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Merlo EM, Tutino R, Myles LAM, Lia MC, Minasi D. Alexithymia, intolerance to uncertainty and mental health difficulties in adolescents with Type 1 diabetes mellitus. Ital J Pediatr 2024; 50:99. [PMID: 38755698 PMCID: PMC11100042 DOI: 10.1186/s13052-024-01647-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 04/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Type 1 Diabetes Mellitus (T1DM) represents a serious chronic condition affecting a wide number of people. Discussion of the physical issues associated with T1DM pervades the literature, however, there is less discussion of the psychological consequences. Mental health difficulties, alexithymia and uncertainty are present in this population, and known to be harmful for the onset, maintenance and worsening of T1DM. This study aimed to evaluate the presence of these phenomena in people with T1DM. METHODS 105 participants aged between 11 and 17 years old (M: 13.88; SD: 2.16) affected by T1DM were included in the sample. To assess the presence of mental health difficulties, SAFA scales (Depression, Anxiety and Somatic symptoms) were included in the protocol together with TAS-20 and IUS-12, which evaluate the presence and role of alexithymia and intolerance to uncertainty in the sample, respectively. RESULTS A concerning presence of anxiety, depression and somatic symptoms was found in the sample. Mental health difficulties appeared to be consistently present in the sample, often overcoming pathological thesholds. Alexithymia and uncertainty were also common, highlighting their role in T1DM. CONCLUSIONS Active mental health difficulties together with high rates of alexithymia and intolerance to uncertainty were prevalent in the sample of adolescents with diabetes.
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Affiliation(s)
- Emanuele Maria Merlo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Rita Tutino
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | | | - Maria Carmela Lia
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Domenico Minasi
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
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de Lafontaine MF, Turcotte S, Denis I, Foldes-Busque G. Investigating the relationship between the five-factor model of distress tolerance, anxiety and anxiety sensitivity. ANXIETY, STRESS, AND COPING 2023; 36:353-365. [PMID: 35587513 DOI: 10.1080/10615806.2022.2077929] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Distress tolerance (DT) has been conceptualized as a vulnerability factor for several psychopathologies. A five factor model of DT has been suggested, but its associations with anxiety and anxiety sensitivity have yet to be explored. OBJECTIVES This study aimed to further validate the five-factor model of DT, identify the associations between its factors and elevated anxiety, and assess if anxiety sensitivity mediates the association between DT and anxiety. DESIGN AND METHODS This observational study included 330 students and university workers (women = 82.7%; mean age = 27.7 years, SD = 9.4). They completed online questionnaires assessing DT, anxiety sensitivity and anxiety levels. RESULTS The five-factor model was a good fit to the data (RMSEA = .04). Two factors, and the sex of the participants, contributed to the variance in anxiety (r2 = .418, p < .001). Tolerance of negative emotion was directly (β = -1.98, 95% CI = [-2.53, -1.42]) and indirectly (β = -1.10, 95% CI = [-1.55, -.78]) associated with lower anxiety through anxiety sensitivity. Tolerance of uncertainty was also directly (β = -.08, 95% CI = [-.10, -.06]) and indirectly (β = -.04, 95% CI = [-.05, -.02]) associated with lower anxiety through anxiety sensitivity. CONCLUSIONS Tolerance of negative emotion and uncertainty were associated with anxiety independently of the other factors of DT. These associations seem partially explained by the effect of anxiety sensitivity.
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Affiliation(s)
- Marie-France de Lafontaine
- School of Psychology, Université Laval, Québec, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
- Research Centre of the Quebec Heart and Lung Institute, Québec, Canada
| | - Stéphane Turcotte
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
| | - Isabelle Denis
- School of Psychology, Université Laval, Québec, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
- Centre de recherche sur les jeunes et les familles (CRUJeF), Québec, Canada
| | - Guillaume Foldes-Busque
- School of Psychology, Université Laval, Québec, Canada
- Research Centre of the Centre intégré de santé et de services sociaux de Chaudière-Appalaches, Lévis, Canada
- Research Centre of the Quebec Heart and Lung Institute, Québec, Canada
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Bredemeier K, Church LD, Bounoua N, Feler B, Spielberg JM. Intolerance of uncertainty, anxiety sensitivity, and health anxiety during the COVID-19 pandemic: Exploring temporal relationships using cross-lag analysis. J Anxiety Disord 2023; 93:102660. [PMID: 36527952 PMCID: PMC9747232 DOI: 10.1016/j.janxdis.2022.102660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 11/23/2022] [Accepted: 12/09/2022] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- Keith Bredemeier
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Leah D. Church
- Department of Psychology, University of Delaware, Newark, DE, USA
| | - Nadia Bounoua
- Department of Psychology, University of Delaware, Newark, DE, USA.
