Predictors of health anxiety among older and young adults

Electronic Health Literacy as a Source of Self-Efficacy Among Community-Dwelling Older Adults

OBJECTIVES

Health-related factors, such as health status, health anxiety, and health literacy, are established contributors to self-efficacy. However, the relationship between electronic health literacy and self-efficacy is less known. The present study examined the role of electronic health literacy in relation to self-efficacy among community-dwelling older adults.

METHODS

Cross-sectional survey data were collected in the United States between September 2022 and March 2023. The survey dataset consisted of 191 responses from individuals in the United States who were ages 65 or older. It provided information about survey respondents' sociodemographic status, perceived health status, health anxiety, electronic health literacy, and self-efficacy. Hierarchical linear regression was conducted to analyze the data.

RESULTS

Electronic health literacy was positively related to self-efficacy, and health anxiety was negatively related to self-efficacy, with sociodemographic status and perceived health status controlled.

CONCLUSIONS

The results indicate that electronic health literacy can be a source of self-efficacy among community-dwelling older adults.

CLINICAL IMPLICATIONS

Improving older adults' electronic health literacy may help them maintain self-efficacy, and the improvement should be made, especially in the domains of evaluating health information found on the internet and making decisions based on the information.

Validation of the Spanish version of the Perceived Control Scale: Perceived Constraints on Personal Control and Perceived Mastery

OBJECTIVES

Perceived control is a relevant variable for understanding middle and older adults' mental health. The Perceived Control Scale has two dimensions, Perceived Constraints on Personal Control and Perceived Mastery, and is a widely used instrument for assessing perceived control in adults. The aim of this study was to analyze the psychometric properties of the Spanish version of the Perceived Control Scale with data from two different studies.

METHOD

In Study 1, 348 older adults between 60 and 92 years old were assessed through face-to-face assessments. In Study 2, 334 adults between 40 and 90 years completed an online survey. Perceived control, self-perceptions of aging, and anxiety and depressive symptomatology were assessed. An exploratory (Study 1) and confirmatory (Study 2) factor analysis of the Perceived Control Scale were performed, and reliability and its relationship with the other assessed variables were evaluated.

RESULTS

Results from parallel, exploratory, and confirmatory factor analyses suggested that the Spanish version of the Perceived Control Scale has a bidimensional structure: Perceived Constraints on Personal Control and Perceived Mastery. Good internal consistency was found for the scale in both samples. The results revealed negative and significant associations with negative self-perceptions of aging, and anxiety and depressive symptomatology.

CONCLUSION

The Spanish version of the Perceived Control Scale shows good psychometric properties which endorse its use with middle-aged and older adults assessed either face-to-face or through online surveys.

Further Evidence for a Dimensional Latent Structure of Health Anxiety: Taxometric Analyses of the Whiteley Index Based on Two German Representative Samples

Health anxiety is an intricate part of illness anxiety and somatic symptom disorder. Based on convenience samples, two out of three available studies indicate that it is a dimensional rather than a categorical construct. Using two representative datasets, this study investigates whether previous results can be clarified. Conventional taxometric analyses as well as comparison curve fit indices (CCFI) profile analyses (MAMBAC and MAXSLOPE procedures) were calculated with two datasets of the German adult population assessing the Whiteley Index (WI-14, N = 2,072; WI-7, N = 2,498). Mean CCFIs indicated a dimensional structure for both the WI-7 (mean CCFI = 0.42, mean CCFI profile = 0.40) and the WI-14 (mean CCFI = 0.44, mean CCFI profile = 0.32). The results support and extend previous findings by strongly suggesting a dimensional distribution of health anxiety in the general population. Implications for research and practice comprise the adoption of a dimensional description of psychopathology as well as transdiagnostic treatment approaches.

Association of health anxiety, fatalism and medication adherence among geriatric clients: An exploratory study

OBJECTIVES

This study explored the relationship between health anxiety, fatalistic beliefs, and medication adherence among geriatric clients. Also, it determines the extent to which health anxiety and fatalism can predict the variance in medication adherence among the same population of geriatric clients.

DESIGN

A cross-sectional analytical survey on 200 eligible participants using the Arabic Version of the Short Health Anxiety Inventory, Fatalism Scale, and Morisky Medication Adherence Scale-8 items.

RESULTS

The study found a statistically significant negative relationship between the studied geriatric clients' fatalism and health anxiety and their medication adherence (r = -0.160, - 0.187, and P = 0.024, 0.008), respectively.

CONCLUSION

This study highlights the importance of considering psychological factors such as health anxiety and fatalistic beliefs in addressing medication adherence among geriatric clients. By addressing these factors, healthcare providers can develop more effective strategies to improve medication adherence and ultimately improve the health outcomes of geriatric clients.

Health anxiety and associated constructs in school-age children and adolescents with congenital heart disease and their parents: A children's healthy-heart activity monitoring program in Saskatchewan cohort study

Youth with congenital heart disease (CHD) have been found to experience higher levels of health anxiety and associated constructs than typically developing peers. The association between youth and parent health anxiety has been explored in typically developing youth but this association remains unknown in youth with CHD. This association was explored using a prospective, cross-sectional study that included 36 school-age children and adolescents with CHD (median age =10.5 years, IQR = 4) and 35 parents (median age = 44 years, IQR = 10.5). Participants completed a demographic form and measures of health anxiety, anxiety sensitivity, intolerance of uncertainty, and anxiety disorder symptom categories (youth) or general anxiety (parent). Associations were observed between child and adolescent panic/agoraphobia symptoms and parent state anxiety (r = .41), child and adolescent intolerance of uncertainty and parent state and trait anxiety (r = .37; r = .46, respectively), and child and adolescent anxiety sensitivity and parent state anxiety (r = .40). No association was observed between health anxiety in children and adolescents and parents nor between child and adolescent health anxiety and parent associated constructs. For parents, associations between health anxiety and all measures of associated constructs of interest were observed. Study findings will facilitate improved understanding of the psychological needs of school-age children and adolescents with CHD.

Anxiety sensitivity elevates the risk of mental health problems in employees with higher probability of contacting COVID-19 at work

Individuals with increased risk of being in contact with COVID-19 cases at work have been reported to suffer from higher fear of infection and associated mental health problems. The present study examines whether this risk is further increased by higher anxiety sensitivity (AS, i.e., fear of bodily symptoms such as breathlessness, which also are core symptoms of COVID-19) that is also known to be associated with an increased risk of psychopathology. In spring 2020, 783 German health care and social workers participated in a cross-sectional online-survey, in which anxiety sensitivity, depression, anxiety, health anxiety, fear of a COVID-19 infection as well as panic symptoms were assessed. Of these participants, 28.7% affirmed contact with COVID-19 cases, which was associated with greater fear of the virus. Individuals with high AS reported more severe anxiety, health anxiety, depressive symptoms, as well as incident and recurrent panic symptoms. Moreover, the risk association of exposure to COVID-19 cases at work with health anxiety, general anxiety, and panic symptoms was further increased by higher levels of AS. These findings suggest that especially employees with contact to COVID-19 cases who also are high in AS might profit from targeted interventions to prevent excessive fear and associated mental health problems.

