A Structural Equation Model of Health Anxiety: The Roles of Fatigue, Spiritual Vitality, Social Support, and Lifestyle in Chronic Fatigue Syndrome

Objective: This study aimed to model health anxiety based on chronic fatigue symptoms and spiritual vitality, considering the mediating roles of social support and lifestyle in patients with chronic fatigue syndrome (CFS). Methods and Materials: A descriptive correlational study was conducted on a sample of 400 patients diagnosed with CFS in Tehran, selected using the Krejcie and Morgan sampling framework. Participants completed validated self-report instruments measuring health anxiety, chronic fatigue, spiritual vitality, social support, and lifestyle. Data were analyzed using SPSS-27 to compute Pearson correlations and AMOS-21 for Structural Equation Modeling (SEM). Assumptions of normality, linearity, multicollinearity, and outliers were confirmed before modeling. Findings: Chronic fatigue symptoms had a significant direct positive effect on health anxiety (β = 0.41, p < .001), while spiritual vitality showed a significant direct negative effect (β = −0.37, p < .001). Both social support (β = −0.26, p < .001) and lifestyle (β = −0.32, p < .001) significantly mediated these relationships. The model demonstrated excellent fit indices (χ²/df = 2.60, GFI = 0.93, CFI = 0.95, RMSEA = 0.063). Total effects indicated that spiritual vitality was the strongest overall predictor of reduced health anxiety (β = −0.59), while chronic fatigue exerted an indirect and attenuated total effect (β = 0.16) through mediators. Conclusion: The findings support a multidimensional model in which spiritual vitality and health-promoting lifestyle behaviors significantly buffer the psychological impact of chronic fatigue symptoms on health anxiety. Clinical interventions for CFS patients should incorporate strategies to enhance spirituality, strengthen social support, and promote lifestyle improvement to mitigate health-related anxiety.