The Short Health Anxiety Inventory: a systematic review and meta-analysis

Symptom Attributions in Illness Anxiety Disorder

OBJECTIVES

A major characteristic of health anxiety is the tendency to attribute benign bodily sensations to serious illnesses. This has been supported by empirical research in non-clinical samples, and samples of individuals diagnosed with Hypochondriasis. However, no study to date has explored symptom attribution styles of individuals with the DSM-5 diagnosis of Illness Anxiety Disorder.

METHODS

Sixty-one participants, including a clinical Illness Anxiety Disorder (n = 35) and healthy control (n = 26) sample, completed self-report measures of health anxiety and an Attribution Task, whereby they were presented with eight common bodily sensations and asked to generate possible explanations for them.

RESULTS

Results showed that relative to healthy controls, participants with Illness Anxiety Disorder overall were more likely to make more serious, 'catastrophic' somatic attributions to symptoms, and less likely to generate non-threatening normalising explanations. These results also extended to their initial attributions, conceptualised as the 'jumping to conclusions' bias, and as an exploratory index of flexibility, they were also found to make less attributions overall compared to healthy controls.

CONCLUSIONS

Findings provide support for the cognitive behavioural theory of health anxiety, and highlight the importance of assessing and addressing symptom attributions with clients with illness anxiety disorder.

Health anxiety and work loss in patients diagnosed with serrated polyposis syndrome: A cross sectional study

BACKGROUND

Serrated polyposis syndrome (SPS) is a polyposis condition with neoplastic potential, but its psychological impact is not well understood.

AIM

To assess health anxiety prevalence in a regional Australian cohort of SPS patients and explore factors influencing it, including workforce impacts of regular surveillance.

METHODS

This cross-sectional study screened patients aged 18-65 undergoing colonoscopy in a regional gastroenterology practice between January 2015 and June 2022. Eligible SPS patients were invited to participate. Data included the Short Health Anxiety Inventory, employment status, and previous demographic and medical findings.

RESULTS

Health anxiety was found in 21.57% of SPS patients, with anxious patients being significantly more concerned about surveillance (OR = 7.70). Patients lost an average of 11.04 work hours per colonoscopy.

CONCLUSION

Health anxiety in SPS patients aligns with rates in other gastroenterology populations. Identifying it may improve management, though further research is needed to better understand prevalence and care improvements.

The association of health anxiety with quality of life among medical students in Egypt: Myth or Menace?

BACKGROUND

Health anxiety (HA) is a prevalent concern among medical students, potentially impacting their academic performance and Quality of Life (QoL). This study aims to assess the prevalence of HA and its predictors among medical students in Egypt and its correlation with the Quality of Life.

METHODS

A descriptive cross-sectional study was conducted during the 2022-2023 academic year across ten Egyptian medical schools. A total of 1,173 students participated by completing an online questionnaire, which included the Short Health Anxiety Inventory (SHAI) and the 12-Item Short Form Survey (SF-12). Data were analyzed using SPSS 25. Chi-square tests, crude odds ratios (COR) with 95% confidence intervals, and Pearson's correlation coefficients were utilized for statistical analysis. A p-value ≤ 0.05 was considered statistically significant.

RESULTS

This study found that 15.7% of participants experienced clinically significant HA. Female students (17.5%) and students dissatisfied with their academic performance (18%) exhibited a significantly higher prevalence of HA. A significant negative correlation was observed between HA and QoL (r = -0.393, p ≤ 0.05), with students experiencing HA reporting lower QoL scores. Key predictors of HA included female gender (OR = 1.41, 95% CI: 1.01-1.96) and lack of academic satisfaction (OR = 1.43, 95% CI: 1.04-1.96).

CONCLUSION

Health anxiety (HA) is a notable issue among Egyptian medical students, particularly affecting females and those dissatisfied with their academic performance and is closely linked to reduced quality of life. Effective interventions could enhance the overall educational experience, helping students improve their well-being and manage HA's impacts on their personal and academic lives.

Effectiveness and prediction of treatment adherence to guided internet-based cognitive behavioral therapy for health anxiety: A cohort study in routine psychiatric care

Objective

Health anxiety, also known as hypochondriasis, is a common psychiatric disorder which leads to considerable distress and is associated with high societal costs. Internet-based cognitive behavioural therapy (ICBT) for health anxiety has demonstrated efficacy in randomized controlled trials (RCTs), but there is limited knowledge regarding its effectiveness in real-world settings. This study aimed to evaluate the clinical effectiveness of guided ICBT for health anxiety in routine psychiatric care, including symptom change, treatment adherence, and potential negative effects. Additionally, we explored predictors of treatment adherence.

Method

A longitudinal cohort study of 447 patients enrolled in 12 weeks of ICBT for health anxiety between 2018 and 2020 in an outpatient psychiatric clinic specializing in ICBT. Primary outcome measure was the 14-item Short Health Anxiety Inventory (SHAI-14) and a within-group design with repeated measures was utilized for the primary analysis.

Results

Participants showed significant improvements from pre- to post-treatment (d = 1.61). At post-treatment, 60 % (95 % CI 58-62) demonstrated statistically reliable change (RCI), and 44 % (95 % CI 42-46) were in remission. On average, participants completed 7 (SD = 4) out of 12 treatment modules. For each additional completed module, the mean reduction was 0.31 (95 % CI 0.10 to 0.54) points on the SHAI-14.

Conclusions

Guided ICBT for health anxiety can be effective when delivered within the context of routine psychiatric care. The study suggests that effect sizes are comparable with those in RCTs and higher treatment adherence is associated with better outcomes in health anxiety. ICBT could be used to increase availability to effective therapy for health anxiety.

Can the Whiteley Index be used to assess health anxiety in adolescents from the general population?

Health anxiety (HA) is characterized by worry about being or becoming ill. The Whiteley Index (WI) is a valid and frequently used measure for HA in adults. We examined item response distribution, floor and ceiling effects, and construct validity of four different one-factor models of the WI (an 8-item model, the widely used WI-7, a revised 7-item version (WI-7-R), and a 6-item version (WI-6-R)) in a population-based sample of adolescents, using data from the 16-17-year follow-up of the Copenhagen Child Cohort 2000 (N = 2521, 16-17 years old). Females generally scored higher on all eight WI items compared to males. Construct validity was examined by confirmatory factor analysis and hypothesis testing. The WI-7-R and WI-6-R both showed acceptable fits. All four models showed good internal consistency. Hypothesis testing showed good discriminant validity, as the hypotheses on positive correlations with anxiety, depression, and physical symptoms, as well as a negative correlation with health-related quality of life, were met for both the WI-7-R and WI-6-R. We advocate for the use of the WI-6-R, which focuses on core HA symptoms and excludes items concerning physical symptoms. The overall testing supports that the WI-6-R possesses valid psychometric properties for use with adolescents in the general population.

Persian version of the Short Health Anxiety Inventory (SHAI) for patients with cancer: Evaluation of psychometric properties, factor structure, and association with related constructs

OBJECTIVE

This study aims to evaluate the psychometric properties of the Short Health Anxiety Inventory (SHAI=short health anxiety inventory) in a sample of patients diagnosed with cancer. Factor structure, internal consistency, convergent validity, and gender differences in SHAI scores were assessed.

METHODS

202 patients diagnosed with cancer participated, with 18 questionnaires excluded for incomplete data. Confirmatory Factor Analysis was conducted to confirm the factor structure. Internal consistency was also assessed using Cronbach's alpha.

RESULTS

A two-factor model (thought intrusion and fear of illness) provided the best fit for the data (SBχ2 (64) = 114.346, p < 0.001, CFI = 0.944, GFI = 0.908, RMSEA = 0.065). Internal consistency was high for the SHAI total score (α = 0.864) and its subscales (thought intrusion: α = 0.753; fear of illness: α = 0.825). Female patients also scored significantly higher than male patients on the SHAI total score (U = 5232.500, p = 0.012), thought intrusion subscale (U = 5189.00, p = 0.008) and fear of illness subscale (U = 5069.500, p = 0.018).

