![Venn diagram indicating overlaps between health anxiety and other psychopathological domains [Color figure can be viewed at wileyonlinelibrary.com]](https://www.researchgate.net/publication/375225498/figure/fig1/AS:11431281255262842@1719411212453/Venn-diagram-indicating-overlaps-between-health-anxiety-and-other-psychopathological_Q320.jpg)
![Potential bidirectional impact of social learning on the vicious circle of health anxiety (Warwick & Salkovskis, 1990) [Color figure can be viewed at wileyonlinelibrary.com]](https://www.researchgate.net/publication/375225498/figure/fig2/AS:11431281255179546@1719411212744/Potential-bidirectional-impact-of-social-learning-on-the-vicious-circle-of-health-anxiety_Q320.jpg)
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Annual Research Review: Health anxiety in children and adolescents—developmental aspects and cross‐generational influences
Journal of Child Psychology and Psychiatry
Abstract and Figures
Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID‐19 pandemic. Recent classification systems acknowledge that impairing health‐related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.
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... Society is worried about health more. (Rask et al., 2024). Health anxiety entails excessive health concerns and the assumption that one has or may acquire a serious ailment. ...
Background Superstitions affect people's health, luck, and daily decisions. Due to cultural and psychological factors, these beliefs affect people differently based on their experiences and societal norms. Methods: This quantitative study used the correlational method on 312 respondents of both genders. The study used the Superstitious Beliefs Scale, Health Anxiety Scale, and demographic variables. Results: The study findings showed a rather high level (44.51) with a mean score of superstitious beliefs of 1.91 (±0.814). Though popular beliefs had the lowest mean (1.56 ± 0.791), personal superstitious beliefs had the highest mean (2.29 ± 1.109). Belief in good fortune ran from 1.52 to 2.38; "I seek good luck" scored highest (2.38). Belief in bad luck ranged from 1.73–1.93; belief in changing luck ranged from 1.94–2.46; with "I can change events through different actions," scoring the highest (2.37). For health anxiety, the mean was 2.09, with major correlations between superstitious beliefs and health anxiety across all dimensions (0.272–0.401, p < 0.001). Sociocultural superstitious behaviors peaked at (1.80). This implies that levels of anxiety in society are much influenced by superstitious ideas. In essence, superstitious beliefs shape attitudes and actions; they also frequently influence emotional well-being and decision-making. Encouragement of critical thinking and awareness-raising will enable people to make more logical decisions and lower unwarranted fear.
... It is not uncommon to find a parent and child reporting similar pains or somatic complaints, prompting questions regarding genetic, environmental, and sociocultural contributors to pediatric FSSs (France et al., 2023). Indeed, parental experiences of chronic pain, persistent fatigue, or anxiety about health can influence how children learn to interpret and cope with their own bodily sensations (Corey et al., 2021;Rask et al., 2024). Children typically observe and internalize parents' reactions to pain or discomfort-especially if the parents themselves have longstanding somatic complaints. ...
Functional somatic symptoms (FSSs) in children—such as headaches, stomachaches, and muscle pain without clear medical explanations—pose a significant clinical challenge, often leading to repeated healthcare visits and impairments in daily functioning. While the role of parental psychological factors in shaping children’s FSSs has been suggested, empirical evidence remains limited and fragmented. This study addresses this gap by systematically examining the associations between parents’ reflective functioning, emotion regulation, alexithymia, and physical and mental health, and the frequency and severity of children’s FSSs. A total of 339 parents of children aged 6–12 completed surveys assessing their capacity to understand mental states, regulate emotions, and identify or describe feelings, as well as their self-reported physical and mental health. They also indicated whether their child experienced FSSs (e.g., headaches, stomachaches) more than once per week. Results revealed that parents of children with FSSs reported significantly lower levels of reflective functioning (lower certainty, higher uncertainty), higher alexithymic traits, and greater emotion regulation difficulties, alongside poorer physical and mental health indices. Logistic regression analyses demonstrated that emotion regulation difficulties and poorer mental health significantly increased the likelihood of a child exhibiting FSSs, while lower reflective functioning also emerged as a significant predictor. Furthermore, multiple linear regression indicated that emotion regulation challenges and poor mental health predicted greater severity of FSSs. These findings offer novel insights into how parents’ psychological and health characteristics can shape children’s somatic symptom expression, highlighting the need for family-focused interventions. By identifying and addressing parental emotional and cognitive difficulties, clinicians may be able to mitigate the intergenerational transmission of maladaptive stress responses, ultimately reducing the burden of FSSs in children.
... According to research, healthcare-induced anxiety in children may lead to serious mental health problems later in life [17]. Meanwhile, hospital staff have considerable influence yet sometimes overlook patients' points of view. ...
Purpose:
Parental satisfaction is essential for evaluating pediatric care quality and influences healthcare practices and performance. Pediatric patients frequently experience anxiety, affecting their and their parents' satisfaction. Nurses play a key role in reducing anxiety and improving care interactions. Meeting parents' expectations shapes long-term outcomes and impacts the hospital's reputation. While instruments such as the Child ZAP (Zufriedenheit in der Arztpraxis) provide comprehensive measures of satisfaction, their use in Indonesia has not been explored. This study aimed to validate the Child ZAP and offer insights to improve pediatric care quality in Indonesia.
Methods:
A cross-sectional study was conducted with 139 mothers whose children were older than 5 years and received treatment at private hospitals. Structured questionnaires were analyzed using partial least squared-structural equation modeling in SmartPLS 4, and a disjoint two-stage method was used to test dimensionality.
Results:
All hypotheses were significant (p<.05), demonstrating strong support. All Child ZAP dimensions, treated as lower-order constructs, effectively measured parents' satisfaction as a higher-order construct. Overall parental satisfaction significantly influenced behavioral intention and mediated its relationship with Child ZAP. The mother's and the child's age served as moderating factors. The research model exhibited strong predictive power, underscoring pediatric nurses' pivotal role in improving communication among parents, physicians, and children to ensure quality care.
Conclusion:
The Child ZAP instrument effectively evaluates parental satisfaction by examining how children interact and communicate with medical staff. It assesses doctors' engagement with children and their communication skills, highlighting nurses' essential role in providing family-centered pediatric care.
... Individuals often elaborate complex avoidance behaviors, and social, occupational, and academic impairment can be considerable. This condition typically has its onset during childhood or early adolescence, a period when key developmental processes might be impacted, leading to entrenched patterns of social isolation that continue into adulthood [7,8]. Recent advances in neuroimaging and psychophysiological research have started to shed light on the neural substrates of misophonia, indicating alterations in sound processing and emotional regulation networks. ...
Misophonia, characterized by intense emotional and physiological responses to specific sounds, represents a complex neurophysiological and behavioral syndrome first identified in 1997. This review synthesizes current understanding of its epidemiology, etiology, pathophysiology, and clinical implications. Population studies indicate prevalence rates of 15-20% in the general population, with 2-3% reporting severe cases, and higher rates among university students (20-25%) and clinical populations (up to 60%). The condition shows female predominance (3:2 ratio) with typical onset between ages 8-12. Neuroimaging studies reveal altered activity in the anterior cingulate cortex, anterior insular cortex, and superior temporal cortex, suggesting disrupted sensory-emotional integration. Multiple factors contribute to its etiology, including neurobiological, genetic, developmental, environmental, and psychological mechanisms. Common triggers include eating sounds, breathing, and repetitive movements, leading to intense autonomic arousal, anxiety, and aggressive impulses. The condition frequently co-occurs with obsessive-compulsive disorder, post-traumatic stress disorder, depression, and anxiety disorders. While standardized diagnostic criteria are lacking, several assessment tools exist, including the Misophonia Assessment Questionnaire and Amsterdam Misophonia Scale. Treatment approaches encompass both non-pharmacological interventions (music therapy, sound management) and pharmacological options (MDMA, ?-blockers). The condition significantly impacts daily functioning, often leading to social isolation, academic difficulties, and reduced quality of life. Future research priorities include establishing standardized diagnostic criteria, developing validated treatment protocols, understanding neurobiological mechanisms, and conducting long-term outcome studies.