| | - Bridget Feler
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
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Heinen A, Varghese S, Krayem A, Molodynski A. Understanding health anxiety in the COVID-19 pandemic. Int J Soc Psychiatry 2022; 68:1756-1763. [PMID: 34823387 DOI: 10.1177/00207640211057794] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The COVID-19 pandemic continues to be one of the greatest public health challenges faced by the UK. Reported rates of psychiatric difficulties have increased and the mechanisms by which the pandemic has affected mental health requires investigation. AIMS The aim of the study was to understand the psychological impact of the COVID-19 pandemic on health anxiety in the general population, with a focus on Oxford Health NHS Foundation Trust, which provides specialist mental health care within Oxfordshire and Buckinghamshire. METHODS We invited participants aged 18+ across Oxfordshire and Buckinghamshire to complete an online questionnaire consisting of standardised questionnaires measuring psychological wellbeing, non-standardised questions to provide demographic information, and information about social circumstances and behaviour during the COVID-19 pandemic. Participants were then invited via email to complete a 3-month follow-up questionnaire. RESULTS About 324 participants completed the baseline survey while 199 completed the follow-up. Our analysis demonstrated that higher scores on a health anxiety inventory were related to reports of depression, anxiety, loneliness, poor quality of life and obsessive-compulsive symptoms and panic. We also identified several predictors of health anxiety such as being female, having a pre-existing physical or mental health condition, and poor tolerance of uncertainty. Lifestyle and demographic factors such as changes in financial situation, changes in employment status, having a close relative or friend with COVID-19, being able to do grocery shopping, being a key worker, and ethnicity were not found to predict health anxiety. CONCLUSIONS Awareness of the impact of health anxiety on people needs to be consistently high among healthcare professionals, especially in the continuing fallout from the COVID-19 pandemic. The relationship between health anxiety and fatigue, sleep quality, gender and co-morbid mental and physical health difficulties needs to be investigated further to determine areas of intervention.
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The Relationship Between Health Anxiety Levels And Healthy Lifestyle Behaviors Of Family Caregivers Of Cancer Patients Receiving Outpatient Chemotherapy. JOURNAL OF BASIC AND CLINICAL HEALTH SCIENCES 2022. [DOI: 10.30621/jbachs.1013611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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O'Bryan EM, McLeish AC, Norr AM, Ely S, Bass Z, Davies CD, Capron DW, Schmidt NB, Mano KEJ. A randomized controlled trial evaluating the efficacy of a brief computerized anxiety sensitivity reduction intervention for health anxiety. J Anxiety Disord 2021; 82:102425. [PMID: 34082279 DOI: 10.1016/j.janxdis.2021.102425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 01/20/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
It is estimated that individuals with severe health anxiety (HA) utilize 41 %-78 % more healthcare resources than individuals with identified medical diagnoses. Thus, identifying targets for intervention and prevention efforts for HA that are appropriate for primary care or specialty clinic settings is imperative. The aim of the present investigation was to evaluate the effect of a single-session, computerized anxiety sensitivity (AS) intervention on AS and HA. Participants were 68 university students (79.4 % female; Mage = 19.68) with elevated levels of AS and HA. Participants were randomized to either the AS intervention condition or an active control condition and completed self-report and behavioral follow-up assessments at post-intervention, 1-week follow-up, and 1-month follow-up. Results indicated a significant Time x Condition interaction for ASI-3 at each follow-up assessment (all ps < .001), such that individuals in the active condition exhibited greater reductions in AS compared to the control condition. There was no significant Time x Condition interaction for HA at any follow-up. Mediation analyses revealed a significant indirect effect of Condition on changes in HA through changes in AS. No significant effects were observed for behavioral outcomes. Findings suggest that this intervention successfully reduces AS among those who are high in HA and AS and may indirectly contribute to reductions in HA over time through reductions in AS.