Attitudes to aging mediate the reciprocal effects of health anxiety and physical functioning

OBJECTIVE

To understand if attitudes to aging mediate the reciprocal effects of health anxiety and physical functioning among older adults with medical conditions. We examined: (1) if these effects are reciprocal; (2) if attitudes to aging (psychological loss, psychological growth, physical change) play a mediating role in these effects.

DESIGN

A sample of 226 community-dwelling older adults (T1 age range = 65-94, mean age = 73.59, SD = 6.29) reporting at least one chronic medical condition completed two phone interviews across six months.

MAIN OUTCOME MEASURES

Background measures, health anxiety, physical functioning, and attitudes to aging at T1 and T2.

RESULTS

T2 attitudes to aging served as a mediator controlling for T1 attitudes. There was a direct effect of worse physical functioning at T1 on increased health anxieties at T2. Negative (but not positive) attitudes to aging mediated that effect. The reversed temporal sequencing (T1 health anxiety leading to T2 physical functioning) was significant only when mediated by negative attitudes to aging.

CONCLUSIONS

Findings suggest that viewing aging as mostly a time of losses (but not as a time of gains) serves as an important mechanism through which health anxieties and physical functioning affect each other among older adults having chronic medical conditions.

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.

Core self-evaluations as resilience and risk factors of psychological distress during the COVID-19 pandemic

In view of the grave consequences of distress reactions to the COVID-19 pandemic, this study investigated CSE (Core Self-evaluations) - internal/external health locus of control, generalized self-efficacy and trait optimism - and intolerance of uncertainty as potential correlates of distress reactions. We conducted an online questionnaire-based cross-sectional study with 422 Israeli respondents. Pandemic-related distress was defined by perceived stress, negative and positive affect, and worries. Predictors were: health locus of control, generalized self-efficacy, trait optimism, and intolerance of uncertainty. The findings show that CSEs and intolerance of uncertainty added between 11% (to perceived stress) and 22% (to negative affect) of explained variance beyond the background variables. Specifically, higher trait optimism and generalized self-efficacy were associated with less distress, and greater intolerance of uncertainty was correlated with higher distress. In conclusion, the CSE framework is useful for explaining psychological distress during the COVID-19 pandemic. Beyond their theoretical contribution, the findings may have practical implications for increasing resilience and ameliorating distress during a pandemic.

The association between health anxiety, physical disease and cardiovascular risk factors in the general population – a cross-sectional analysis from the Tromsø study: Tromsø 7

Background

Health anxiety (HA) is defined as a worry of disease. An association between HA and mental illness has been reported, but few have looked at the association between HA and physical disease.

Objective

To examine the association between HA and number of diseases, different disease categories and cardiovascular risk factors in a large sample of the general population.

Methods

This study used cross-sectional data from 18,432 participants aged 40 years or older in the seventh survey of the Tromsø study. HA was measured using a revised version of the Whiteley Index-6 (WI-6-R). Participants reported previous and current status regarding a variety of different diseases. We performed exponential regression analyses looking at the independent variables 1) number of diseases, 2) disease category (cancer, cardiovascular disease, diabetes or kidney disease, respiratory disease, rheumatism, and migraine), and 3) cardiovascular risk factors (high blood pressure or use of cholesterol- or blood pressure lowering medication).

Results

Compared to the healthy reference group, number of diseases, different disease categories, and cardiovascular risk factors were consistently associated with higher HA scores. Most previous diseases were also significantly associated with increased HA score. People with current cancer, cardiovascular disease, and diabetes or kidney disease had the highest HA scores, being 109, 50, and 60% higher than the reference group, respectively.

Conclusion

In our general adult population, we found consistent associations between HA, as a continuous measure, and physical disease, all disease categories measured and cardiovascular risk factors.

Maternal threats and college student mental health: The role of perceived anxiety control

Objective: Although parental threatening behaviors are associated with poor mental health outcomes among college students, the underlying mechanisms of this relationship are understudied. This investigation examined the underlying role of perceived anxiety control in the association between childhood exposure to maternal threatening behaviors and depression, worry, and attention/deficit hyperactivity disorder (attention-deficit/hyperactivity disorder) symptoms. Participants: Participants (N = 862; Mage = 18.75 years, SD = 1.04, age range = 18-24) were recruited from a large state university in the northeast. Methods: Participants completed a battery of self-report questionnaires. Results: Tests of indirect effects indicated that greater childhood exposure to maternal threats was associated with lower perceived anxiety control, which in turn was associated with more severe depression, worry, and ADHD symptoms, respectively. Conclusions: Childhood exposure to maternal threatening behaviors may contribute to college students' low perceived anxiety control, which in turn increases the risk for these symptom clusters.

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.

Emotion regulation strategies and difficulties in older adults: A systematic review

OBJECTIVES

The purpose of this systematic review was to assess the types of emotion regulation (ER) strategies used and difficulties in emotion regulation experienced by older adults, within the theoretical frameworks proposed by Gross, and by Gratz and Roemer, respectively.

METHODS

A systematic search was conducted using principal electronic scientific databases (PubMed, Scopus, and Web of Science). The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines.

RESULTS

The final number of articles included was 44. Older adults reported a higher use of adaptive ER strategies, as well as fewer difficulties in ER, compared with younger adults. Findings from this review also suggest that the use of maladaptive ER strategies can also expose older adults to psychological distress, and may affect their adaptation to negative disease-related outcomes more common in later life.

CONCLUSIONS

Older adults generally showed a greater emotional control compared with younger subjects. Adaptive control strategies, rather than maladaptive control strategies, were correlated with more positive outcomes for psychological distress and adaptation to chronic diseases.

CLINICAL IMPLICATIONS

Understanding the nature of ER processes in older adults may contribute to implement tailored interventions aimed at reinforcing adaptive ER processes.