... Further associated repercussions of health anxiety includes psychological distress, functional damage and overuse of medical sources as well (Lee et al., 2015). Symptoms of health anxiety among youngsters are allied with distress, impairment, overutilization of health care, comorbidity with emotional problems (Rask et al., 2024). In post COVID-19 scenario, health anxiety emerged as a common problem anticipating threat to have a disease (Tyrer, 2020). ...
The present study investigated health anxiety among patients of general outpatient departments of public and private sector hospitals in Faisalabad. In order to meet that research objective, Health Anxiety Questionnaire (HAQ), developed by Lucock and Morely (1996), was translated in Urdu language in order to extend its application for the population whose first language is Urdu. Reliability and validity analysis determined the application of Urdu version of HAQ for examining health anxiety. In the second phase, prevalence and gender difference was determined on the sample of one hundred and seventy six (n =176) patients selected from general outpatient departments. Ages of them ranged from 21 to 60 with mean age (M = 44.93; SD = 8.44). Data were collected via demographic information sheet and Health Anxiety Questionnaire (HAQ). Statistical analysis revealed majority of patients experiencing moderate level of health anxiety, while women reported more health anxiety pertaining to their current physical health status as compared to men in terms of health worry and preoccupation, fear of illness and death, reassurance seeking behavior and interference with life. Present findings imply the integration of psychological assessment and treatment procedures while dealing patients suffering from physical complaints.
... In fact, one could see the pandemic as a natural experimental test of the role societal influences play in mental health in general, and health anxiety in particular (Sonuga-Barke, 2021). In this way, the fantastic Annual Research Review of health anxiety research findings, as they relate especially to children and adolescents, by Rask, Duholm, Poulsen, Rimvall, and Wright (2024), could not have been more timely. For us, the key messages from the Rask review were that: ...
Researchers continue to count the short‐ and longer‐term mental health costs for children and adolescents of the COVID‐19 pandemic and the associated exceptional restrictions imposed by governments on their lives in an attempt to control the pandemic and its impacts. Despite being at low risk of serious physical illness from COVID‐19 themselves, some studies have reported a decline in the mental health of many young people during the pandemic. Some have suggested that this could even create a risk for long‐term morbidity. In this commentary, we reflect on the excellent article by Rask and colleagues on paediatric health anxiety and consider key research gaps for the field in general and for the specific challenges and questions posed by the COVID‐19 pandemic and its legacy.
... US surgeon general etc. From 2012 to 2018 there was a 34.6% increase in the prevalence of mental illness, with rates continuing to rise during the COVID-19 pandemic (Rask et al., 2023;Tkacz & Brady, 2021). Despite these devastating increases, there is a disproportionate lack of attention and funding paid toward addressing child mental health, despite knowledge that childhood is a time of tremendous brain development and developmental plasticity, and that earlier intervention reduces the intensity and severity of psychopathology. ...
From its inception, development and psychopathology theorists have sought to uncover the earliest forms of risk for mental health challenges in children, to prevent the development of more severe, intractable manifestations of psychopathology. Large familial risk registries have advanced our understanding of early, potentially modifiable factors that could prevent or mitigate the expression of challenging symptoms of neurodevelopmental conditions, and similar registries have been proposed to advance understanding of ADHD and related phenotypes. Data from single-site studies, largely focused on perinatal exposure to maternal mood disorders, reveal that a robust predictor of child psychopathology is parental psychopathology. However, early developmental trajectories of psychopathology risk may be better captured using transdiagnostic approaches in pregnancy, capturing the full range of mental health symptoms. We describe here the need for a parental mental health registry that begins prenatally that includes deep behavioral phenotyping across a range of transdiagnostic indicators of mental health risk to prevent psychopathology in children. This registry has the potential to uncover pathways to psychopathology risk in childhood and support the discovery of novel mechanisms to be targeted for prevention and intervention.
Purpose of Review
We review recent evidence on Illness Anxiety Disorder (IAD), including risk factors and precipitants, diagnostic classification, clinical characteristics of the disorder, and assessment and treatment in both children and adults.
Recent Findings
IAD places a substantial burden on both individuals and society. Despite its impact, understanding of the disorder is lacking and debates remain about whether IAD should be classified as an anxiety disorder and whether it is distinct from Somatic Symptom Disorder. Cognitive behavioural therapy (CBT) is an effective treatment for IAD and there are multiple validated measures of health anxiety available. However, research on health anxiety in children and youth is limited.
Summary
IAD is chronic, and debilitating, but when identified, it can be effectively treated with CBT. Research using DSM-5 IAD criteria is lacking, and more research is needed to better understand the disorder, particularly in children and youth.
A family-based treatment for childhood anxiety was evaluated. Children (n = 79) aged 7 to 14 who fulfilled diagnostic criteria for separation anxiety, overanxious disorder, or social phobia were randomly allocated to 3 treatment conditions: cognitive–behavioral therapy (CBT), CBT plus family management (CBT + FAM), and waiting list. The effectiveness of the interventions was evaluated at posttreatment and at 6 and 12 months follow-up. The results indicated that across treatment conditions, 69.8% of the children no longer fulfilled diagnostic criteria for an anxiety disorder, compared with 26% of the waiting-list children. At the 12-month follow-up, 70.3% of the children in the CBT group and 95.6% of the children in the CBT + FAM group did not meet criteria. Comparisons of children receiving CBT with those receiving CBT + FAM on self-report measures and clinician ratings indicated added benefits from CBT + FAM treatment. Age and gender interacted with treatment condition, with younger children and female participants responding better to the CBT + FAM condition.
Cyberchondria has become a severe health problem and a significant public concern. In addition to the impacts that cyberchondria involves, individual psychological and behavioral factors have been identified. However, the role of family function and the mediating and moderating mechanisms underlying these relations are not understood well, especially among adolescents. Based on family functioning and cognitive-behavioral theory, this study sought to examine whether family dysfunction was associated with cyberchondria, and a moderated mediation model was prepared as a means of exploring whether health anxiety was a mediator of relationships between family dysfunction and cyberchondria, as well as whether optimism moderated these mediating processes. A total of 2074 Chinese adolescents (mean = 15.08 years, SD = 1.79) reported their demographic information, family dysfunction, health anxiety, optimism, and cyberchondria. The findings showed that family dysfunction was positively related to cyberchondria. Moreover, health anxiety partially mediated the relationship between family dysfunction and cyberchondria. Finally, optimism moderated the interplay among health anxiety and cyberchondria. Consistent with the expectancy-value models, this positive relationship was weaker for adolescents with a higher level of optimism. These results suggest that it is vital to simultaneously consider individual and family factors as a means of understanding adolescent cyberchondria when performing cyberchondria intervention programs.
The COVID-19 pandemic has been suggested to have adverse impacts on psychiatric disorders. This study aimed to investigate the changes in medical visits due to a wide range of psychiatric disorders in children during the COVID-19 pandemic. The medical visits of all Korean children and adolescents (0–19 years old) due to the 12 following psychiatric disorders were investigated: autism; attention-deficit/hyperactivity disorder (ADHD); depressive disorder; bipolar disorder; primary insomnia; schizophrenia; panic disorder; hypochondriasis; posttraumatic stress disorder (PTSD); anxiety disorder; anorexia nervosa; and adephagia. The mean medical visits before and during the COVID-19 pandemic were compared. The mean number of clinical visits due to autism, ADHD, depressive disorder, bipolar disorder, panic disorder, hypochondriasis, PTSD, anxiety disorder, and anorexia nervosa was higher during the COVID-19 pandemic than before the COVID-19 pandemic (all p < 0.05). The higher mean number of medical visits due to psychiatric disorders was maintained in age and sex subgroups. The female and adolescent groups demonstrated a higher mean number of medical visits due to psychiatric disorders during the COVID-19 pandemic. The medical visits due to many psychiatric disorders were higher during the COVID-19 pandemic than before COVID-19 in children and adolescents in Korea. Women and adolescents were more susceptible to psychiatric disorders during the COVID-19 pandemic.
