Structural equation modeling of cancer sense of coherence based on time perspective with the mediating role of coherent self-knowledge and perfectionism

Subject Areas : Psychological Models and Methods

mehdi sheikhi ¹ , abolghasem yaghoobi ² , تورج سپهوند ³ , reyhane sheykhan ⁴

1 -
2 - Professor, Department of Psychology, Faculty of Economics and Social Sciences, Bu-Ali Sina University, Hamedan, Iran
3 - استادیار گروه علوم تربیتی، دانشکده علوم انسانی، دانشگاه اراک، اراک، ایران
4 - دانشگاه خوارزمی تهران

Received: 2025-05-19 Accepted : 2025-08-15 Published : 2025-09-22

Keywords: Sense of cohesion, time perspective, perfectionism, self -knowledge,

Abstract :

Introduction. The aim of this study was to develop a causal model of sense of coherence based on time perspective with the mediating role of perfectionism and coherent self-knowledge in cancer patients using the structural equation model.

Method: This study was descriptive in terms of its fundamental objective and in terms of data collection. Its statistical population was all cancer patients referred to medical centers in Markazi province, of which 200 were selected purposefully. The measurement tools included Zimbardo and Boyd's Time Perspective Questionnaire Antonovsky's Sense of Coherence Questionnaire Identity Perfectionism Questionnaire and Felt (1999), and the Victim Coherence Self-Knowledge Questionnaire. Data analysis was performed using the structural equation model using Smart-PLS4 and SPSSv26 software.

Results: The model fit criterion was met appropriately. The direct effect of time perspective on perfectionism (β = -0.482) and sense of coherence (β = -0.189) and coherent self-knowledge was confirmed at the level of (P < 0.01). Also, the direct effect of perfectionism (β = -0.360) and coherent self-knowledge on sense of coherence was also supported at the level of (P < 0.01). The role of perfectionism and coherent self-knowledge was also confirmed as a mediating variable in this study.

Conclusion: This study highlighted the role of time perspective in predicting sense of coherence for health researchers in order to help cancer patients adapt and cope better with their disease.

 

References:

