Developing a Predictive Model of Death Anxiety Based on Self-Efficacy and Health Locus of Control with the Mediating Role of Sense of Coherence in Patients with Gastrointestinal Cancer

Sara  Adhami; Sara Hashemi; Abdolali  Shahrasebi

Authors

Sara Adhami Department of Psychology, UAE.C., Islamic Azad University, Dubai, United Arab Emirates Author https://orcid.org/0009-0008-7937-7244
Sara Hashemi Department of Clinical Psychology, SR.C., Islamic Azad University, Tehran, Iran https://orcid.org/0009-0008-0737-7923
Abdolali Shahrasebi Assistant Professor, Department of Hematology and Oncology, Bu Ali Hospital, TeMS.C., Islamic Azad University, Tehran, Iran Author https://orcid.org/0009-0000-0220-7943

Keywords:

Death Anxiety, Self-Efficacy, Health Locus of Control, Sense of Coherence, Gastrointestinal Cancer, Structural Equation Modeling

Abstract

Purpose: This study aimed to develop and test a predictive model of death anxiety based on self-efficacy and health locus of control, with the mediating role of sense of coherence, in patients with gastrointestinal cancer.

Methods and Materials: This applied study used a descriptive-correlational design based on structural equation modeling. The statistical population consisted of male and female patients with gastrointestinal cancer referred to teaching and treatment hospitals affiliated with Iran University of Medical Sciences in Tehran. A total of 256 patients were selected through purposive sampling according to the inclusion and exclusion criteria. Data were collected using the Templer Death Anxiety Scale, Multidimensional Health Locus of Control Scale, Sherer General Self-Efficacy Scale, and Sense of Coherence Questionnaire. Data were analyzed using SPSS and AMOS. Pearson correlation analysis and structural equation modeling with maximum likelihood estimation were employed to examine direct and indirect relationships among the study variables.

Findings: The structural model demonstrated acceptable fit (χ²/df = 2.10, RMSEA = .05, CFI = .94, NFI = .91, GFI = .96, AGFI = .94). Health locus of control significantly and negatively predicted death anxiety (β = -.36, t = -6.15, p = .001), and self-efficacy also had a significant negative direct effect on death anxiety (β = -.44, t = -7.81, p = .001). Sense of coherence significantly mediated the relationship between health locus of control and death anxiety (β = -.39, p = .001) and the relationship between self-efficacy and death anxiety (β = -.49, p = .001). In addition, meaning in life showed significant indirect effects in the relationships of health locus of control (β = -.39, p = .001) and self-efficacy (β = -.40, p = .001) with death anxiety.

Conclusion: The findings indicate that self-efficacy and health locus of control are significant predictors of death anxiety in patients with gastrointestinal cancer and that sense of coherence plays an important mediating role in these relationships, suggesting the value of strengthening personal competence, perceived control, and psychological coherence in psycho-oncological interventions.

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