In this Editorial Perspective, we take a systematic look at the overall nature of the Covid‐19 related research on mental health in children and young people, to gain insight into the major trends in this area of research and inform future lines of investigation, clinical practices, and policies. By means of state‐of‐the‐art scientometric approaches, we identified 3,692 relevant research outputs, mainly clustering around the following themes: (a) mental health consequences of the Covid‐19 pandemic in children and young people; (b) impact of the pandemic on pre‐existing psychiatric disorders; (c) family outcomes (i.e., family violence and parental mental health); and (d) link between physical and mental conditions. Only 23% of the retrieved publications reported new data, the remaining ones being reviews, editorials, opinion papers, and other nonempirical reports. The majority of the empirical studies used a cross‐sectional design. We suggest that future research efforts should prioritise: (a) longitudinal follow‐up of existing cohorts; (b) quasi‐experimental studies to gain insight into causal mechanisms underlying pandemic‐related psychopathology in children and young people; (c) pragmatic randomised controlled trials (RCTs) to test evidence‐based intervention strategies; and (d) evidence‐based guidelines for clinicians and policymakers.
Anxiety disorders are globally one of the most prevalent and disabling forms of psychopathology in adults and children. Having a parent with an anxiety disorder multiplies the risk of anxiety disorders in the offspring, although the specific mechanisms and processes that play a role in this intergenerational transmission remain largely unknown. According to information processing theories, threat-related biases in cognitive processing are a causal mechanism in the development and maintenance of anxiety. These theories propose that individuals with anxiety are more likely to cognitively process novel stimuli in their environment as threatening. Creswell and colleagues proposed a theoretical model that highlighted the role of these cognitive biases as a mechanism in the intergenerational transmission of anxiety (Creswell et al., in Hadwin, Field (eds) Information processing biases and anxiety: a developmental perspective, Wiley, pp 279–295, 2010). This model postulated significant associations between (1) parents’ and children’s threat-related cognitive biases (2) parents’ threat-related cognitive biases in their own and their child’s environment, (3) parents’ threat-related cognitive biases and parenting behaviors that convey anxiety risk to the offspring (e.g., modeling of fear, and verbal threat information transmission), and (4) parenting behaviors and child threat-related biases. This theoretical review collated the recent empirical work testing these four core hypotheses of the model. Building on the reviewed empirical work, an updated conceptual model focusing on threat-related attention and interpretation is proposed. This updated model incorporates the links between cognition and anxiety in parents and children and addresses the potential bidirectional nature of parent–child influences.
Objective:
Sweden is an international exception in its public health response to the COVID-19 pandemic, with a higher number of deaths, albeit not pediatric, compared with other Nordic countries. The objective of this study was to investigate what worries children and adolescents living in Sweden expressed in relation to the pandemic.
Methods:
Using an anonymous web-survey, 1,047 children (4-12 years; N = 717) and adolescents (13-18 years; N = 330) responded to five background and four open-ended questions, one of which was: Is there anything that you are worried about when it comes to 'Corona'? The responses were coded using manifest content analysis. Interrater reliability was .95, assessed on the code level.
Results:
Worry was common (77%); mostly (60%) related to disease or death of elderly relatives, parents, the child him/herself or general worry for the elderly/risk groups. Existential worry (15%) comprised worries about the future, including economy and worries about the world perishing or the contagion becoming uncontrollable. A developmental trajectory was evident in the nature of responses. Adolescents' worries about the future included missing out on their youth and employment. They also worried about society (6%), for example, the future of democracy and the world economy. There was no indication of socioeconomic status or geographic area (urban vs. rural) affecting the presence of worrisome thoughts.
Conclusions:
Worry about "Corona" was common. Universal preventative mental health intervention is warranted and could be conducted in the school setting. Intervention could be tailored by age, covering discussion on financial aspects with adolescents.
There has been significant disruption to the lives and mental health of adolescents during the COVID-19 pandemic. The purpose of this study was to assess the psychological and lifestyle impact of the pandemic on Australian adolescents, using an online survey, administered during the outbreak. Self-report surveys were administered online to a sample of 760 Australian adolescents aged 12–18 years assessing impact on a range of domains including behaviour, education, relationships, lifestyle factors (exercise, technology use, and sleep), and mental health outcomes (psychological distress, loneliness, health anxiety and well-being). Results showed that three quarters of the sample experienced a worsening in mental health, since the pandemic began, with negative impacts reported on learning, friendships and family relationships. There were also high higher levels of sleep disturbance, psychological distress and health anxiety, relative to normative samples. Effects on mental health were worse among those who reported a previous diagnosis of depression and/or anxiety relative to those without no such history. Adolescents are already vulnerable to the onset of mental illness at this developmental stage, and the current research underscores the need to find rapid and accessible ways to support adolescent mental health during times of crisis.
The aim was to explore the potential clinical role of health anxiety (HA) symptoms in children and adolescents diagnosed with obsessive–compulsive disorder (OCD). The study investigated differences in demographic and various clinical variables between young people with OCD, with and without HA symptoms, and the effect of HA symptoms on overall OCD treatment outcome. The study sample comprised 269 children and adolescents with OCD (aged 7–17 years) from the large Nordic Long-term OCD Treatment Study. OCD symptoms and severity were assessed with The Children’s Yale-Brown Obsessive–Compulsive Scale (CY-BOCS), which includes one item regarding HA-like obsessions and one item regarding HA-like compulsions that were used to define the HA group. Several other instruments were used to assess comorbidity and other clinical aspects. All participants were treated with 14 weekly protocolled sessions of exposure-based cognitive behavioral therapy (CBT). HA symptoms were present in 31% of participants. Other anxiety symptoms and comorbid anxiety disorders were more prevalent among those with HA symptoms. These patients also presented with significantly more types of OCD symptoms. HA symptoms were reduced following OCD treatment with CBT and having HA symptoms did not affect CBT outcome. Results suggest that pediatric OCD with HA symptoms is characterized by more anxiety symptoms and a more heterogeneous OCD symptom profile. Standardized CBT seems equally effective in treating child and adolescent OCD with or without HA symptoms.
Clinical trials registration: Nordic Long-term Obsessive–Compulsive Disorder Treatment Study: www.controlled-trials.com; ISRCTN66385119.
Background
Health-related fear is a normal and common response in the face of the global pandemic of COVID-19. Children and young people are frequently being exposed to messages about the threat to health, including from the media and authorities. Whilst for most, their anxiety will be proportionate to the threat, for some, existing preoccupation with physical symptoms and illness will become more problematic. There is a growing body of evidence that health anxiety may occur in childhood, however much of the literature is taken from research using adult samples.
Aims
This practitioner review aims to give an overview of the assessment and treatment of health-related worries in children and young people in the context of the COVID-19 pandemic. This review is based on the limited existing evidence in this population and the more substantial evidence base for treating health anxiety in adults. We consider the adaptations needed to ensure such interventions are developmentally appropriate.
Background
Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses.
Methods
We used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained.
Results
There were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes ‘excessive.’ The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features.
Conclusions
The concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.
Background
Severe health anxiety (HA) is characterized by excessive and impairing worry and preoccupation with health issues and can cause increased and unnecessary medical examinations. HA in childhood and adolescence is scarcely explored, hindering the potential for prevention and early intervention.
Methods
HA was assessed in 1,278 children/youths at two time points at ages 11 and 16 years in a general population‐based birth cohort. Register‐based data on costs related to nonhospital‐based primary and secondary somatic health services were obtained over the follow‐up period. The presence of functional somatic symptoms, emotional disorders and chronic somatic illness at baseline were included as covariates.
