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Koops TU, Uhlenbusch N, Löwe B, Härter M, Harth V, Briken P. Do indicators for DSM-5 sexual dysfunction and somatic symptom disorder overlap? Evidence from the Hamburg City Health Study population-based sample. J Sex Med 2024:qdae113. [PMID: 39293967 DOI: 10.1093/jsxmed/qdae113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 08/04/2024] [Accepted: 08/20/2024] [Indexed: 09/20/2024]
Abstract
BACKGROUND Symptoms of sexual dysfunction and somatic symptom disorder may resemble each other in their presentation as lasting and distressing alterations of expected bodily "functioning"; their co-occurrence has not yet been studied in nonclinical settings or by DSM-5 criteria (Diagnostic and Statistical Manual of Mental Disorders, fifth edition). AIM To investigate (1) the association of indicators consistent with DSM-5 sexual dysfunction and somatic symptom disorder diagnoses, (2) whether individuals with different sexual dysfunction diagnoses differ in somatic symptoms and their perception, and (3) whether distress from sexual difficulties is related to somatic symptoms and symptom perception. METHODS We examined links among sexual dysfunctions/distress from sexual difficulties (Brief Questionnaire on Sexuality), somatic symptom severity (Patient Health Questionnaire-15 [PHQ-15]), and symptom perception (Somatic Symptom Disorder-B Criteria Scale) in 9333 participants of the Hamburg City Health Study aged 45 to 74 years. For a sensitivity analysis, we repeated all analyses after excluding an item on sexual difficulties from the PHQ-15 score. OUTCOMES Outcomes included scores on the Brief Questionnaire on Sexuality indicating sexual difficulties and dysfunction according to DSM-5, PHQ-15 for somatic symptom severity, and Somatic Symptom Disorder-B Criteria Scale for symptom perception. RESULTS Indicators consistent with DSM-5 sexual dysfunction and somatic symptom disorder diagnoses were linked (P = .24) before the sensitivity analysis but not after. Individuals with different sexual dysfunction diagnoses did not differ in their somatic symptom severity or their symptom perception. Distress from sexual difficulties was weakly correlated with somatic symptom severity (after sensitivity analysis: ρ = .19, P = .01) and symptom perception (ρ = .21, P = .01). Both correlations were stronger for men than for women. CLINICAL IMPLICATIONS Our results convey that it is worth exploring sexual difficulties and somatic symptom disorder in patients presenting with either complaint but also that sexual difficulties should still be regarded as an independent phenomenon. STRENGTHS AND LIMITATIONS Our sample consisted of participants from one metropolitan region who were >45 years of age and thus does not demographically represent the general population. Assessing via self-report questionnaires may have influenced the reporting of symptoms, as may have prevailing shame around experiencing sexual dysfunction. The final sample size was reduced by missing values from some questionnaires. Despite these limitations, sample sizes for all analyses were large and offer meaningful new observations on the subject. CONCLUSION Our data suggest that indicators for sexual dysfunction and somatic symptom disorder somewhat overlap but still represent distinct phenomena and should be treated accordingly in research and clinical practice.
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Affiliation(s)
- Thula U Koops
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Natalie Uhlenbusch
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Volker Harth
- Institute for Occupational and Maritime Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine, and Forensic Psychiatry, University Medical Centre Hamburg-Eppendorf, Hamburg 20246, Germany
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Köteles F, Szemerszky R, Petrie K, Nordin S. Modern health worries and annoyance from environmental factors are largely unrelated to smoking, alcohol consumption, and physical activity. J Psychosom Res 2023; 172:111417. [PMID: 37331267 DOI: 10.1016/j.jpsychores.2023.111417] [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: 03/09/2023] [Revised: 05/30/2023] [Accepted: 06/13/2023] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Modern health worries, as well as environmental annoyance from chemical agents, noise, and electromagnetic exposure are associated with symptom reporting and marked affective-behavioural changes. As promotion and protection of health is a primary characteristic of these conditions, it can be expected that they will be related to less risk behaviour (smoking and alcohol consumption) and more health behaviour (physical activity), both cross-sectionally and longitudinally. METHODS Hypotheses were tested in a sample of 2336 individuals participating in T1 and T2 data collection (3 years apart) of the Västerbotten Environmental Health Study, Sweden. Health-related behaviours were assessed using single self-report questions. Smoking was measured on a binary (yes-or-no) scale; frequency of alcohol consumption and physical activity was measured on a 5-point and a 4-point scale, respectively. RESULTS Modern health worries showed no cross-sectional association with the three behaviours, whereas annoyance was typically inversely, very weakly, related to smoking and alcohol consumption. Physical activity was significantly positively associated only with chemical annoyance. None of the variables significantly predicted change of behaviours at T2 after controlling for the respective T1 value and demographic variables. CONCLUSIONS Individuals with high levels of modern health worries and annoyance from various environmental agents are not clearly characterized by a healthier lifestyle. Perhaps they focus on the alleviation of their existing symptoms; alternatively, somatic symptom distress decreases their cognitive-affective resources necessary for a long-term life style change.