Antonovsky, A, (1987). Unraveling the mystery of health,How people manage stress and stay well,Sanfrancisco, Jossey-Bass.Association. http://pajoohande.sbmu.ac.ir/article-1-1046-en.html.
Dubczak, H., & Lewko, I. (2021). A sense of coherence as a factor of resistance to stress of future specialists in socionomic professions. Journal of Educational Sciences & Psychology, 11(1).‏
Kulcar, V., Kreh, A., Juen, B., & Siller, H. (2023). The Role of Sense of) Coherence During the COVID-19 Crisis: Does it Exercise a Moderating or a Mediating Effect on University Students’ Wellbeing? Sage Open, 13(1), https://doi.org/10.1177/215824402311601
Lindblad, C., Langius‐Eklöf, A., Petersson, L. M., Sackey, H., Bottai, M., & Sandelin, K. (2018). Sense of coherence is a predictor of survival: A prospective study in women treated for breast cancer. Psycho‐oncology, 27(6), 1615-1621https://doi.org/10.1002/pon.4702
Eriksson, M. (2022). The sense of coherence: the concept and its relationship to health. The handbook of salutogenesis, 61- https://doi.org/10.1007/978-3-030-79515
Antonovsky, A, (1987). Unraveling the mystery of health,How people manage stress and stay well,Sanfrancisco, Jossey-Bass.Association. http://pajoohande.sbmu.ac.ir/article-1-1046-en.html
Kulcar, V., Kreh, A., Juen, B., & Siller, H. (2023). The Role of Sense of) Coherence During the COVID-19 Crisis: Does it Exercise a Moderating or a Mediating Effect on University Students’ Wellbeing? Sage Open, 13(1), https://doi.org/10.1177/215824402311601
Fayazi, Homa, Esmaili, Roghieh, Rouhani, Kamelia, Nasiri, Malihe, and Fayazi, Neda. (2013). The relationship between sense of coherence with physical function and social support in a sample of Iranian elderly people with cancer. Koomesh, 24(4 (90)), 460-468. SID. [in Persian]. https://sid.ir/paper/1059095/fa
Hinz, A., Schulte, T., Ernst, J., Mehnert-Theuerkauf, A., Finck, C., Wondie Y., & Ernst, M. (2023). Sense of coherence, resilience, and habitual optimism in cancer patients. International Journal of Clinical and Health Psychology, 23(2), 100358 doi: 10.1016/j.ijchp.2022.100358.
Hakanen, J. J., Feldt, T., & Leskinen, E. (2007). Change and stability of sense of coherence in adulthood: Longitudinal evidence from the Healthy Child study. Journal of research in personality, 41(3), 602-617.‏
Hinz, A., Schulte, T., Ernst, J., Mehnert-Theuerkauf, A., Finck, C., Wondie, Y., & Ernst, M. (2023). Sense of coherence, resilience, and habitual optimism in cancer patients. International Journal of Clinical and Health Psychology, 23(2), 100358.‏ https://doi.org/10.1016/j.ijchp.2022.1003
Stolarski, M., Waleriańczyk, W., & Pruszczak, D. (2019). Introducing Temporal Theory to the Field of Sport Psychology: Toward a Conceptual Model of Time Perspectives in Athletes’ Functioning. Frontiers in Psychology, 9, 2772. https://doi.org/10.3389/FPSYG.2018.0277
Moksnes, U. K. (2021). Sense of coherence. Health promotion in health care–vital theories and research https://link.springer.com/chapter/10.1007/978-3-030-63135-2_4
Stolarski, M., Zajenkowski, M., Jankowski, K. S., & Szymaniak, K. (2020). Deviation from the balanced time perspective: A systematic review of empirical relationships with psychological variables. Personality and Individual Differences, 156, 109772.
Roozitalab A, maredpour A, taghvaeinia A. (2022). The effect of time perspective intervention on psychological well-being, meaning in life and vitality in wives of war veterans and martyrs. Journal of Psychological Science. 21(116), 1663-1678[in Persian]. http://psychologicalscience.ir/article-1-1693-fa.html
Hosseini Mehkame, Arefi Mozhgan, & Sajjadian Ilnaz (2017). The effect of the time perspective educational package on students' time balance and anxiety MS). Journal title 2021; 15 (2) 5URL: http://rph.khu.ac.ir/article-1-3997-fa.html
Stolarsk Maciej, and Fieulaine, Nicolas. Wessel, van Beek (2014). "Time Perspective Theory". Review, Research and Application, DOI 10.1007/978-3-319-07368-2_2.
Bukowski, H. (2019). Self-knowledge. In V. Zeigler-Hill & T. K. Shackelford (Eds.) Encyclopedia of personality and individual differences (pp. 61–76). Springer. DOI:10.1007/978-3-319-28099-8_2004-1
Scheffler, S. (2025). Temporal Neutrality and Temporal Bias. 35–63. https://doi.org/10.1093/9780197754740.
Fowler, S. A., Davis, L. L., Both, L. E., & Best, L. A. (2018). Personality and perfectionism as predictors of life satisfaction: The unique contribution of having high standards for others. Facets, 3(1), 227-