Results
High HA (top 10% score) at age 11 predicted high HA at age 16 (relative risk [RR] 2.03, 95% CI: 1.26–3.31). The group with persistent HA was small (n = 17, 1.3%), resulting in broad confidence intervals. The statistical effect of HA at age 11 on HA at age 16 was heavily reduced after adjustment for sex and all covariates (RR: 1.49, 95% CI: 0.85–2.60). In the adjusted model, somatic illness at age 11 (RR: 1.91, 95% CI: 1.22–2.98) and female sex (RR: 3.33, 95% CI: 2.01–5.50) were independently associated with HA at age 16. Persistent HA was associated with approximately doubled healthcare costs compared to the group with consistently low HA. Incident HA at age 16 was associated with increased costs over follow‐up. The increased costs were not explained by chronic somatic illness.
Conclusions
A small subgroup of children had persistent high levels of HA from late childhood to adolescence and displayed increased healthcare costs. Female sex and chronic somatic disorders at age 11 were independent risk factors of HA at age 16. These findings provide potential means of early identification and of therapeutic levers. Further intervention development and evaluation are needed.
Background
Health anxiety is common, disabling and costly due to patients’ extensive use of health care services. Internet-delivered treatment may overcome barriers of accessibility to specialized treatment. We aimed to evaluate the efficacy of internet-delivered acceptance and commitment therapy (iACT).
Methods
A randomized, controlled trial of iACT versus an internet-delivered discussion forum (iFORUM), performed in a Danish university hospital setting. Patients self-referred and underwent video-diagnostic assessment. Eligible patients (≥18 years) with health anxiety were randomized to 12 weeks of intervention. The randomization was blinded for the assessor. The primary outcome was between-group unadjusted mean differences in health anxiety symptoms measured by the Whiteley-7 Index (WI-7, range 0–100) from baseline to 6-month follow-up (6-MFU) using intention to treat and a linear mixed model. The study is registered at clinicaltrials.gov, number NCT02735434.
Results
A total of 151 patients self-referred, and 101 patients were randomized to iACT ( n = 53) or iFORUM ( n = 48). A mean difference in change over time of 19.0 points [95% confidence interval (CI) 10.8–27.2, p < 0.001] was shown on the WI-7, and a large standardized effect size of d = 0.80 (95% CI 0.38–1.23) at 6-MFU. The number needed to treat was 2.8 (95% CI 1.8–6.1, p < 0.001), and twice as many patients in iACT were no longer clinical cases (35% v. 16%; risk ratio 2.17, 95% CI 1.00–4.70, p = 0.050). Adverse events were few and insignificant.
Conclusions
iACT for health anxiety led to sustained effects at 6-MFU. The study contributes to the development of easily accessible treatment options and deserves wider application.
Worry is common in children and adolescents, yet some youth experience excessive worries that persist over time and cause significant distress. Whilst the literature on worry and generalised anxiety disorder (GAD) in adults is well established, relatively less is known about the cognitive mechanisms underlying child and adolescent worry. An influential cognitive model of adult pathological worry (Hirsch and Matthews in Behav Res Therapy 50:636–646, https://doi.org/10.1016/j.brat.2012.06.007, 2012) proposes that negative information-processing biases, reduced executive functions, and verbal worry are critical in the aetiology of GAD in adults. The current systematic review investigated whether this cognitive model of worry could be extended to understand child and adolescent worry. Following a systematic search of the literature and screening for eligibility, 30 studies were identified. Evidence indicates that negative information-processing biases and reduced executive functions play an important role in worry and GAD in children and adolescents. However, evidence that children and adolescents experience verbal worry is inconclusive. Building upon Hirsch and Matthews' cognitive model (Behav Res Therapy 50:636–646, https://doi.org/10.1016/j.brat.2012.06.007, 2012), we propose a model of child and adolescent worry to provide a guiding framework for future research. We conclude that cognitive models of worry should incorporate a developmental framework in order to provide greater insight into the mechanisms uniquely associated with worry in children and adolescents and help to identify the cognitive processes to target for early interventions and treatments.
Background
Health anxiety may be an increasing problem because of the focus on monitoring health and increasing use of the Internet for self-diagnosis (cyberchondria). There is very little information about changes in the prevalence of health anxiety.
Aim
We compared the prevalence of health anxiety in four medical clinics in one hospital over a 4-year period using the Health Anxiety Inventory (HAI) as a diagnostic marker.
Method
Patients attending cardiology, endocrine, gastroenterology and respiratory medicine clinics at King’s Mill Hospital, North Nottinghamshire, completed the HAI while waiting for their appointments. There were eight research assistants involved in collecting data, two in the 2006–2008 period and six in the 2008–2010 period. As a consequence, more data were collected on the second occasion.
Results
There was an increase in the prevalence of health anxiety from 14.9% in 2006–2008 (54 positive of 362 assessed) to 19.9% (1,132 positive out of 5,704 assessed) in 2008–2010. This increase was primarily noted in gastroenterology clinics (increase of 10%) and not shown in endocrine ones.
Conclusion
The prevalence of health anxiety is increasing in those who attend medical out-patient clinics. Reasons are given that this may be a possible result of cyberchondria, as the excessive use of the Internet to interpret troubling symptoms is growing. Further studies are needed in other populations, but there is reason to be concerned at this trend as it is likely to increase the number of medical consultations unnecessarily.
Background
Functional disorders (FD) are present across the age span and are commonly encountered in somatic health care. Psychological therapies have proven effective, but mostly the effects are slight to moderate. The advent of third wave cognitive behavioural therapies launched an opportunity to potentially improve treatments for FD.MethodA narrative review of the literature on the application of mindfulness-based therapies (MBT) and Acceptance & Commitment Therapy (ACT) in children and adult populations with FD.ResultsThere were very few and mainly preliminary feasibility studies in children and adolescents. For adults there were relatively few trials of moderate to high methodological quality. Ten MBT randomised trials and 15 ACT randomised trials of which 8 were internet-delivered were identified for more detailed descriptive analysis. There was no evidence to suggest higher effects of third wave treatments as compared to CBT. For MBT, there seemed to be minor effects comparable to active control conditions. A few interventions combining second and third wave techniques found larger effects, but differences in outcomes, formats and dosage hamper comparability.Conclusions
Third wave treatments are getting established in treatment delivery and may contribute to existing treatments for FD. Future developments could further integrate second and third wave treatments across the age span. Elements unambiguously targeting specific illness beliefs and exposure should be included. The benefit of actively engaging close relatives in the treatment not only among younger age groups but also in adults, as well as the effect of more multimodal treatment programmes including active rehabilitation, needs to be further explored.
This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To carry out a meta-analysis of identified studies to determine whether CBT leads to remission of 1) the primary child/adolescent anxiety disorder and 2) all anxiety diagnoses, and/or 3) a clinically significant reduction in anxiety symptoms in comparison with passive (waiting list) controls, active controls, treatment as usual, or medication. To determine the comparative efficacy of CBT alone, and the combination of CBT and medication, versus drug placebo. To determine whether post-treatment gains of CBT are maintained at longer-term follow-up. To describe the age range of participants included in CBT trials in order to determine the age of the youngest participants. To determine whether CBT for anxiety leads to a clinically significant reduction in depressive symptoms, and/or improvements in global functioning. To carry out subgroup analyses of different types of CBT according to 1) amount of therapist contact time; and 2) delivery format (child-focused individual, group, and with/without family involvement, and parent-delivered). To carry out a subgroup analysis of CBT for children and adolescents with ASD and for children and adolescents with intellectual impairments.
Background
Health anxiety (HA) is an increasing public health problem related to increased health service costs, and associated with functional somatic symptoms (FSS) and considerable personal suffering. Abnormal bodily experiences which may resemble HA and FSS are common in psychotic disorders, but a potential link between HA and psychosis vulnerability in childhood is largely unexplored. The current study estimates the association between subclinical psychotic experiences (PE) and HA and FSS in a general population cohort of preadolescents.
Methods
The study population consisted of 1,572 11–12‐year‐old children from the Copenhagen Child Cohort 2000. PE were comprehensibly assessed as either present or not present using the Kiddie Schedule of Affective Disorders and Schizophrenia psychosis section. HA and FSS were assessed by self‐report on validated questionnaires. Additional variables on general psychopathology, puberty, and chronic somatic illness were also obtained.