The Doctor Is In(ternet): The Mediating Role of Health Anxiety in the Relationship between Somatic Symptoms and Cyberchondria

Cyberchondria is a dysfunctional behavioral pattern characterized by an excessive and anxiety-amplifying engagement in searching for reassuring health information on the Internet. Research demonstrated that somatic symptoms and health anxiety might foster maladaptive health-related behaviors, such as cyberchondria. However, the relationships between somatic symptoms, health anxiety, and cyberchondria have been scarcely examined. Accordingly, this study aimed to test the mediating effect of health anxiety on the association between somatic symptoms and cyberchondria. Four hundred and thirty-one adults from the community (158 males, 36.66%), aged between 18 and 74, were recruited via an online survey. Participants completed self-report measures of somatic symptoms, health anxiety, and cyberchondria. A mediation analysis demonstrated that the severity of somatic symptoms predicted increased levels of cyberchondria and that health anxiety partially mediated this association. Therefore, interventions aimed at decreasing health anxiety may also play a role in decreasing the risk of developing cyberchondria.

Worrying But Not Acting: The Role of Intolerance of Uncertainty in Explaining the Discrepancy in COVID-19-Related Responses

Research indicates that Intolerance of Uncertainty (IU) is associated with COVID-19 emotional responses, but not necessarily with engaging in COVID-19 preventative behaviors. The current study was designed to further evaluate this discrepancy. Participants (N = 454) completed self-report forms about COVID-19 emotional responses (i.e., fear, worry, sensitivity to symptoms) and COVID-19 behavioral interference/responses (i.e., interference in daily activities, interference due to worry, and engagement in preventative behaviors). IU was positively associated with COVID-19-related emotional responses as well as two of the COVID-19-related behavioral interference/responses (i.e., interference in daily activities and interference due to worry), but negatively predicted engagement in COVID-19 preventative behaviors. Exploratory analyses revealed a significant indirect effect of IU on lower engagement in preventative behaviors through lower belief in the effectiveness of such behaviors. Thus, we further document the role of IU in statistically predicting higher distress but lower levels of adaptive health behaviors. Furthermore, we provide preliminary support for the hypothesis that these relationships may be explained by associations between IU and lower belief in the efficacy of health behaviors. Because some current analyses indicate small effect sizes, future studies should investigate IU alongside other potentially important markers.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-022-10321-0.

Does cyberchondria predict Internet addiction among students during the COVID-19 pandemic? A web-based survey study

BACKGROUND

Previous literature has investigated the association of this phenomenon and Internet addiction. Nevertheless, little research has been conducted to elucidate the predictive associations among these concepts among students.

OBJECTIVE

This study reported students' cyberchondria and Internet addiction, and it examined whether cyberchondria predicts Internet addiction.

MATERIAL AND METHODS

During the COVID-19 pandemic, cross-sectional data were collected using a web survey from a convenience snowball sample of 143 students enrolled in e-learning courses at a governmental university.

RESULTS

A moderate level of cyberchondria and a mild level of Internet addiction was evident among students. A moderate level of cyberchondria and a mild level of Internet addiction was evident among students. Moderate to high significant correlations were reported among the studied concepts and with the sample's characteristics. Cyberchondria and unavailability of the Internet at school were predictors of Internet addiction.

IMPLICATIONS

Healthcare providers, including nurses, should provide information that preserves students' mental health during stressful periods such as the COVID-19 pandemic and should offer clear instructions on stress and anxiety management during such times. A longer scale, especially for cyberchondria, is warranted in future research with a random and larger sample.

CONCLUSIONS

Findings suggest that cyberchondria serves as a predictor of Internet addiction, contrary to findings of previous studies. Various psychosocial interventions should always be initiated to help students prevent or address cyberchondria and Internet addiction.

How Anxiety Our Adult Patients Before Venepuncture Procedure: A Study in UiTM Medical Centre Sungai Buloh (UiTMMC)

Background: Venepuncture is one of the commonest stressful invasive procedures in the health care setting. Unfortunately, to date, there was a lack of locally published studies that studied anxiety, especially before the procedure among adult patients. Hence, this study was conducted to determine the factors associated with the state and trait-anxiety among adult patients before the venepuncture procedure in UiTMMC. Methods: A cross-sectional pilot study was conducted among patients while waiting for a venepuncture procedure in March 2020. Patients aged 18 years old and above, Malaysian, able to understand English or Malay and had experienced venepuncture in UiTMMC were recruited. Malay validated version of the State-Trait-Anxiety-Inventory (STAI) Questionnaire was used to assess the anxiety level. Data were analysed using IBM SPSS Version 26.0, and multiple linear regression was used to determine the associated factors for state and trait-anxiety before the venepuncture procedure. Results: A total of 330 patients with a mean age of 46.34 ± 14.34 years participated in this study. The mean of the state-anxiety score was 38.02 ± 14.25 and the mean trait-anxiety score was 36.46 ± 11.47. The correlation between state-anxiety and trait-anxiety scores was highly significant (r=0.870, p<0.001). Factors associated with state-anxiety and trait-anxiety contributed with 72.6% and 58.5% variances, respectively. Conclusions: Adult patients who waiting for venepuncture in were average low state and trait anxiety scores. Although the associated factors were majority non-modifiable, this finding still can instil awareness to the health care workers who are dealing with needle procedurals.

Assessment of intolerance of uncertainty: Validation of a modified anagram task

BACKGROUND AND OBJECTIVES

Intolerance of uncertainty (IU) is an individual difference factor that reflects difficulty tolerating emotional distress in the context of uncertainty and is a robust transdiagnostic risk factor for emotional disorders. A limitation of prior research on IU is the heavy reliance on self-report measures to assess this construct. The aim of the present study was to examine the validity of a brief, computerized anagram task modified to assess IU (the PACT Anagram Task; PAT).

METHODS

Participants were 221 unselected undergraduate students (71% female; M_age = 19; 89% Caucasian) who completed the PAT and a series of self-report measures of convergent, discriminant, and incremental validity, and measures of anxiety and depression symptoms online for course credit.

RESULTS

Greater PAT-Distress was positively correlated measures of convergent validity and demonstrated incremental validity in relation to self-reported IU above and beyond attentional control. None of the PAT indicators were associated with compassion or empathic concern, evidencing discriminant validity. PAT-Distress and PAT-Answers were each associated with greater worry above and beyond self-reported IU.

LIMITATIONS

Study limitations include the cross-sectional design and lack of diversity in terms of sample demographics. Furthermore, we did not examine convergence between this task and other behavioral measures of IU.

CONCLUSION

Subjective distress following completion of the PAT may serve as one indicator of IU. Further research is needed in order to replicate these results and validate the use of the PAT in clinical samples.