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Affiliation(s)
- Emily M O'Bryan
- Department of Psychology, University of Cincinnati, USA; Anxiety Disorders Center, Hartford Hospital/Institute of Living, USA. Emily.O'
| | | | - Aaron M Norr
- VA VISN 20 Northwest Network Mental Illness Research, Education and Clinical Center (MIRECC), USA; Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, USA
| | - Sarah Ely
- Department of Psychology, University of Cincinnati, USA
| | - Zoey Bass
- Department of Psychology, University of Cincinnati, USA
| | - Carolyn D Davies
- Anxiety Disorders Center, Hartford Hospital/Institute of Living, USA; Department of Psychological and Brain Sciences, University of Massachusetts Amherst, USA
| | - Daniel W Capron
- School of Psychology, University of Southern Mississippi, USA
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O’Bryan EM, Stevens KT, Bimstein JG, Jean A, Mammo L, Tolin DF. Intolerance of Uncertainty and Anxiety Symptoms: Examining the Indirect Effect Through Anxiety Sensitivity Among Adults with Anxiety-Related Disorders. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2021. [DOI: 10.1007/s10862-021-09912-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khoury JMB, Watt MC, MacLean K. Anxiety Sensitivity Mediates Relations Between Mental Distress Symptoms and Medical Care Utilization During COVID-19 Pandemic. Int J Cogn Ther 2021; 14:515-536. [PMID: 34178209 PMCID: PMC8216097 DOI: 10.1007/s41811-021-00113-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/09/2021] [Indexed: 11/30/2022]
Abstract
Anxiety and uncertainty are common during pandemics. The present study extended previous pandemic research by investigating the role of two transdiagnostic risk factors — anxiety sensitivity (AS: fear of physiological anxiety or “fear of fear”; Reiss & McNally, 1985) and intolerance of uncertainty (IU; Buhr & Dugas, 2009) — in explaining relations between mental distress symptoms and behavioural responding during the COVID-19 pandemic. Student and community-based participants (N=457; 87.6% female) were recruited between May and July 2020 to complete measures of anxiety (health, panic, general), depression, and stress. Anxiety and related symptoms were found to be higher than in previous studies. Parallel mediation analyses showed that clinically meaningful levels of mental distress symptoms directly influenced safety behaviours and medical care utilization but also indirectly influenced the latter (vs. former) through AS-physical concerns (vs. IU). CBT interventions, targeting AS-physical concerns, may reduce mental distress symptoms during pandemic and prevent overuse of healthcare.
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Affiliation(s)
- Juliana M B Khoury
- Department of Psychology, St. Francis Xavier University, Antigonish, Nova Scotia Canada
| | - Margo C Watt
- Department of Psychology, St. Francis Xavier University, Antigonish, Nova Scotia Canada.,Departments of Psychology/Neuroscience and Psychiatry, Dalhousie University, Halifax, Nova Scotia Canada
| | - Kim MacLean
- Department of Psychology, St. Francis Xavier University, Antigonish, Nova Scotia Canada
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Foroughi AA, Mohammadpour M, Khanjani S, Pouyanfard S, Dorouie N, Parvizi Fard AA. Psychometric properties of the Iranian version of the Anxiety Sensitivity Index-3 (ASI-3). TRENDS IN PSYCHIATRY AND PSYCHOTHERAPY 2019; 41:254-261. [PMID: 31644692 DOI: 10.1590/2237-6089-2018-0078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/07/2019] [Indexed: 02/16/2023]
Abstract
INTRODUCTION Anxiety sensitivity plays a prominent role in the etiology of anxiety disorders. This construct has attracted widespread interest from experts and researchers. The Anxiety Sensitivity Index (ASI-3) is the most common scale for measuring anxiety sensitivity. OBJECTIVE To analyze the psychometric properties and factor structure of the ASI-3 in Iranian student samples. METHODS 220 students (135 women, 85 men) from Kermanshah University of Medical Sciences were selected by the convenience sampling method to evaluate the psychometric properties and analyze the factor structure of the ASI-3. The subjects were also asked to complete the Acceptance and Action Questionnaire-II (AAQ-II), Whiteley Index, Intolerance of Uncertainty, and Neuroticism scales. LISREL and SPSS were used to analyze the data. Cronbach's alpha and correlation coefficients were calculated and confirmatory factor analysis was conducted. RESULTS The results of the confirmatory factor analysis revealed a three-factor structure with physical, cognitive, and social components (comparative fit index = 0.94; normed fit index = 0.91; root mean square error of approximation = 0.09). The ASI-3 had positive and significant correlations with health anxiety (0.59), intolerance of uncertainty (0.29), and neuroticism (0.51). Furthermore, the ASI-3 had a negative and significant correlation with the AAQII (-0.58). Cronbach's alpha coefficients for the whole scale and for the physical, cognitive, and social concerns factors were 0.90, 0.74, 0.79, and 0.78, respectively. The invariance of the index was significant compared to the original English version. CONCLUSION In general, the results support the adequacy of the psychometric properties of the Persian version of the ASI-3. Theoretical and applied implications will be discussed.
