Modeling the Structural Relationships of Irritable Bowel Syndrome Symptom Severity Based on Hostile Attribution, Perceived Stress, and Cognitive Bias With the Mediating Role of Negative Meta-emotion

Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder that significantly impairs quality of life and is commonly associated with psychological factors. This study explores the mediating role of negative meta-emotions, defined as emotional responses to one's own emotions (eg, shame about anxiety), in the relationship between IBS symptom severity, perceived stress, cognitive bias, and hostile attribution. This descriptive-correlational and cross-sectional study was conducted in 2024 and involved 300 patients with IBS, 18 to 60 years of age, who were attending gastroenterology clinics in Tabuk, Saudi Arabia. Participants completed a set of validated questionnaires, including the Hostile Attribution Scale, Perceived Stress Scale, Negative Meta-Emotions Scale, Cognitive Bias Questionnaire, and the IBS Symptom Severity Scale (IBS-SSS). Data were analyzed using SPSS and AMOS. Structural equation modeling was used to examine both direct and indirect effects. Perceived stress (β=0.42), hostile attribution (β=0.30), and cognitive bias (β=0.35) had significant direct effects on IBS symptom severity. Negative meta-emotions significantly mediated the effects of all 3 variables, with perceived stress showing the strongest total effect (β=0.56). Model fit indices confirmed a good fit (root mean square error of approximation=0.047, comparative fit index=0.94). The findings highlight the critical role of negative meta-emotions in intensifying IBS symptoms and support the integration of psychological interventions, especially those targeting stress reduction, emotion regulation, and cognitive restructuring, into standard IBS care. Further longitudinal studies are recommended to clarify the temporal order and causality of these psychological influences.