The Role of Avoidance Coping and Illness Uncertainty in the Relationship Between Transition Readiness and Health Anxiety

PURPOSE

The transition to college is associated with numerous stressors, including environmental changes, increased academic expectations, and changes in social support, all of which may be exacerbated by the added responsibility of managing a chronic medical condition. Huang (2019) proposed a model examining the relationships between coping styles, transition readiness, and health anxiety, and suggested that greater transition readiness is associated with adaptive coping strategies and less health anxiety. However, there are limited findings as to how poor transition readiness relates to health anxiety. Therefore, the current study tested a serial mediation model (i.e., poor transition readiness → avoidance coping → illness uncertainty → health anxiety).

DESIGN AND METHODS

College students (N = 194) with a chronic medical condition completed self-report questionnaires.

RESULTS

Results indicated several direct effects among the modeled variables and a significant poor transition readiness → avoidance coping → illness uncertainty → health anxiety serial mediation (path a₁d₂₁b₂ = 0.438, 95% CI = 0.153 to 0.913).

CONCLUSIONS

Worse transition readiness was associated with increased avoidance as a coping mechanism, which in turn is associated with increased illness uncertainty, and ultimately health anxiety. The current findings identified possible drivers of health anxiety in college students with a chronic medical condition.

PRACTICE IMPLICATIONS

These findings highlight that good transition readiness skills may buffer against maladaptive avoidance, illness uncertainty, and health anxiety. Modules aimed at improving healthcare management, avoidance, and illness uncertainty may be beneficial additions to interventions to reduce health anxiety.

Psychiatric and cognitive characteristics of older adults admitted to a Video-EEG monitoring (VEM) unit

OBJECTIVE

To compare the clinical, psychiatric, and cognitive characteristics of older with younger patients presenting to a video-EEG monitoring (VEM) unit.

METHOD

This was a retrospective case-control study involving patients admitted for VEM over a two-year period (from April 2018 to April 2020) at two comprehensive epilepsy units. Patients were categorized into an older (≥60 years) and a younger (<60 years) group. Younger patients were individually matched to older adults to form a matched younger group. Diagnosis was determined by a consensus opinion of epileptologists, neurologists, and neuropsychiatrists. The main diagnostic categories were epilepsy, psychogenic nonepileptic seizures (PNES), and 'other' diagnosis (non-diagnostic and other nonepileptic diagnoses). Clinical psychiatric diagnoses were obtained from neuropsychiatric reports. Objective cognitive function was measured with the Neuropsychiatry Unit Cognitive Assessment Tool (NUCOG). Subjective cognitive function was assessed using the Quality of Life in Epilepsy Inventory-89 (QOLIE-89) cognitive subscales.

RESULTS

Five-hundred and thirty three patients (71 older, 462 younger) aged 16-91 years were admitted to the VEM unit during the study period. There was a diagnosis of focal epilepsy in 55% of the older group and 48% of the younger group, generalized epilepsy in 3% of the older group and 10% of the younger group, and 'other' in 32% of the older group and 19% of the younger group. Ten percent (2 males and 5 females) of the older group were diagnosed with PNES compared to 22% of the younger group (p = 0.016). A depressive disorder was diagnosed in 34% of the older group and 24% of the younger group (p = 0.20). An anxiety disorder was diagnosed in 15% of the older group and 25% of the younger group (p = 0.15). Mild neurocognitive disorder was more common in the older group (34%) compared to the matched younger group (34% vs 3%, p < 0.001). The older group had lower mean NUCOG scores compared to the matched younger group (79.49 vs 87.73, p = <0.001). There was no evidence for a relationship between mean NUCOG score and overall subjective cognitive difficulties for the older group (r = 0.03, p = 0.83). Among older adults, those diagnosed with PNES had more experiences of childhood trauma. Measures of dissociation, depression, or general anxiety did not differ between PNES and non-PNES diagnoses in the older group.

CONCLUSION

Psychiatric comorbidities are common among older adults admitted for VEM. The psychological impact of epilepsy and risk factors for PNES seen in younger patients are also applicable in the older group. The older group demonstrated more cognitive impairments than the younger group, although these were usually unrecognized by individuals. Older adults admitted to VEM will benefit from psychiatric and neuropsychological input to ensure a comprehensive care approach to evaluation and management.

Parenting in poor health: Examining associations between parental health, prescription drug use, and child maltreatment

RATIONALE

Child maltreatment and problematic parenting are related to negative outcomes for children. Poor parental health could be a risk factor for problematic parenting through several mechanisms: 1) inadequate emotional regulation and coping; 2) impairment of parental capacity; and, 3) impairment of the parent-child relationship.

OBJECTIVE

This study examines relationships between self-rated parental health, prescription drug use, and a broad array of negative parenting outcomes.

METHODS

A sample of general population parents of children aged ten and younger was recruited from 30 mid-sized cities in California (n = 681). Weighted mixed-effects negative binomial and logistic regression models were used to examine associations between poor parental health, prescription drug use and child maltreatment (physical abuse, supervisory neglect, and physical neglect), and problematic parenting (psychological aggression and corporal punishment).

RESULTS

Parents in poor health used physical abuse, corporal punishment, and psychological aggression more frequently and had higher odds of supervisory neglect. Parents who were taking more prescription medications had higher odds of physical neglect. Exploratory analyses suggested that prescriptions for certain medical conditions both increased and decreased the risk of problematic parenting.

CONCLUSIONS

Poor health and prescription drug use are not uncommon and present largely under-recognized risk factors for a spectrum of adverse parenting outcomes. Our study provides additional evidence that parents in poor health are at heightened risk of negative parenting, and need targeted intervention supports to support family well-being.

The prevalence risk of anxiety and its associated factors among university students in Malaysia: a national cross-sectional study

BACKGROUND

Anxiety disorder is one of the most common mental health problems worldwide, including Malaysia, and this issue has gained concern and attention from many, including experts and authorities globally. While average levels of stress and worry may help to motivate students to perform well in their studies, excessive feelings will increase their level of anxiety.

METHODS

A cross-sectional study was conducted at selected government and private universities throughout Malaysia. A total of 1851 students participated in this study. The students were asked to complete self-administered questionnaires, including socio-demographic, academic, and psychosocial characteristics. The Generalized Anxiety Disorder-7 (GAD-7) questionnaire was used to measure the prevalence risk of anxiety among the students. Chi-square analysis was conducted to find the relationship between the variables and anxiety, and multivariate logistic regression analysis was used to identify the predictors.

RESULTS

The response rate was 97.90%, where 1821 out of 1860 students participated in the study. The prevalence risk of anxiety in this study was recorded at 29%. The data revealed that academic year, financial support for the study, alcohol consumption, poor sleep quality, body mass index (BMI), having a good friend in the university, having doubt regarding the future, actively involved in the society, and having problems with other students and lecturer(s) were significantly associated with risk of anxiety; with the academic year as the primary predictor.

