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Health anxiety levels in chronic pain clinic attenders
Abstract
An application of the cognitive-behavioural model of health anxiety (hypochondriasis) to chronic pain depends on the extent to which high levels of health anxiety occur in chronic pain, which has yet to be established.
The occurrence of health anxiety in consecutively recruited chronic pain patients (n=161) and nonclinical controls with (n=34) and without pain (n=70) was investigated using a questionnaire measure of health anxiety.
Conservative figures estimated a frequency of 36.7% for hypochondriasis and 51.1% of severe and disabling health anxiety in the chronic pain sample.
The current finding that high levels of health anxiety are indeed very common in chronic pain indicates the potential value of an application of the cognitive-behavioural health anxiety model to at least the subgroup of highly health-anxious chronic pain patients.
... Examples of this include multiple sclerosis (25%; Kehler and Hadjistavropoulos, 2009), myalgic encephalomyelitis/chronic fatigue syndrome (42.4%; Daniels et al., 2020) and chronic pain (51.5%; Rode et al., 2006) which exceed the range of incidence of Tyrer et al. (2011). ...
... It also has a growing evidence base for reliable use in medical populations (Alberts et al., 2011;Donkin et al., 2006;Kehler and Hadjistavropoulos, 2009;Rode et al., 2006), and therefore shows the most promise for assessing health anxiety in PwPHC. ...
... However, distinguishing a 'normal' response from a 'pathological' response associated with distress remains controversial (Lebel et al., 2020). Some studies have proposed higher cut-off scores are needed for PwPHC (Rode et al., 2006;Seivewright et al., 2004), as those with medical complaints are likely to be more aware of aches/pain in their body all of the time (item 2) or feel afraid of having a serious illness (item 5), resulting in elevated scores. Evidence shows that individuals with physical health conditions report significantly higher levels of health anxiety compared with those without such conditions Rode et al., 2006;Tyrer et al., 2011), and so may be more likely to perceive somatic sensations and perceive them as 'dangerous' (i.e. ...
The objectives of study 1 were to use expert opinion to identify the limitations of the Health Anxiety Inventory – Short Version (SHAI) for administration in medical populations and to develop an adapted version for medical populations. The objective of the second study was to evaluate the psychometric properties of the adapted measure. A three-round Delphi study method was used in study 1. Eight experts with experience of living with a physical health condition and four experts by profession working within physical health were invited to review the SHAI. Study 2 employed a cross-sectional mixed methods questionnaire design. Individuals with multiple sclerosis ( n =115), myalgic encephalomyelitis/chronic fatigue syndrome ( n =84) and chronic pain ( n =116) were invited to complete a battery of questionnaires via an online survey. The adapted version of the SHAI for Medical Populations (HAI-M) consisted of 12 items scoring from 0 to 3, reaching high consensus (75% agreement) for administration in medical populations. All groups rated the HAI-M as more acceptable than the SHAI and no significant differences were found on HAI-M scores between clinical groups. The HAI-M demonstrated high internal consistency (.875), good test–retest reliability (.812) and convergent validity (.801). Divergent validity was also acceptable (.515). This study provides preliminary evidence for a psychometrically sound health anxiety screening tool for use in medical populations.
Key learning aims
(1) To gain insights into the presentation of health anxiety in medical conditions.
(2) To consider the validity and reliability of using questionnaire measures developed using analogue sample norms, and how this may affect measurement when used in different context and settings.
(3) The process of systematically adapting, developing and testing standardised measures for use in special subgroups.
... Newby & Moulds, 2010;Williams & Moulds, 2008). It is plausible that the extent to which people with chronic pain negatively interpret the experience of imagery could also contribute to distress and disability, for example through the exacerbation of anxiety and depression, with which chronic pain is highly comorbid (e.g., Bair et al., 2003;Rode et al., 2006), or via maladaptive efforts to suppress the images, which could potentially influence underlying emotional distress and prevent processing or resolution (as is the case in the context of PTSD; Ehlers et al., 2004). ...
... The short 14-item version is comparable to the full scale, with good internal consistency (α = 0.89). It has been used with chronic pain (Rode et al., 2006;Tang et al., 2007aTang et al., , 2007b and is sufficiently reliable with clinical and non-clinical groups (Alberts et al., 2013). Internal consistency in the present study was good (α = 0.87). ...
... The first step of the hierarchy controlled for basic demographic details (age and gender). Second, variables were entered that previous research indicates are strongly associated with pain experience, namely health anxiety, generalised anxiety and depression (Bair et al., 2003;Hirsch et al., 2007;Rode et al., 2006). Finally, the presence of intrusive pain-related imagery (yes/no) was added in the third step. ...
Purpose
Chronic pain is a highly prevalent and distressing condition with limited treatment efficacy. Prior research reports associations between the experience of mental imagery about chronic pain and pain itself, particularly in those with anxiety and depression. However, many aspects of these associations remain unexplored. A better understanding could help improve cognitive-behavioural therapies for chronic pain. This study aimed to describe the prevalence of intrusive pain-related mental imagery in a sample of people with chronic pain, examine the extent to which this imagery explained variation in pain intensity and disability, and examine the association between negative interpretations of imagery and pain.
Method
A cross-sectional online survey was conducted. Participants with chronic pain (n = 151) completed standardised measures of anxiety, depression, health anxiety, general imagery use, and an adapted questionnaire about intrusive pain-related imagery.
Results
Intrusive pain-related imagery was present in 52.3% of the sample. Demographic variables, anxiety, depression, and health anxiety significantly explained 19% (p < .001) of the variation in pain intensity and 20.2% (p < .001) in pain disability. The presence/absence of intrusive pain-related imagery did not significantly explain any additional variance for either outcome. However negative interpretations of imagery explained additional variance in pain disability. Intrusive imagery was interpreted negatively, experienced as moderately distressing, and was associated with higher rates of anxiety, depression and health anxiety.
Conclusions
Experiencing intrusive imagery about pain is common, but its presence or absence appears to have no direct relationship on pain intensity or disability. The relationship is likely to be more complex, warranting further investigation. Negative interpretations of imagery represent a potential treatment target amenable to intervention.
... This is a common mental health difficulty seen across medical settings Tyrer et al., 2011) yet the rate of health anxiety within emergency settings such as the ED has not yet been established. With high rates of presentation of pain in the ED (Todd et al., 2007) and elevated health anxiety seen in chronic pain and other chronic conditions (51.1%; Rode et al., 2006;Tyrer et al., 2011), it is likely that health anxiety is prevalent in an ED setting, particularly as those with chronic health problems are often high impact users. ...
... This study aimed to determine the prevalence of health anxiety in an ED setting and identify key psychological factors that predicted health anxiety and pain in ED walk-in attendees. Findings indicate that 14% of ED walk-ins reported severe levels of health anxiety; this is similar to the levels seen in medical clinics (Tyrer et al., 2011) but contrasts significantly with the rates of health anxiety observed in chronic pain settings which is around 50% (Rode et al., 2006). In line with previous research, the present study also found that over 80% of patients presenting to the ED attend with pain (Todd et al., 2007). ...
... This can be done using a brief screening measure such as the SHAI, which has now shown good reliability in this setting. Consistent with the literature Rode et al., 2006;Tyrer et al., 2011), participants with pre-existing health conditions reported significantly higher levels of health anxiety compared with those without any pre-existing health conditions. This suggests that those with pre-existing medical conditions may be more distressed in relation to their presenting health needs in the ED. ...
Background
Health anxiety in attendees of out-patient medical clinics is well established; however, there has been a lack of research into health anxiety within emergency settings.
Aims
This study explored the prevalence of health anxiety in ambulatory presentations in a tertiary emergency department (ED) as well as the factors associated with pain and health anxiety in this setting.
Method
A cross-sectional questionnaire design was used to gather data from adult ED ambulatory attendees across a 4-day sampling period to assess psychological and physical health variables. Number of attendances to ED over the previous 12 months was accessed through healthcare records.
Results
Of the final sample ( n = 106), 77% were white British, 54% were male, and 14% presented with severe health anxiety as measured by the Short Health Anxiety Inventory (≥18). Participants with pre-existing health conditions had significantly higher levels of health anxiety ( M = 12.36, SE = 1.59) compared with those without ( M = 7.79, SE = 0.66). Stepwise multiple regression analyses identified anxiety sensitivity and pain catastrophizing as significant independent predictors of health anxiety, explaining 51% of the variance in health anxiety. Pain catastrophizing was also a significant independent predictor of pain level, accounting for 20% of the variance.
Conclusion
This study provides insight into the prevalence of health anxiety in ED ambulatory presentations and key psychological predictors of health anxiety and pain. This has implications for treatment in an ED setting whereby patients may benefit from referral to medical psychology or mental health services.
... [10,11] It has been reported that the non-pathological type of health anxiety has become widespread with COVID-19. [2,[12][13][14] Özdin et al. [3] found that female gender, accompanying chronic disease, and previous psychiatric history are risk factors for health anxiety in Turkish society. On the other hand, Rode et al. [14] showed that 51.1% of patients with chronic pain have health anxiety. ...
... [2,[12][13][14] Özdin et al. [3] found that female gender, accompanying chronic disease, and previous psychiatric history are risk factors for health anxiety in Turkish society. On the other hand, Rode et al. [14] showed that 51.1% of patients with chronic pain have health anxiety. Negative illness perceptions have been also associated with higher pain intensity and more limitations in physical functioning in patients with chronic musculoskeletal pain. ...
... Consequently, psychosocial characteristics of pain such as health anxiety or illness perception gain importance in the present literature. [14,15,25] Another result of the present study was that the percentage of people who experienced pain in the past year was higher in the spinal pain group during the COVID-19 lockdown. Cortical-limbic circuitry is considered to have a sensitive response to emotional stress and the subsequent changes in the prefrontal cortex led to chronification of the present pain. ...
Objectives: In the COVID-19 pandemic, physical inactivity and health anxiety which are common risk factors for musculoskeletal pain, have become widespread due to strict precautions and isolation. Thus, we aimed to compare physical activity, health anxiety, and spinal pain history in people experiencing and not experiencing spinal pain during the COVID-19 lockdown.
Material and Methods: This study was designed as a case-control study. Assessments including the Nordic Musculoskeletal Questionnaire (NMQ), the International Physical Activity Questionnaire-Short Form, and the Short Health Anxiety Inventory were performed through an online questionnaire using Google Forms during the COVID-19 lockdown. We reached 494 volunteers, and 348 were eliminated by the exclusion criteria. 156 participants were classified into the spinal pain group (n= 70) and the asymptomatic group (n=86) based on the NMQ.
Results: The total amount of physical activity was less in the spinal pain group than the asymptomatic group (p<0.05). The spinal pain group had higher levels of health anxiety than the asymptomatic group (p<0.05). Further, the percentage of people who experienced spinal pain in the last year was higher in the spinal pain group (p<0.05).
Conclusion: People experiencing spinal pain during the COVID-19 lockdown were physically less active and more concerned about their health. These results may be useful to improve the management of spinal pain during the lockdown or possible pandemic wave scenarios.
Keywords: musculoskeletal pain, anxiety, exercise, spine, pandemics, COVID-19 lockdown
... Health anxiety (HA) often complicates outcomes for individuals with chronic pain. The occurrence of HA in chronic pain is estimated to be as high as 51% [3], and is associated with pain-related disability and maladaptive pain behaviours [4,5]. As there is conceptual overlap between cognitive constructs in both HA and chronic pain, examining HA constructs within pain samples may enhance our understanding of the relationship between the two [5,6]. ...
... As there is conceptual overlap between cognitive constructs in both HA and chronic pain, examining HA constructs within pain samples may enhance our understanding of the relationship between the two [5,6]. For example, outcomes in HA are influenced by selective attention to illness information, which prompt dysfunctional assumptions about health and influence catastrophic beliefs that maintain HA [3,7]. Similarly, pain-related disability is influenced by catastrophic misinterpretations of somatic sensations [8] and attentional bias to pain-related information [9]. ...
... This suggests that pain-related disability may be partially due to the dysfunctional metacognitions individuals hold regarding how they should think about their overall health, in addition to their beliefs specifically regarding their pain condition. The results of the current study might suggest that metacognitions about biased thinking could result in an attentional bias towards symptoms, thereby resulting in increased catastrophizing and maladaptive behaviours that contribute to both elevated HA and painrelated disability, such as avoidance and safety-seeking behaviours [3,7,11]. Clinical implications of our study suggest that Metacognitive Therapy [14] is a potentially viable treatment option for individuals with chronic pain, and that specifically targeting metacognitions about biased thinking might help improve pain-related disability outcomes. ...