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Affiliation(s)
- Ferenc Köteles
- Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Hungary.
| | - Renáta Szemerszky
- Institute of Psychology, Károli Gáspár University of the Reformed Church in Hungary, Hungary.
| | - Keith Petrie
- Department of Psychological Medicine, University of Auckland, New Zealand.
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden.
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Szemerszky R, Dömötör Z, Witthöft M, Köteles F. Modern health worries and idiopathic environmental intolerance attributed to electromagnetic fields are associated with paranoid ideation. J Psychosom Res 2021; 146:110501. [PMID: 33930739 DOI: 10.1016/j.jpsychores.2021.110501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Paranoid ideation is assumed to characterize worries about possible harmful effects of modern technologies (MHWs) and idiopathic environmental intolerances (IEIs), such as IEI attributed to electromagnetic fields (IEI-EMF). Empirical evidence on these associations is scarce. METHODS In a cross-sectional on-line survey, participants of a community sample (n = 700; mean age: 28.4 ± 12.0; 434 females) completed the Somatosensory Amplification Scale, the Modern Health Worries Scale, and the Paranoid Ideation scale of the Symptom Checklist 90 Revised. They were considered IEI-EMF if (1) they categorized themselves so, (2) they had experienced symptoms that they attributed to the exposure to electromagnetic fields, and (3) the condition impacted their everyday functioning. RESULTS Paranoid ideation was significantly positively associated with MHWs (standardized β = 0.150, p < .001) even after controlling for socio-demographic variables and somatosensory amplification tendency, an indicator of somatic symptom distress. Also, paranoid ideation explained significant variability in IEI-EMF (OR = 1.090, 95% CI: 1.006-1.180, p = .035) even after statistically controlling for socio-demographic variables and somatosensory amplification. CONCLUSIONS Paranoid ideation was found to be associated with MHWs and IEI-EMF. This association appears independent of general somatic symptom distress in both cases. This might partly explain the temporal stability of these constructs.
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Affiliation(s)
- Renáta Szemerszky
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Zsuzsanna Dömötör
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary.
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany.
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary.
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Köteles F, Szemerszky R, Witthöft M, Nordin S. No evidence for interactions between modern health worries, negative affect, and somatic symptom distress in general populations. Psychol Health 2020; 36:1384-1396. [DOI: 10.1080/08870446.2020.1841761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Renáta Szemerszky
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
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Bräscher AK, Schulz SM, Van den Bergh O, Witthöft M. Prospective study of nocebo effects related to symptoms of idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). ENVIRONMENTAL RESEARCH 2020; 190:110019. [PMID: 32777274 DOI: 10.1016/j.envres.2020.110019] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 06/11/2023]
Abstract
The exact causes of Idiopathic Environmental Intolerance Attributed to Electromagnetic Fields (IEI-EMF, i.e., experience of somatic symptoms attributed to low-level electromagnetic fields) are still unknown. Psychological causation such as nocebo effects seem plausible. This study aimed to experimentally induce a nocebo effect for somatic symptom perception and examined whether it was reproducible after one week. We also examined whether these effects were associated with increased sympathetic activity and whether interoceptive accuracy (IAcc) moderated these relationships. Participants were recruited from the general population and instructed that electromagnetic exposure can enhance somatosensory perception. They participated twice in a cued exposure experiment with tactile stimulation and sham WiFi exposure in 50% of trials. The two sessions were scheduled one week apart (session 1: N = 65, session 2: N = 63). Before session 1, participants watched either a 6-min film on adverse health effects of EMF or a neutral film on trade of mobile phones. IAcc was assessed with the heartbeat detection paradigm. Electrodermal activity served as a measure of sympathetic activation. Evidence for a nocebo effect (i.e., increased self-reported intensity and aversiveness and electrodermal activity) during sham WiFi exposure was observed in both sessions. IAcc moderated the nocebo effect, depending on stimulus intensity. Contrary to previous findings, no difference emerged between the health-related EMF and the neutral films. Based on negative instructions, somatic perception and physiological responding can be altered. This is consistent with the assumption that IEI-EMF could be due to nocebo effects, suggesting an important role for psychological interventions.