CONCLUSIONS

The findings highlight the current prevalence risk of anxiety among university students in Malaysia. The outcome of this study can serve as the evident baseline data and help with the development of specific interventions in addressing and managing the issue appropriately.

Psychological Predictors of COVID-19 Prevention Behavior in Hungarian Women Across Different Generations

BACKGROUND

Age related differences were found in prevention behavior, showing that older individuals tend to be the most proactive. The aim of the study was the identification of psychological predictors on COVID-19 prevention behavior in women, across four generations. In addition, the predictive role of the psychological variables was explored through the lens of negative and positive information processing perspective on total and domain-specific COVID-19 prevention behavior.

METHODS

A cross-sectional research was conducted. The sample included 834 Hungarian speaking women. The assessed variables were: COVID-19 knowledge, risk perception, COVID-19 health anxiety, negative automatic thoughts, psychological flexibility, and four domains of COVID-19 prevention behavior (social distancing, general hygiene, information seeking, health behavior). A three-level hierarchical linear regression analysis was conducted to investigate the predictors of preventive behavior in each generation.

RESULTS

A diversity across generations was found. In case of baby boomer generation, the final model explained 32.4% of the variance for total prevention behavior [F(14,215) = 8.847, p < 0.001], and only perceived risk made a significant contribution. For Gen X the final model accounted for 21.1% of variance of total prevention behavior [F(14,341) = 7.788, p < 0.001], marital status, perceived risk, COVID-19 health anxiety, and negative automatic thoughts made significant contributions. In case of Gen Y the final model accounted for 6.2% of variance on total prevention behavior [F(14,147) = 1.761, p = 0.05], only perceived risk had a contribution to the final model. For Gen Z the final model accounted for 23.4% of variance on total preventive behavior [F(13,71) = 2.979, p = 0.002], and only psychological flexibility made a contribution to the model. The results on the distinct domains of COVID-19 prevention behavior emphasized details in the dissimilarity among generations.

CONCLUSION

The role of generational identity on COVID-19 prevention behavior is relevant. The coexistence of negative and positive information processing may have its beneficial role in certain areas of prevention.

The Relationship Between Ruminating the Catastrophic Consequences of Bodily Changes and Positive Reappraisal and Practical Problem-Solving Strategies in Individuals With Illness Anxiety Disorder

Introduction:

Cognitive emotion regulation is suggested to contribute to Illness Anxiety Disorder (IAD). Reappraisal and suppression are essential ER strategies with controversial data about their roles in IAD. Relevant studies are mostly limited to exploring these two strategies in individuals without such disorder. Therefore, we aimed to study the role of emotion regulation in the psychopathology of IAD by evaluating other ER strategies in illness-anxious individuals. Furthermore, we investigated the relationship between IAD and emotion regulation by targeting the role of interpretation bias for health-related information.

Methods:

The study participants were 60 university students. They underwent a semi-structured clinical interview to assess the presence or absence of IAD symptoms (n=30/group). They completed a battery of questionnaires measuring IAD, emotion regulation, and interpretation bias.

Results:

The illness-anxious group applied significantly less reappraisal and refocus on planning and more rumination, catastrophizing, and acceptance strategies, compared to the controls. Besides, interpretation bias was positively correlated with rumination and catastrophizing; while its association with reappraisal and planning was negative.

Conclusion:

Both functional (e.g. reappraisal & planning) and dysfunctional strategies (e.g. rumination & catastrophizing) contributed to the psychopathology of IAD. The biased interpretation of bodily information could make individuals prone to ruminate about the catastrophic consequences of bodily changes; such conditions interrupt fostering more positive reappraisal or practical problem-solving strategies.

Assessment of Anxiety in Long-Term Care Residents: Issues and Strategies

The experience of clinically significant anxiety and anxiety disorders represent significant and often debilitating problems for many residents in long-term care (LTC) settings. However, anxiety problems often go undetected and untreated in this growing population. The purposes of this paper are to examine the prevalence and impact of anxiety problems among residents in LTC facilities, describe the efficacy of the current instruments that are used to detect anxiety in these settings, and provide clinical guidance for the thorough assessment of anxiety. Regarding measurement tools, the GAI, GAI-SF, GAS-LTC, and the BADS are the only self-report measures designed for older adults that have been successfully validated for use with older adults living in LTC settings. Clinicians should focus on ways to educate LTC directors and staff to emphasize the importance of screening and assessing for anxiety, using validated measures, to improve the assessment and treatment of anxiety in their residents.

Positive and Detached Reappraisal of Threatening Music in Younger and Older Adults

Past empirical studies have suggested that older adults preferentially use gaze-based mood regulation to lessen their negative experiences while watching an emotional scene. This preference for a low cognitively demanding regulatory strategy leaves open the question of whether the effortful processing of a more cognitively demanding reappraisal task is really spared from the general age-related decline. Because it does not allow perceptual attention to be redirected away from the emotional source, music provides an ideal way to address this question. The goal of our study was to examine the affective, behavioral, physiological, and cognitive outcomes of positive and detached reappraisal in response to negative musical emotion in younger and older adults. Participants first simply listened to a series of threatening musical excerpts and were then instructed to either positively reappraise or to detach themselves from the emotion elicited by music. Findings showed that, when instructed to simply listen to threatening music, older adults reported a more positive feeling associated with a smaller SCL in comparison with their younger counterparts. When implementing positive and detached reappraisal, participants showed more positive and more aroused emotional experiences, whatever the age group. We also found that the instruction to intentionally reappraise negative emotions results in a lesser cognitive cost for older adults in comparison with younger adults. Taken together, these data suggest that, compared to younger adults, older adults engage in spontaneous downregulation of negative affect and successfully implement downregulation instructions. This extends previous findings and brings compelling evidence that, even when auditory attention cannot be redirected away from the emotional source, older adults are still more effective at regulating emotions. Taking into account the age-associated decline in executive functioning, our results suggest that the working memory task could have distracted older adults from the reminiscences of the threat-evoking music, thus resulting in an emotional downregulation. Hence, even if they were instructed to implement reappraisal strategies, older adults might prefer distraction over engagement in reappraisal. This is congruent with the idea that, although getting older, people are more likely to be distracted from a negative source of emotion to maintain their well-being.

Poor Treatment Outcomes Following Repositioning Maneuvers in Younger and Older Adults With Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-analysis

OBJECTIVE

This systematic review aimed to methodically review the available evidence on poor treatment outcomes after repositioning maneuver treatments in adults with BPPV and whether there are differences in the outcomes for older and younger adults.