Background:
The occurrence of health anxiety (HA) in chronic pain is associated with adverse outcomes. As such, it is important to identify constructs that might influence HA and pain-related outcomes. Metacognitions are an emerging area of interest in both HA and chronic pain, but the relationship between the three factors has not been extensively examined. The current study sought to examine the role of metacognitions about health in HA and pain-related outcomes in chronic pain.
Methods:
This study utilized a cross-sectional design. Undergraduate students with self-reported chronic pain (n = 179) completed online measures of HA, pain intensity, pain disability, and metacognitions about health.
Results:
Regression analyses indicated that both metacognitions about biased thinking and that thoughts are uncontrollable predicted HA in chronic pain, while only metacognitions about biased thinking predicted pain-related disability beyond pain intensity.
Conclusion:
Results demonstrate that HA and pain-related disability are not associated when taking metacognitions about health into account, suggesting that metacognitions about health at least partially account for the relationship between the two. Further, results suggest that metacognitions about biased thinking may independently influence HA and pain-related disability within chronic pain.
... The short form of the HAI, developed to measure academicians' health anxiety, was created by Rode et al. (19) and is an 18-item self-report scale. The reliability and validity study of the scale for Turkish was done by Aydemir et al. (20). ...
... A study determined that the health anxiety scale mean scores of academicians with chronic diseases were significantly higher (23). Similarly, a review of studies in the literature showed that individuals with chronic diseases have higher anxiety levels than those without chronic diseases (19). A study conducted with university students reported that students with health problems had higher levels of cyberchondria (31). ...
... and the scores of mothers with children without illness as 9.0±5.0. Rode et al. [31] reported that those with chronic pain scored 16.3±7.8 and those without scored 8.5±4.4. ...
... In the study, the presence of chronic disease was found to be a risk factor for health anxiety. In studies conducted in various groups, it was reported that the level of health anxiety of those with chronic disease was higher than those without chronic disease [12,29,31,37]. Ucar et al. [32] reported that the level of health anxiety of patients with fibromyalgia was higher than that of healthy individuals and that the level of health anxiety increased with increasing disease duration and number of tender points. ...
Objective:
Health anxiety is defined as the negative over-interpretation of the usual physical sensations, although the person does not have any physical illness. The study aims to evaluate the health anxiety levels of individuals over the age of 18 who admit to primary healthcare institutions in Eskisehir and the factors that may be associated with it.
Methods:
This is a cross-sectional study. The study was conducted in adults who admitted to primary healthcare institutions in Eskisehir. The study group consists of 1200 individuals. For the purpose of collecting data, a questionnaire including the questions regarding the factors related to health anxiety and the Health Anxiety Scale were used. In the analysis of the data, a logarithm of The Short Health Anxiety Inventory (SHAI) scores was performed to determine the factors affecting the inventory score and hierarchical multiple linear regression analysis was used.
Results:
The total scores from The SHAI ranged from 1 to 47, with an mean of 16.4±8.7 and a median score of 15. Of 41.9% of study group scored above mean score. Female gender, deterioration of family income, presence of chronic disease, worsening of general health status, symptoms of mental and behavioral disorders, high number of admissions to health institutions, and hospitalization history were found to be factors affecting the level of health anxiety.
Conclusion:
Health anxiety was found to be an important problem among those who admitted to primary healthcare institutions in Eskisehir. Providing education to individuals in risky groups in terms of health anxiety, and these groups should be closely monitoring in terms of health anxiety and providing psychosocial support when necessary will prevent excessive use of health services in the long-term.
... Although has been shown to have good psychometric characteristics and is considered practical to use, it has not been evaluated as a screening tool [21]. A cut-off of 18 points for clinically significant health anxiety has been proposed [22], but we are not aware of any empirical basis for this specific cut-off. Further empirical investigation of cut-off points for clinically significant health anxiety on the SHAI-14 could be essential for screening purposes and for evaluating treatment effectiveness. ...
... For this purpose, we investigated what score on the SHAI-14 that best discriminated between individuals with clinically significant health anxiety and healthy individuals. A symmetrically weighted cut-off point of 18 with a sensitivity and specificity of 99% would be ideal in this context and the same cut-off score has previously been proposed to identify individuals meeting DSM-IV criteria for hypochondriasis [22]. In sum, 18 points on the SHAI is probably the best threshold if one is interested in using a cut-off in research in order to establish whether an individual has achieved diagnostic remission. ...
Background
The 14-item Short Health Anxiety Inventory (SHAI-14) is a common measure of health anxiety but its screening properties have not been studied. The aims of this study were to evaluate the SHAI-14 as a screening instrument, identify cut-offs for clinically significant health anxiety and investigate which scores correspond to different severity levels.
Method
The study included 1729 psychiatric patients and 85 healthy controls. Participants completed the SHAI-14 and underwent a diagnostic interview. Cut-off scores were evaluated in three scenarios to approximate screening 1) in a psychiatric clinic, 2) in a low prevalence setting and, 3) of healthy volunteers (cut-off for remission). Receiver operating characteristics were used. Classification of severity was based on the distribution of SHAI-14 scores reported by patients with clinically significant health anxiety.
Results
The area under the curve (AUC) values were high in all scenarios (above 0.95). The optimal cut-off scores on the SHAI-14 were 22 in the psychiatric context, 29 in a setting with low prevalence of psychiatric disorders and 18 versus healthy controls. SHAI-14 scores of 0–27 represented no or mild health anxiety, 28–32 moderate health anxiety and 33–42 substantial health anxiety.
Conclusion
Brief self-report measures used as screening instruments are a simple way of gathering information about the presence of specific symptoms and thus a way to detect the likelihood of a diagnosis. The SHAI-14 shows evidence of good diagnostic utility in both clinical and non-clinical settings. However, which cut-off score is to be used, depends on the intended purpose and the setting where the cut-off is used.
... Items concerning the Negative Consequences of being ill were not included. Based on the SHAI score, participants were characterized as normal (0-14), suffering from health anxiety (>14) and suffering from clinical (severe) health anxiety (>18) (18). In our study the Greek version of the Short Health Anxiety Inventory was used, which has shown good internal consistency in previous studies in Greek population (19). ...
... We adopted cutoff scores proposed by Rode et. al. (18), who report that "a cut-off point of 18 or higher in the short form reliably and exclusively identified people fulfilling DSM-IV diagnostic criteria for hypochondriasis", while individuals scoring 15-17 "were three standard deviations above the norms for nonclinical controls". However different cutoff values have been used by other research teams and cutoff values should be further investigated (24). ...
Background:
Ectopic Health Sciences students often experience higher level of stress due to clinical knowledge, and it has been reported that they frequently develop worries and symptoms of illness. These observations had lead to the hypothesis that studying health sciences may increase the risk for developing health anxiety.
Objective:
To investigate the correlation between studying health sciences and health anxiety risk in students of a Greek university.
Methods:
A cross-sectional study was conducted among health science and non-health science students from the University of Thessaly, Greece. The 14 item - Short Health Anxiety Inventory (SHAI) was used to measure students' health anxiety. Univariable and multivariable logistic regression analyses were used to test the hypothesis.
Results:
The population sample consisted of 562 health science students and 204 agriculture and computer science students. The prevalence of health anxiety (SHAI score >14) was 18.1% (95% CI 15.4%-21.1%) while 8.3% (95% CI 6.4%-10.5%) of the participants suffered from clinical health anxiety (SHAI score >18). Health science students had higher SHAI scores compared to non-health science students. Multivariable analysis revealed an increased risk for health anxiety in health science students (OR: 2.01, 95% CI: 1.02-3.97, p=0.044). Health anxiety was also associated with sex (female) (p<0,008) and the presence of health anxiety in a family member (p<0,001).
Conclusion:
The current study identified studying health sciences as a determinant of health anxiety in students of a Greek university, after considering several confounding factors. This relatively neglected hypothesis should be further examined, preferably in a prospective cohort design.
... 3 A prevalence of 36.7% for hypochondriasis and 51.1% for severe and disabling health anxiety was reported in chronic pain patients in a comparative study of health anxiety among patients attending chronic pain clinic with controls using SHAI. 4 Studies on health anxiety in diabetes mellitus and multiple sclerosis have reported high levels of health anxiety. 5,6 A community study done in German population (n = 2198) reported that only 0.4% fulfilled the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, criteria for hypochondriasis and approximately 6% of subjects found to have high health anxiety. ...
... Age did not have any correlation with health anxiety score that is in accordance with earlier studies. 4 Many studies have reported higher rates of health anxiety in women 17 this study did not find any difference and gender did not have any correlation with health anxiety. Though female patients were more in psychiatry (56%) than neurology, the mean SHAI score was higher in males than in females. ...
Objectives Prevalence of health anxiety is highly varied based on different settings and samples studied. This study aimed to assess the prevalence of health anxiety among outpatients attending neurology and psychiatry outpatient setting in tertiary care hospital and understand the clinical correlates.
Participants and Methods This was a cross-sectional study conducted in the outpatient settings including participants fulfilling study criteria. The assessments included semi-structured proforma for demographic and clinical details, general hypochondriasis subscale of Illness Behavior Questionnaire, and Short Health Anxiety Inventory. Data were collected in Epi-info and data analysis was done using STATA12.
Results The health anxiety was reported to be 25% and 19% among psychiatry and neurology outpatients, respectively. Higher education level positively correlated with health anxiety. Skilled workers tend to have higher health anxiety than semiskilled workers. Patients with diagnosis of somatoform disorder and multiple diagnosis scored higher on health anxiety in both the settings.
Conclusion Health anxiety appears to be common in psychiatry and neurology settings and needs further evaluation to understand its impact on consultation and health resource usages.
... Subjects responded for each statement as a zero to three item scores; then they are summed to obtain the total score which ranged from zero to fifty four. A score of 27 is utilized as an optimal cut-off score or an appropriate threshold for the diagnosis of significant health anxiety and its severe form in clinical settings (Rode et al., 2006) (32) . The IAS originally involved as a self-report inventory contains 29 questions divided into 9 main dimensions or subscales assesses fears, attitudes, beliefs, behaviors, and effects related to hypochondriasis, HA and abnormal illness behavior. ...
... Subjects responded for each statement as a zero to three item scores; then they are summed to obtain the total score which ranged from zero to fifty four. A score of 27 is utilized as an optimal cut-off score or an appropriate threshold for the diagnosis of significant health anxiety and its severe form in clinical settings (Rode et al., 2006) (32) . The IAS originally involved as a self-report inventory contains 29 questions divided into 9 main dimensions or subscales assesses fears, attitudes, beliefs, behaviors, and effects related to hypochondriasis, HA and abnormal illness behavior. ...
The experience of anxiety feelings about health condition has an omnipresent influence on life domains of younger and older adults, and takes place if various stressors (chronic disease dilemma, functional limitations, and physical disabilities) can exaggerate the disorder.Severe health anxiety result from acute cardiac episodes has significant negative impacts on well-being, social & occupational functioning and health care resources utilization. Investigating health anxiety in clinical medical practice populations with varied age categories and within gender differences provides an opportunity to understand how these sorts of difficulties may arise and be maintained as a result of health-related experiences.
... The online Pregnancy Questionnaire was created using Google Forms. The questionnaire was inclusive of the Short Health Anxiety Inventory (26) Since there is no standardized cut off score for the short version of the health anxiety inventory, the authors felt, based on previous research using the HAI short version (27), that a score below 10 equated to a low health anxiety, between 11 and 16; moderate health anxiety and a score above 18; high health anxiety. A decision informed by previous cut off points used for this scale. ...
... The benefits of accessing health information online include accessibility, convenience, anonymity and social support (5,6). Individuals with high health anxiety search online for information more frequently, spend longer searching and find searches more worrying than those with low or no health anxiety (27). Indeed, savvy internet users acknowledge the expectation of worse case scenarios when searching for information online (6). ...
Background:
The internet has become a quick, easy and accessible source for health-related information. Women are more likely to search for health information online and this likelihood increases further during pregnancy. Searching online for health-related information can have both positive and negative impacts upon levels of health anxiety during pregnancy. This research initially explored how health impacts heath anxiety during pregnancy. Secondly, the sources of offline support that predict health anxiety and thirdly, how online health seeking behaviour predicts health anxiety.