CONCLUSION

The SHAI demonstrates adequate psychometric properties for assessing health anxiety in cancer patients.

Development and psychometric properties of the Health Anxiety Behavior Inventory (HABI)

BACKGROUND

Mainstream cognitive behavioural theory stipulates that clinically significant health anxiety persists over time at least partially due to negatively reinforced health-related behaviours, but there exists no broad and psychometrically valid measure of such behaviours.

AIMS

To draft and evaluate a new self-report scale - the Health Anxiety Behavior Inventory (HABI) - for the measurement of negatively reinforced health anxiety behaviours.

METHOD

We drafted the HABI from a pool of 20 candidate items administered in a clinical trial at screening, and before and after cognitive behaviour therapy (n=204). A psychometric evaluation focused on factor structure, internal consistency, convergent and discriminant validity, test-retest reliability, and sensitivity to change.

RESULTS

Based on factor analysis, the HABI was completed as a 12-item instrument with a four-dimensional factor structure corresponding to the following scales: (i) bodily preoccupation and checking, (ii) information- and reassurance-seeking, (iii) prevention and planning, and (iv) overt avoidance. Factor inter-correlations were modest. The internal consistency (α=.73-.87) and 2-week test-retest reliability (r=.75-.90) of the scales was adequate. The bodily preoccupation and checking, and information- and reassurance-seeking scales were most strongly correlated with the cognitive and emotional components of health anxiety (r=0.41, 0.48), and to a lower extent correlated to depressive symptoms and disability. Change scores in all HABI scales correlated with improvement in the cognitive and emotional components of health anxiety during cognitive behaviour therapy.

CONCLUSIONS

The HABI appears to reliably measure negatively reinforced behaviours commonly seen in clinically significant health anxiety, and might be clinically useful in the treatment of health anxiety.

Positive affect longitudinally buffers the negative effect of health anxiety on gastrointestinal symptoms

People with significant health anxiety may experience brain-gut dysregulation, leading to increased visceral sensitivity and greater gastrointestinal (GI) symptoms. Positive affect (PA), on the other hand, may serve as a protective characteristic, buffering the negative impact of health anxiety on GI symptoms. This study investigated interrelationships between health anxiety, PA, and GI symptoms. Longitudinal data were collected on health anxiety, PA, and GI symptoms via an online survey from 861 adults at two timepoints, 4 weeks apart. Regression models were conducted to examine the moderating effect of PA at baseline on future GI symptoms. Greater health anxiety at baseline predicted GI symptoms at follow-up, whereas higher levels of PA predicted reduced GI symptoms at follow-up. Post hoc testing revealed that PA significantly moderated the relationship between health anxiety and GI symptoms over time, such that higher levels of PA attenuated the effect of health anxiety on belly pain, nausea and vomiting, and reflux at follow-up. This study provides preliminary evidence PA may buffer the negative impact of health anxiety on GI symptoms. Future studies should explore whether the promotion of PA through interventions similarly attenuates health related anxiety's impact on GI symptoms.

[Health anxiety: Another epidemic to prepare for]

Health anxiety (HA) is a frequent problem (up to 20% of consultants in the context of secondary care) responsible for decreased well-being, disability, somatic and psychiatric complications, which contributes to high healthcare expenditures at the population level. It is likely, if not definitely established, that the prevalence of ACS is increasing, and this can partly be explained by the growing medicalization of society in general, the appetite of Media for health issues, and the uncontrolled use of the Internet (which can lead certain vulnerable subjects to cyberchondria). The pandemic of COVID-19 could have contributed to it, at least by the significant increase in the overall level of psychological distress in the population it has caused, although this has not formally been demonstrated to date. The diagnosis of ACS is easy, as soon as its assessment is considered as a mandatory part of any medical consultation. Certain intuitive attitudes of doctors, such as reassurance, prove to be iatrogenic for the patient with HA. The management of HA can be facilitated by an acculturation of physicians to cognitive conceptions of anxiety in general and HA in particular. HA is effectively treatable by certain psychotherapy and in the first place cognitive and behavioral therapies (CBT), but the availability of trained therapists and accessible at a lower cost is sorely lacking, particularly in France.

Mechanistic studies in pathological health anxiety: A systematic review and emerging conceptual framework

BACKGROUND

Pathological health anxiety (PHA) (e.g., hypochondriasis and illness anxiety disorder) is common in medical settings and associated with increased healthcare costs. However, the psychological and neurobiological mechanisms contributing to the development and maintenance of PHA are incompletely understood.

METHODS

We performed a systematic review to characterize the mechanistic understanding of PHA. PubMed, PsycINFO, and Embase databases were searched to find articles published between 1/1/1990 and 12/31/2022 employing a behavioral task and/or physiological measures in individuals with hypochondriasis, illness anxiety disorder, and PHA more broadly.

RESULTS

Out of 9141 records identified, fifty-seven met inclusion criteria. Article quality varied substantially across studies, and was overall inadequate. Cognitive, behavioral, and affective findings implicated in PHA included health-related attentional and memory recall biases, a narrow health concept, threat confirming thought patterns, use of safety-seeking behaviors, and biased explicit and implicit affective processing of health-related information among other observations. There is initial evidence supporting a potential overestimation of interoceptive stimuli in those with PHA. Neuroendocrine, electrophysiology, and brain imaging research in PHA are particularly in their early stages.

LIMITATIONS

Included articles evaluated PHA categorically, suggesting that sub-threshold and dimensional health anxiety considerations are not contextualized.

CONCLUSIONS

Within an integrated cognitive-behavioral-affective and predictive processing formulation, we theorize that sub-optimal illness and health concepts, altered interoceptive modeling, biased illness-based predictions and attention, and aberrant prediction error learning are mechanisms relevant to PHA requiring more research. Comprehensively investigating the pathophysiology of PHA offers the potential to identify adjunctive diagnostic biomarkers and catalyze new biologically-informed treatments.

Illness Anxiety Disorder: A Review of the Current Research and Future Directions

PURPOSE OF REVIEW

We review recent evidence on Illness Anxiety Disorder (IAD), including risk factors and precipitants, diagnostic classification, clinical characteristics of the disorder, and assessment and treatment in both children and adults.

RECENT FINDINGS

IAD places a substantial burden on both individuals and society. Despite its impact, understanding of the disorder is lacking and debates remain about whether IAD should be classified as an anxiety disorder and whether it is distinct from Somatic Symptom Disorder. Cognitive behavioural therapy (CBT) is an effective treatment for IAD and there are multiple validated measures of health anxiety available. However, research on health anxiety in children and youth is limited. IAD is chronic, and debilitating, but when identified, it can be effectively treated with CBT. Research using DSM-5 IAD criteria is lacking, and more research is needed to better understand the disorder, particularly in children and youth.

COVID-19 anxiety and its relation to anxiety-related disorder symptoms and mechanisms

The COVID-19 pandemic had a significant impact on the mental health of individuals, particularly in the area of anxiety-related disorders. Anxiety regarding COVID-19 has been associated with health anxiety, panic disorder, and obsessive-compulsive disorder symptoms. Additionally, COVID-19 anxiety has been associated with anxiety sensitivity, disgust, maladaptive metacognitions, and intolerance of uncertainty. While researchers have established that anxiety disorders and anxiety-related mechanisms were associated with COVID-19 anxiety, which specific anxiety-related symptoms and mechanisms are primarily associated with COVID-19 anxiety needs to be more extensively explored. The current study sought to further this area by examining which particular anxiety-related disorder symptoms and mechanisms were uniquely associated with COVID-19 anxiety. A non-clinical sample of 593 Canadian undergraduate participants (Mage = 21.13 years; 67.7 % female) completed this cross-sectional study between September 2020 and February 2021. Participants completed online questionaries assessing anxiety-related disorder symptoms and mechanisms in addition to multiple scales of COVID-19 anxiety. When examining symptoms, health anxiety (prs = 0.17-0.29) and obsessive-compulsive disorder (prs = 0.16-0.35) symptoms had the strongest unique associations with COVID-19 anxiety. Among the anxiety-related mechanisms, disgust sensitivity (prs = 0.14-0.16) and health anxiety-specific intolerance of uncertainty (prs = 0.12-0.30) had the strongest unique associations with COVID-19 anxiety. Individuals experiencing these disorders and anxiety-related mechanisms may be at a heightened vulnerability to experiencing heightened anxiety during future pandemics. Mental health professionals should discuss COVID-19 anxiety with individuals experiencing health anxiety or obsessive-compulsive disorder symptoms. Lastly, the study highlights the significance of considering a variety of specific anxiety-related disorder symptoms and mechanisms when working to understand pandemic anxiety.

