conclusion
As individuals age, their performance in various life domains often declines, leading to reduced impact on both their environment and others. This, in turn, can result in a failure to meet their own needs for autonomy, competence, and relatedness. Aging is often accompanied by the emergence of physical and cognitive symptoms associated with declining health. Misinterpreting these symptoms can lead older adults to experience health anxiety. Increased engagement in HPBs is associated with reduced health anxiety. According to cognitive theory, anxiety arises from erroneous and exaggerated beliefs about existing threats. Conversely, HPBs involve intentional planning and conscious actions aimed at preventing illness and improving health, motivating individuals to pursue a higher quality of life. Individuals with high resilience accept stressful events and are psychologically more resilient. As resilience leads to increased toughness, older adults exhibit greater patience in facing the negative consequences of aging, thereby reducing their anxiety. Satisfying BPNs can play a significant role in resilience, as fulfilling these needs provides the necessary conditions for growth, stability, and well-being. Individuals who feel autonomous in their actions have a greater sense of competence, which in turn enhances their resilience. Satisfying these needs fosters greater adaptability in facing the consequences of aging, including health anxiety, among older adults.
Ethical Consideration
Ethical Code
To comply with ethical standards in the research, the current study was pre-registered at Mohaghegh Ardabili University.
Financial Support
 This study had no financial support
Authors’ Contributions
M.M: Project administration, Data curation, Resources, software, validation, formal analysis, writing- original draft, writing-review & editing, Visioalization; S.B: Conceptualization, methodology, Supervision, writing-review & editing Resources, Visioalization
Conflict of Interest
The author had no conflicts of interest.
Acknowledgments
The authors deem it necessary to express gratitude to all older participants involved in this study.
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