Suh, H., & Chong, S. S. (202‏2). What predicts meaning in life? The role of perfectionistic personality and self-compassion. Journal of Constructivist Psychology, 35(2719-733 https://doi.org/10.1080/15283488.2019.15660
Stoeber J. (2017). The psychology of perfectionism: Theory, research, applications. Routledge. https://doi.org/10.4324/9781315536255.
Ko, A., Hewitt, P. L., Cox, D., Flett, G. L., & Chen, C. (2019). Adverse parenting and perfectionism: A test of the mediating effects of attachment anxiety, attachment avoidance, and perceived defectiveness. Personality and Individual Differences, 150, Article 109474. https://doi.org/10.1016/j.paid.2019.06.01
Pakizeh, Ali, Mahmoudzadeh, Sepideh and Habibi, Seyed Nazifollah. (1402). Investigating the change in cognitive bias towards sad faces on indicators of depression, hope and life orientation. Cognitive and Behavioral Sciences Research, 13(2), 57-74. doi: 10.22108/cbs.2024.138605.1805
Patterson, H., Firebaugh, C. M., Zolnikov, T. R., Wardlow, R., Morgan, S. M., & Gordon, B. (2021). A systematic review on the psychological effects of perfectionism and accompanying treatment. Psychology, 12(1), 1-24.‏ DOI: 10.4236/psych.2021.121001
Stolarski, M., Zajenkowski, M., Jankowski, K. S., & Szymaniak, K. (2020). Deviation from the balanced time perspective: A systematic review of empirical relationships with psychological variables. Personality and Individual Differences, 156, 109772.‏
Hewitt PL, Fleet G I. Perfectionism in the self and social contexts: Conceptualization, assessment, and association with psychology. Journal of personality and social psychology. 1991; 60, 4, 456-470. DOI:10.1037/0022-3514.60.3.456
Basharat, Mohammad Ali (2004). Exploratory analysis of the relationship between perfectionism and personality. Scientific Research Journal of Educational and Psychological Studies, 6th period, 1st issue, pp. 81-96[in Persian].
Ali Alipour, Nasim Sharif. Validity and reliability of the Sense of Coherence (SOC) ‎questionnaire in university ‎students. pajoohande 2012; 17 (1) :50-56 URL: http://pajoohande.sbmu.ac.ir/article-1-1276-fa.html
Hosseinzadeh, Ghorbani, and Nabavi. (2011). Comparison of self-destructive personality tendencyand coherent self-knowledge in patients with MS and healthy individuals, Contemporary Psychology, 6(2); 35-44
Henseler, J., Hubona, G. S., & Ray, P. A. (2016). Using PLS path modelling in new technology research: Updated guidelines. Industrial Management & Data Systems116(1), 2–19
Henseler, J., Ringle, C. M., & Sinkovics, R. R. (2009). The use of partial least squares path modeling in international marketing. In R. R. Sinkovics & P. N. Ghauri (Eds.), Advances in international marketing (pp. 277–320). https://doi.org/10.1108/IMDS-09-2015-0382
Hair, J. F., Sarstedt, M., Pieper, T. M., & Ringle, C. M. (2012). The use of partial least squares structural equation modeling in strategic management research: A review of past practices and recommendations for future applications. Long Range Planning, 45(5–6), 320–340https://doi.org/10.1016/j.lrp.2012.09.
Fornell, C., & Larcker, D. F. (1981). Evaluating structural equation models with unobservable variables and measurement error. Journal of Marketing Research, 39–50
Ruzhytska, M. (2015). Relationship between time perspective and sense of coherence in subjects of doing. Sci. Edu. New Dimension. Pedagogy Psychol, 31(61), 61-64. https://doi.org/10.1177/003329412211446.
Wiesmann, U., Ballas, I., & Hannich, H. J. (2018). Sense of coherence, time perspective and positive aging. Journal of Happiness Studies, 19(3), 817-839.‏
Jess Feist, Gregory J. Theories of personality by Jess Feist and Gregory J. Feist, translated by Yahya Seyed Mohammadi. Rovan Publishing, (2023
Idan O., Eriksson M., Al-Yagon M. (2017). The salutogenic model: The role of generalized resistance resources. In Mittelmark M. B., Sagy S., Eriksson M., Bauer G. F., Pelikan J. M., Lindström B., Espnes G. A. (Eds.), The handbook of salutogenesis (pp. 57-69). Cham: Springer Nature Switzerland A
Mooney, A., Earl, J. K., Mooney, C. H., & Bateman, H. (2017). Using balanced time perspective to explain well-being and planning in retirement. Frontiers in Psychology, 8, Article 1781. https://doi.org/10.3389/fpsyg.2017.0178.
Lagoutina, Y. (2017). Perfectionism and time perspectives: An inquiry into the association between perfectionism subtypes and categorical time perspectives. Time & Society, 26(3), 286–304. https://doi.org/10.1177/0961463X155772