Annual Research Review: Health anxiety in children and adolescents-developmental aspects and cross-generational influences

Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID-19 pandemic. Recent classification systems acknowledge that impairing health-related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.

Patient activation and psychological coping strategies to manage challenging circumstances during the COVID-19 pandemic in people with kidney disease

BACKGROUND

Coping with health problems requires some degree of self-management; however, an individual's ability to self-manage can be threatened during challenging times, such as the COVID-19 pandemic. Exploring differences and changes in psychological well-being and coping strategies between those with low and high patient activation may inform appropriate interventions to support psychological coping.

METHODS

People with chronic kidney disease (CKD) (non-dialysis and transplant) were recruited from 11 hospital sites across England between August and December 2020. Participants responded to an online survey study, including the Brief Coping Orientation to Problem Experienced (COPE) Inventory, Depression, Anxiety and Stress Scale (DASS-21), Short Health Anxiety Index (SHAI), and Patient Activation Measure (PAM-13). A follow-up survey was conducted 6-9 months later. Paired t tests assessed within-group changes, and chi-squared tests compared coping strategies utilised by low- and high-activated participants. General linear modelling was performed to determine the relationship between patient activation and coping strategies, and covariates.

RESULTS

Two hundred and fourteen participants were recruited (mean age: 60.7, 51% male, mean eGFR: 38.9 ml/min/1.73 m2). Low-activated participants were significantly more anxious than high-activated participants (P = 0.045). Health anxiety significantly decreased (i.e., got better) for high-activated participants (P = 0.016). Higher patient activation scores were associated with greater use of problem-focused strategies (β = 0.288, P < 0.001). Age (β = - 0.174, P = 0.012), sex (β = 0.188, P = 0.004), and education level (β = 0.159, P = 0.019) significantly predicted use of problem-focused strategies.

DISCUSSION

Those with higher activation had lower levels of anxiety, and more frequently used adaptive coping strategies during the pandemic. Targeted support and interventions may be required for people with CKD to enhance patient activation, encourage more positive adaptive coping strategies, and mitigate maladaptive coping strategies.

Linguistic analysis of health anxiety during the COVID-19 pandemic

Health anxiety, which is defined as fear of having or contracting serious physical illness, is particularly salient in light of the COVID-19 pandemic. We conducted a mixed methods study in which 578 narrative samples were analyzed using Linguistic Inquiry and Word Count (LIWC) software to determine linguistic markers from six LIWC categories relevant to cognitive-behavioral features of health anxiety. Broad linguistic predictors were analyzed through three backward elimination regression models in order to inform subcategory predictors of each area of health anxiety. Thus, both broad and specific linguistic predictors of general health anxiety, virus-relevant body vigilance, and fears of viral contamination were examined. Greater use of affective category words in written narratives predicted general health anxiety, as well as body vigilance and viral contamination fears. These findings represent the first direct demonstration of linguistic analysis of health anxiety and provide nuanced information about the nature and etiology of health anxiety.

Exposure therapy for health anxiety: Effectiveness and response rates in routine care of an outpatient clinic

OBJECTIVE

Many randomized controlled trials (RCTs) have demonstrated the efficacy and benefits of exposure therapy in the treatment of health anxiety. However, the application of these research results to routine care has not been considered sufficiently. The aim of this study is to analyze the effectiveness of exposure therapy in the routine treatment of health anxiety patients.

METHOD

Data were available for 35 patients, who repeatedly filled in comprehensive general questionnaires, and those specific to health anxiety.

RESULTS

The data analysis showed that health anxiety symptoms decreased significantly both posttreatment (Cohen's d = 0.97-1.00) and at follow-up (Cohen's d = 1.33-1.34). In addition, the scores of depressiveness, somatic symptoms, and psychological distress showed improvements with effect sizes of d = 0.35-0.51. Regarding the primary outcome measures for health anxiety, response rates were 51%-63%, and remission rates were 29%-43%.

CONCLUSION

Exposure therapy is effective and sustainable regarding the treatment of health anxiety, even under naturalistic conditions, whereas response and remission rates are lower than for RCT.

Illness Anxiety Disorder and Distress among Female Medical and Nursing Students

Objective

This study aims to compare the prevalence of illness anxiety disorder (IAD) and distress between medical and nursing students and examine their associations with students' characteristics.

Methods

Cross-sectional data were collected using the Short Health Anxiety Inventory (SHAI, for measuring IAD) and the Medical Students' Disease (MSD) Perception and Distress Scales.

Results

Two hundred and sixteen Medical students and 250 Nursing students were recruited from a public female university in Saudi Arabia. Their mean age was 21.27 years. The findings showed that the overall prevalence of IAD (SHAI scores ≥18) among the total sample was 38.8%, with a significantly lower prevalence in medical students compared to the prevalence in nursing students (57.2% vs 17.6%, respectively, X2=45.26, p<.001). Nursing students had significantly higher SHAI scores and lower MSD Perception scores than medical college students, but there were no significant differences among them in the MSD Distress scale. Significant differences in the main study variables scores were reported among nursing students but not among medical students, with the fourth-year level nursing students having higher SHAI and lower MSD Perception and perception scores than other nursing students.

Conclusion

The highlights that medical and nursing students are susceptible to developing anxiety-related disorders and distress that may have negative impacts on their academic achievements and future careers. Both nursing and medical faculty should help in identifying strategies to support the students' mental health and well-being.

Association between health anxiety dimensions and preventive behaviors during the COVID-19 pandemic among Japanese healthcare workers

Objective

Health anxiety (HA), defined as excessive worry about having a serious medical condition, may affect preventive behaviors during the coronavirus disease 2019 (COVID-19) pandemic. We examined the distinct role of two dimensions of HA-perceived likelihood (probability dimension) and awfulness of illness (awfulness dimension)-in self-protection, as reflected in preventive behaviors during the pandemic.

Methods

Participants comprised 657 healthcare workers. Data were collected between February 24 and 26, 2021. The Short Health Anxiety Inventory determined the HA dimensions. Adherence to the government's recommendations for COVID-19 preventive behaviors was self-rated. An independent association between each HA dimension and participants' adherence to the recommendations was examined using multivariable regression.

Results

Within the analyzed sample of 560 subjects, severe HA was observed in 9.1 %. The more the participants felt awful, the less frequently they engaged in the recommended preventive behaviors (adjusted odds ratio = 0.993, 95 % confidence interval: 0.989, 0.998, p = 0.003) regardless of their profession, working position, psychological distress, sleep disturbance, and current physical diseases. However, the probability dimension was not associated with their preventive behaviors.

Conclusion

The awfulness dimension of HA could be a more sensitive marker of preventive behaviors than the probability dimension. Paying particular attention to the awfulness dimension may help optimize self-protection strategies during the COVID-19 pandemic. A two-dimensional understanding of HA may be useful for the maintenance of the healthcare system and public health as well as healthcare workers' own health.

Somatic Symptom Disorder and Health Anxiety: Assessment and Management

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) Somatic Symptom Disorder (SSD) and Illness Anxiety Disorder (IAD) replaced the diagnostic entities of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) somatoform disorders and hypochondriasis. SSD turns away from specifying the presence or absence of a medical condition for presented symptoms and instead focuses on excessive symptom-related affects, cognitions, and behaviors. People with pathological health anxiety can be diagnosed with SSD or IAD, depending on the intensity of accompanying somatic symptoms. Cognitive-behavioral therapy shows the best empirical evidence for an effective treatment of SSD and IAD.