Methods:
The sample consisted of 159 pregnant women who completed an online questionnaire to investigate significant predictors of health anxiety during pregnancy.
Results:
Multiple regression analyses showed health anxiety increased during pregnancy when medical complications had been experienced in a previous pregnancy and if under medical treatment for a non-pregnancy related condition. Interestingly, health anxiety was not affected by medical complications in the current pregnancy. Knowing when you have had enough information and repeating searches were significant predictors of levels of health anxiety, whereas using the same or different sources was not.
Conclusions:
For many the internet is a convenient platform for information however the information is not always accurate, reliable or helpful. Relevant health care professionals should continue to sign-post pregnant women to validated health information websites with the aim to reassure women during pregnancy. Further research in this area would benefit from exploring how women use the internet when pregnant and devising guidelines which can be followed and recommended when doing so.
... While we have observed growth in the area, we still have a limited understanding of the phenomena, in particular how and if health anxiety is experienced in specialized child or adolescent physical health populations. Health anxiety has been explored and observed in adults with various physical health conditions, such as chronic pain (Rode et al., 2006), fibromyalgia (Uçar et al., 2015), Ménière's disease (Kirby and Yardley, 2009), multiple sclerosis (Kehler and Hadjistavropoulos, 2009), and noncardiac chest pain (Bozkurt Zincir et al., 2014) demonstrating significantly higher levels of health anxiety compared to controls. ...
... Our current findings are consistent with those of adult populations with certain chronic physical health conditions (i.e. chronic pain, fibromyalgia, Ménière's disease, multiple sclerosis, and noncardiac chest pain; Bozkurt Zincir et al., 2014;Kehler and Hadjistavropoulos, 2009;Kirby and Yardley, 2009;Rode et al., 2006;Uçar et al., 2015). ...
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.
... American literature uses the term "health anxiety". Up to 9% of patients in general practice meets diagnostic criteria for hypochondriasis (Creed & Barsky 2004, Gureje et al. 1997, Rode et al. 2006, Ghanizadeh & Firoozabadi 2012). Health anxiety not only causes great suffering for the patient and those around him or her but is also costly in terms of higher medical care utilization (Barsky et al. 2001, Noyes et al. 1994) and occupational disability (Mykletun et al. 2009). ...
... There is no difference between the sexes. For one third of patients with chronic pain syndrome it is considered them having an underlying hypochondriac disorder (Rode et al. 2006). Common risk factor for hypochondriacal disorder is abuse (usually sexual) in childhood (Creed & Barsky 2004). ...
... Elective PCI aims to treat stable angina. However, patients with chronic pain also tend to experience high levels of health anxiety [58] which explains the current findings. ...
Background
Cognitive complaints (e.g., health anxiety and illness disruption) are commonly experienced by patients with coronary heart disease (CHD). While it is known that sex and gender affect health, their influence on cognitive complaints remains unknown. The current study explored sex and gender differences in cognitive complaints during the first month (acute phase) and beyond, up to 2 years (recovery phase) after percutaneous coronary intervention (PCI).
Method
A total of 514 ( M age = 64.2 ± 8.9, 84.2% male) completed the cognitive scale of the Health Complaints Scale (i.e., overall cognitive complaints, health worry, illness disruption) at baseline, 1, 12, and 24 months post-PCI. Additional questionnaires to gauge gender identity, traits, and norms were administered in a follow-up study. General linear mixed model analyses were conducted to examine the influence of sex, gender, sex × gender, and covariates on cognitive complaints.
Results
Cognitive complaints only decreased in the first month post-PCI (all p < .01). There were no clear sex differences. However, gender generally predicted cognitive complaints in the first 2 years post-PCI: masculinity was related to less complaints, whereas feminine individuals reported higher absolute levels of complaints.
Conclusion
The current findings reveal that gender is a valuable factor concerning health complaints and indicate the need to further elaborate on the discrepancies between sex and gender in health research.
... Given the high prevalence of health anxiety in patients with chronic pain (Rode et al., 2006), the SHAI was employed to characterise subjects and to illustrate their levels of health anxiety using a clinical cut-off score of ≥18 (Salkovskis et al., 2002). However, the measure was not included as one of the main outcomes of the study. ...
Chronic pain is common and debilitating, and recommended treatments are only moderately effective for pain relief. Focus has shifted to refining targets for change within psychological therapy to improve pain management. Evidence has shown the role of intrusive images in many psychological disorders. However, only a few studies have advanced our knowledge of the presence and impact of mental imagery in chronic pain. This exploratory study aimed to increase our understanding of how people with chronic pain perceive intrusive visual images to influence their daily life. The study employed a qualitative design, using semi-structured interviews to explore the content, emotional valence, cognitive and behavioural impact of pain-related visual images of ten participants with self-reported diagnosis of chronic pain. Data analysis was conducted by performing an inductive thematic analysis. Three key themes were identified: (1) ‘I start to create images in my head’: pain-related mental images, which revolves around descriptions of participants’ most significant visual image; (2) metaphors for pain, related to the imagery as a means to conceptualise and give meaning to the pain; and (3) “With the pain comes the image”: a companion to pain, which focuses on the role of intrusive images in the experience of pain. Results show that pain-related mental imagery appeared to be an intrusive, uncontrollable, and vivid cognitive accompaniment for many pain sufferers. The findings suggest that mental images may serve as an additional target in cognitive behavioural therapy to enhance individuals’ cognitive, behavioural and emotional change.
Key learning aims
(1) To understand the role of mental imagery in the daily life of individuals with chronic pain.
(2) To examine the impact of intrusive images on the emotions, cognitions, and behaviours of people with chronic pain.
(3) To consider clinical implications for CBT interventions targeting pain-related mental images to manage chronic pain.
... This 14-item measure asks about health-related anxieties over the prior week, with responses ranging from 0 to 3. Higher scores indicate greater health anxiety, with a score greater than 17 indicating significantly elevated health anxiety. 25 The Patient Health Questionnaire-9 (PHQ-9) 26 is a brief screening measure evaluating depression. This 9-item measure asks about depression in the prior 2 weeks, with answers ranging from 0 (not at all) to 3 (nearly every day). ...
Background
We sought to understand the trends in media use, and how consumption and source affected mental health of persons with inflammatory bowel disease during the early parts of the pandemic. Dissemination of news during the coronavirus disease 2019 (COVID-19) pandemic was integral to educating the public but also could be harmful if constantly consumed, leading to worsening anxiety.
Methods
We performed a survey study in autumn 2020 during the second wave of COVID-19 in Manitoba. The survey included questions on consumption of COVID-19 news, along with validated measures of perceived stress, generalized anxiety, health anxiety, and depression. We used multivariable logistic regression analysis to assess trusted sources of news as a predictor of clinically significant mental health symptoms.
Results
Of the 2940 participants in the registry, 1384 (47.1%) persons responded. The most trusted sources of news were television (64.2%), internet (46.1%), newspaper (27.6%), friends/family (21.7%), social media (16.9%), and radio (16.6%). Those who trusted social media had higher odds of depression (aOR 1.52, 95%CI 1.04-2.22), and perceived stress (aOR 2.56, 95%CI 1.09-2.21). Persons who reported extreme difficulty limiting their time-consuming news about COVID-19 and who spent more than 1 h daily consuming information on COVID-19 both had increased odds of any clinically significant mental health symptoms.
Conclusions
It is unknown if consumption of COVID-19 news led to heightened mental health symptoms or if increasing anxieties and concerns led to consuming more news. Further research is needed to assess whether these elevated mental health symptoms led to worse disease outcomes.
... Chronic body pain (lower back pain and hip pain) and disability caused by musculoskeletal system disorders might be associated with anxiety and depression. [29][30][31] The benefits of pain relief were particularly apparent in group A patients, and the reconstruction of joint function played an important role in group NA. However, psychological status differed between the groups in different disease stages. ...
Objective
Hip ankylosis is a prevalent condition in patients with Ankylosing spondylitis (AS) that can significantly impact their psychological well-being. This study aimed to investigate the impact of Total Hip Arthroplasty (THA) on anxiety and depression among AS patients.
Methods
62 AS patients undergoing primary THA were recruited and separated into two groups based on preoperative hip motion. The 40 patients with hip mobility of 0° were assigned to group A, and others were assigned to group NA. Self-rating Anxiety Scale (SAS), Self-rating Depression scale (SDS), Harris hip scores (HHS) and 36-Item Short Form Survey (SF-36) were obtained one week before and there, six and twelve months after THA.
Results
The study found that AS patients in group A had significantly higher levels of anxiety and depression (SAS score = 75.05±2.79, SDS index score = 0.74±0.02) compared to group B (SAS score = 54.58±3.35, SDS index score= 0.64±0.03, P=0.01). However, both groups showed significant improvements in anxiety and depression scores from there to twelve months after THA (P<0.001). Correlation analyses revealed that the improvement in group NA was associated with hip pain relief (p<0.001), while the improvement in group A was related to joint function, disease duration, age at THA and spine imaging lesions (p<0.001).
Conclusion
Some degree of anxiety and depression was present in both groups of AS patients. Levels of depression and anxiety were higher in patients with combined hip ankylosis. And their improvement was associated with improved hip function and quality of life after THA. Hip pain relief played a significant role in patients without hip joint ankylosis. The impact of the degree of lesion on spinal imaging on psychological status needs to be considered in both groups.
... Each statement is scored between 0 and 3 and summed with higher scores indicating more severe health anxiety in clinical, non-clinical and medical samples [31]. The cut-off scores of the SHAI vary across studies [32][33][34], however, a previous study concluded that a score of 27 and greater differentiated health anxiety from other anxiety disorders [30]. Therefore, a cut-off score of 27 was decided for the present study. ...
Background:
An increase in health anxiety was observed during the COVID-19 pandemic. However, due to physical distancing restrictions and a strained mental health system, people were unable to access support to manage health anxiety. Chatbots are emerging as an interactive means to deliver psychological interventions in a scalable manner and provide an opportunity for novel therapy delivery to large groups of people including those who might struggle to access traditional therapies.
Objective:
The aim of this mixed-methods pilot study was to investigate the feasibility, acceptability, engagement and effectiveness of a cognitive behavior therapy-based chatbot (Otis) as an early health anxiety management intervention for adults in New Zealand during the COVID-19 pandemic.
Methods:
Users were asked to complete a 14-day program run by Otis, a primarily decision-tree based chatbot on Facebook Messenger. Health anxiety, general anxiety, intolerance of uncertainty, personal well being and quality of life were measured pre-intervention, post-intervention, and at a 12-week follow-up. Paired samples t-tests and one-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semi-structured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analysed.
Results:
29 participants completed the trial by providing outcomes measures at both post-intervention and follow-up. Although an average decrease in health anxiety did not reach significance at post-intervention (P=.55) or follow-up (P =.08), qualitative analysis demonstrated that participants perceived benefiting from the intervention. Significant improvement in general anxiety, personal well being, and quality of life was associated with the use of Otis at post-intervention and follow-up. Anthropomorphism, Otis' appearance and delivery of content facilitated the use of Otis. Technical difficulties and high performance and effort expectancy were in contrast, barriers to acceptance and engagement of Otis.
Conclusions:
Otis may be a feasible, acceptable, and engaging means of delivering CBT to improve anxiety management, quality of life and personal well being but not a significant reduction in health anxiety.
Clinicaltrial:
... It has been determined that causes such as physical limitations and a decrease in quality of life in individuals with chronic disease can increase health anxiety [31]. A study similarly found that people with chronic disease had significantly higher health anxiety levels [32]. ...
Abstract
Objective: Health literacy levels of individuals are very important during epidemic periods such as COVID19. The aim of this study is to evaluate the relationship between adaptation to preventive behavior and health
anxiety with health literacy level in the COVID-19 process.
Material and Methods: This study is a descriptive and correlational study. The data were collected between
January and April 2021 via Google Drive Form. The study involved 428 people who met the inclusion criteria
working in a Provincial Municipality in north-west Turkey. The data were collected using Socio-demographic
and compliance to preventive behavior data form, “Turkey Health Literacy Scale” and “Health Anxiety Scale”.
Results: Participants in the study were found to have adequate health literacy (35.51 ± 7.13). It was observed
that the level of adequate health literacy of individuals during the COVID-19 process were effective complying
with preventive behavior. It was found that there was a significant negative correlation between the health
literacy score averages and the health anxiety score averages (r= -0.459, p=0.000).
Conclusion: Health literacy education and counseling services especially by those working in the field of
primary health care and public health, can reduce health anxiety by increasing the adaptation of individuals to
preventive behaviors during the COVID-19 period.