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Affiliation(s)
- Anne-Kathrin Bräscher
- Johannes Gutenberg University Mainz, Department for Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Germany.
| | - Stefan M Schulz
- Johannes Gutenberg University Mainz, Department for Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Germany
| | | | - Michael Witthöft
- Johannes Gutenberg University Mainz, Department for Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Germany
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Dömötör Z, Nordin S, Witthöft M, Köteles F. Modern health worries: A systematic review. J Psychosom Res 2019; 124:109781. [PMID: 31443819 DOI: 10.1016/j.jpsychores.2019.109781] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Modern health worries (MHWs) refer to people's concerns about possible harmful effects of modern technologies, and are widespread in the developed countries. The aim of the present work was to provide comprehensive, yet integrated understanding for MHWs and associated factors. METHODS Following the PRISMA guideline, a systematic review was conducted based on 48 empirical articles published between 2001 and 2018 (Prospero registration number: CRD42018103756). All empirical studies were included that (1) were published between 2001 and 2018 in peer-reviewed scientific journals in English, German, or Hungarian, (2) used the Modern Health Worries Scale or any of its sub-scales, and (3) assessed associations between MHWs and other constructs and/or compared criterion groups (i.e. purely psychometric studies were excluded). RESULTS The results from the review suggest that female gender, age, somatic symptom distress and idiopathic environmental intolerances, holistic thinking, and paranoid beliefs are positively associated with MHWs, whereas educational qualification and the five major dimensions of personality appear not to be. CONCLUSION Scientific inquiry on the MHWs phenomenon is still in its descriptive-explorative phase; more rigorously designed studies are needed. The presented theoretical framework integrates illness-related and holistic thinking-related aspects of MHWs as a starting point to guide further research in this area.
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Affiliation(s)
- Zsuzsanna Dömötör
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary.
| | | | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany.
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary.
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Modern health worries: Deriving two measurement invariant short scales for cross-cultural research with Ant Colony Optimization. PLoS One 2019; 14:e0211819. [PMID: 30730928 PMCID: PMC6366774 DOI: 10.1371/journal.pone.0211819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022] Open
Abstract
Worries about possible harmful effects of new technologies (modern health worries) have intensely been investigated in the last decade. However, the comparability of translated self-report measures across countries is often problematic. This study aimed to overcome this problem by developing psychometrically sound brief versions of the widely used 25-item Modern Health Worries Scale (MHWS) suitable for multi-country use. Based on data of overall 5,176 individuals from four European countries (England, Germany, Hungary, Sweden), Ant Colony Optimization was used to identify the indicators that optimize model fit and measurement invariance across countries. Two scales were developed. A short (12-item) version of the MHWS that represents the four-factor structure of the original version and an ultra-short (4-item) scale that only measures the general construct. Both scales show that overall levels of health worries were highest in England and Hungary, but that the main reason for concern (e.g. electromagnetic radiation or food related fears) differs considerably between these countries. This study also shows that even if measurement invariance of translated self-report instruments across countries is problematic, it can be optimized by using adequate item selection procedures. Differences of modern health worries across countries and recommendations for cross-cultural research are discussed.