DATA SOURCES

Embase, CINAHL, Scopus, PsycINFO (Ovid), Central Register of Controlled Trials (CENTRAL), and PubMed.

REVIEW METHODS

Studies were included if they were prospective experimental or observational studies with a minimal follow-up of 1 month; the subjects were at least 18 years old, had BPPV, and were treated with repositioning maneuvers. Studies were excluded if they were not available in English full text and if the outcomes used were confined to positional tests and subjective vertigo rating. Methodological quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists. Meta-analysis was performed to compare outcomes for younger and older (≥60 years) subjects where multiple studies utilized similar outcomes.

RESULTS

Thirty-five studies were selected. The methodological quality was poor in more than 60% of the studies. Treatment efficacy, based on positional test results and symptom resolution and recurrence were the most common outcomes. Balance and quality of life measures improved after treatment but were not always normalized. Residual symptoms and psychoemotional consequences persisted in some subjects, despite BPPV resolution. Meta-analyses indicated poorer dynamic balance recovery and increased self-perceived level of handicap in the older group relative to the younger group.

CONCLUSIONS AND IMPLICATIONS

Although repositioning maneuvers were effective in BPPV management, some patients experienced residual dizziness, postural instability, recurrences, and psychoemotional consequences at least 1 month after repositioning. Moreover, older adults experienced less improvements in dynamic balance and self-perceived handicap rating compared with younger people. These issues may further impact on older adults with BPPV physically and mentally and should be addressed by future better-quality research and interventions.

Geriatric Anxiety Scale: Development and Preliminary Validation of a Long-Term Care Anxiety Assessment Measure

Objectives: Anxiety is a significant problem for many individuals in various long-term care (LTC) settings and is often undetected and under-treated. This study examined the psychometric properties of a new quantitative anxiety screening measure specifically designed for use in long-term care settings, the Geriatric Anxiety Scale - Long Term Care Version (GAS-LTC).Method: Data were collected from LTC residents (N = 66; M age = 84.4 years, range = 59 to 100 years; 74.2% women) who completed the GAS-LTC, the Geriatric Anxiety Inventory (GAI), the Geriatric Depression Scale-15 (GDS-15), and the Prospective and Retrospective Memory Questionnaire (PRMQ).Results: The GAS-LTC demonstrated good internal consistency (α = .80), and good convergent validity with the GAI (r = .70, p < .01), the GDS-15 (r = .67, p < .01), and the PRMQ (r = .54, p < .01). Internal consistency on the GAS-LTC did not significantly vary between groups with high (α = .75) and low (α = .77) self-reported subjective memory impairment.Conclusions: The results from this study preliminarily indicate that the GAS-LTC is reliable and valid for use with older adults in LTC settings.Clinical Implications: Use of the GAS-LTC in LTC settings may help improve detection and treatment for individuals experiencing elevated anxiety in LTC.

Does Intolerance of Uncertainty Affect the Magnitude of Limitations or Pain Intensity?

BACKGROUND

Intolerance of uncertainty-the tendency to overestimate the chance of and be unwilling to accept potential, but unlikely, negative outcomes in uncertain situations-is a cognitive construct that has been shown to affect symptoms and limitations for patients with traumatic and nontraumatic upper-extremity conditions. Cognitive flexibility and tolerance of uncertainty can be trained and practiced, with the potential to increase musculoskeletal health. However, to our knowledge, the degree to which intolerance of uncertainty might be associated with symptom intensity and the magnitude of limitations in adults with upper-extremity problems has not been characterized.

QUESTIONS/PURPOSES

After accounting for personal and social factors, is intolerance of uncertainty independently associated with (1) the magnitude of physical limitations and (2) pain intensity?

METHODS

In this cross-sectional, observational study, 139 new and returning patients presenting to one of four orthopaedic offices in a large urban area completed the Intolerance of Uncertainty Scale (a validated measure of the level of comfort with uncertain situations), the Patient-reported Outcomes Measurement Information System-Physical Function Upper Extremity computer adaptive test (to measure the magnitude of limitations), and an 11-point ordinal measure of pain intensity. The mean age of the 139 participants was 51 years ± 16 years and 55% (76 of 139) were men. Participants presented to the clinics with a wide variety of upper-extremity conditions, such as trigger finger, distal radius fractures, lateral epicondylitis, or non-specific shoulder pain. We also assessed sex, race, marital status, education level, income, public versus private insurance, area deprivation index, and the participant's self-perception of their healthcare experience through a multiple-choice question (answer choices: none, some, a little, and a lot of experience). The following patient characteristics were more common in our study participants: white, employed, part of a married or unmarried couple, and private insurance coverage. We created two multivariable linear regression models to assess factors independently associated with the magnitude of limitations and pain intensity.

RESULTS

After controlling for potentially confounding variables including sex, insurance, area deprivation index, and type of visit, we found that fewer physical limitations were associated with a greater intolerance of uncertainty (regression coefficient [β] -0.30; 95% confidence interval, -0.50 to -0.10; p = 0.003; semi-partial r = 0.07; adjusted r for the full model = 0.16), as was being a man (β 3.2; 95% CI, 0.08-6.3; p = 0.045; semi-partial r = 0.03) and having private insurance coverage (β 5.2; 95% CI, 2.1-8.2; p = 0.001; semi-partial r = 0.08). After controlling for one important potentially confounding variable, the level of education, greater pain intensity was associated with a greater intolerance of uncertainty (β 0.08; 95% CI, 0.02-0.14; p = 0.009; semi-partial r = 0.05; adjusted r for the full model = 0.08).

CONCLUSIONS

Intolerance of uncertainty-a byproduct of cognitive bias and error, which are elements of the normal functioning of the human mind-increases limitations and pain intensity across diagnoses, independent of demographic and social factors. Future studies can address the effect of strategies that incorporate mindset training (for example, cognitive behavioral therapy and its derivatives) on musculoskeletal symptoms and limitations.

LEVEL OF EVIDENCE

Level II, prognostic study.

Age differences in the use of emotion regulation strategies derived from the process model of emotion regulation: a systematic review

OBJECTIVES

This review examines differences in the use of emotion regulation (ER) strategies among younger and older adults.

METHOD

A systematic review using search terms related to ageing and ER identified 23 relevant studies. Narrative synthesis was adopted to analyse the findings.