Joint factor analysis and approximate equipercentile linking of common trait health anxiety measures: a cross-sectional study of the 14-, 18- and 64-item health anxiety inventory, the illness attitude scale, and the 14-item Whiteley Index

BACKGROUND

Research on health anxiety has bloomed in recent years, but summaries of the literature are complicated by the use of dissimilar self-report questionnaires. Furthermore, these instruments have rarely been administered in parallel, and especially not in clinical samples. In this study, we aimed to investigate the relationship between five widespread health anxiety measures, and to draft guidelines for the conversion of different sum scores.

METHODS

Clinical trial participants with principal pathological health anxiety (n = 335) and a sample of healthy volunteers (n = 88) completed the 14-item Whiteley Index (WI-14), the Illness Attitude Scale (IAS), and the 14-, 18-, and 64-item Health Anxiety Inventory (the HAI-64, HAI-18, and HAI-14). Cross-sectional data from all participants were pooled (N = 423) and we conducted a joint factor analysis and approximate equipercentile linking of the WI-14, IAS, HAI-64, HAI-18, and HAI-14.

RESULTS

Inter-scale correlations were high (rs ≥ 0.90 and ≥ 0.88 in adjusted analyses), and the scree plot of the joint factor analysis spoke for a unifactorial solution where 89/105 items (85%) had loadings ≥ 0.40. Most items at the core of this broad trait health anxiety factor pertained to the worry about health, the fear of having or developing a serious disease, and to some extent bodily preoccupation. We present a cross-walk table of observed equipercentile linked sum scores.

CONCLUSIONS

This study speaks clearly in favor of the WI-14, IAS, HAI-64, HAI-18, and HAI-14 all tapping into the same trait health anxiety construct, the core of which appears to concern the worry about health, the fear of having or developing a serious disease, and to some extent bodily preoccupation. Based on recently reported cut-offs for the HAI-14, a reasonable cutoff for pathological health anxiety in a psychiatric setting probably lies around 7-8 on the WI-14, 52-53 on the IAS, 82-83 on the HAI-64, and 26-27 on the HAI-18.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01966705, NCT02314065.

COVID-19 anxiety and mental health among university students during the early phases of the U.S. pandemic

OBJECTIVE

This study examined the impact of COVID-19 in the early stages of the pandemic on university students in the U.S. by: (1) characterizing COVID-19-related disruptions; (2) evaluating health anxiety, obsessive-compulsive (OC), depression, and stress symptoms; and (3) analyzing the unique role of COVID-19 anxiety on mental health outcomes, after accounting for relevant variables.

PARTICIPANTS

Participants included 263 students (63.9% female).

METHODS

Data were collected online between March 19, 2020 and May 1, 2020.

RESULTS

Participants screened positive for health anxiety (6.5%), OC symptoms (48.7%), or depression (29.7%). COVID-19 anxiety was positively associated with mental health symptoms. After controlling for demographics and COVID-19 impact, COVID-19 anxiety accounted for significant variance in health anxiety, OC symptoms, and stress.

CONCLUSIONS

Findings demonstrate the vast impact of COVID-19 on mental health among university students and provide guidance for identifying mental health priorities in the context of public health crises.

Effects of Health Anxiety, Social Support, and Coping on Dissociation with Mediating Role of Perceived Stress during the COVID-19 Pandemic

BACKGROUND

Our study aimed to examine whether health anxiety, social support, and ways of coping relate to dissociation directly or only through the mediation of perceived stress, moderated by the time of measurement (lockdown). We investigated the effect of perceived stress on different forms (sub-scales) of dissociation.

METHODS

A cross-sectional survey was conducted by an online form at two points in time: the beginning and the later stage of the COVID-19 pandemic.

RESULTS

We received a total of 1711 responses. Perceived stress moderately correlated with dissociation in both international and Hungarian samples. Health anxiety showed a strong direct and indirect correlation with dissociation. Regarding social support, the support of family significantly decreased the dissociative experiences in the Hungarian sample mediated by perceived and direct stress. In the international sample, goal-oriented coping strategies strongly decreased all dissociation scales in the first measurement, through the mediation of perceived stress. As for the Hungarian sample, positive thinking was found to decrease dissociation by decreasing perceived stress.

CONCLUSION

health anxiety, coping, and social support appeared to influence dissociation directly and through the mediation of perceived stress. Social support, mainly support of the family and problem-focused coping strategies may decrease the level of stress, this way decreasing dissociative behavior.

Snacking and anxiety during the coronavirus disease (COVID-19) pandemic: A prospective cohort study

Anxiety and snacking increased during the initial coronavirus disease 2019 (COVID-19) lockdowns, but it remains unknown whether this change in snacking persisted and if it related to anxiety levels. We used prospective data to examine changes in snacking frequency from t1 (eased restrictions in England in May-June 2020) to t2 (national lockdown in December 2020-March 2021), the association of anxiety (assessed by the Generalised Anxiety Disorder-7 questionnaire at t1) with the snacking change, and the mediating and moderating effects of disinhibition and flexible restraint (assessed by the Three Factor Eating Questionnaire in 2016-17). Analyses including 2128 adults (mean age 28.4 y) residing in England from the Avon Longitudinal Study of Parents and Children showed that snacking frequency increased over time (mean change 1.23 (95% CI 0.81, 1.65) snacks/wk). Linear regressions of snacking adjusted for sociodemographic covariates showed that having clinical levels of generalised anxiety at t1, versus not, was associated with 1.22 (95% CI 0.07, 2.37) more snacks/wk at t2. Disinhibition partially mediated the association between Generalised Anxiety Disorder and snacking (βindirect = 0.15, 95% CI 0.01, 0.32), while there was no evidence that flexible restraint moderated the association (β = 0.05, 95% CI -0.57, 0.66). Our longitudinal findings highlight a detrimental anxiety-snacking association partly operating via disinhibition, suggesting future research could target mitigating anxiety and disinhibited eating behaviours to benefit diet-related outcomes following the pandemic.

Factors Associated With Patient Satisfaction Measured Using an Iterative Scale

BACKGROUND AND OBJECTIVES

Patient experience measures tend to have notable ceiling effects that make it difficult to learn from gradations of satisfaction to improve care. This study tested 2 different iterative satisfaction measures after a musculoskeletal specialty care visit in the hope that they might have less ceiling effect. We measured floor effects, ceilings effects, skewness, and kurtosis of both questionnaires. We also assessed patient factors independently associated with the questionnaires and the top 2 possible scores.

METHODS

In this cross-sectional study, 186 patients completed questionnaires while seeing 1 of 11 participating orthopedic surgeons in July and August 2019; the questionnaire measured: (1) demographics, (2) symptoms of depression, (3) catastrophic thinking in response to nociception, (4) heightened illness concerns, and (5) satisfaction with the visit on 2 iterative satisfaction scales. Bivariate and multivariable analyses sought associations of the explanatory variable with the satisfaction scales.

RESULTS

There is a small correlation between the 2 scales ( r = 0.27; P < .001). Neither scale had a floor effect and both had a ceiling effect of 45%. There is a very small correlation between greater health anxiety and lower satisfaction measured with one of the scales ( r = -0.16; P = .05).

CONCLUSION

An iterative satisfaction questionnaire created some spread in patient experience data, but could not limit ceiling effects. Additional strategies are needed to remove ceiling effects from satisfaction measures.