Keywords: COVID-19, Public health, Health literacy, Health anxiety, Preventive behaviors.
... 29 A score of >17 was used to indicate high health anxiety. 30 We identified patients to participate in the current study from the pool of survey patients who had high physical symptom severity only (10% of survey participants), high health anxiety only (13%) or both (21%). Interview participants were not selected for age, gender or other demographic characteristics. ...
Background
Patients with multiple, persistent symptoms and health anxiety often report poor health outcomes. Patients who are difficult to reassure are challenging for family physicians. The therapeutic alliance between a physician and a patient can influence the prognosis of these patients. Optimising the quality of the physician–patient alliance may depend on a better understanding of the interpersonal processes that influence this relationship.
Objective
The purpose of this study is to understand the experiences of patients who experience multiple persistent symptoms or high health anxiety and their physicians when they interact.
Design, participants and setting
A qualitative study was conducted using grounded theory of 18 patients, purposively sampled to select patients who reported high physical symptom severity, high health anxiety or both, and 7 family physicians in the same clinic. This study was conducted at a family medicine clinic in a teaching hospital.
Results
A model of interpersonal tension and collaboration for patients and physicians in primary care was developed. Helpful attitudes and actions as well as troublesome topics influence crucial dilemmas between patients and physicians. These dilemmas include if patients feel heard and validated and the alignment of goals and mutual respect of expertise and experience between patients and physicians. These experiences contribute to a constructive collaboration and in turn positive outcomes.
Conclusions
This model of patient–physician interaction may facilitate providers to turn their attention away from the contentious topics and towards actions and attitudes that promote beneficial outcomes.
... Studies conducted in somatic specialist healthcare have reported a prevalence of severe HA among patients Fig. 1 The association between the exposure variable HA and healthcare use for the outcome variables primary healthcare (a), somatic specialist healthcare (b) and mental specialist healthcare (c), indicating mean healthcare use with 95% confidence intervals (Y axis) for each unit increase in the WI-6 score (X axis) Norbye et al. BMC Health Services Research (2022) 22:138 as high as 20-60% [22,40], indicating that among those who use health services, HA is common. ...
Background
Healthcare use is increasing, and health anxiety (HA) is recognized as an important associated factor. Previous research on the association between HA and healthcare use has mostly explored HA as a dichotomous construct, which contrasts the understanding of HA as a continuous construct, and compared healthcare use to non-use. There is a need for studies that examine the association between healthcare use and the continuum of HA in a general population.
Aim
To explore the association between HA and primary, somatic specialist and mental specialist healthcare use and any differences in the association by level of healthcare use.
Methods
This study used cross-sectional data from the seventh Tromsø study. Eighteen thousand nine hundred sixty-seven participants aged 40 years or older self-reported their primary, somatic specialist and mental specialist healthcare use over the past 12 months. Each health service was categorized into 5 groups according to the level of use. The Whiteley Index-6 (WI-6) was used to measure HA on a 5-point Likert scale, with a total score range of 0–24. Analyses were conducted using unconstrained continuation-ratio logistic regression, in which each level of healthcare use was compared with all lower levels. Morbidity, demographics and social variables were included as confounders.
Results
HA was positively associated with increased utilization of primary, somatic specialist and mental specialist healthcare. Adjusting for confounders, including physical and mental morbidity, did not alter the significant association. For primary and somatic specialist healthcare, each one-point increase in WI-6 score yielded a progressively increased odds ratio (OR) of a higher level of use compared to all lower levels. The ORs ranged from 1.06 to 1.15 and 1.05 to 1.14 for primary and somatic specialist healthcare, respectively. For mental specialist healthcare use, the OR was more constant across levels of use, ranging between 1.06 and 1.08.
Conclusions
In an adult general population, HA, as a continuous construct, was significantly and positively associated with primary, somatic specialist and mental healthcare use. A small increase in HA was associated with progressively increased healthcare use across the three health services, indicating that the impact of HA is more prominent with higher healthcare use.
... The outbreak of health anxiety is high among people during COVID-19 pandemic. 1,8,9 In a study about Health anxiety levels in chronic pain was estimate at least 51% of chronic pain patients had disabling health anxiety. 1 The number of new emerging viral diseases, such as severe acute respiratory syndrome (SARS) in 2002, swine flu pandemic (H1N1) in 2009, Middle-East respiratory syndrome (MERS) in 2012, Ebola in 2014, and Zika in 2016 has increased during the last 15 years. These new emerging viral diseases, in addition to making serious concerns in general health, resulted in the death, fear, and anxiety among people. ...
Background and aims: The prevalence of coronavirus disease 2019 (COVID-19) resulted in health anxiety among general population and unreasonable referring to health centers. This study aimed to assess health anxiety related to COVID-19 in individuals referring to healthcare centers of Arak, Iran in 2020. Methods: Using convenient sampling method, the participants of this cross-sectional study were selected from 16 urban health centers of Arak. Salkovskis 18-item Health Anxiety Inventory (HAI-18) was completed by 392 participants. The collected data entered in SPSS software version 24 and was analyzed by Mann-Whitney U and Kruskal-Wallis tests. Results: Mean ± SD of total score of health anxiety was 28.96 ± 7.62. Most participants (74.7%) had medium anxiety and 19.1% had high anxiety. The mean of total score of health anxiety was higher in the 30-59 age range, higher education, single people and students. Participants with chronic diseases and symptoms of cold and people who referred to health centers due to COVID-19 screening had a higher anxiety level. Conclusion: Most people referring to health centers of arak had moderate anxiety. COVID-19-related health anxiety was higher in middle age range, higher education, students, people with chronic diseases, and people with symptoms of common cold.
... 19,99,106 Abundant research demonstrates that people with chronic pain show both a greater tendency to attend to pain and pain-related information (attention bias 20,100 ) and interpret ambiguous stimuli as threatening (interpretation bias 89 ), whereby these biases are believed to be underlying poor pain outcomes and maintenance of chronic pain. 56,81 Finally, severe and disabling levels of health anxiety have been estimated at 51% for clinic attenders with chronic pain 87 and have been associated with poor prognosis. 42 Health anxiety is characterized by catastrophic misinterpretation of bodily sensations, disease conviction, dysfunctional beliefs about health or illness, and maladaptive coping behaviors (eg, reassurance seeking and checking behaviors), which provide relief in the short run but paradoxically perpetuate the dysfunctional beliefs in the long run. ...
... The very-short version HAI has demonstrated good reliability, criterion validity, and sensitivity to treatment (27). A cut-off point of ≥18 signifies hypochondriasis, and a cut-off point of ≥15 represents high health anxiety (28). ...
Objective: The burden of suicidal behavior is anticipated to increase as a sequela of the COVID-19 pandemic. However, there is limited evidence on suicidal behavior among healthcare workers, an at-risk population. Our study aimed to investigate suicidal ideation in terms of the rate and associated factors in a sample of Malaysian healthcare workers during the early-phase of the COVID-19 pandemic.
Methods: A subpopulation analysis (N = 171) was conducted within a larger, nation-wide cross-sectional study of Malaysian healthcare worker psychological distress from March 18–21, 2020. Current suicidal ideation was measured with item 9 of the Patient Health Questionnaire-9 (PHQ-9). The following independent variables were assessed: socio-demographic profile, occupation and service-related factors, health-anxiety (Health Anxiety Inventory, HAI), lifetime anxiety disorder and severity of depression (PHQ-9).
Results: The proportion of healthcare workers with current suicidal ideation (19/171) and clinical depression (17/171) were 11.1 and 9.9%, respectively. Multivariable analysis showed that clinical depression was the most significant factor associated with current suicidal ideation (p < 0.001, OR = 55.983, 95% CI = 9.015–347.671) followed by mild (subthreshold) depression (p = 0.001, OR = 115.984, 95% CI = 2.977–85.804). Service duration of more than 10 years was associated with significantly less suicidal ideation (p = 0.049, OR = 0.072, 95% CI = 0.005–0.993).
Conclusions: Depression (subthreshold and especially within the clinical range) and early-career status (<10 years in service) may be target areas of early intervention for reduction of suicidal ideation amongst healthcare workers who have served during the COVID-19 pandemic. Further research is warranted to elucidate specific occupational stressors related to COVID-19 work conditions to tailor appropriate suicide preventive strategies in this population.
... 9 People with chronic pain appear prone to elevated levels of anxiety about their health. 54 If they experience themselves as particularly vulnerable in the pandemic, this may additionally contribute to elevated level of anxiety. Pain comorbid with anxiety has been shown to entail significant detrimental implication for health. ...
Aims:
People with chronic pain may be particularly vulnerable to the impact of the pandemic COVID-19, and psychological flexibility may protect them. This study investigates psychological functioning in the context of COVID-19, including fear and avoidance in the context of COVID-19, specifically its association with daily functioning, and the role of psychological flexibility, among people with chronic pain.
Methods:
Responses from 555 adults with chronic pain were collected through a cross-sectional online survey and analysed.
Results:
Eight out of ten participants reported significant depression and nearly nine out of ten reported significant functional impairment. COVID-19-related fear and avoidance significantly correlated with pain, pain-related disability, depression, and work and social adjustment (r=18-.32), as well as psychological flexibility processes, including pain acceptance, self-as-context, and committed action, |r|=.13-.30. COVID-19-related fear and avoidance and COVID-19-related interference were significant predictors of some measures of daily functioning beyond demographics and pain, β=.09-.14. However, these associations weakened when psychological flexibility processes were factored into the models, with fear of COVID-19 no longer being a significant predictor of pain-related disability or depression, and COVID-19 avoidance no longer a significant predictor of depression.
Conclusions:
The psychological functioning in the context of COVID-19 appears to be negatively associated with daily functioning in people with chronic pain, and is statistically significant in this regard. Psychological flexibility may have a role in these associations for people with chronic pain in the pandemic.
Perspective:
This article demonstrates the psychological implication of COVID-19 and its association with broader emotional and daily functioning in people with chronic pain. It also demonstrates that Psychological flexibility may have a role in these associations for people with chronic pain in the pandemic.
... Scores for each item are added for a possible range of 0 to 42. Scores of 15 or above indicate elevated health anxiety (Rode et al., 2006;Tang et al., 2007). Internal consistency in the current sample was α = .86. ...
The COVID-19 pandemic is positioned to exact a substantial mental health toll on the global population. Heightened fears of viral contamination and fears of the negative consequences of social distancing (e.g., fears related to home confinement, fears of loneliness and isolation) might contribute to the distress caused by the pandemic. Cross-sectional data were collected from undergraduates (N = 608) residing in a U.S. pandemic "hotspot" at the time of data collection (between 7 April to 9 May, 2020). Outcome variables included viral contamination fears and social distancing fears. Predictor variables included biological sex, underlying medical vulnerability, number of recent viral symptoms, presence of positive COVID-19 test in social network, anxiety, depression, stress, emotion dysregulation, intolerance of uncertainty, body vigilance, and health anxiety. Female sex, anxiety severity, intolerance of uncertainty, and health anxiety uniquely predicted fears of viral contamination. Female sex and depression severity uniquely predicted fears of social distancing. Multiple anxiety-related vulnerabilities are potential intervention targets for reducing viral contamination fears. Depression is a potential intervention target for social distancing fears. Females might be at greater risk for both types of fears.
... Scores for each item are summed (range = 0-42). Scores of 15 or above indicate a clinically significant level of health anxiety (Rode et al., 2006;Tang et al., 2007). Internal consistency in the current sample was α = .87. ...
Evidence of the psychological distress associated with the COVID-19 pandemic, including depression, anxiety, and health anxiety, has been documented globally. College students are a unique sub-set of the population with consistently elevated psychological distress associated with the pandemic, and well-informed intervention is urgently needed. The current study is the first, to our knowledge, to document the effects of the COVID-19 pandemic on the mental health of undergraduates in a heavily impacted area in the United States. Cross-sectional, self-report data on psychological distress and COVID-19 exposure were collected from a racially and ethnically diverse sample of 641 undergraduates between April 7–9 May 2020. Nearly half of the students reported elevated psychological distress, including health anxiety, general anxiety, and depression. Heightened risk of psychological distress was associated with female sex, a COVID-19 case in one’s immediate social network, underlying medical vulnerabilities, and recent experience of ≥3 viral symptoms. Vigilance to viral symptoms and worry about coronavirus were also factors associated with more severe psychological distress. The current study highlights some of the factors associated with a greater risk of developing psychological distress due to COVID-19 and can be used to inform the dissemination of psychological interventions.