Results
Psychotic experiences were associated with the top 10% high scores of HA (Odds Ratio (OR) 3.2; 95% CI: 2.1–4.8) and FSS (OR 4.6; 95% CI: 3.1–6.9) in univariate analyses. After mutual adjustment, the association was reduced to (HA: OR 2.3; 95% CI: 1.5–3.5; FSS: OR 3.7; 95% CI: 2.4–4.7), suggesting interdependence. Further adjustment for potential confounders and general psychopathology only reduced the associations slightly: HA OR 2.2 (95% CI: 1.4–3.4); FSS OR 3.3 (95% CI: 2.1–5.2). Secondary analyses of subdimensions of HA showed that PE were associated with fears (OR 3.0; 95% CI: 2.0–4.6) and daily impact of HA symptoms (OR 5.0; 95% CI: 3.4–7.5), but not help seeking (OR 1.2; 95% CI: 0.7–2.1).
Conclusions
This is the first study to investigate the associations between PE and HA and FSS, respectively. PE were significantly associated with HA and FSS over and above general psychopathology in preadolescence. Individuals with PE expressed high levels of health‐related fears and daily impact, but no corresponding help‐seeking behavior.
Objective: We conducted meta-analyses to assess risk of anxiety disorders among offspring of parents with anxiety disorders and to establish whether there is evidence of specificity of risk for anxiety disorders as opposed to depression in offspring, and whether particular parent anxiety disorders confer risks for particular child anxiety disorders. We also examined whether risk was moderated by offspring age, gender, temperament and the presence of depressive disorders in parents.
Method: We searched PsycINFO, PubMed and Web of Science in June, 2016 and July, 2017 (PROSPERO CRD42016048814). Study inclusion criteria: published in peer-reviewed journals; contained at least one group of parents with anxiety disorders and at least one comparison group of parents who did not have anxiety disorders; reported rates of anxiety disorders in offspring, and used validated diagnostic tools to ascertain diagnoses. We used random and mixed-effects models and evaluated study quality.
Results: We included 25 studies (7285 offspring). Where parents had an anxiety disorder, offspring were significantly more likely to have anxiety (RR: 1.76, 95% CI = 1.58-1.96) and depressive disorders (RR: 1.31, 95% CI = 1.13-1.52) than offspring of parents without anxiety disorders. Parent Panic Disorder and Generalized Anxiety Disorder appeared to confer particular risk. Risk was greater for offspring anxiety than depressive disorders (RR: 2.50, 95% CI = 1.50-4.16), and specifically for offspring Generalized Anxiety Disorder, Separation Anxiety Disorder and Specific Phobia, but there was no evidence that children of parents with particular anxiety disorders were at increased risk for the same particular anxiety disorders. Moderation analyses were possible only for offspring age, gender and parental depressive disorder; none were significant.
Conclusions: Parent anxiety disorders pose specific risks of anxiety disorders to offspring. However, there is limited support for transmission of the same particular anxiety disorder. These results support the potential for targeted prevention of anxiety disorders.
Purpose of review:
To examine the diagnosis of health anxiety, its prevalence in different settings, public health significance, treatment, and outcome.
Recent findings:
Health anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Lifetime prevalence rates are 6% in the population and as high as 20% in hospital out-patients, leading to greater costs to health services through unnecessary medical contacts. Its prevalence may be increasing because of excessive internet browsing (cyberchondria). Drug treatment with antidepressants has some efficacy but is not well-liked, but psychological treatments, including cognitive behavior therapy, stress management, mindfulness training, and acceptance and commitment therapy, given either individually, in groups, or over the Internet, have all proved efficacious in both the short and longer term. Untreated health anxiety leads to premature mortality. Health anxiety has become an increasing clinical and public health issue at a time when people are being formally asked to take more responsibility in monitoring their own health. More attention by health services is needed.
Background:
Severe health anxiety (hypochondriasis), or illness anxiety disorder according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, is characterized by preoccupation with fear of suffering from a serious illness in spite of medical reassurance. It is a debilitating, prevalent disorder associated with increased health care utilization. Still, there is a lack of easily accessible specialized treatment for severe health anxiety.
Objective:
The aims of this paper were to (1) describe the development and setup of a new internet-delivered acceptance and commitment therapy (iACT) program for patients with severe health anxiety using self-referral and a video-based assessment; and (2) examine the feasibility and potential clinical efficacy of iACT for severe health anxiety.
Methods:
Self-referred patients (N=15) with severe health anxiety were diagnostically assessed by a video-based interview. They received 7 sessions of clinician-supported iACT comprising self-help texts, video clips, audio files, and worksheets over 12 weeks. Self-report questionnaires were obtained at baseline, post-treatment, and at 3-month follow-up. The primary outcome was Whiteley-7 Index (WI-7) measuring health anxiety severity. Depressive symptoms, health-related quality of life (HRQoL), life satisfaction, and psychological flexibility were also assessed. A within-group design was employed. Means, standard deviations, and effect sizes using the standardized response mean (SRM) were estimated. Post-treatment interviews were conducted to evaluate the patient experience of the usability and acceptability of the treatment setup and program.
Results:
The self-referral and video-based assessments were well received. Most patients (12/15, 80%) completed the treatment, and only 1 (1/15, 7%) dropped out. Post-treatment (14/15, 93%) and 3-month follow-up (12/15, 80%) data were available for almost all patients. Paired t tests showed significant improvements on all outcome measures both at post-treatment and 3-month follow-up, except on one physical component subscale of HRQoL. Health anxiety symptoms decreased with 33.9 points at 3-month follow-up (95% CI 13.6-54.3, t11= 3.66, P=.004) with a large within-group effect size of 1.06 as measured by the SRM.
Conclusions:
Treatment adherence and potential efficacy suggest that iACT may be a feasible treatment for health anxiety. The uncontrolled design and small sample size of the study limited the robustness of the findings. Therefore, the findings should be replicated in a randomized controlled trial. Potentially, iACT may increase availability and accessibility of specialized treatment for health anxiety.
Trial registration:
Danish Data Protection Agency, Central Denmark Region: 1-16-02-427-14; https://www.rm.dk/sundhed/faginfo/forskning/datatilsynet/ (Archived by Webcite at http://www.webcitation.org/6yDA7WovM).
Background
Intolerance of uncertainty (IU) has been implicated in the development and maintenance of worry and anxiety in adults and there is an increasing interest in the role that IU may play in anxiety and worry in children and adolescents.
Method
We conducted a systematic review and meta-analysis to summarize existing research on IU with regard to anxiety and worry in young people, and to provide a context for considering future directions in this area of research. The systematic review yielded 31 studies that investigated the association of IU with either anxiety or worry in children and adolescents.
Results
The meta-analysis showed that IU accounted for 36% of the variance in anxiety and 39.69% in worry. Due to the low number of studies and methodological factors, examination of potential moderators was limited; and of those we were able to examine, none were significant moderators of either association. Most studies relied on questionnaire measures of IU, anxiety, and worry; all studies except one were cross-sectional and the majority of the studies were with community samples.
Limitations
The inclusion of eligible studies was limited to studies published in English that focus on typically developing children.
Conclusions
There is a strong association between IU and both anxiety and worry in young people therefore IU may be a relevant construct to target in treatment. To extend the existing literature, future research should incorporate longitudinal and experimental designs, and include samples of young people who have a range of anxiety disorders.
Accommodation refers to the ways in which family members act to alleviate a child's symptoms and distress. In the context of youth obsessive-compulsive disorder (OCD) and anxiety, accommodation may contribute to the development and maintenance of the disorder. We review the theory and research literature on accommodation, including measures of accommodation. Findings support the idea that accommodation is not a preferred parenting strategy; the sequelae of accommodation are negative and are often associated with both parent and sibling distress. Accommodation should be assessed and targeted in treatment for youth OCD and anxiety. We conclude by identifying several areas for future research, including the development of interventions that specifically target accommodation, the evaluation of potential family factors implicated in accommodation, and the exploration of the construct of accommodation in other childhood disorders. © 2017 American Psychological Association. Published by Wiley Periodicals, Inc., on behalf of the American Psychological Association
BACKGROUND
Health anxiety by proxy is described as a parent's obsessive worries that their child is severely sick although not medically confirmed. Research on health anxiety by proxy suggests that it is highly distressing for the parent, and their child may be at risk of developing maladaptive symp-tom coping strategies. Until now no targeted treatment options for this group existed. PROXY is a newly developed 8-week psychological internet treatment for parents with health anxiety by proxy.