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Affiliation(s)
- Ali Akbar Foroughi
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mohsen Mohammadpour
- Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sajad Khanjani
- Department of Clinical Psychology, School of Behavioral Sciences and Mental Health, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Sahar Pouyanfard
- Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Nadia Dorouie
- Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Ali Akbar Parvizi Fard
- Department of Clinical Psychology, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Bottesi G, Noventa S, Freeston MH, Ghisi M. Seeking certainty about Intolerance of Uncertainty: Addressing old and new issues through the Intolerance of Uncertainty Scale-Revised. PLoS One 2019; 14:e0211929. [PMID: 30742694 PMCID: PMC6370219 DOI: 10.1371/journal.pone.0211929] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 01/24/2019] [Indexed: 01/30/2023] Open
Abstract
Intolerance of Uncertainty is a trans-diagnostic process that spans a range of emotional disorders and it is usually measured through the Intolerance of Uncertainty Scale-12. The current study aims at investigating some issues in the assessment of Intolerance of Uncertainty (IU) through the Italian Intolerance of Uncertainty Scale-Revised, a measure adapted from the Intolerance of Uncertainty Scale-12 to assess IU across the lifespan. In particular we address the factor structure among a large community sample, measurement invariance across gender, age, and over time, together with reliability and validity of the overall scale and its subscales. The questionnaire was administered to community (N = 761; mean age = 35.86 ± 14.01 years) and undergraduate (N = 163; mean age = 21.16 ± 2.64 years) participants, together with other self-report measures assessing constructs theoretically related to IU. The application of a bifactor model shows that the Italian Intolerance of Uncertainty Scale-Revised possesses a robust general factor, thus supporting the use of the unit-weighted total score of the questionnaire as a measure of the construct. Furthermore, measurement invariance across gender, age, and over time is supported. Finally, the Italian Intolerance of Uncertainty Scale-Revised appears to possess adequate reliability and validity. These findings support the unidimensionality of the measure, a conceptually reasonable result in line with the trans-diagnostic nature of Intolerance of Uncertainty. In addition, this study and comparison with published factor structures of the Intolerance of Uncertainty Scale-12 and of the Intolerance of Uncertainty Scale-Revised identify some issues for the internal structure of the measure. In particular, concern is expressed for the Prospective IU subscale. In light of the promising psychometric properties, the use of the Italian Intolerance of Uncertainty Scale-Revised as a univocal measure is encouraged in both research and clinical practice.
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Affiliation(s)
- Gioia Bottesi
- Department of General Psychology, University of Padova, Padova, Italy
| | | | - Mark H. Freeston
- School of Psychology, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Marta Ghisi
- Department of General Psychology, University of Padova, Padova, Italy
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Stein AT, Freeman SZ, Smits JAJ. Cognitive Mechanisms Underlying the Link Between Anxiety, Health Behaviors, and Illness Outcomes: Commentary on a Special Issue. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-09999-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Horenstein A, Rogers AH, Bakhshaie J, Zvolensky MJ, Heimberg RG. Examining the Role of Anxiety Sensitivity and Intolerance of Uncertainty in the Relationship Between Health Anxiety and Likelihood of Medical Care Utilization. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9980-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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