... When considering the heterogeneity, uncertain prognosis, lack of understanding and confidence among health professionals (Daniels et al., 2020), it seems logical that patients with this condition worry about their health. Health anxiety in those with ME/CFS has been found to be significantly higher than that of other medical conditions (Tyrer et al., 2011) and is comparable to the levels found in chronic pain (Rode et al., 2006). ...
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition, characterised by unexplained and excessive fatigue, muscle pain and sleep disturbances. Health anxiety is common in ME/CFS and accurate measurement is essential in facilitating therapeutic gains. However, there are clinical concerns over the utility of the Short Health Anxiety Inventory (SHAI) in measuring health anxiety in this population. This study aims to use qualitative responses from two ex-service users and specialist health clinicians to explore the barriers to completing the SHAI within a specialist ME/CFS service. Qualitative responses from a focus group consisting of 15 specialist health professionals including occupational therapists, physiotherapists, dieticians, cognitive behavioural therapists, counsellors, clinical psychologists and assistant psychologists were transcribed and analysed for themes. Patient voices were represented by two former service users through individual semi-structured interviews on the telephone, which were recorded, transcribed and later analysed thematically. Clinicians and service user involvement agreed on core difficulties with the utility of the SHAI in the ME/CFS population. The timing of the SHAI being administered pre-diagnosis, the language of the SHAI and lack of context around the questionnaire were identified as barriers that were likely to contribute to the SHAI not being completed by service users. Sensitive and accurate measurement is required in order to retain patient engagement, which could further facilitate appropriate assessment and treatment of health anxiety and ME/CFS. Findings suggest that adaption of the SHAI is vital for use with ME/CFS.
Key learning aims
(1) To understand the different barriers to completing the SHAI in a ME/CFS service.
(2) To understand the implications of administering the SHAI to ME/CFS service users.
(3) To learn from multi-disciplinary ME/CFS health professionals about perceived difficulties in administering the SHAI.
... Participants with high health anxiety were more fatigued, anxious and depressed, demonstrating lower levels of physical functioning than those without; health anxiety was confirmed as a significant predictor in a three factor model of physical functioning, but not at all in fatigue. Overall, findings from study one support, replicate and extend previous work ( ) suggesting health anxiety in CFS/ME is highly prevalent, significantly more so than in other medical settings (Tyrer et al., 2011) but similar to those found in the chronic pain population (Rode, Salkovskis, Dowd, & Hanna, 2006). The commonality between the chronic pain and CFS/ME population may be attributed to the absence of a unifying theory to underpin and explain physical symptoms that are heterogeneous in nature; the chronicity associated with 'chronic' pain and 'chronic' fatigue syndrome/ME may present fertile breeding ground for health focussed anxiety where other relevant factors co-exist, particularly considering the stigmatisation and deligitamization reported in CFS/ME (Dickson, Knussen, & Flowers, 2007). ...
Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME) is a debilitating condition that affects 0.2-0.4% of the population. Health focussed anxiety is common across medical conditions, and may be relevant in CFS/ME. This study sought to identify the prevalence and impact of health anxiety (HA) in CFS/ME and evaluate the effectiveness of Cognitive Behavioural Therapy for HA in CFS/ME. Cross-sectional questionnaire methods and case-series design were used to achieve study aims. Analysis indicated that 41.9% of the CFS/ME clinic sample experienced threshold levels of health anxiety, which was associated with elevated symptom severity across several dimensions. Stepwise multiple regression indicated physical functioning and depression accounted for 23.8% of variance in fatigue; depression, fatigue and HA, accounted for 32.9% of variance in physical functioning. Large effect sizes and clinically significant changes were generated in the treatment study. HA is common in CFS/ME and likely to exacerbate fatigue and physical functioning. This study identifies HA as an important target for treatment, trial findings should be further replicated on a larger scale.
© 2019 Asociación Española de Psicología Conductual. Published by Elsevier España, S.L.U.
... For our questionnaire, we used the first factor of the SHAI, which includes health anxiety (four items). For the scale of health anxiety, there is a cut-off score of >15 for participants with an elevated level of health anxiety and >18 for hypochondria (22). ...
Background
Effects of emotion suppression on physical health might be contingent on culture. Existing research on emotion regulation has mainly included western participants. Herewith the question arises, whether this gained expertise is transferable to an Asian culture.
Objectives
This cross-sectional study evaluated to what extent the regulation of emotions is related to migraine and if the relation between emotion regulation and migraine complaints differs between a Western and an Asian population. Therefore, the main characteristics and symptoms of patients with migraine from both Germany and Japan are compared.
Methods
261 Japanese and 347 German headache patients participated in this online study and completed self-report measures of emotion regulation (suppression and reappraisal) and headache complaints.
Results
Cultural groups did not differ regarding their demographic data, intake of medication and number of days with headache. German participants showed significantly higher levels of anxiety and lower levels of emotion suppression compared to Japanese patients. Emotion regulation is not correlated with headache complaints either in the Japanese or in the German patient group.
Conclusion
Although group differences were found with respect to anxiety and emotion suppression, subsequent regression analysis revealed these differences were unrelated to headache complaints. As our baseline analysis focused on group means, approaches that examine individual reaction patterns to stress and accompanying sensory stimulus processing may prove to be more fruitful and illuminating.
... A number of 30 participants scoring very low on the SHAI (< 10, as one SD below the M = 14.03, SD = 8.92) and a number of 50 participants scoring high on the SHAI (more than 18), as previously considered in the literature with nonclinical populations (Rode, Salkovskis, Dowd, & Hanna, 2006) were further included in the study. All of them provided written informed consent and were offered course credits. ...
Illness anxiety disorder, formerly known as hypochondria, has been conceptualised in the psychological literature as an anxiety disorder, and its dimensional correlate is usually referred to as health anxiety. Similarly to other anxiety disorders, health anxiety has also been investigated in the context of attention biases as maintaining factors. However, so far, there is little consensus in the literature concerning the types of biases most relevant to health anxiety (i.e. facilitation, difficulty in disengaging, or avoidance), and whether biases occur towards generally threatening or specific stimuli. The current study aimed to investigate the presence of all three types of biases in relation to both general-threat and health-related threat pictures in clinical participants with illness anxiety disorder as compared to participants with low levels of health anxiety. The results showed a larger difficulty in disengagement bias for health-related threatening stimuli than for general-threatening stimuli in all participants regardless of group factor. No other significant effects were identified. Thus, attention biases follow a simiar pattern in illness anxiety and low-anxiety participants.
... For that same reason, we must emphasize that our estimated prevalence rate is a cautious one, being based off the cutoff score proposed for the English version of the SHAI by Rode et al. (2006) who found this to be the optimal score that identified individuals who meet the DSM-4 criteria for hypochondriasis. Moreover, while we have shown that many parents do experience varying levels of these maladaptive thoughts, the SHAI cannot replace the diagnosis of a trained psychiatrist in diagnosing clinical health anxiety. ...
Purpose: Health anxiety is a clinical entity characterized by a pathological fear of illness. Illness cognition refers to persistent positive or negative thoughts an individual has towards illness. Evidence has shown that patients with chronic conditions who possess negative illness cognitions experience greater social, emotional, and physical difficulties than patients with positive illness cognitions. This study aims to measure the prevalence of health anxiety in a population of parents of children with cancer, and investigate the association between positive and negative illness cognitions and health anxiety.
Methods: We interviewed 105 parents of children with cancer and administered Arabic versions of the Illness Cognition Questionnaire – Parent Version and the Short Health Anxiety Inventory.
Results: The mean parental age was 37.7 years with the majority of participants being mothers (78.1%) and married (94.3%) and with 35.2% having completed university education. The average age of the child with cancer was 8.4 years, with the largest proportion of children suffering from leukemia. The prevalence of health anxiety among parents of children with cancer was 21%. The following two dimensions of illness cognition were significantly associated with health anxiety: Helplessness (B = 0.222, p = 0.021) and lower Acceptance (B = −0.242, p = 0.008). Other variables associated with health anxiety were perceived inadequate income (B = −0.238, p = 0.021) and personal illness or illness of a family member/close friend (B = 0.251, p = 0.013).
Conclusions: Parents of children with cancer may experience health anxiety. Predictors of health anxiety include feelings of helplessness, lower acceptance, inadequate income, and extended family illnesses.
... Thus, cyberchondria represents a potentially important avenue for research in the context of chronic pain. Individuals with chronic pain are often anxious about their health due to the uncertainty about the origins of their pain problems (Rode, Salkovskis, Dowd, & Hanna, 2006;Serbic & Pincus, 2014) and frequently use the internet to search for information that may provide explanations for their symptoms (de Boer et al., 2007). Given that pain catastrophizing amplifies distress and anxiety about pain symptoms and their potential adverse consequences or associations with illness (Heathcote & Eccleston, 2017;Sullivan et al., 2001), it is plausible that this may also make chronic pain patients susceptible to escalations in health anxiety from researching online for health information. ...
Chronic pain is a prevalent and debilitating health problem that often persists in the absence of an identifiable biomedical cause. Uncertainty regarding the possible origins of a pain problem may lead to significant pain catastrophizing and unfruitful healthcare seeking behaviors. Individuals with chronic pain often turn to the internet to identify a possible cause or source of their pain symptoms, thus affirming their pain experience. However, despite evidence that pain catastrophizing amplifies distress about pain complaints, no studies have investigated whether pain catastrophizing is associated with escalations in health anxiety that result from searching for health information on the internet (i.e., cyberchondria). The aim of the present study was to investigate whether pain catastrophizing predicted variance in cyberchondria above and beyond health anxiety. Undergraduate students (N = 221, 70.6% female) completed questionnaires assessing trait pain catastrophizing, health anxiety, and cyberchondria. Results from hierarchical regression models indicated that pain catastrophizing predicted unique variance in four key dimensions of cyberchondria: compulsion, distress, excessiveness, and reassurance. Findings are consistent with previous research highlighting the consequences of pain catastrophizing on a range of psychological outcomes. Individuals who catastrophize about pain experiences may be vulnerable to developing severe health anxiety from searching the internet for health information. Implications for future research among individuals with chronic pain are discussed.
... Data was available for 174 individuals that participated in the larger trial (Hadjistavropoulos et al., 2017); however, the current study sought only to assess change of symptoms in individuals that reported elevated levels of health anxiety at pre-treatment (i.e., 18 or greater on the SHAI). This cutoff score is based on a discriminant function analysis conducted by Rode et al. (2006) wherein a score of 18 or higher identified individuals that met diagnostic criteria for the previous diagnosis of hypochondriasis and represented clinically significant levels of health anxiety (Seivewright et al., 2004); as such, numerous researchers use 18 as a cut-off score when seeking to identify individuals with diagnostically relevant health anxiety symptoms (e.g., Hayter et al., 2016;Patel et al., 2016). Of the 174 participants randomized to the larger ICBT trial, 72 participants met criteria for the current study (i.e., SHAI ≥ 18); 39 received standard support and 33 received optional support. ...
Health anxiety is associated with significant personal distress and economic cost; as such, widely available and effective treatment options are crucial. Several studies suggest that Internet-delivered cognitive behavior therapy (ICBT) programs that specifically target health anxiety are efficacious for this condition. However, no known studies have examined the impact of transdiagnostic ICBT, which emphasizes the acquisition of broad coping skills applicable to a variety of mental health concerns, on symptoms of health anxiety. The current study sought to explore changes in health anxiety symptoms by utilizing data available from a previously published study of 8-week transdiagnostic ICBT. Specifically, changes in symptoms of health anxiety in response to a transdiagnostic ICBT program that targeted broad symptoms of depression and anxiety, were examined in a subsample of individuals who endorsed elevated symptom scores on the Short Health Anxiety Inventory at pre-treatment (n = 72). Following treatment, large reductions in health anxiety symptoms (Cohen's d = 0.91; 20% improvement), depression (Cohen's d = 0.85; reduction = 38%), generalized anxiety (Cohen's d = 1.21; reduction = 42%), and disability (Cohen's d = 0.90; reduction = 35%) were reported. Furthermore, results showed that transdiagnostic ICBT was rated as acceptable to people with high health anxiety symptoms. Despite elevated pre-treatment health anxiety scores, email correspondence between clients and their therapist revealed very few mentions of health anxiety. These findings provide preliminary evidence for transdiagnostic ICBT for symptoms of health anxiety and suggest further research is warranted.