OBJECTIVE
The aim of this article is to describe the protocol for a study investigating potential effect of PROXY on parents' worries about their children's health.
METHODS
A replicated randomized single-case experimental design with AB-phases will be conducted. Each of the five participants will be randomized to a baseline period between 7-26 days before entering treatment and they will report daily anxiety level by text message throughout the study. Data will be submitted to visual analysis, and randomization tests will be conducted for each participant to test the null hypothesis that PROXY will have no effect on participants' anxiety.
RESULTS
The recruitment of parents began in June 2022 and is expected to be complete in February 2023, with data collection ceasing in April 2023.
CONCLUSIONS
This is the first testing of a treatment for health anxiety by proxy. Using single-case experimental design with replicated randomized phases enables a methodologically sound testing with very few participants. Results will inform researchers on individual treatment courses and effect which may direct future research.
CLINICALTRIAL
Trial registration number is NCT04830605.
Objective:
To clarify, using an extended adoption design, the sources of parent-offspring transmission for anxiety disorder (AD) and its major subforms and their familial cross-generational relationship with major depression (MD).
Methods:
Offspring (born 1960-1992) and their parents, from six family types (intact, not-lived-with biological father or mother, lived-with step-father or step-mother, and adoptive), were ascertained from Swedish national samples. Diagnoses were obtained from national medical registers. We assessed three sources of parent-child resemblance: genes plus rearing, genes only, and rearing only. To test comorbidity effects, single diagnoses were assigned in comorbid cases based on frequency and recency.
Results:
For AD to AD parent-child transmission, best-estimate tetrachoric correlations for the three types of parent-offspring relationships genes plus rearing, genes only, and rearing only-equaled +0.16 (95% CI=0.16, 0.16), +0.12 (95% CI=0.10, 0.13), and +0.06 (95% CI=0.04, 0.07), respectively, with broadly similar results for MD to MD transmission. Cross-disorder cross-generation correlations were modestly lower, with genetic and rearing correlations for AD and MD estimated at +0.83 (95% CI=0.76, 0.90) and +0.83 (95% CI=0.69, 0.96), respectively. Analyses for panic disorder and generalized anxiety disorder (GAD) produced comparable findings, with the genetic correlation with MD modestly higher for generalized anxiety disorder than panic disorder. Applying a diagnostic hierarchy to comorbid cases resulted in a decline in cross-disorder cross-generation transmission with the estimated genetic correlation equaling +0.46 (95% CI=0.30, 0.62).
Conclusions and relevance:
For AD and its major subforms, cross-generational transmission includes both genetic and rearing effects. In traditional analyses, AD and MD demonstrate highly correlated genetic and rearing effects. The genetic correlation weakened when applying a diagnostic hierarchy.
Background
Classification of hypochondriasis as an obsessive-compulsive and related disorder in the International Classification of Diseases 11th Revision (ICD-11) has generated new heuristics for treatment of this common, chronic and disabling disorder. Standard treatment involves cognitive behaviour therapy (CBT) or selective serotonin reuptake inhibitors (SSRIs), but no meta-analysis has so far considered hypochondriasis as a structured diagnosis or assessed the role of medication. A clearer understanding of the relative effectiveness of these interventions and identification of clinically relevant factors moderating the treatment response is needed for clinical guideline development.
Methods
The current systematic review and meta-analysis of interventions for hypochondriasis was preregistered on PROSPERO (CRD42020185768) and follows PRISMA guidelines. We searched MEDLINE, PsycINFO, and Cochrane Library databases until July 2021 for randomized controlled trials (RCTs) of interventions for patients diagnosed with hypochondriasis (or historical diagnostic equivalents). We assessed aspects of study quality using: the CONSORT Checklist for evaluation of RCTs, the Cochrane Risk of Bias 2 tool, researcher allegiance and treatment fidelity. The primary outcome was improvement in hypochondriasis symptoms, comparing intervention and control groups at trial endpoint. Moderator variables were assessed using subgroup and meta-regression analyses.
Results
Searches identified 13 randomized controlled trials (RCTs) (N = 1405); 12 included CBT (N = 1212) and three included SSRI (N = 193) arms as the experimental intervention. Random effects meta-analysis yielded a moderate-to-large effect size for CBT versus all controls (g = −0.71, [95% CI -0.99, −0.42; I² = 81.49]). Funnel plot asymmetry indicated possible publication bias and two potentially missing trials, reducing the effect size (g = −0.60, [95% CI -0.88, −0.32]). Subgroup analysis showed that choice of control significantly moderated effect size, with those in CBT vs. wait-list (g = −1.32 [95% CI -1.74 to −0.90; I2 = 0, k = 7]) being double those of CBT vs. psychological or pharmacological placebo controls (g = −0.58 [95% CI -0.95 to −0.22; I2 = 82, k = 7]). Analysis of studies directly comparing CBT and SSRIs found a numerical, but not statistical advantage for SSRIs (g = 0.21 [95% CI -0.46 to 0.87; I2 = 58.34) and a modest effect size emerged for SSRIs vs. pill placebo (g = −0.29 [95% CI -0.57 to −0.01, I2 = 0]). Most studies (11/13) were rated as high on potential researcher allegiance bias in favour of CBT. Meta-regressions revealed that effect sizes were larger in younger participants, and smaller in better quality and more recent RCTs and those with greater CBT fidelity.
Conclusion
CBT and SSRIs are effective in the acute treatment of hypochondriasis, with some indication that intervention at a younger age produces better outcomes for CBT. In the case of CBT, effect sizes appear to have been significantly inflated by the use of wait list controls, and researcher allegiance bias. We recommend that a definitive, adequately controlled trial, designed with respect to the methodological issues raised in this meta-analysis, is needed to determine the magnitude effects for CBT and SSRIs with confidence and the long-term effect of treatments, to inform mental health service provision for this overlooked patient group.
The COVID-19 pandemic has been accompanied by unprecedented levels of stress and threats in a variety of domains (e.g., health, livelihood). Individual differences in threat reactivity may explain why some individuals are at elevated risk for the development or maintenance of psychopathology during the COVID-19 pandemic. This article describes several prominent models, mechanisms, and components of threat reactivity (e.g., appraisals, intolerance of uncertainty, avoidance) and discusses how they might help improve understanding of changes in psychopathology during and following the COVID-19 pandemic.
Purpose
The coronavirus disease 2019 (COVID-19) pandemic has a severe impact on the general population. During the pandemic, children may develop emotional and psychological symptoms, including increased worries about health and illness, known as health anxiety symptoms (HASs). We aimed to explore HAS in 7–9-year-old children from the Danish Odense Child Cohort (OCC) during the first COVID-19 lockdown period in Denmark, and to examine associations with potential risk factors.
Material and methods
OCC is a cohort of children born between 2010 and 2012, which originally recruited 2874 of 6707 pregnancies (43%). Among the current OCC population of 2430 singleton children, 994 participated in this study (response rate 40%). Children and their parents filled out questionnaires about child HAS, family exposure to COVID-19 infection and parental HAS. Adjusted odds ratios (aORs) were calculated between high score child HAS (≥90th percentile) and covariates by use of logistic regression.
Results
Most children (n = 686, 69%) reported few worries about their health. Children reporting high score HAS also had higher levels of internalizing symptoms at age 5; aOR 2.15 (1.20;3.85), p = .010, and higher levels of maternal and paternal HAS; aOR 2.40 (1.44;3.97), p = .001, and 2.00 (1.10;3.65), p = .023, whereas no association with child sex or familial exposure to COVID-19 was detected (n = 65, 6.5%).