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Witthöft M, Freitag I, Nußbaum C, Bräscher AK, Jasper F, Bailer J, Rubin GJ. On the origin of worries about modern health hazards: Experimental evidence for a conjoint influence of media reports and personality traits. Psychol Health 2017; 33:361-380. [DOI: 10.1080/08870446.2017.1357814] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Ina Freitag
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Christiane Nußbaum
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Anne-Kathrin Bräscher
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Fabian Jasper
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Medical Faculty Mannheim, University Heidelberg, Mannheim, Germany
| | - G. James Rubin
- Department of Psychological Medicine, King’s College London, London, UK
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Dömötör Z, Doering BK, Köteles F. Dispositional aspects of body focus and idiopathic environmental intolerance attributed to electromagnetic fields (IEI-EMF). Scand J Psychol 2016; 57:136-43. [DOI: 10.1111/sjop.12271] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/02/2015] [Indexed: 11/29/2022]
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Szemerszky R, Gubányi M, Árvai D, Dömötör Z, Köteles F. Is There a Connection Between Electrosensitivity and Electrosensibility? A Replication Study. Int J Behav Med 2015; 22:755-63. [DOI: 10.1007/s12529-015-9477-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Köteles F, Simor P. Modern health worries, somatosensory amplification and subjective symptoms: a longitudinal study : a longitudinal study. Int J Behav Med 2014; 20:38-41. [PMID: 22207442 DOI: 10.1007/s12529-011-9217-y] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Modern health worries (MHWs; i.e., concerns about possibly harmful features of modern life) have been associated with somatic symptoms and somatosensory amplification in previous cross-sectional studies. Causal relationship among these variables is yet to be discovered. PURPOSE The study investigates the temporal association among subjective symptoms, somatosensory amplification (SSA), and modern health worries (MHWs). METHOD Baseline and follow-up questionnaires (somatic symptoms--PHQ-15, somatosensory amplification scale--SSAS, modern health worries scale--MHW, PANAS negative affect scale-NA) were completed by 366 undergraduate students in a 2-month longitudinal study. RESULTS MHWs were predicted by baseline MHWs (β = 0.721, p < 0.001) and by somatic symptoms (β = 0.084, p < 0.05). Somatic symptoms were predicted by baseline symptoms (β = 0.610, p < 0.001), NA (β = 0.104, p < 0.05), and SSAS scores (β = 0.089, p < 0.05). The only predictor of SSA was baseline SSAS score (β = 0.628, p < 0.001). CONCLUSION Based on the results, a linear model (proneness to somatosensory amplification leads to subjective symptoms which lead to MHWs) was proposed, where MHWs serve as explanations of physical symptoms or as possible environmental threats to avoid.
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Affiliation(s)
- Ferenc Köteles
- Institute for Health Promotion and Sport Sciences, Faculty of Education and Psychology, Eötvös Loránd University, Bogdánfy u. 10, 1117, Budapest, Hungary.
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Spangenberg L, Zenger M, Rief W, Brähler E, Glaesmer H. Assessing modern health worries: Dimensionality and factorial invariance across age and sex of the Modern Health Worries Scale in a general population sample. J Health Psychol 2013; 19:1302-8. [DOI: 10.1177/1359105313488980] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Previous work suggests a four-factor structure of the Modern Health Worries Scale. This study is the first to investigate its dimensionality and factorial invariance across age and sex in a representative population sample ( N = 2524) using confirmatory factor analysis. The proposed four-factor model failed to achieve good model fit. Model fit was optimized by allowing correlating error terms resulting in acceptable model fit. Multi-group analysis revealed invariance across age and sex. Our study proved the proposed four-factor structure across age and sex. Consequently, the Modern Health Worries Scale can be applied in general population surveys using subscale scores.
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KÖTELES FERENC, SZEMERSZKY RENÁTA, FREYLER ANETT, BÁRDOS GYÖRGY. Somatosensory amplification as a possible source of subjective symptoms behind modern health worries. Scand J Psychol 2010; 52:174-8. [DOI: 10.1111/j.1467-9450.2010.00846.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bailer J, Witthöft M, Rist F. Modern health worries and idiopathic environmental intolerance. J Psychosom Res 2008; 65:425-33. [PMID: 18940372 DOI: 10.1016/j.jpsychores.2008.05.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2007] [Revised: 04/10/2008] [Accepted: 05/06/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE We conducted two studies to test whether modern health worries (MHWs) were associated with central features of a condition called idiopathic environmental intolerance (IEI) and medical care utilization. METHODS In Study 1, 474 Internet users completed an Internet-based questionnaire that assessed MHWs, IEI features, and medical care utilization. In Study 2, the diagnostic specificity of MHWs was investigated by comparing the level of MHWs of three diagnostic groups: 46 people with IEI, 38 people with somatoform disorder but without IEI, and 46 people with neither IEI nor somatoform disorder. RESULTS The good psychometric properties of the MHW scale were confirmed. MHWs were related to various features of IEI, and people who met IEI case criteria showed consistently higher levels of MHWs compared with people without IEI. The link between MHWs and number of doctor visits was mediated by perceived IEI complaints. In Study 2, the MHW scale effectively discriminated the IEI group from the non-IEI groups. CONCLUSIONS These results suggest that MHWs may contribute to the development of IEI. However, only prospective longitudinal studies will enable us to determine the predictive importance of MHWs for later development of IEI.
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Affiliation(s)
- Josef Bailer
- Department of Clinical Psychology, Central Institute of Mental Health, Mannheim, Germany.
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