... For the first research aim, the sample was split into two groups, based on an ''illness likelihood'' cut-off score of 15. While different cut-off points for the SHAI have been used for differentiating the degree of health anxiety and unofficial diagnosis of hypochondriasis (see Alberts et al., 2013), this study utilised the cut-off of 15 (indicating severe health anxiety, without diagnosis), as suggested by Rode, Salkovskis, Dowd, and Hanna (2006). A MANOVA, split-file descriptive statistics and two hierarchical regressions were performed on the data to test the proposed research aims. ...
This study investigated two primary research aims surrounding health anxiety: a) to examine what differences exist in emotion regulations strategies of health anxious and non-health anxious populations, and b) to investigate what emotion regulation strategies predict health anxiety, before and after controlling for trait cognitive and somatic anxiety. 95 participants of the general population completed a series of online questionnaires. A single factor between groups MANOVA revealed that a health anxious group scored significantly higher in several emotion regulation strategies: distraction, external attribution, emotion expression, and acting out; anxiety related variables: trait cognitive and somatic anxiety; and beliefs about the negative consequences of becoming ill. Hierarchical regressions showed that several emotion regulation strategies were significantly associated with higher levels of health anxiety, before: distraction, external attribution, capitalising, positive reappraisal and emotional expression; and after: external attribution and capitalising, the control of trait anxiety. Overall, the results demonstrated that a) emotional intelligence and behavioural attempts to understand emotional experiences may be associated with specific health anxiety symptomology, while a lack of effective cognitive strategies and worry, may be responsible for the associated trait anxiety dimensions.
... A score of 27 or above indicates the likely presence of health anxiety (Alberts et al, 2013). However, a less conservative score of 18 or above was suggested by Rode et al (2006). The score that is used in mental health services in the UK to indicate caseness is 18 or above (IAPT, 2011a). ...
Bu çalışma akademisyenlerin internetten sağlık ve sağlık bilgisi arama davranışları (siberkondri) ile sağlık anksiyeteleri arasındaki ilişkinin incelenmesi amacıyla yapılmıştır. Araştırmanın katılımcıları yaşları 23 ile 66 arasında değişen (Ortyaş=37,34, SSyaş=8,403) 289 öğretim elemanından oluşmaktadır. Araştırma verileri Siberkondri Ciddiyet Ölçeği Kısa Formu (SCÖ-15), Sağlık Anksiyetesi Ölçeği ve demografik bilgilerin yer aldığı anket formu ile toplanmıştır. Ölçeklerin boyutları normal dağılıma uygunluk gösterdiği için boyutlar çeşitli değişkenlere göre karşılaştırılırken ikili gruplarda t testi (independent t test), üç ve daha fazla değişkenli gruplarda ise ANOVA (F testi) kullanılmıştır. Akademisyenlerin siberkondri düzeyleri ve sağlık anksiyeteleri arasındaki ilişki ise korelasyon analizi ile ortaya konulmuştur. Çalışma sonucunda sağlık anksiyetesi gövde boyutu ile SCÖ zorlantı, aşırı kaygı, aşırılık ve içini rahatlatma boyutları arasında; sağlık anksiyetesi olumsuz sonuç boyutu ile SCÖ zorlantı, aşırı kaygı ve doktora güvensizlik boyutları arasında pozitif yönde anlamlı bir ilişki olduğu ortaya konulmuştur.
Abstract
Objective: Health literacy levels of individuals are very important during epidemic periods such as COVID-19. The aim of this study is to evaluate the relationship between adaptation to preventive behavior and health anxiety with health literacy level in the COVID-19 process.
Material and Methods: This study is a descriptive and cross-sectional study. The data were collected between January and April 2021 via Google Drive Form. The study involved 428 people who met the inclusion criteria working in a Provincial Municipality in north-west Turkey. The data were collected using Socio-demographic and compliance to preventive behavior data form, “Turkey Health Literacy Scale” and “Health Anxiety Scale”.
Results: Participants in the study were found to have adequate health literacy (35.51 ± 7.13). It was observed that the level of adequate health literacy of individuals during the COVID-19 process were effective complying with preventive behavior. It was found that there was a significant negative correlation between the health literacy score averages and the health anxiety score averages (r= -0.459, p=0.000).
Conclusion: Health literacy education and counseling services especially by those working in the field of primary health care and public health, can reduce health anxiety by increasing the adaptation of individuals to preventive behaviors during the COVID-19 period.
Keywords: COVID-19, Public health, Health literacy, Health anxiety, Preventive behaviors.
Purpose
The transition to college is associated with numerous stressors, including environmental changes, increased academic expectations, and changes in social support, all of which may be exacerbated by the added responsibility of managing a chronic medical condition. Huang (2019) proposed a model examining the relationships between coping styles, transition readiness, and health anxiety, and suggested that greater transition readiness is associated with adaptive coping strategies and less health anxiety. However, there are limited findings as to how poor transition readiness relates to health anxiety. Therefore, the current study tested a serial mediation model (i.e., poor transition readiness → avoidance coping → illness uncertainty → health anxiety).
Design and methods
College students (N = 194) with a chronic medical condition completed self-report questionnaires.
Results
Results indicated several direct effects among the modeled variables and a significant poor transition readiness → avoidance coping → illness uncertainty → health anxiety serial mediation (path a1d21b2 = 0.438, 95% CI = 0.153 to 0.913).
Conclusions
Worse transition readiness was associated with increased avoidance as a coping mechanism, which in turn is associated with increased illness uncertainty, and ultimately health anxiety. The current findings identified possible drivers of health anxiety in college students with a chronic medical condition.
Practice implications
These findings highlight that good transition readiness skills may buffer against maladaptive avoidance, illness uncertainty, and health anxiety. Modules aimed at improving healthcare management, avoidance, and illness uncertainty may be beneficial additions to interventions to reduce health anxiety.
Objective:
Persistent pelvic pain is a complex condition often influenced by psychological factors that can alter treatment outcomes. These factors are potentially modifiable; however, currently there is no instrument to screen for them in these individuals. The purpose of this study was to determine (1) which psychological factors should be screened in individuals with persistent pelvic pain and (2) the most appropriate statements to represent these psychological factors.
Methods:
The study used a focus group design followed by an electronic-Delphi (e-Delphi) process. A focus group consisting of 8 experts was conducted to determine the relevant psychological factors to screen. These results informed round 1 of the e-Delphi process, consisting of a panel of 14 pain/pelvic pain experts. The e-Delphi process consisted of 3 rounds of online surveys and 2 teleconference discussions to establish consensus on the most appropriate statement to screen for each of the psychological factors.
Results:
The focus group identified 13 relevant psychological factors. During the e-Delphi process, relevant screening statements were assessed using a 100-point allocation system. Experts could reword and suggest new statements. Statements were assessed for consensus and stability and were eliminated as the rounds progressed if they met the exclusion criteria. At the termination of round 3, there were 15 statements remaining.
Conclusions:
The final list of 15 statements will assist clinicians in screening for psychological factors and is an important step for clinicians in providing psychologically informed care to people with persistent pelvic pain. Future research should determine the psychometric properties of the statements to determine their clinical utility as a questionnaire.
Impact:
This study has refined a list of statements to help screen for psychological factors in individuals with persistent pelvic pain. Developed robustly using an e-Delphi method, this list is an important first step forward for clinicians to provide psychologically informed care to these individuals.
Background:
Excessive health anxiety can lead to significant disorders such as hypochondriasis. In children, assessment of the severity of health anxiety has been performed using the Childhood Illness Attitudes Scales (CIAS); however, no validated Arabic version of this tool exists.
Aims:
This study developed and validated an Arabic version of the CIAS questionnaire in Jordan in 2017 to provide a tool to measure the severity of health anxiety in the Arabic-speaking world.
Methods:
The CIAS was translated from English to Arabic then back-translated by a different translator and the 2 versions were compared before cognitive interviews were conducted. The final version of the questionnaire was circulated to 597 children. Of these, 200 were asked to retake the questionnaire after 10-15 days to evaluate test-retest reliability. Confirmatory factor analysis (CFA) on the 4-factor model suggested by the original questionnaire version was performed. Internal consistency and test-retest reliability were evaluated.
Results:
The CFA showed good fit (goodness of fit index = 0.92) with the 4-factor model of fears, help seeking, treatment experience, and symptom effects. Test-retest reliability was high and the model had good discriminant validity and internal consistency.
Conclusions:
The Arabic version of the CIAS provides a suitable tool to investigate the prevalence and severity of childhood anxiety in the Middle East.
The Short Health Anxiety Inventory (SHAI) is a well-established, self-report measure of health anxiety (HA). However, no psychometrically adequate Arabic-speaking version of this measure is yet available. This study was therefore designed to provide an Arabic version of the SHAI and assess its latent structure, measurement invariance across gender, and internal consistency reliability. Forty hundred and twenty-one Saudis completed the Arabic SHAI online (68.65% women), mean age 25.90, and standard deviation 6.65. Exploratory and confirmatory factor analyses in different subsamples suggested a 2-factor solution: (1) illness likelihood (IL) with 13 items and (2) negative consequences (NC) with 4 items. This structure was found invariant across gender. Cronbach’s α for the full scale, IL, and NC were .85, .83, and .77, respectively. Corrected item–total correlations for all items ranged from .35 to .68. Performance on the scale did not appear to correlate with gender, while age associated weakly but statistically significant with the total score and IL factor. The present Arabic SHAI appears to be a psychometrically promising tool for the assessment of HA. Further investigations of the scale psychometrics, particularly using a paper-and-pencil format, and clinical utility are warranted.
Access to health information has steeply grown, mainly through the availability of online health information. Associated with a number of potential benefits, accessing health information can be non-adaptive and particularly for individuals prone to health anxiety. For those individuals, accessing health information often serves as reassurance seeking to assuage health concerns. However, accessing health information can prompt distress for individuals prone to health anxiety. The present study sought to further understand when accessing health information prompts distress by examining the moderating role of intolerance of uncertainty (IU). Individuals prone to health anxiety ( N = 98), as indicated by an elevated score on a self-report measure rather than through formal assessment of meeting criteria for disorders marked by elevated health anxiety (e.g., illness anxiety disorder), participated in a lab-based session where they viewed a provocation of health concerns and were given the choice to either access or avoid further health information. As predicted, participants with high, but not low, IU reported significantly greater distress when they chose to access versus avoid health information. Study results further highlight IU as potentially important for understanding when accessing health information relates to greater negative emotionality. Future directions are discussed.
Background and objectives:
Affect tolerance factors, including anxiety sensitivity, intolerance of uncertainty, and emotional distress tolerance, have been implicated in the exacerbation of health anxiety. Therefore, identifying methods to improve affect tolerance in health anxious populations is imperative. Despite the link between mindfulness and greater affect tolerance in non-clinical populations, no work has examined the role of mindfulness skills in terms of affect tolerance among individuals with elevated health anxiety. The aim of the current study was to examine the unique contribution of mindfulness skills in terms of distress tolerance, anxiety sensitivity, and intolerance of uncertainty.
Methods:
Participants were 218 undergraduates with clinically elevated levels of health anxiety (75.7% female; Mage = 19.53, SD = 3.16, Range = 18-45) who completed self-report measures for course credit.
Results:
Findings indicated that, after controlling for theoretically relevant covariates, greater acting with awareness, non-judgment, and non-reactivity were uniquely associated with greater distress tolerance, and greater non-reactivity was associated with lower levels of intolerance of uncertainty. Though none of the mindfulness skills emerged as specific individual predictors of anxiety sensitivity, these skills collectively accounted for unique variance in anxiety sensitivity.
Conclusions:
These findings suggest that mindfulness skills may be helpful in targeting affect tolerance factors among individuals with elevated health anxiety.
Research has shown that health anxiety (HA) significantly contributes to disability in chronic pain populations. The aim of the current study was to examine if metacognitive beliefs may account for the relationship between chronic pain and HA. University students who reported experiencing (n = 157), or not experiencing (n = 128), chronic or recurring pain completed the Chronic Pain Grade Scale (CPGS), Short Health Anxiety Inventory (SHAI), and Metacognitions about Health Questionnaire (MCQ-HA). Bivariate correlations were conducted to determine whether CPGS intensity and disability subscale scores correlated with SHAI scores. Partial correlations were conducted to examine whether these correlations remained significant when controlling for MCQ-HA scores. In the pain sample, bivariate correlations revealed that HA significantly correlated with disability, r = .20, but not with intensity, r = .13. Partial correlations controlling for metacognitive beliefs revealed that the relationship between HA and disability was no longer significant, r = .04. In the non-pain sample, bivariate correlations revealed that HA significantly correlated with both disability, r = .19, and intensity, r = .26. Partial correlations revealed that the relationship between HA and both intensity, r = .16, and disability, r = .02, were no longer significant when controlling for metacognitions. Metacognitions appear to contribute to the relationship between chronic pain and HA. These results have implications for the treatment of HA in chronic pain populations. Future research should examine the contributions of metacognitive beliefs in delineating the relationship between chronic pain and HA.