COVID-19 stress syndrome in the German general population: Validation of a German version of the COVID Stress Scales

The COVID Stress Scales (CSS) are a new self-report instrument for multidimensional assessment of psychological stress in the context of the pandemic. The CSS have now been translated and validated in over 20 languages, but a validated German version has not yet been available. Therefore, the aim was to develop a German version of the CSS, to test its factor structure, reliability, and validity, and to compare it with international studies. In an online survey (08/2020-06/2021), N = 1774 individuals from the German general population (71.5% female; Mage = 41.2 years, SD = 14.2) completed the CSS as well as questionnaires on related constructs and psychopathology. After eight weeks, participants were asked to participate again for the purpose of calculating retest reliability (N = 806). For the German version, the 6-factor structure with good model fit (Root Mean Square Error of Approximation, RMSEA = 0.06) was confirmed, with the six subscales: Danger, Socio-Economic Consequences, Xenophobia, Contamination, Traumatic Stress, and Compulsive Checking. Internal consistencies ranged from ω = .82-.94 (except Compulsive Checking ω = .70), and retest reliability from rtt = .62-.82. Convergent and discriminant validity were confirmed for the German version. Related constructs such as health anxiety, general xenophobia, obsessive-compulsive behavior, and posttraumatic stress disorder symptoms correlated moderately with the respective subscale and lower with the other scales. With anxiety and depression, Traumatic Stress showed the strongest correlation. Overall, there was a high degree of agreement in an international comparison. The CSS can help to identify pandemic-related psychological stress and to derive appropriate interventions.

Pandemic panic? Results of a 14-month longitudinal study on fear of COVID-19

BACKGROUND

Fear is an evolutionary adaptive emotion that serves to protect the organism from harm. Once a threat diminishes, fear should also dissipate as otherwise fear may become chronic and pathological. While actual threat of the COVID-19 pandemic (i.e., number of infections, hospitalizations, and deaths) has substantially varied over the course of the pandemic, it remains unclear whether (subjective) fear has followed a similar pattern.

METHOD

To examine the development of fear of COVID-19 during the pandemic and investigate potential predictors of chronic fear, we conducted a large online longitudinal study (N = 2000) using the Prolific platform between April 2020 and June 2021. Participants were voluntary response samples and consisted of residents of 34 different countries. The Fear of the Coronavirus Questionnaire (FCQ) and several other demographic and psychological measures were completed monthly.

RESULTS

Overall, we find that fear steadily decreased since April 2020. Additional analyses showed that elevated fear was predicted by region (i.e., North America > Europe), anxious traits, gender, risks for loved ones, general health, and media use.

LIMITATIONS

The interpretation of the results of this study is limited by the non-representativeness of the sample and the lack of data points between August 2020 and June 2021.

CONCLUSIONS

This study helps to characterize the trajectory of fear levels throughout the COVID-19 pandemic and establish several relevant predictors of increased fear.

Validity and clinical utility of distinguishing between DSM-5 somatic symptom disorder and illness anxiety disorder in pathological health anxiety: Should we close the chapter?

OBJECTIVE

To investigate the validity and clinical utility of distinguishing between DSM-5 somatic symptom disorder (SSD) and illness anxiety disorder (IAD) in pathological health anxiety: the excessive and recurrent fear of, or preoccupation with, having or developing a serious health condition.

METHODS

We compared SSD to IAD in pathological health anxiety (N = 334) with regard to concurrent, antecedent, and predictive validators. This was primarily a cross-sectional study, though we studied the effect of CBT longitudinally. Because we were interested in the discriminatory value of SSD and IAD over and above trait health anxiety, we used trait health anxiety as a covariate.

RESULTS

SSD (68%; 228/334) vs. IAD (32%; 106/334) differences were mostly non-significant and small in sociodemographics, core clinical characteristics, apparent course, etiological attribution, and physician visits (gs = -0.18-0.20; RRs = 0.84-1.09; IRRs = 0.87-0.99). However, SSD was associated with a significantly higher somatic symptom burden (gs = 0.20-0.72), more psychologist visits (IRR = 2.02, 95% CI: 1.24-3.28), and slightly higher disability (g = 0.22, 95% CI: 0.03-0.42). There was no significant difference in symptom reduction during CBT (g = -0.16, 95% CI: -0.37-0.05).

CONCLUSION

Although not all differences between SSD and IAD in pathological health anxiety seem to be explained by the level of trait health anxiety, the SSD vs. IAD distinction appears to convey little useful information in pathological health anxiety. Tentatively, considering the well-documented clinical characteristics and effective clinical interventions, it is probably most helpful to regard pathological health anxiety as a de facto anxiety or perhaps obsessive-compulsive spectrum disorder, regardless of the DSM-5 diagnosis of SSD or IAD.

Non-Cardiac Chest Pain as a Persistent Physical Symptom: Psychological Distress and Workability

Non-Cardiac Chest Pain (NCCP) is persistent chest pain in the absence of identifiable cardiac pathology. Some NCCP cases meet criteria for Persistent Physical Symptoms (PPS), where the symptoms are both persistent and distressing/disabling. This study aimed to identify patients that might need specialist treatment for PPS by examining cases of NCCP that meet PPS criteria. We analysed data from 285 chest pain patients that had received an NCCP diagnosis after attending an emergency cardiac department. We compared NCCP patients who did and did not meet the additional criteria for heart-related PPS and hypothesised that the groups would differ in terms of psychological variables and workability. We determined that NCCP patients who meet PPS criteria were more likely than other NCCP patients to be inactive or unable to work, reported more general anxiety and anxiety about their health, were more depressed, ruminated more, and, importantly, had a higher number of other PPS. A high proportion of NCCP patients meet PPS criteria, and they are similar to other PPS patients in terms of comorbidity and disability. This highlights the importance of focusing psychological interventions for this subgroup on the interplay between the range of physical and psychological symptoms present.

Effect of the COVID-19 pandemic on depression, perceived stress and hypochondria of frontline dental staff (FDS): A cohort study

BACKGROUND

The coronavirus 2019 (COVID-19) pandemic had several mental effects on medical staff.

OBJECTIVE

This study intended to evaluate deviations in Frontline Dental Staff (FDS) depression, perceived stress and hypochondria during the COVID-19 outbreak, and to assess whether the existence of potential risk-factors influenced these symptoms over time.

METHODS

This prospective cohort study surveyed FDS three periods from February 1, 2021 to April 8, 2022. FDSs' mental health was assessed through Beck Depression Inventory, Cohen Perceived Stress and the Evans Self-Illness Questionnaires; multivariate linear regression were used to identify potential factors associated with changes on each outcome (depression, perceived stress and hypochondria) over time. All analyses were performed in STATA ver.14.

RESULTS

In a total of 635 FDS, about 69%, 83%, and 71% reported relative depression, 77%, 87%, and 64% reported moderate to high stress level, and 60%, 76% and 74% reported moderate hypochondriac from first, second, and third survives, respectively. The mean and standard deviation of the variables increased dramatically at second survive (July 17 to October 21, 2021) and decreased again at third survive significantly. Being female, working in public sector, and low socioeconomic level were main predictors of higher levels of depression (p < 0.001) and perceived stress (p < 0.001). Perceived stress was a strong predictor of high-level depression (t  =  7.79, p < 0.001).

CONCLUSION

FDSs' depression, stress and hypochondria were high and positively associated with being female, working in public-sector, and low socioeconomic level. To increase the effectiveness and decrease work burnout, psychological support should be provided.

Prevalence and correlates of health anxiety among medical students: a cross-sectional study from the United Arab Emirates

Background

It is often reported that medical students repeatedly develop health anxiety related to the diseases that they are studying. To the best of our knowledge, health anxiety has not been investigated in medical students in the United Arab Emirates (UAE). Therefore, we aimed to investigate the prevalence of health anxiety among a sample of medical students attending the United Arab Emirates University (UAEU). We conducted a cross-sectional study of 193 undergraduate medical students (68 males, 125 females) across the 6 years of the College of Medicine at the UAEU. Students were screened for health anxiety using the Short Health Anxiety Inventory (SHAI).

Results

Eighteen students (9.3%) reached the threshold for clinically significant health anxiety on the SHAI (score ≥ 27). There was no statistically significant difference between those with and those without health anxiety in age, gender, place of origin, or year of study. There was a statistically significant difference (p < 0.05) between the two groups as regards a past history of medical or mental health conditions influencing their choice of college. No specific student demographic or background characteristics significantly predicted the occurrence of clinically significant health anxiety.