Conclusions
High score child HAS during the first lockdown period of the COVID-19 pandemic was not associated with family exposure to COVID-19 infection, but to being a more anxious child a priori and to HAS in parents.
Background
: Theoretical and empirical evidence suggests that maternal anxiety relates to overprotection, yet studies have found conflicting evidence. The literature would benefit from a systematic review.
Methods
: In April 2020, a systematic review on the relation between maternal anxiety and overprotection was conducted. The search was updated in January 2021. A total of 13 articles were included.
Results
: Of 16 reported bivariate correlations, 12 showed that maternal anxiety accounted for significant variance in overprotection (7 reported a small effect and 5 reported a medium effect). In a group differences study, mothers with anxiety showed greater overprotection. Additionally, in 4 out of 7 multivariate relations maternal anxiety accounted for significant variance in overprotection over and above other factors while 3 suggested that maternal anxiety did not account for significant variance in overprotection. In a multivariate, longitudinal study, maternal anxiety predicted overprotection, over and above other factors. Given conflicting evidence, we evaluated article's methodological strength and found stronger evidence supporting a small to medium size relation compared to evidence supporting no significant relation.
Limitations
: We report ranges of coefficients and effect sizes, but meta-analytic results are needed to determine the magnitude of these relations based on various factors. More longitudinal studies are needed to determine directionality.
Conclusions
: Although the literature shows conflicting results, the present review supports that maternal anxiety relates to overprotection, though the effect of this relation is small to medium. It may be beneficial to incorporate mental health for parents into existing parenting interventions.
Food neophobia (FN) describes problematic fear-based avoidance/restriction of novel foods. Using the novel parent-reported Measure of Food Neophobia (MFN), the authors examined FN symptoms and impairment in 305 Salvadorian children and explored clinical correlates. Factor analysis supported the MFN's designed structure to inquire about FN symptoms and FN impairment. At least one FN symptom was observed in 91% of the sample; however, only 9% were rated as having moderate or greater impairment. Demographic variables were not associated with FN; however, FN was positively correlated with internalizing, externalizing, inattention, health anxiety, and obsessive-compulsive symptoms. Inattention symptoms and health anxiety emerged as significant predictors of FN symptoms, while FN symptoms were the only significant predictor of FN impairment. The present study supports the MFN and provides information about FN in a general population, including the prevalence of clinically significant symptoms and association with psychological domains. Continued investigation of FN is still needed.
Objective
Health anxiety by proxy is a newly introduced term to describe parents’ experience of excessive and unpleasant worries about their child’s health. This article describes the development of a new measure, the Health Anxiety by Proxy Scale (HAPYS), for systematic assessment of health anxiety by proxy.
Method
The development of the HAPYS was performed over three phases. (1) Patients clinically assessed to have health anxiety by proxy participated in semi-structured interviews to elaborate their experience of worries regarding their child's health and their related behaviours, and to examine the face validity of items in an existing questionnaire: ‘Illness Worry Scale – parent version’. (2) Based on the findings from Phase 1 the project group and a panel of experts selected and formulated questionnaire items and scoring formats. (3) The HAPYS was pilot-tested twice using cognitive interviewing with healthy parents and parents with health anxiety by proxy followed by further adjustments.
Results
The final version of HAPYS consists of 26 items characteristic of health anxiety by proxy and of an impact section with five items.
Conclusion
Based on the pilot testing the HAPYS showed good face and content validity. It holds the potential to be a valid questionnaire to help clinicians across health care settings assess parents suffering from health anxiety by proxy.
Background:
Previous Cochrane Reviews have shown that cognitive behavioural therapy (CBT) is effective in treating childhood anxiety disorders. However, questions remain regarding the following: up-to-date evidence of the relative efficacy and acceptability of CBT compared to waiting lists/no treatment, treatment as usual, attention controls, and alternative treatments; benefits across a range of outcomes; longer-term effects; outcomes for different delivery formats; and amongst children with autism spectrum disorders (ASD) and children with intellectual impairments.
Objectives:
To examine the effect of CBT for childhood anxiety disorders, in comparison with waitlist/no treatment, treatment as usual (TAU), attention control, alternative treatment, and medication.
Search methods:
We searched the Cochrane Common Mental Disorders Controlled Trials Register (all years to 2016), the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, and PsycINFO (each to October 2019), international trial registries, and conducted grey literature searches.
Selection criteria:
We included randomised controlled trials of CBT that involved direct contact with the child, parent, or both, and included non-CBT comparators (waitlist/no treatment, treatment as usual, attention control, alternative treatment, medication). Participants were younger than age 19, and met diagnostic criteria for an anxiety disorder diagnosis. Primary outcomes were remission of primary anxiety diagnosis post-treatment, and acceptability (number of participants lost to post-treatment assessment), and secondary outcomes included remission of all anxiety diagnoses, reduction in anxiety symptoms, reduction in depressive symptoms, improvement in global functioning, adverse effects, and longer-term effects.
Data collection and analysis:
We used standard methodological procedures as recommended by Cochrane. We used GRADE to assess the quality of the evidence.
Main results:
We included 87 studies and 5964 participants in quantitative analyses. Compared with waitlist/no treatment, CBT probably increases post-treatment remission of primary anxiety diagnoses (CBT: 49.4%, waitlist/no treatment: 17.8%; OR 5.45, 95% confidence interval (CI) 3.90 to 7.60; n = 2697, 39 studies, moderate quality); NNTB 3 (95% CI 2.25 to 3.57) and all anxiety diagnoses (OR 4.43, 95% CI 2.89 to 6.78; n = 2075, 28 studies, moderate quality). Low-quality evidence did not show a difference between CBT and TAU in post-treatment primary anxiety disorder remission (OR 3.19, 95% CI 0.90 to 11.29; n = 487, 8 studies), but did suggest CBT may increase remission from all anxiety disorders compared to TAU (OR 2.74, 95% CI 1.16 to 6.46; n = 203, 5 studies). Compared with attention control, CBT may increase post-treatment remission of primary anxiety disorders (OR 2.28, 95% CI 1.33 to 3.89; n = 822, 10 studies, low quality) and all anxiety disorders (OR 2.75, 95% CI 1.22 to 6.17; n = 378, 5 studies, low quality). There was insufficient available data to compare CBT to alternative treatments on post-treatment remission of primary anxiety disorders, and low-quality evidence showed there may be little to no difference between these groups on post-treatment remission of all anxiety disorders (OR 0.89, 95% CI 0.35 to 2.23; n = 401, 4 studies) Low-quality evidence did not show a difference for acceptability between CBT and waitlist/no treatment (OR 1.09, 95% CI 0.85 to 1.41; n=3158, 45 studies), treatment as usual (OR 1.37, 95% CI 0.73 to 2.56; n = 441, 8 studies), attention control (OR 1.00, 95% CI 0.68 to 1.49; n = 797, 12 studies) and alternative treatment (OR 1.58, 95% CI 0.61 to 4.13; n=515, 7 studies). No adverse effects were reported across all studies; however, in the small number of studies where any reference was made to adverse effects, it was not clear that these were systematically monitored. Results from the anxiety symptom outcomes, broader outcomes, longer-term outcomes and subgroup analyses are provided in the text. We did not find evidence of consistent differences in outcomes according to delivery formats (e.g. individual versus group; amount of therapist contact time) or amongst samples with and without ASD, and no studies included samples of children with intellectual impairments.
Authors' conclusions:
CBT is probably more effective in the short-term than waiting lists/no treatment, and may be more effective than attention control. We found little to no evidence across outcomes that CBT is superior to usual care or alternative treatments, but our confidence in these findings are limited due to concerns about the amount and quality of available evidence, and we still know little about how best to efficiently improve outcomes.
Objective:
The Whiteley Index (WI) is the most widely used screening tool for health anxiety/illness worry. Diverse versions (different number of items and factors) have been used. We aimed to examine psychometric properties of 7 items of the WI besides adding a new item on obsessive illness rumination for better future detection of health anxiety.
