Metacognitive beliefs about uncontrollability relate most strongly to health anxiety among US‐based non‐Latinx White primary care patients: Comparing strength of relations with US‐based non‐Latinx Black and Latinx primary care patients

Abstract

Metacognitive beliefs have emerged as important to health anxiety, particularly beliefs that health-related thoughts are uncontrollable. Preliminary research examining generalized worry indicates uncontrollability beliefs relate more strongly to anxiety among US-based self-identifying White relative to Black college students. The present study sought to extend that line of research by examining if metacognitive beliefs about the uncontrollability of health-related thoughts differentially relate to health anxiety among self-identifying non-Latinx Black (n = 123), Latinx (n = 104) and non-Latinx White (n = 80) US-based primary care patients. As predicted, although positive associations were seen across all three groups, beliefs that health-related thoughts are uncontrollable more strongly related to health anxiety among White patients compared to both Black and Latinx patients. Those differential relations held in multivariate analyses while statistically controlling for positive depression screening status, generalized anxiety symptom severity and medical morbidity. Although the effect size surrounding the differential relations was small in magnitude, the present results further support the notion that metacognitive beliefs about uncontrollability relate less strongly to anxiety among US-based ethnoracial minorities compared to White individuals. Potential reasons for the differential relations are discussed, along with additional areas for future research.

A systematic review evaluating metacognitive beliefs in health anxiety and somatic distress

“…Nine studies (22%; Dai et al, 2018 ; Fergus et al, 2022 ; Kollmann et al, 2016 ; Marino et al, 2020 ; Melli et al, 2018 ; Schutze, Rees, Smith, Slater, Catley, & O'Sullivan, 2019 ; Sen Demirdogen et al, 2021 ; Yoshida et al, 2012 ) were evaluated to have relatively high quality, scoring a minimum of 65% on the QATSDD ( Supporting Information ). The remaining studies were evaluated to be of moderate quality, scoring between 50% and 64.9%.…”

“…Twelve studies assessed the relationship between HA and metacognitions, of which nine were of moderate quality (Akbari et al, 2021 ; Bailey & Wells, 2013 , 2015a , 2015b , 2016a , 2016b ; Bouman & Meijer, 1999 ; Melli et al, 2016 ; Solem et al, 2015 ). The other three studies were rated as high quality (Dai et al, 2018 ; Fergus et al, 2022 ; Melli et al, 2018 ). Only three studies used clinical samples; two studies employed clinical samples diagnosed with hypochondriasis (Bouman & Meijer, 1999 ) or self‐reported having a diagnosis of hypochondriasis or IAD (Melli et al, 2018 ).…”

“…The five studies, which examined the correlation between HA and specific HA metacognitive beliefs using the MCQ‐HA (Bailey & Wells, 2015b , 2016a ; 2016b ; Dai et al, 2018 ; Fergus et al, 2022 ; Melli et al, 2018 ) all found significant positive correlations between HA and biased thinking ( r = .19 to .58), thoughts can cause illness ( r = .26 to .52) and beliefs about uncontrollability of thoughts ( r = .49 to .72). Three of these studies also reported a significant association between each of the three subscales and HA in regression analyses (Bailey & Wells, 2015b , 2016a ; 2016b ; Dai et al, 2018 ).…”

“…However, Melli et al ( 2018 ) only found that beliefs about uncontrollability of thoughts had a significant association with HA in their regression analysis. One study assessed whether the strength of the relationship between beliefs that thoughts are uncontrollable, and HA varies according to ethnicity, with results indicating a stronger association in White than Black and Latinx participants (Fergus et al, 2022 ).…”