The purpose of this study was to explore the relationship between symptoms on burning mouth syndrome and health anxiety and compare patients diagnosed as burning mouth syndrome with general patients in dental clinic from the perspective the influence of health anxiety on affective conditions. Thirty-eight patients with burning mouth syndrome and 100 general patients in dental clinic were assessed by questionnaire consisted of pain intensity, oral dryness, Japanese version of Oral Health Impact profile-14（OHIP-14），the subscale of depression-dejection, tension-anxiety in Japanese version of Profile of Mood State-Brief （POMS-B），Short Health Anxiety Inventory（SHAI）. The results of this study showed that health anxiety was not related with pain intensity, oral dryness, and oral health-related QOL, and was related with anxiety and depression.
Hypocondriasis is associated with several anxiety disorders, including panic disorder. The available estimates of panic disorder patients with identified hypochondriacal symptoms are 50% to 70%. Complimentary, 13% to 17% of hypochondriac patients were associated with panic disorder. Comorbidity and hypocondriasis occur when health care issues are not delimited by panic disorder symptoms. We reported a patient that, during the follow-up period, has evolved to an associated hypocondriasis and panic disorder scenario. The psychiatric symptoms were properly addressed and discussed, as well the associated conceptual aspects, diagnoses and prognosis.
The present paper describes a theoretical model for exaggerated pain perception which has been generated from a multidisciplinary team approach to the problem of chronic low-back pain. The model is an attempt to explain how and why some individuals develop a more substantial psychological overlay to their pain problem than do others.Central to the model is the concept of ‘fear of pain’ which, it is suggested, leads to differing responses in different individuals. The two extreme responses are those of ‘confrontation’ and ‘avoidance’, although most individuals probably exhibit a mixture of the two. The former, it is argued, leads the individual to resume an increasing range of physical and social activities as the organic basis for the pain resolves and, as a consequence, ensures minimal psychological overlay. By contrast, an avoidance strategy is thought to produce a number of physical and psychological consequences which promote the development of the invalid status and the phenomenon of exaggerated pain perception.The model suggests that the type of strategy adopted (i.e. confrontation or avoidance) is influenced by a number of psychosocial factors.
Pain interrupts and demands attention. The authors review evidence for how and why this interruption of attention is achieved. The interruptive function of pain depends on the relationship between pain-related characteristics (e.g., the threat value of pain) and the characteristics of the environmental demands (e.g., emotional arousal). A model of the interruptive function of pain is developed that holds that pain is selected for action from within complex affective and motivational environments to urge escape. The implications of this model for research and therapy are outlined with an emphasis on the redefinition of chronic pain as chronic interruption.
A self-rated measure of health anxiety should be sensitive across the full range of intensity (from mild concern to frank hypochondriasis) and should differentiate people suffering from health anxiety from those who have actual physical illness but who are not excessively concerned about their health. It should also encompass the full range of clinical symptoms characteristic of clinical hypochondriasis. The development and validation of such a scale is described.
Three studies were conducted. First, the questionnaire was validated by comparing the responses of patients suffering from hypochondriasis with those suffering from hypochondriasis and panic disorder, panic disorder, social phobia and non-patient controls. Secondly, a state version of the questionnaire was administered to patients undergoing cognitive-behavioural treatment or wait-list in order to examine the measure's sensitivity to change. In the third study, a shortened version was developed and validated in similar types of sample, and in a range of samples of people seeking medical help for physical illness.
The scale was found to be reliable and to have a high internal consistency. Hypochondriacal patients scored significantly higher than anxiety disorder patients, including both social phobic patients and panic disorder patients as well as normal controls. In the second study, a 'state' version of the scale was found to be sensitive to treatment effects, and to correlate very highly with a clinician rating based on an interview of present clinical state. A development and refinement of the scale (intended to reflect more fully the range of symptoms of and reactions to hypochondriasis) was found to be reliable and valid. A very short (14 item) version of the scale was found to have comparable properties to the full length scale.
The HAI is a reliable and valid measure of health anxiety. It is likely to be useful as a brief screening instrument, as there is a short form which correlates highly with the longer version.
INTRODUCTION AND AIMS: Hypertension is the leading cause of cerebrovascular disease, congestive heart failure and chronic kidney disease. Approximately
30% of Japanese general population and more than 75% of Japanese CKD stage 3-5 has hypertension. Hypertension accelerates
progression of CKD. The higher the stage of CKD, the more the patients with hypertension. High salt intake causes hypertension
and results in kidney injury. Therefore, restriction of salt intake is a therapeutics for hypertension and CKD. Awareness
of high salt intake by the CKD patient is the first step for treatment of hypertension. However, 24-hour (24-h) urinary collection
is most reliable method for estimation of daily salt intake but cumbersome. Two equations for estimating 24-hour urinary sodium
excretion from spot urine have been developed in Japanese general population but they have not been evaluated in CKD population.
METHODS: The following equations were used for estimation of 24-h urinary Na excretion.
Tanaka's equation: 24-h urinary Na excretion (mEq/day) = 21.98 x UNa/UCr x {-2.04 x age + 14.89 x weight (kg) + 16.14 x height
(cm) -2244.45}^ 0.392
Kawasaki's equation: 24-h urinary Na excretion (mEq/day)=16.3x {(UNa/UCr)x 24h-UCr }^ 0.5
male:estimated 24h-UCr(mg/day)=15.1x BW + 7.4 x height - 12.4 x age - 80
female:estimated 24h-UCr(mg/day)=8.6 x BW + 5.1 x height - 4.7 x age - 75
We validated the equations by using urine samples of 24-h urinary collection and the first morning void in 136 patients with
CKD who visited Nagoya University Hospital.
RESULTS: Both equation were well estimated urinary creatinine excretion compared to measured UCr (Tanaka; r=0.670, p<0.01, Kawasaki;
r=0.690, p<0.01). Bias, RMSE, accuracy within 30% of the estimated 24-h UNa by calculated both equations compared to measured
24-h UNa were shown.
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Many authors report that a high percentage of patients with chronic pain have no or insufficient underlying physical pathology to explain their pain. Even when patients do have an identified diagnosis, many patients profess to have little understanding of the source of their pain or fear that they may suffer from more severe pathology. This may be particularly true for patients with chronic musculoskeletal pain given the lack of “objective” findings for soft tissue pain complaints. In the present study, we examined whether chronic neck and back pain patients were able to identify the physiologic source of their pain, and based on their responses patients were placed in one of three groups: (1) patients who did not know the cause of their pain; (2) patients who did know the cause and agreed with their clinical diagnosis; and (3) patients who identified a cause for their pain that was different from their clinical diagnosis. The sample was comprised primarily of individuals with musculoskeletal pain problems (70%) referred to an outpatient chronic pain rehabilitation program. Each patient completed a pretreatment test battery, and group differences were examined on responses to the McGill Pain Questionnaire, Survey of Pain Attitudes, Brief Symptom Inventory, Coping Strategies Questionnaire, and Pain Disability Index. Upon initial evaluation, 47.2% (n = 85) of patients indicated that they did not know what was causing their pain. Of patients who articulated a cause for their pain, 20% (n = 36) attributed it to factors that did not agree with their diagnosis. Only 32.8% (n = 59) of persons in the entire sample were able to accurately identify the cause of their pain. Patients who disagreed with their clinical diagnosis were more likely to be diagnosed with musculoskeletal pain and reported the highest levels of pain (F(2,169) = 3.41, p .05) as well as the greatest levels of affective distress (F(2,169) = 3.54, p .05). Patients who were unsure of or disagreed with their diagnosis tended to report a greater belief in pain being a signal of harm (F(2,169) = 11.5, p .001) and described themselves as more disabled (F(2,169) = 8.43, p .001). In addition, both the “unsure” and “disagree” groups tended to use maladaptive pain strategies more frequently, and persons unsure of their diagnosis had the lowest levels of perceived control over pain. A hierarchical regression analysis examining a cognitive/behavioral model of pain disability indicated that lack of knowledge of pain etiology, a belief that pain is a signal of harm, catastrophizing and affective distress all significantly predicted increased disability, while pain intensity did not. The data suggests that lack of knowledge about the origin of pain is associated with maladaptive cognitions in relation to pain (i.e., fear of harming oneself and catastrophizing) and increased emotional distress which in turn are related to heightened disability due to pain. These data argue that educating patients regarding their diagnosis and the origin of their pain, thereby dispelling dysfunctional pain beliefs, may be an important component of pain treatment, particularly among patients with chronic musculoskeletal pain.
Despite its high prevalence and implications for health care resources, health anxiety is still a relatively neglected area of research. This paper describes the development of the Health Anxiety Questionnaire (HAQ), a measure based on a cognitive-behavioural analysis of health anxiety. The measure was developed to identify individuals with high levels of concern about their health. Psychiatric and medical samples were used in the reported studies. The HAQ was found to have good internal consistency (coefficient alpha and split-half reliability) and short-term temporal stability (test-retest reliability). Long-term stability (one year) was modest but predictably responsive to external events. Analysis of the structure of the HAQ (cluster and factor analyses) revealed four factors: worry and health preoccupation, fear of illness and death, reassurance-seeking behaviour and the extent to which symptoms interfere with a person's life. Studies of the HAQ's validity indicate that it has appropriate discriminate validity. It is concluded that the HAQ appears to reflect relatively enduring features consistent with the cognitive-behavioural model of health anxiety. It is anticipated that the HAQ should be able to predict response to reassurance following medical examination.
Simple estimation of prevalence from sample survey data may be biased because of imperfections in the measurement instrument. An alternative approach is to use two-phase sampling in which a subsample of screened individuals is investigated more intensively with a gold standard measure to reveal their true disease status. A variant design is to use a calibration or validation sample of individuals who are assessed using both the screen and gold standard methods. The analysis of two-phase samples is described, including the use of simple conditional probabilities, inverse probability weights, and a more general framework in which the EM algorithm is used. Bayesian approaches are also mentioned briefly. Statistical software for the analysis of multiphase data is mentioned, together with an outline of certain design considerations.
Some inadequacies of the classical conditioning analysis of phobias are discussed: phobias are highly resistant to extinction, whereas laboratory fear conditioning, unlike avoidance conditioning, extinguishes rapidly; phobias comprise a nonarbitrary and limited set of objects, whereas fear conditioning is thought to occur to an unlimited range of conditioned stimuli. Furthermore, phobias, unlike laboratory fear conditioning, are often acquired in one trial and seem quite resistant to change by “cognitive” means. An analysis of phobias using a more contemporary model of fear conditioning is proposed. In this view, phobias are seen as instances of highly “prepared” learning (Seligman, 1970). Such prepared learning is selective, highly resistant to extinction, probably noncognitive and can be acquired in one trial. A reconstruction of the notion of symbolism is suggested.
This study examined the relationship of self-reports of illness behavior to pain ratings and overt pain behaviors in a group of chronic low back pain patients referred for pain management. Illness behavior was measured using the Pilowsky and Spence Illness Behavior Questionnaire (IBQ) and pain behavior was recorded using a standard behavioral observation method. Multivariate regression analyses revealed that scores on the IBQ were highly predictive of a variety of indices of pain and pain behavior. These results were obtained even after controlling for significant demographic and medical status variables. The findings of this study support the utility of the IBQ in the behavioral assessment of chronic pain patients.