Methods:
Data from a large population-based study in Denmark (N = 9656). Construct validity was examined by exploratory (EFA) and confirmatory factor analysis (CFA) plus hypothesis testing. Criterion validity was evaluated via Receiver Operating Characteristic curves and area under the curve (AUC) using a diagnostic criterion as gold standard.
Results:
Factor loadings of EFA revealed viable one-factor models (6, 7, or 8 items) and two-factor models (7 or 8 items). Factor one indicated a dimension of illness worry. Factor two indicated a somatic symptoms dimension. The new item on obsessive illness rumination merged well with the existing items. EFA of two-factor models and one-factor 6-item model showed good fit. CFA resembles these findings. A one-factor 6-item model (including the item on obsessive illness rumination and excluding two items concerning somatic symptoms) was chosen as the optimal model and presented good criterion validity: AUC 0.88 (95%CI(0.84;0.92)). Main hypotheses concerning associations with somatic symptoms, anxiety, and depression were met.
Conclusions:
We found good psychometric properties for a new one-factor 6-item version of the WI. Through elimination of items concerning somatic symptoms and inclusion of obsessive illness rumination, we propose a clear, unidimensional and improved measure of illness worry: Whiteley-6-R.
Health anxiety can be defined as a multifaceted trait that is primarily characterised by a fear of, or preoccupation with, serious illness. Whereas low levels of health anxiety can be helpful, clinically significant levels are associated with personal suffering and substantial societal costs. As general anxiety is probably on the rise, and the Internet has increased access to health-related information, it is commonly speculated that health anxiety has increased over the past decades. We tested this hypothesis based on a systematic review and meta-analysis of birth cohort mean health anxiety in Western university student samples from 1985 to 2017. Sixty-eight studies with 22 413 student participants were included. The primary analysis indicated that the mean score on the Illness Attitudes Scales had increased by 4.61 points (95 % CI: 1.02, 8.20) from 1985 to 2017. The percentage of general population Internet users in the study year of data collection was not predictive of student mean health anxiety. In conclusion, this study corroborates the hypothesis of an increase in health anxiety, at least in the student population, over the past decades. However, this increase could not be linked to the introduction of the Internet.
Our understanding of the phenomenon of health anxiety in children and adolescents has expanded considerably in recent years. The role emotion regulation may play in the etiology of health anxiety has yet to be explored. The purpose of the current investigation was to examine the relationship between self-reported health anxiety, emotion regulation, and associated constructs in children and adolescents. The sample was comprised of 79 children and adolescents between the ages of 7 to 15 years (mean age = 10.89 years; SD = 2.11). Participants completed a series of measures examining health anxiety, emotion regulation, anxiety sensitivity, and depression. Statistically significant associations were not observed between health anxiety and emotion regulation; however, some statistically significant associations were demonstrated between anxiety sensitivity and depression and emotion regulation. Statistically significant associations were observed between health anxiety and anxiety sensitivity. This investigation contributes to a more complete understanding of the factors that may or may not contribute to the etiology of health anxiety in children and adolescents. Our findings may be employed to develop evidence-based assessments and interventions for children and adolescents with elevated health anxiety.
Objective: To develop a measure to assess fetal health anxiety and examine its factor structure, convergent and divergent validity.
Methods: In Study 1, the Short Health Anxiety Inventory-14 item version (SHAI) (Salkovskis et al., Psychol Med. 2002;32:843–853) was adapted for use with pregnant women to examine fetal health anxiety named the Fetal Health Anxiety Inventory (FHAI). Four pregnant women and three subject matter experts (SMEs) reviewed the FHAI. In Study 2, 100 pregnant women completed the FHAI and related self-report measures.
Results: In Study 1, both reviewer groups provided feedback directing minor changes to the FHAI. In Study 2, a revised version was used. The revised FHAI demonstrated excellent internal consistency (α = 0.91). Results from an EFA suggested that the FHAI may be conceptualized as a one- or two-factor scale. Convergent (pregnancy-related anxiety [r = 0.56, p = .0001], parental health anxiety [r = 0.53, p = .0001], anxiety [r = 0.57, p = .0001], anxiety sensitivity [r = 0.28, p = .004] and intolerance of uncertainty [r = 0.29, p = .003]) and divergent (parental depression [r = 0.16, p = .12]) validity was evidenced with additional measures of interest.
Conclusion: Preliminary findings suggest that the FHAI represents a psychometrically sound instrument to measure the construct of fetal health anxiety. Practical and theoretical implications of the present results are discussed.
Health anxiety (HA) is defined as excessive worries focused on one’s health. The cognitive-behavioral and the interpersonal models assume an association between childhood experiences and the development of HA. The aim of this review is to identify studies which have investigated the association between childhood and family factors and HA. The literature search was generated in PUBMED, EMBASE, and PsycINFO. 25 papers were included. The results show a trend toward an association between the presentation of HA in adulthood and intergenerational transmission of HA and illness beliefs, illness experiences during childhood, and an anxious attachment style. However, no strong empirical evidence could be determined for any of these factors. Possible directions for future research are discussed.
This study explored health anxiety and associated constructs in children and adolescents with congenital heart disease and typically developing children and adolescents. A total of 84 participants (7–16 years) completed measures of health anxiety, intolerance of uncertainty, anxiety sensitivity, and DSM-IV anxiety disorder symptom categories. Results demonstrated that children and adolescents with congenital heart disease experienced significantly higher levels of health anxiety and associated constructs compared to typically developing children and adolescents. Our findings highlight a specific chronic physical health population who may be at risk of clinical levels of health anxiety and related psychopathology and require appropriate intervention.
Objective
The Childhood Illness Attitude Scales (CIAS) were created as a developmentally appropriate measure for symptoms of health anxiety (HA) in school-aged children. Despite overall sound psychometric properties reported in previous studies, more comprehensive examination of the latent structure and potential response bias in the CIAS is needed. The purpose of the present study was to cross-validate the latent structure of the CIAS across genders and to examine gender-specific variations in CIAS scores.
Methods
The sample comprised data from 602 Canadian and Danish school-aged children (Mage = 10.54, SD = 0.99; 52.5% girls). Confirmatory factor analyses were conducted to test 3-, modified 3-, and 4-factor models in both samples. Multigroup confirmatory factor analysis was performed to test factor structure invariance across boys and girls in a combined sample. Differential Item Functioning (DIF) was assessed using test characteristic curves.
Results
A modified 3-factor solution (i.e., fears = 11 items, help-seeking = 6 items, and symptom effects = 4 items) provided the best fit to the data (χ² (364, N = 602) = 681.7, p < 0.001; χ²/df = 1.803; RMSEA = 0.037; CFI = 0.926). The factor structure was stable, well-fitting, and indicated measurement invariance across groups. DIF analyses revealed no gender-based response bias at the scale level.
Conclusion
Results support a revised 3-factor version of the CIAS that can be used with confidence to assess symptoms of HA in school-aged boys and girls.
Background:
Health anxiety (HA), or hypochondriasis, is a psychological problem characterized by a preoccupation with the belief that one is physically unwell. A 2007 Cochrane review (Thomson and Page, 2007) found cognitive behavioural therapy (CBT) to be an effective intervention for individuals with HA. Similar findings were reported in a recent meta-analysis (Olatunji et al., 2014), which did not employ a systematic search strategy. The current review aimed to investigate the efficacy of CBT for HA, and to update the existing reviews.
Method:
A systematic search was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance, including randomized controlled trials that compared CBT with a control condition for people with HA. Five hundred and sixty-seven studies were found in the original search, of which 14 were included in the meta-analysis.
Results:
Meta-analysis was conducted on 21 comparisons and a large effect size for CBT compared with a control condition was found at post therapy d = 1.01 (95% confidence interval 0.77-1.25), as well as at 6- and 12-month follow-up.
Conclusions:
This systematic review and meta-analysis provides support for the hypothesis that CBT is an effective intervention for HA when compared with a variety of control conditions, e.g. treatment-as-usual, waiting list, medication, and other psychological therapies.