RESULTS

Generally, greater use of situation selection and attentional deployment was identified among older adults, although these relationships were dependent on contextual/moderator variables. While older adults employed greater levels of situation modification in response to negative stimuli, there was considerable variation in age differences across specific situation modification subtypes. Available evidence pointed to an absence of age differences in the cognitive change strategy of cognitive reappraisal. The use of relatively less-cognitively demanding cognitive change subtypes (e.g. acceptance) was, under particular circumstances, greater among older adults. Findings regarding the response modulation strategy of expressive suppression were equivocal.

CONCLUSION

Adult development is not characterised by straightforward shifts in preferences for use of different ER strategies. Moderator variables appear to be of central importance in shaping the emergence of age differences in ER. Systematically examining interactions of age with individual difference variables and situational factors in samples including oldest-old adults will be important for advancing knowledge regarding developmental differences in ER.

Frequency of Adverse Events Following Q Fever Immunisation in Young Adults

Q fever is a zoonosis of concern in many countries. Vaccination is the most effective means of prevention, and since 1989, Australia has had a licensed Q fever vaccine, Q-VAX^®. This vaccine was also used in the Netherlands in 2011 following the largest recorded Q fever outbreak globally. There is a paucity of available data regarding adverse events following immunisation (AEFI) for young adult females. Such data are important for informing future vaccination recommendations both within Australia and internationally. This study collected Q fever vaccine (Q-VAX^®) AEFI data in veterinary and animal science students at Australian universities. Students were enrolled at the time of vaccination and were emailed a link to an online AEFI survey one week later. Of the 60% (499/827) that responded, 85% were female and the median age was 18 years. Local injection site reactions (ISRs) occurred in 98% (95%; CI 96–99%) of respondents, of which 30% (95% CI 24–32%) were severe. Systemic AEFI occurred in 60% (95%; CI 55–64%) of respondents within the seven days following immunisation. Medical attention was sought by 19/499 (3.8%) respondents, of whom one sought treatment at a hospital emergency department. Females were more likely than males to experience any local ISR (odds ratio [OR] 9.3; 95% CI 2.5–33.8; p < 0.001), ISRs of greater severity (OR 2.5; 95% CI 1.5–4.2; p < 0.001), and any systemic AEFI (OR 1.9; 95% CI 1.1–3.1; p = 0.016). These safety data suggest that a high frequency of adverse events following immunisation should be expected in young adults, particularly females. However, the consequences of Q fever disease are potentially far more debilitating.

How do illness-anxious individuals process health-threatening information? A systematic review of evidence for the cognitive-behavioral model

According to the cognitive-behavioral model, illness anxiety is developed and maintained through biased processing of health-threatening information and maladaptive responses to such information.

OBJECTIVE

This study is a systematic review of research that attempted to validate central tenets of the cognitive-behavioral model regarding etiological and maintenance mechanisms in illness anxiety.

METHODS

Sixty-two studies, including correlational and experimental designs, were identified through a systematic search of databases and were evaluated for their quality.

RESULTS

Outcomes were synthesized following a qualitative thematic approach under categories of theoretically driven mechanisms derived from the cognitive-behavioral model: attention, memory and interpretation biases, perceived awareness and inaccuracy in perception of somatic sensations, negativity bias, emotion dysregulation, and behavioral avoidance.

CONCLUSIONS

Findings partly support the cognitive-behavioral model, but several of its hypothetical mechanisms only receive weak support due to the scarcity of relevant studies. Directions for future research are suggested based on identified gaps in the existing literature.

Emotion Regulation in Chronic Disease Populations: An Integrative Review

BACKGROUND AND PURPOSE

Emotion regulation, the experiencing, processing, and modulating of emotional response, is necessary to manage the emotional stressors common in patients with chronic illness. Overwhelming emotional demands deplete the resources needed for everyday self-care management of chronic disease, contributing to poor health outcomes. Emotion regulation is shown to impact behaviors in healthy individuals; yet, a review of literature examining evidence of associations in chronically ill populations is lacking. The purpose of this article is to examine the state of the science relative to the impact of emotion regulation on health outcomes in chronic illness populations.

METHODS

Articles were reviewed (N = 14) that focused on emotion regulation and outcomes of patients with chronic illness.

RESULTS

Indicate that most of the studies focused on these concepts are cross-sectional and measure emotion regulation using various surveys. Potential relationships exist with increased age, male gender, higher education, decreased stress, depressive, and anxiety symptoms being associated with more adaptive emotion regulation. Of primary importance to patients with chronic illnesses is the potential link between greater difficulties with emotion regulation and the presence of chronic disease as well as poorer physical function.

IMPLICATIONS FOR PRACTICE

Care should include attention to affective regulation as well as physiologic responses of chronic illness.

Metacognitive beliefs as a predictor of health anxiety in a self-reporting Italian clinical sample

Research has supported the specific role that anxiety sensitivity, health-related dysfunctional beliefs, and metacognitive beliefs may play in the development and maintenance of health anxiety symptoms. However, the role of metacognitive beliefs in health anxiety has only been explored in analogue samples. The aim of this study was to explore for the first time the association between metacognitive beliefs and health anxiety symptoms in a sample of participants who reported having received a diagnosis of severe health anxiety (hypochondriasis) or illness anxiety disorder and test whether these beliefs are significant predictors of health anxiety after controlling for anxiety, depression, anxiety sensitivity, and dysfunctional beliefs. A series of dimensional self-report measures were administered to a large Italian sample (N = 458). At a bivariate level, Beliefs that Thoughts are Uncontrollable had a stronger association with health anxiety than any of the dysfunctional beliefs and anxiety sensitivity subscales. Results from hierarchical multiple regression analysis indicated that Beliefs that Thoughts are Uncontrollable predicted health anxiety symptoms over-and-above depression, general anxiety, anxiety sensitivity, and health-related dysfunctional beliefs. Despite many important limitations, this study supported the hypothesis that metacognition may have an important role in health anxiety in clinical samples.

Psychological Predictors of Health Anxiety in Response to the Zika Virus

The threat of a United States (U.S.) Zika virus pandemic during 2015-2016 was associated with public anxiety. Such threats represent opportunities to examine hypotheses about health anxiety. The present study investigated psychological predictors of Zika-related anxiety during the 2015-2016 outbreak. U.S. adults (N = 216) completed a battery of measures assessing Zika-related anxiety as well as psychological variables hypothesized to predict anxious responding to the threat of a domestic Zika outbreak. Contrary to hypotheses, regression analyses indicated that only contamination severity overestimates and greater Zika knowledge significantly predicted Zika-related anxiety. Study limitations and clinical implications are discussed.