Acute lower backache often occurs in general practice. Over a period of four years 7.5% of the population at risk in the practice studied consulted the doctors with this complaint. The overall annual inception rate was 24.3 per 1,000 in males and 20.3 per 1,000 in females, but there was considerable variation by age. A peak in both males and females occurred in the 50–59 decade, this age group experiencing twice the overall inception rate. No cause was evident for the attacks in 79.3% of males and in 88.8% of females ; there was a recent history of strain in only 10.9% of males and 4.3% of females, and only a small proportion of patients had definite evidence of nerve-root pressure (7.6% of males and 5.6% of females). The majority of the attacks were of short duration, lasting less than two weeks in 62% of cases. The duration of the attacks was not significantly related to age or sex, nor to the presence of referred pain, but it was related to the presence of objective signs of root pressure. Ninety per cent of the attacks were managed by the general practitioners, who used only symptomatic treatment. Recurrences were not related to age, sex, or the presence of referred pain, but were more likely to occur in patients diagnosed as having nerve-root pressure and in those whose index attack lasted longer than two weeks. Of the patients identified by an attack during the incidence study 44.6% had a recurrence within four years, which is almost four times the rate expected in a group with the same age and sex distribution. © 1966, British Medical Journal Publishing Group. All rights reserved.
One hundred patients, referred for the management of intractable pain, completed a 52-item Illness Behaviour Questionnaire (IBQ). Responses were scored on 7 scales: general hypochondriasis, disease conviction, psychological versus somatic perception of illness, affective inhibition, affective disturbance, denial, and irritability. IBQ scale profiles were subjected to numerical analysis and 6 taxonomic clusters were identified. Patients in groups 1-3 were characterized by a relatively non-neurotic, reality-oriented attitude to illness, as indicated by low scores on the first three scales. Patients in groups 4-6 manifested greater evidence of 'abnormal illness behaviour', and presented syndromes resembling 'hysteria', 'conversion reaction', and 'hypothchondriasis' respectively.
A 52 item self-administered questionnaire was constructed to assess illness behaviour. It was administered to 100 patients referred for the management of pain that had not responded adequately to conventional treatment. Responses were factor analysed using principal component analysis and rotated to orthogonal structure. Seven meaningful factors accounting for 63·3% of the the variance were extracted and labelled as follows: general hypochondriacal factor, disease conviction factor, psychological vs somatic factor, affective inhibition factor, affective disturbance factor, denial factor and irritability factor. The significance of these dimensions of illness behaviour was discussed.
Hypochondriasis and other syndromes in which health anxiety is prominent are frequently seen in clinical practice and often pose problems of management. In contrast with other anxiety problems, the conceptualization and treatment of health anxiety has developed very little in recent years. Behavioural approaches to treatment have only recently been applied. In the present paper, current theoretical models are critically evaluated and a cognitive-behavioural approach is proposed to account for the development and maintenance of hypochondriacal problems. Principles of cognitive-behavioural treatment based on this approach are outlined, together with some suggestions for research.
In order to explore attitudes and beliefs in patients with the pelvic pain syndrome, the authors matched gynaecological patients with this syndrome (N = 41) with other gynaecological patients. They administered the Illness Behavior Questionnaire and Illness Attitude Scales (that measure attitudes, fears and beliefs about illness) to both groups. In spite of thorough investigations, 18 patients (44%) with the pelvic pain syndrome believed that their physician had not diagnosed their illness correctly and feared that they had a serious disease. The findings appear to have implications for treatment.
A short form of the McGill Pain Questionnaire (SF-MPQ) has been developed. The main component of the SF-MPQ consists of 15 descriptors (11 sensory; 4 affective) which are rated on an intensity scale as 0 = none, 1 = mild, 2 = moderate or 3 = severe. Three pain scores are derived from the sum of the intensity rank values of the words chosen for sensory, affective and total descriptors. The SF-MPQ also includes the Present Pain Intensity (PPI) index of the standard MPQ and a visual analogue scale (VAS). The SF-MPQ scores obtained from patients in post-surgical and obstetrical wards and physiotherapy and dental departments were compared to the scores obtained with the standard MPQ. The correlations were consistently high and significant. The SF-MPQ was also shown to be sufficiently sensitive to demonstrate differences due to treatment at statistical levels comparable to those obtained with the standard form. The SF-MPQ shows promise as a useful tool in situations in which the standard MPQ takes too long to administer, yet qualitative information is desired and the PPI and VAS are inadequate.
The concept of ‘hypochondriasis’ is examined and an alternative cognitive-behavioural approach to health preoccupation is proposed. Avoidance behaviour (reassurance seeking and checking bodily status) is suggested as an important maintaining factor. In two single case experiments, short-and long-term effects of medical reassurance are assessed in ‘hypochondriacal’ patients; results are fully consistent with the model. Treatment designed to eliminate reassurance and hence to facilitate self-directed exposure and cognitive change proved rapidly effective.
In order to explore fears, beliefs, and attitudes of patients with DSM-III hypochondriasis, the authors administered the self-rated Illness Attitude Scales to 21 patients with hypochondriasis, matched family practice patients, nonpatient employees, and nonhypochondriacal psychiatric patients. Hypochondriacal patients reported more fears of and false beliefs about disease; they attended more to bodily sensations, had more fears about death, and distrusted physicians' judgments more, yet sought more medical care than other subjects. They did not take better precautions about their health. The self-report of overt attitudes suggests a characteristic syndrome, consistent with the DSM-III description of hypochondriasis. Two of the subscales of the Illness Attitude Scales yielded characteristic responses in hypochondriasis.
Two studies are presented that investigated 'fear of movement/(re)injury' in chronic musculoskeletal pain and its relation to behavioral performance. The 1st study examines the relation among fear of movement/(re)injury (as measured with the Dutch version of the Tampa Scale for Kinesiophobia (TSK-DV)) (Kori et al. 1990), biographical variables (age, pain duration, gender, use of supportive equipment, compensation status), pain-related variables (pain intensity, pain cognitions, pain coping) and affective distress (fear and depression) in a group of 103 chronic low back pain (CLBP) patients. In the 2nd study, motoric, psychophysiologic and self-report measures of fear are taken from 33 CLBP patients who are exposed to a single and relatively simple movement. Generally, findings demonstrated that the fear of movement/(re)injury is related to gender and compensation status, and more closely to measures of catastrophizing and depression, but in a much lesser degree to pain coping and pain intensity. Furthermore, subjects who report a high degree of fear of movement/(re)injury show more fear and escape/avoidance when exposed to a simple movement. The discussion focuses on the clinical relevance of the construct of fear of movement/(re)injury and research questions that remain to be answered.
Hypochondriasis is generally considered difficult to manage. This study aimed to assess the effectiveness of cognitive therapy and to compare it with an equally credible, alternative treatment.
Forty-eight patients with hypochondriasis were initially randomly assigned to either cognitive therapy, behavioural stress management or a no treatment waiting list control group. At the end of the waiting period, patients in the control group were randomly assigned to one of the two treatments. Assessments were at pre-, mid- and post-treatment or waiting list and at three-, six- and 12-month post-treatment follow-up.
Comparisons with the waiting list group showed both treatments were effective. Comparisons between the treatments showed that cognitive therapy was more effective than behavioural stress management on measures of hypochondriasis, but not general mood disturbance at mid-treatment and at post-treatment. One year after treatment patients who had received either treatment remained significantly better than before treatment, and on almost all measures the two therapies did not differ from each other.
Cognitive therapy is a specific treatment for hypochondriasis. Behavioural stress management is also effective but its specificity remains to be demonstrated.
In an attempt to explain how and why some individuals with musculoskeletal pain develop a chronic pain syndrome, Lethem et al. (Lethem J, Slade PD, Troup JDG, Bentley G. Outline of fear-avoidance model of exaggerated pain perceptions. Behav Res Ther 1983; 21: 401-408).ntroduced a so-called 'fear-avoidance' model. The central concept of their model is fear of pain. 'Confrontation' and 'avoidance' are postulated as the two extreme responses to this fear, of which the former leads to the reduction of fear over time. The latter, however, leads to the maintenance or exacerbation of fear, possibly generating a phobic state. In the last decade, an increasing number of investigations have corroborated and refined the fear-avoidance model. The aim of this paper is to review the existing evidence for the mediating role of pain-related fear, and its immediate and long-term consequences in the initiation and maintenance of chronic pain disability. We first highlight possible precursors of pain-related fear including the role negative appraisal of internal and external stimuli, negative affectivity and anxiety sensitivity may play. Subsequently, a number of fear-related processes will be discussed including escape and avoidance behaviors resulting in poor behavioral performance, hypervigilance to internal and external illness information, muscular reactivity, and physical disuse in terms of deconditioning and guarded movement. We also review the available assessment methods for the quantification of pain-related fear and avoidance. Finally, we discuss the implications of the recent findings for the prevention and treatment of chronic musculoskeletal pain. Although there are still a number of unresolved issues which merit future research attention, pain-related fear and avoidance appear to be an essential feature of the development of a chronic problem for a substantial number of patients with musculoskeletal pain.
The last few decades has seen psychological theories of chronic pain dominated by behavioural concepts and particularly, by the operant model as described by Fordyce et al. (1968: Fordyce, W., Fowler, R., & DeLateur, B. (1968) An application of behavior modification technique to a problem of chronic pain. Behaviour Research and Therapy, 6, 105-107, 1976: Fordyce, W.E. (1976) Behavioral methods for chronic pain and illness. St Louis, MO: C. V Moseby). More recently, cognitive constructs have been included, giving the impression that the operant theory of chronic pain has been replaced by a cognitive-behavioural theory (CBT). Given the fact that CBTs were introduced essentially to overcome some inherent problems with operant theory, it is notable that they are still very much based on operant theory and continue to be founded upon operant principles. Further, the extent to which CBTs (at this stage) have included contemporary cognitive research has been limited. This paper argues that it is of questionable validity to continue to include problematic concepts (e.g., operant principles) into a revised theory (e.g., CBT). Instead, consistent with research from other areas (particularly the anxiety disorders), chronic pain and the problems associated with it may be better explained by a reformulated cognitive-behavioural theory which although not ignoring the observable behaviours of pain patients and their associations with social reinforcers, interprets these phenomena from a cognitive perspective. Thus, a modified CBT is proffered, focusing more directly on patients' thoughts about, and appraisals of, their pain. Evidence in support of such a theory is provided, as are suggestions for further research and the implications such a theory has for treatment.
Cognitive-behavioural approaches to treatment have become an important part of the clinical management of chronic pain. More recent developments in cognitive-behavioural theory, based on recent developments in the understanding and treatment of health anxiety, have emphasized the importance of catastrophizing appraisals, which drive both attentional processes and behavioural responses, which in turn are believed to be crucial for the maintenance of chronic pain. The experiment conducted here investigated the responses of pain patients (n=39) and controls (n=71) to a behavioural task (prolonged squeezing a dynamometer). Subsequently, the impact of a cognitive task, which fully engaged participants' attention (dichotic listening) was examined. Participants were asked, firstly, to sustain an isometric muscle contraction task (squeezing); secondly, to learn an attentional demanding task (dichotic listening); thirdly, to recall the discomfort experienced in the squeezing task and lastly, to perform both squeezing and dichotic listening at the same time. The squeezing tasks were experimentally manipulated by attaching a more or less negative label ("pain tolerance test" vs. "muscle stamina and strength test"). Patients were found to be less able to sustain prolonged muscle tension than controls, but the effect was not evident once the distracting task was introduced; similar effects were found for discomfort. All participants subsequently recalled the squeezing task as being longer and associated with less discomfort than they had actually recorded it at the time. In the dichotic listening tasks, although patients detected the same number of words overall as controls did, they were less able to focus on the target channel (i.e. they detected more of the words included as distractors on the unattended channel).
Prevalence of disease, estimation from screening data Encyclopedia of epidemio-logical methods
- Pickles A Dunn
Pickles A, Dunn G. Prevalence of disease, estimation from screening data. In: Benichou J, Gail MH, editors. Encyclopedia of epidemio-logical methods. Wiley7 Chichester, 2000. pp. 729 – 35.
The cognitive approach to anxiety: threat beliefs, safety-seeking behavior, and the special case of health anxiety and obsessions Frontiers of cognitive therapy
- Pm Salkovskis
Salkovskis PM. The cognitive approach to anxiety: threat beliefs, safety-seeking behavior, and the special case of health anxiety and obsessions. In: Salkovskis PM, editor. Frontiers of cognitive therapy. Guilford Press: New York, NY, 1996. pp. 48–74.
Clinical epidemiology, overview Encyclopedia of epidemiological methods
- Meenan Rf
- Felson
- Dt
Meenan RF, Felson DT. Clinical epidemiology, overview. In: Benichou J, Gail MH, editors. Encyclopedia of epidemiological methods. Chichester7 Wiley, 2000. pp. 188 – 92.
The cognitive approach to anxiety: threat beliefs, safety-seeking behavior, and the special case of health anxiety and obsessions
- Salkovskis