Conclusions

Health anxiety was prevalent in a significant proportion of subjects in our sample (almost one in every ten students). Individual experiences of medical and mental illness may play a role in the development of health anxiety and in the choice of studying medicine.

Personality Pathology and Functional Impairment in Patients With Hypochondriasis

BACKGROUND

Research indicates substantial co-occurance of personality pathology and hypochondriasis, which both involve significant psychosocial impairment.

OBJECTIVE

This study sought to investigate the role of personality pathology for explaining functional impairment in patients with hypochondriasis, while accounting for the influence of health anxiety severity.

METHODS

Patients diagnosed with hypochondriasis (N = 84; 60% women) were administered interview- and self-report instruments for personality pathology, health anxiety severity, and functional impairment (general, social, and physical): The Structured Clinical Interview for DSM-IV Axis II (SCID-II), the Personality Inventory for DSM-5 (PID-5), the Short Health Anxiety Inventory (SHAI), the 36-item Short Form health survey (SF-36), and the Global Assessment of Functioning (GAF). Hierarchical regression analyses were performed with boot-strapping (1000 samples).

RESULTS

Findings overall showed that personality pathology incrementally explained functional impairment over the influence of health anxiety severity. More specifically, findings revealed that the incremental effect of PID-5 trait dimensions was substantially larger than the SCID-II personality disorder criterion-count. Functional impairment was specifically associated with SCID-II symptoms of Avoidant Personality disorder and dependent personality disorder as well as PID-5 trait domains of negative affectivity, detachment, and psychoticism.

CONCLUSIONS

The findings highlight the potential significance of personality pathology for understanding and clinical management of functional impairment in patients with hypochondriasis. The personality features that best explained functional impairment were avoidant personality disorder and dependent personality disorder and, in particular, DSM-5 and the International Classification of Diseases, 11th revision personality trait domains of negative affectivity, detachment, and psychoticism.

Health anxiety in stroke survivors: a cross-sectional study on the prevalence of health anxiety in stroke survivors and its impact on quality of life

PURPOSE

To explore the prevalence of health anxiety in stroke survivors and its relative impact on quality of life.

MATERIALS AND METHODS

A cross-sectional design was used including between group comparisons of high and low health anxious stroke survivors. Stroke survivors (n = 105) were recruited via online stroke community forums. Participants completed measures of health anxiety (Short Health Anxiety Inventory), general anxiety and depression (Hospital and Anxiety and Depression Scale), disability (WHO Disability Assessment Schedule), and quality of life (Quality of Life Index). Demographics and medical histories were also assessed.

RESULTS

Thirty percent of the sample scored above the clinical cut off for health anxiety. Stroke survivors with high health anxiety (HiHA) were found to have significantly lower quality of life (p < 0.001) and higher rates of depression (p < 0.001). Regression analysis found health anxiety to be a significant predictor of quality of life (β = -0.12; p < 0.05) in addition to levels of depression (β = -0.33; p < 0.001) and disability (β = -0.53; p < 0.001).

CONCLUSIONS

Almost a third of stroke survivors were experiencing clinical levels of health anxiety, with HiHA significantly associated with lower quality of life. Future research should explore the use of existing evidence based psychological interventions for health anxiety in this population.Implications for rehabilitationOur findings suggest almost one in three stroke survivors residing in the community have clinical levels of health anxiety.High health anxiety in stroke survivors was significantly related to lower levels of quality of life.Given this finding, evidence-based treatments for health anxiety may improve quality of life and reduce distress for a significant proportion of stroke survivors.Rehabilitation approaches aimed at improving overall quality of life for stroke survivors should consider both physical and psychological interventions, with levels of physical disability, depression and anxiety all significantly associated with quality of life.

Intolerance of uncertainty, anxiety sensitivity, and health anxiety during the COVID-19 pandemic: Exploring temporal relationships using cross-lag analysis

Intolerance of uncertainty (IU) and anxiety sensitivity (AS) have been widely discussed and explored as factors that may contribute to health anxiety. We propose that IU and AS are salient issues for many during the COVID-19 pandemic, and may play a role in the development or exacerbation of health anxiety during the pandemic. Studies have examined links between IU and AS with health anxiety during the pandemic, but these relationships have not been tested together using a longitudinal study design. In the present study, measures of IU, AS, and health anxiety were collected from 301 adults at two time points 6 months apart during (early stages of) the COVID-19 pandemic using an online survey platform. Cross-lagged analysis was utilized to simultaneously estimate cross-sectional and longitudinal associations between these three variables. Robust cross-sectional associations were observed, and IU prospectively predicted changes in both health anxiety and AS. No other statistically significant prospective associations emerged. Present findings support the putative role of IU in health anxiety, suggesting that some observed links between AS and health anxiety could be driven by shared variance with IU. IU may be an important factor to monitor and target in health anxiety interventions during the pandemic.

Sleep disturbance during COVID-19: Correlates and predictive ability for mental health symptomatology in a Canadian online sample

BACKGROUND

Sleep disturbance is associated with mental health symptomatology, but this impact is understudied during COVID-19. The aims of this study are to: 1) examine correlates of sleep disturbance, and 2) examine the longitudinal relationship between sleep disturbance and mental health symptoms 6 months later, during the pandemic.

METHODS

Data were analyzed from COVID-19 Survey Canada conducted between May 2020 (T1) and November 2021 (T2) (n = 489). We examined COVID-related baseline correlates of sleep disturbance at T1, and used multivariable regressions to examine the relationship between T1 sleep disturbance and T2 post-traumatic stress (PTS), health anxiety, generalized anxiety, and depressive symptoms, controlling for baseline mental health symptoms and sociodemographics.

RESULTS

Females, ages 30-49, and those with an annual household income <$50,000, showed a higher prevalence of clinically significant sleep disturbance. After adjustment, compared to those without sleep disturbance at baseline, those with sleep disturbance showed a significant increase in PTS symptoms at 6 months (b = 11.80, 95% CI = [8.21-15.38], p < 0.001).

LIMITATIONS

Results are not nationally representative. Data may be subject to response biases due to self-report methods and we are unable to determine causality.

CONCLUSION

Being able to predict adverse mental health implications of sleep disturbance will help clinicians be equipped to target future impacts of the COVID-19 pandemic as well as any future potential pandemics or traumas. This study emphasizes the importance of screening individuals for sleep disturbance.

The 14-item short health anxiety inventory (SHAI-14) used as a screening tool: appropriate interpretation and diagnostic accuracy of the Swedish version

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.

Excessive and Unreliable Health Information and Its Predictability for Anxiety: A Cross-Sectional Observational Study

INTRODUCTION

Being ignorant or unaware is not expected in a situation like the pandemic of COVID-19 with modern internet connectivity and the era of social media. However, information overload may itself lead to health anxiety.

AIMS AND OBJECTIVES

This study investigated the predictability of health anxiety with information overload and sociodemographic profiles during the COVID-19 pandemic.

MATERIALS AND METHODS

A cross-sectional study was done among 400 caretakers of non-covid patients in a tertiary healthcare medical college. The consenting participants provided their sociodemographic details and responded to the short health anxiety inventory (SHAI), Beck anxiety inventory (BAI) and Information overload scale (IOS) for COVID-19.

RESULTS

A total number of 400 participants aged 35.58 ± 10.57 years participated and out of which 88.2% acknowledged health-related anxiety and 56.8% for excessive use of social media. BAI measured anxiety was mild for 19.8%, moderate for 3.5% and severe for 3%. The linear regression analysis predicted health anxiety by three variables only: total anxiety as measured by the Beck anxiety inventory [β = 0.416, t = 9.318, p = 0.000], information overload (rejection of information) [β = 0.171, t = 3.126, p = 0.002], and excessive use of social media [β = 0.124, t = 2.888, p = 0.004].

CONCLUSION

Information overload, its rejection and excessive use of social media were found to be predictive of health-related anxiety.

