述情障碍对健康焦虑的影响：认知与元认知的中介作用

目的：采用健康焦虑的认知行为理论及元认知理论，探讨述情障碍、认知因素、元认知因素与健康焦虑 之间的关系。方法：采用简版健康焦虑量表、健康焦虑元认知量表、健康认知量表、多伦多述情障碍量表对1 164 名医学生进行评估。结果：1)相关分析显示：述情障碍、功能失调性信念、元认知和健康焦虑水平之间均存在显著 正相关关系(r=0.227~0.477，均P<0.01)。2)多重中介效应检验结果表明：述情障碍对健康焦虑水平的直接效应不显著 (β=–0.05，95% CI：–0.123~0.021)。述情障碍既能通过功能失调性信念影响健康焦虑(β=0.192，95% CI：0.156~0.235)， 还能通过功能失调性信念和元认知的中介链对健康焦虑产生间接效应(β=0.103，95% CI：0.077~0.135)，功能失调性信 念在述情障碍和健康焦虑水平之间起完全中介作用(β=0.247，95% CI：0.196~0.290)。结论：功能失调性信念和元认知 在述情障碍对健康焦虑的影响中起到多重中介作用。

Effect of alexithymia on health anxiety: Mediating role of cognition and meta-cognition

Objective: According to the cognitive behavior theory and meta-cognitive theory of health anxiety, to examine the association between alexithymia, cognition factors or meta-cognition factors and health anxiety. Methods: A total of 1 164 medical students were investigated by the Short Health Anxiety Inventory, the Health Cognitions Questionnaire, the Meta-cognitions about Health Questionnaire and the Toronto Alexithymia Scale. Results: 1) Correlation analysis showed that alexithymia, dysfunctional beliefs, meta-cognition were significantly positively correlated with health anxiety (r=0.227–0.477, all P<0.01); 2) The results of structural equation model indicated that alexithymia could not exert effects on health anxiety directly (β=–0.05, 95% CI –0.123 to 0.021). The alexithymia could exert effects on health anxiety indirectly not only through dysfunctional beliefs (β=0.192, 95% CI 0.156 to 0.235), but also through the chain-mediated effect of dysfunctional beliefs and meta-cognitions (β=0.103, 95% CI 0.077 to 0.135). Dysfunctional beliefs fully mediated the relation between alexithymia and health anxiety (β=0.247, 95% CI 0.196 to 0.290). Conclusion: Alexithymia can affect health anxiety through the mediating effects of dysfunctional beliefs and meta-cognition.