The Role of Emotion Reactivity in Health Anxiety

Emotion reactivity, defined as heightened sensitivity, intensity, and persistence of emotional states, has been shown to contribute to the exacerbation of anxiety. However, the association between emotion reactivity and health anxiety has yet to be examined. The aim of the present investigation was to examine the unique predictive ability of emotion reactivity in terms of health anxiety in a sample of medically healthy undergraduates ( n = 194; 59.3% female, M_age = 19.42, SD = 1.51, range = 18-26 years; 84.0% Caucasian). Findings indicated that, after controlling for the effects of gender, age, and anxiety sensitivity, greater emotion reactivity significantly predicted greater overall health anxiety (3.1% variance), as well as higher levels of affective (4.1% unique variance) and behavioral (4.8% unique variance) components. Findings suggest that experiencing emotions more frequently, intensely, and for longer durations of time prior to returning to baseline are associated with greater health preoccupations.

Anxiety Sensitivity, Experiential Avoidance, and Mindfulness Among Younger and Older Adults: Age Differences in Risk Factors for Anxiety Symptoms

In this cross-sectional study, we examined age-related differences in anxiety sensitivity (AS), experiential avoidance (EA), and mindfulness among younger adult students (N=426; M age=20.1 years) and community-dwelling older adults (N=85; M age=71.8 years). Participants anonymously completed the Anxiety Sensitivity Index-3, Acceptance and Action Questionnaire-II, Mindful Attention Awareness Scale, Kentucky Inventory of Mindfulness Skills, Beck Anxiety Inventory, Geriatric Anxiety Scale, and State-Trait Anxiety Inventory. Independent t tests indicated that younger adults reported significantly higher levels of AS and EA, whereas older adults reported significantly higher levels of trait mindfulness. Correlational analyses demonstrated that AS and EA were significantly associated with each other and with anxiety-related symptoms. However, trait mindfulness was significantly inversely related to AS, EA, and to trait and state anxiety. To date, these three factors have yet to be examined simultaneously within the context of age differences, and the present study illuminates these differences as well as their relationships. AS, EA, and low mindfulness appear to be significant correlates for anxiety-related symptoms in younger and older adults.

Health anxiety and the non-medical use of prescription drugs in young adults: A cross-sectional study

INTRODUCTION

Studies have demonstrated a relation between health anxiety (hypochondriasis) and substance use, but this minimal body of literature has focused on alcohol or illicit drugs. The use of medications without a physician's prescription (i.e., non-medical use of prescription drugs, NMUPD) is increasingly prevalent among young adults. Health anxiety, a tendency to worry excessively about health, is a factor that could contribute to NMUPD, but this has not been examined. The purpose of the current study was to examine the relations among health anxiety, NMUPD, and other psychological variables related to substance use.

METHODS

In the present study, young adult college students (N = 758), ages 18-25, completed an anonymous online survey assessing demographics, health anxiety, NMUPD, and other psychological characteristics, including depression and general anxiety.

RESULTS

Participants who reported NMUPD had higher scores in health anxiety, as well as more frequent healthcare appointments, and were more likely to report having a chronic health condition. Given that multiple factors influence a decision to engage in NMUPD, a multivariable logistic regression analysis was performed. Results suggested that hopelessness, sensation-seeking, and health anxiety were risk factors for NMUPD, and that health anxiety predicted NMUPD over and above these other variables.

CONCLUSIONS

Medical professionals and mental health service providers should be aware of the increased risk of NMUPD for patients with health anxiety. Future research on NMUPD should more closely examine the role of health anxiety.

Intolerance of Uncertainty: Shaping an Agenda for Research on Coping with Multiple Sclerosis

Multiple sclerosis (MS) is a chronic and progressive neurologic condition that, by its nature, carries uncertainty as a hallmark characteristic. Although all patients face uncertainty, there is variability in how individuals cope with its presence. In other populations, the concept of "intolerance of uncertainty" has been conceptualized to explain this variability such that individuals who have difficulty tolerating the possibility of future occurrences may engage in thoughts or behaviors by which they attempt to exert control over that possibility or lessen the uncertainty but may, as a result, experience worse outcomes, particularly in terms of psychological well-being. This topical review introduces MS-focused researchers, clinicians, and patients to intolerance of uncertainty, integrates the concept with what is already understood about coping with MS, and suggests future steps for conceptual, assessment, and treatment-focused research that may benefit from integrating intolerance of uncertainty as a central feature.

Predictors of anxiety in centenarians: health, economic factors, and loneliness

BACKGROUND

Centenarians' psychological well-being is presently of great interest in psychogeriatric research but little is known about factors that specifically account for the presence of clinically relevant anxiety symptoms in this age group. This study examined the presence of anxiety and its predictors in a sample of centenarians and aims to contribute to a better understanding of anxiety determinants in extreme old age.

METHODS

We examined how socio-demographic, health, functional, and social factors contribute to the presence of clinically significant anxiety symptoms in centenarians recruited from two Portuguese centenarian studies. The Geriatric Anxiety Inventory - Short Form (GAI-SF) was used to assess anxiety symptoms.

RESULTS

A total of 97 centenarians (mean age 101.1 years; SD = 1.5 years; range = 100-108) with no/minor cognitive impairment were included. Clinically significant anxiety symptoms (GAI-SF ≥3) were present in 45.4% (n = 44) of the sample. Main predictive factors included worse health perception, higher number of medical conditions, financial concerns related to medical expenses (income inadequacy) and loneliness.

CONCLUSIONS

Results suggest that along with health status (subjective and objective), income inadequacy related to medical expenses and feeling lonely may predispose centenarians to clinically significant anxiety and be important to their overall well-being. Further research is needed on the repercussions of clinical anxiety in centenarians' quality of life and on co-morbid conditions (e.g. depression) at such advanced ages.

Mediators in internet-based cognitive behavior therapy for severe health anxiety

According to the cognitive behavioral model of severe health anxiety (hypochondriasis) four central maintaining mechanisms are how the individual perceives the risk of disease and how negative its consequences would be, attention to bodily sensations, and intolerance of uncertainty. The aim of the present study was to investigate the mediating role of these putative mechanisms in Internet-delivered CBT for severe health anxiety. We analyzed data from an RCT where participants were randomized to Internet-delivered CBT (n=40) or to a control condition (n=41). Mediators and outcome, i.e. health anxiety, were assessed weekly throughout the treatment, enabling fulfillment of the criterion of temporal precedence of changes occurring in the mediator in relation to the outcome to be met. The results showed that reduced perceived risk of disease, less attention to bodily symptoms, and reduced intolerance of uncertainty significantly mediated improvement in health anxiety. The study supports the validity of the cognitive behavioral model of health anxiety. The findings have theoretical and clinical implications as they indicate processes that may be causally related to the improvements observed after CBT for health anxiety.