Cyberchondria, Anxiety Sensitivity, Hypochondria, and Internet Addiction: Implications for Mental Health Professionals

Repetitive online searches for health information increase anxieties and result in Internet addiction. Internet addiction, cyberchondria, anxiety sensitivity, and hypochondria have been studied separately, but how these concepts are reciprocally linked has not been investigated. This study aimed to determine the levels, correlations, and predictors of Internet addiction, cyberchondria, anxiety sensitivity, and hypochondria among students based on the sample's characteristics. A sample of 143 university students participated in this cross-sectional online survey. A self-reported questionnaire was employed to collect data from students. The studied concepts had moderate to high correlations with each other and with the students' characteristics. Not getting infected with the coronavirus was among the demographic factors inserted into the regression model that only predicted cyberchondria. The model of cyberchondria was significant and explained 11.5% of the variance in the score of concepts. The results of the standard regression analysis indicated that the model predicting Internet addiction accounted for 41.2% of the variability. Our unique findings indicate that cyberchondria can contribute to developing Internet addiction compared to earlier studies. The findings suggest the importance of empowering students to overcome their anxieties by managing cyberchondria and Internet addiction. Mental health professionals, namely psychiatric nurses, are at the forefront of taking preventive mental health measures on campus, such as screening and referring students who exhibit these problems to psychological support and counseling to cope with their anxieties.

Interoceptive anxiety-related processes: Importance for understanding COVID-19 and future pandemic mental health and addictive behaviors and their comorbidity

The COVID-19 pandemic is associated with an increased prevalence of mental health problems and addictive behaviors. There is a growing theoretical and empirical evidence that individual differences in interoceptive anxiety-related processes are a one set of vulnerability factors that are important in understanding the impact of pandemic-related mental health problems and addictive behavior. However, there has not been a comprehensive effort to explore this rapidly growing body of research and its implications for public health. In this paper, we discuss why interoceptive anxiety-related processes are relevant to understanding mental health and addictive behaviors during the COVID-19 pandemic. We then provide a narrative review of the available COVID-19 literature linking interoceptive fear and anxiety-related processes (e.g., anxiety sensitivity, health anxiety, and COVID-19 anxiety, fear, and worry) to mental health and addictive behaviors. We then propose a novel transdiagnostic theoretical model that highlights the role of interoceptive anxiety-related processes in mental health and addictive behavior in the context of the present and future pandemics. In the final section, we utilize this conceptualization to underscore clinical implications and provide guidance for future research initiatives in the management of COVID-19 mental health and addictive behaviors and inform the public health field for future pandemics.

Coping styles associated with depression, health anxiety and health-related quality of life in pulmonary hypertension: cross-sectional analysis

OBJECTIVES

Pulmonary hypertension (PH) is a life-shortening disease associated with early mortality and high morbidity. With advancements in medical treatment, people are living longer with the disease, and research is now needed to explore variables that help to enhance patient-reported outcomes. This study investigated the coping strategies of individuals with PH and examined the relationship between coping, depression, health anxiety and health-related quality of life (HRQoL).

DESIGN

A cross-sectional survey design was used.

PARTICIPANTS

Participants (n=121) were recruited from membership of Pulmonary Hypertension Association (PHA) UK.

OUTCOME MEASURES

Participants completed a series of questionnaires assessing depression (Patient Health Questionnaire-9), health anxiety (Short Health Anxiety Inventory), HRQoL (emPHasis-10) and coping (Brief COPE). A principal component analysis was used to identify participants' coping profile. A series of correlational, linear and moderated multiple regression analyses were performed to examine the relationship between coping and health-related outcomes.

RESULTS

Overall, 43% participants met criteria for potential clinical depression. Depression and health anxiety were strongly associated with HRQoL, explaining 37% and 30% of variance respectively (p<0.001). A principal component analysis identified a four-component model of coping. Dimensions were named based on construct items: 'cognitive and affirmation coping' (seven items), 'passive coping' (four items), 'external coping' (seven items) and 'substance use coping' (two items). Cognitive and affirmation and external coping moderated the relationship between depression and HRQoL, with high use of these coping strategies reducing the impact of depression on HRQoL. External coping also moderated the effect of health anxiety on HRQoL.

CONCLUSIONS

The results uniquely highlight the importance of coping styles and psychological distress in predicting HRQoL in PH. Our findings indicate the importance to assess for psychological distress in this population and suggest the need to offer psychological interventions that take into account coping resources and strategies.

Health Anxiety and Its Relationship to Thyroid-Hormone-Suppression Therapy in Patients with Differentiated Thyroid Cancer

Differentiated thyroid cancer (DTC) has a good prognosis; however, patients often need lifelong follow up, and they face potential side effects. The aim of this study was to investigate health anxiety among DTC patients and its relationship to TSH suppression. In 2020, patients from a previous cohort who were from Stockholm completed the 14-item Short Health Anxiety Inventory (SHAI-14; 0−42; 18 being the threshold for clinical significance) and a study-specific questionnaire. Clinical information was also retrieved from medical records. Linear regression was used to investigate the relationship between the TSH levels and the SHAI-14, while adjusting for potential confounders. In total, 146 (73%) patients were included. A total of 24 respondents (16%) scored 18 or more on the SHAI-14, and the mean score was 11.3. Patients with TSH levels of 0.1−0.5 (mE/L) scored, on average, 3.28 points more (p-value 0.01) on the SHAI-14 compared to patients with TSH levels > 0.5. There was no statistically significant difference between patients with TSH levels < 0.1 and TSH levels > 0.5. Thus, we found no linear relationship between the TSH values and health anxiety. Clinically significant levels of health anxiety are slightly higher than those in the general population, but do not appear to be a major psychiatric comorbidity among patients with DTC.

Fear of COVID-19 predicts vaccination willingness 14 months later

Vaccines are an important tool for governments and health agencies to contain and curb the Coronavirus Disease-19 (COVID-19) pandemic. However, despite their effectiveness and safeness, a substantial portion of the population worldwide is hesitant to get vaccinated. In the current study, we examined whether fear of COVID-19 predicts vaccination willingness. In a longitudinal study (N = 938), fear for COVID-19 was assessed in April 2020 and vaccination willingness was measured in June 2021. Approximately 11% of our sample indicated that they were not willing to get vaccinated. Results of a logistic regression showed that increased fear of COVID-19 predicts vaccination willingness 14 months later, even when controlling for several anxious personality traits, infection control perceptions, risks for loved ones, self-rated health, previous infection, media use, and demographic variables. These results show that fear of COVID-19 is a relevant construct to consider for predicting and possibly influencing vaccination willingness. Nonetheless, sensitivity and specificity of fear of COVID-19 to predict vaccination willingness were quite low and only became slightly better when fear of COVID-19 was measured concurrently. This indicates that other potential factors, such as perceived risks of the vaccines, probably also play a role in explaining vaccination willingness.

Factors associated with health anxiety in medical students at a private university in Lima, Peru

INTRODUCTION

There are few studies that examine the factors associated with the different levels of health anxiety in medical students. The objective was to determine the factors associated with the levels of health anxiety in medical students in 2018.

METHODS

An analytical cross-sectional study was carried out with 657 medical students from a private Peruvian university. Participants answered a questionnaire from which information was collected regarding levels of health anxiety (SHAI). For the analysis, linear regression was used to calculate crude and adjusted betas, and their 95% confidence intervals.

RESULTS

The mean health anxiety score was 14 ± 6.7. An association between health anxiety and the year of study is reported, with the second year showing the highest scores. In addition, an association between health anxiety and smoking is highlighted, as there are higher levels in occasional smokers, as well as a weak inverse correlation with age. No association was found with sex, place of birth, or having a first-degree relative that is a doctor or health worker.

CONCLUSIONS

The present study showed that age, year of studies and smoking are associated with health anxiety levels. More studies are required, especially of a longitudinal nature.

A Cognitive Behavior Therapy Chatbot (Otis) for Health Anxiety Management: A Mixed-Methods Pilot Study (Preprint)

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 behavioral therapy (CBT)–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, postintervention, and at a 12-week follow-up. Paired samples t tests and 1-way ANOVAs were conducted to investigate the associated changes in the outcomes over time. Semistructured interviews and written responses in the self-report questionnaires and Facebook Messenger were thematically analyzed.