Pakizeh, Mahmoudzadeh, & Mehroosh. (2024). The effect of cognitive bias correction on the resilience and perfectionism of perfectionist sports students. New Psychological Research Quarterly, 19(74), 147-155[in Persian] https://doi 10.22034/jmpr.2024.59796.5993.
Stolarski, M., Zajenkowski, M., Jankowski, K. S., & Szymaniak, K. (2020). Deviation from the balanced time perspective: A systematic review of empirical relationships with psychological variables. Personality and Individual Differences, 156, Article 109772. https://doi.org/10.1016/j.paid.2019.109772.
Gilbert, P., Durrant, R., and McEwan, K. (2006). Investigating relationships between perfectionism, forms and functions of self-criticism, and sensitivity to put-down. Personality and Individual Differences 41 (7) 1299-1308. https://doi.org/10.1016/j.paid.2006.05.00
Flett, G. L., Hewitt, P. L., & Nepon, T. (2019). The Self-Generated Stress Scale: Development, Psychometric Features, and Associations With Perfectionism, Self-Criticism, and Distress. Journal of Psychoeducational Assessment, 38(1), 69-83. https://doi.org/10.1177/073428291987954
Pekin, Z., & Güme, S. (2025). Self-Criticism: Conceptualization, Assessment and Interventions. Psikiyatride Güncel Yaklaşımlar, 17(1), 107-123.‏
Stricker, J., & Preckel, F. (2022). Global Self-Esteem Differentially Predicts Multidimensional Perfectionism in Early Adolescents Two Years Later. The Journal of Early Adolescence, 42(2), 149.171 https://doi.org/10.1177/02724316211016069.
Almeida, I., Becattini, V., Guendelman, S., Leleu, A., Barnby, J. M., & Ciaunica, A. (2024). Disintegrated Self in Time: The Effect of Depersonalisation Experiences on Time Perspective. https://doi.org/10.31234/osf.io/3qcuw.
Scheffler, S. (2025). Temporal Neutrality and Temporal Bias. 35–63. https://doi.org/10.1093/9780197754740.0
Mandrykina, M., & Molchanova, O. (2013). Connection between self-attitude components and personal time perspective profiles.‏
nolvi, M., Lindqvist Forsberg, A. J., Brogårdh, C., Jacobsson, L., & Lexell, J. (2022). The Meaning of Sense of Coherence (SOC) in Persons with Late Effects of Polio—A Qualitative Study. International Journal of Environmental Research and Public Health, 19(10), 6314. https://doi.org/10.3390/ijerph19106314
Burras-Sando, J., Jensen, M., & Wong, K. (2023). Help me stay afloat. Nursing management, 54(2), 9–14. https://doi.org/10.1097/01.NUMA.0000918204.
Kiamarthi, Azar, & Taheri Fard. (2020). Comparison of self-compassion, sense of coherence and positive thinking in students with and without clinical perfectionism. Clinical Psychology and Personality, 18(1) [in Persian] https://www.researchgate.net/publication/34382680
Petersson, S., Perseius, K. I., & Johnsson, P. (2014). Perfectionism and sense of coherence among patients with eating disorders. Nordic journal of psychiatry, 68(6), 409–415. https://doi.org/10.3109/08039488.2013.85173
Banville, C., Massicotte, V., Caplette-Gingras, A., Langlois, F., Gouin, J. P., Flett, G., ... & Savard, J. (2024). A qualitative study of perfectionism among self-identified perfectionist women with nonmetastatic breast cancer. Journal of Psychosocial Oncology Research and Practice, 6(1), 00.‏ DOI:10.1097/OR9.0000000000000122
Callaghan, T., Greene, D., Shafran, R., Lunn, J., & Egan, S. J. (2024). The relationships between perfectionism and symptoms of depression, anxiety andobsessive-compulsive Dol.oorg/10.1080/16506073.2023.227712.
Alizadeh Fard, S., Mohtashami, T., Haghighatgoo, M., & Zimbardo, P. G. (2020). Investigation of Psychometric Characteristics of Time Perspective Inventory (Short Form) in Adult Population of Tehran. Clinical Psychology and Personality, 14(2), 157-169. doi: 10.22070/14.2.157
Savard, J., Slim, L. M., Roy, R. C., Flett, G. L., Hewitt, P. L., & Ivers, H. (2017). The relationship of perfectionism with psychological symptoms in cancer patients and the contributing role of hyperarousability and coping. Psychology & Health, 32(4), 381-401URL: http://ijme.mui.ac.ir/article-1-3781-fa.html.
Jess Feist, Gregory J. Theories of personality by Jess Feist and Gregory J. Feist, translated by Yahya Seyed Mohammadi. Rovan Publishing, (2023(
Stricker, J., & Preckel, F. (2022). Global Self-Esteem Differentially Predicts Multidimensional Perfectionism in Early Adolescents Two Years Later. The Journal of Early Adolescence, 42(2), 149.171 https://doi.org/10.1177/02724316211016069
Montano, R. L. T. (2025). Examining the link between perfectionism and distress among licensure examination reviewees: pre-examination coping styles as mediator. Educational and Developmental Psychologist, 1–13. https://doi.org/10.1080/20590776.2024.2445292.