Results

The trial was completed by 29 participants who provided outcome measures at both postintervention and follow-up. Although an average decrease in health anxiety did not reach significance at postintervention (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 postintervention 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 might not significantly reduce health anxiety.

The association of efficacy, optimism, uncertainty and health anxiety with inflammatory bowel disease activity

OBJECTIVE

Positive and negative psychological attributes have been shown to influence disease outcomes in many chronic health conditions. We aimed to evaluate the association between self-efficacy, optimism, health anxiety and intolerance of uncertainty and disease activity in inflammatory bowel disease (IBD).

METHODS

Adults with confirmed and recently active IBD enrolled in a prospective cohort study. Demographics, disease information, validated measures of psychological functioning related to general self-efficacy, optimism, health anxiety and intolerance of uncertainty were collected at baseline, week 26 and week 52. Clinical disease activity was assessed using the Inflammatory Bowel Disease Symptom Inventory (IBDSI), self-reported flares, and intestinal inflammation using fecal calprotectin (FCAL), collected at baseline, weeks 26 and 52. Generalized estimating equations were used to test the association between psychological functioning and disease activity.

RESULTS

Participants' (n = 154) mean age was 43.4 years (SD 12.5), 69.5% were women and 64.1% had Crohn's disease. Adjusting for demographic variables, higher self-efficacy was associated with lower likelihood of flare by self-report (odds ratio [OR] 0.80, 95% confidence interval [CI] 0.71, 0.91) and IBDSI (OR 0.89, 95% CI 0.80, 0.99), while higher health anxiety was associated with greater likelihood of flare by self-report (OR 1.07, 95% CI 1.01, 1.18) and higher symptomatic disease activity (IBDSI; OR 1.14, 95% CI 1.05, 1.24). The psychological attributes were not significantly associated with active disease as measured by inflammation (FCAL).

CONCLUSION

General self-efficacy and health anxiety are relevant in understanding patient experience with disease activity, and may be appropriate targets for psychological intervention in the care of individuals with IBD.

Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial

BACKGROUND

Health anxiety is a prevalent and debilitating disorder associated with extensive use of healthcare services and reduced quality of life (QoL). Regional variability in specialised clinics or specialist healthcare providers limits access to evidence-based treatment, which may be overcome by internet-delivered Acceptance and Commitment Therapy (iACT).

OBJECTIVE

This study investigated the cost effectiveness of iACT for severe health anxiety in adults.

METHODS

Based on a Danish randomised controlled trial (March 2016-March 2017), the economic evaluation compared costs and effects between iACT and an active control condition (iFORUM). Effectiveness was measured using self-report questionnaires. The cost analysis applied a societal perspective. Resource use and healthcare costs were extracted from the Danish National Registries. Linear regression analysis was applied using change in costs/effectiveness outcomes as the dependant variable. Time, group, and interaction between time and group were independent variables. The primary outcome was the proportion of clinically significant improvements, defined as a ≥ 25% reduction in two measures of health anxiety. The probability of cost effectiveness was presented in a cost-effectiveness acceptability curve for a range of threshold values for willingness to pay.

RESULTS

No significant differences were detected in healthcare costs between groups; however, the iACT group significantly improved in all effectiveness outcomes. The economic analysis showed that, from the healthcare perspective, iACT was associated with an incremental cost-effectiveness ratio of €33 per additional case of clinically significant improvement compared with iFORUM and that, from the societal perspective, iACT dominated iFORUM because it was more effective and less expensive.

CONCLUSIONS

We found no statistically significant differences in costs between groups; however, iACT for severe health anxiety may be cost effective, as evidenced by significant differences in effect.

TRIAL REGISTRY NUMBER

Clinicaltrials.gov, no. NCT02735434.

Fear of Becoming Infected and Fear of Doing the Wrong Thing - Cross-Cultural Adaptation and Further Validation of the Multidimensional Assessment of COVID-19-Related Fears (MAC-RF)

Background

With the COVID-19 infection speeding around the world, many experience fear and anxiety. To detect those at risk of psychopathology and provide treatment, valid instruments are needed. The aim of this study was to cross-culturally validate the theory-based instrument Multidimensional Assessment of COVID-19-Related Fears (MAC-RF) in Croatian and to further examine the scale's validity by exploring its relationship with relevant constructs.

Method

A total of 477 participants completed an online survey during a rapid rise in new daily COVID-19 cases in Croatia and while new restrictions were being imposed.

Results

MAC-RF had a stronger association with health anxiety, cyberchondria, and anxiety sensitivity compared to depression, attesting to its convergent and divergent validity. However, a 2-factor structure was revealed in this sample: Fear of infection and Fear of using an inadequate strategy in dealing with pandemic. Fear of infection had a stronger association with health anxiety and COVID-19 anxiety and was a better predictor of COVID-19 related protective health behaviors. Fear of choosing an inadequate strategy had a stronger association with cyberchondria, fear of consequences of the epidemic on mental health, as well as financial consequences, and loss of civil liberties.

Conclusion

Fear of infection captures negative emotional states due to feared consequences on personal somatic health and the health of loved ones, while Fear of choosing an inadequate strategy in dealing with the pandemic reflects a metacognitive aspect. Treatments may have to target both aspects of COVID-19 related fear.

Health anxiety During COVID-19: Predictive Roles of Health Promoting Behaviors and Sensory Processing Sensitivity

OBJECTIVE

The emergence of the COVID-19 pandemic resulted in major changes in daily life and economic conditions while heightening physical and mental health problems, including health anxiety. Health authorities and elected officials have encouraged individuals to engage in health behaviors. Perceptions of and reactions to these changes could be subject to individual differences. In this line, the current study investigated the predictive roles of health promoting behaviors, sensory processing sensitivity, and their interactions with health anxiety.Design and measures: In this cross-sectional study, 355 participants (73% female, 25.9% male) whose ages range from 19 to 72 (M = 25.91, SD = 9.80) filled out self-reported measures on health promoting behaviors, sensory processing sensitivity, and health anxiety via an online platform between April and May 2020.

RESULTS

It was revealed that caring for a healthy diet, taking responsibility for health and sensory processing sensitivity, but not physical activity and stress management, were associated with health anxiety. Diagnoses and perceptions of physical and mental health problems also contributed to health anxiety during the COVID-19 pandemic.

CONCLUSION

Individuals with higher levels of sensory processing sensitivity and health responsibility were more likely to experience higher levels of health anxiety, while typical physical activities and stress management behaviors were less likely to have an impact during the COVID-19 pandemic. These results highlight the importance of having a healthy diet and the need for pandemic-specific interventions for stress management and sport activities.

COVID-19 related distress in the Swedish population: Validation of the Swedish version of the COVID Stress Scales (CSS)

BACKGROUND

The COVID Stress Scales (CSS) assess health- and contamination-related distress in the face of a medical outbreak like the ongoing COVID-19 pandemic. Though the CSS is translated into 21 languages, it has not been validated in a Swedish national sample.

AIM

Our general objective is to provide a translation, replication, and validation of the CSS and test its convergent- and discriminant validity in relation to anxiety, health anxiety, depression, and stress in the general Swedish population. We also present latent psychometric properties by modelling based on item response theory.

METHODS

Participants consisted of 3044 Swedish adults (> 18 years) from a pre-stratified (gender, age, and education) sample from The Swedish Citizen Panel. Mental health status was assessed by validated instruments, including the CSS, PHQ-4, SHAI-14, and PSS-10.

RESULTS

Results indicate that our Swedish translation of CSS has good psychometric properties and consists of 5 correlated factors.

DISCUSSION

The CSS is useful either as a unidimensional or multidimensional construct using the CSS scales to measure key facets of pandemic-related stress.

CONCLUSIONS

The findings support the cross-cultural validity of the CSS and its potential utility in understanding many of the emotional challenges posed by the current and future pandemics.