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Neß V, Humberg C, Lucius F, Eidt L, Berger T, Claßen M, Syring NC, Berrang J, Vietor C, Buderus S, Rau LM, Wager J. Development and Evaluation of the Abdominal Pain Knowledge Questionnaire (A-PKQ) for Children and Their Parents. CHILDREN (BASEL, SWITZERLAND) 2024; 11:846. [PMID: 39062295 PMCID: PMC11276134 DOI: 10.3390/children11070846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Revised: 06/21/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024]
Abstract
BACKGROUND Abdominal pain is a common and often debilitating issue for children and adolescents. In many cases, it is not caused by a specific somatic condition but rather emerges from a complex interplay of bio-psycho-social factors, leading to functional abdominal pain (FAP). Given the complex nature of FAP, understanding its origins and how to effectively manage this condition is crucial. Until now, however, no questionnaire exists that targets knowledge in this specific domain. To address this, the Abdominal Pain Knowledge Questionnaire (A-PKQ) was developed. METHODS Two versions were created (one for children and one for parents) and tested in four gastroenterology clinics and one specialized pain clinic in Germany between November 2021 and February 2024. Children between 8 and 17 years of age (N = 128) and their accompanying parents (N = 131) participated in the study. Rasch analysis was used to test the performance of both versions of the questionnaire. RESULTS The original questionnaires exhibited good model and item fit. Subsequently, both questionnaires were refined to improve usability, resulting in final versions containing 10 items each. These final versions also demonstrated good model and item fit, with items assessing a variety of relevant domains. CONCLUSION The A-PKQ is an important contribution to improving assessment in clinical trials focused on pediatric functional abdominal pain.
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Affiliation(s)
- Verena Neß
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (V.N.); (C.H.); (F.L.); (L.E.); (T.B.); (L.-M.R.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Clarissa Humberg
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (V.N.); (C.H.); (F.L.); (L.E.); (T.B.); (L.-M.R.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Franka Lucius
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (V.N.); (C.H.); (F.L.); (L.E.); (T.B.); (L.-M.R.)
| | - Leandra Eidt
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (V.N.); (C.H.); (F.L.); (L.E.); (T.B.); (L.-M.R.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Thomas Berger
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (V.N.); (C.H.); (F.L.); (L.E.); (T.B.); (L.-M.R.)
| | - Martin Claßen
- Hospital Group Gesundheit Nord, Klinikum Bremen Mitte, Centre for Children and Parents—Prof. Hess Paediatric Clinic, 28205 Bremen, Germany; (M.C.); (N.C.S.)
| | - Nils Christian Syring
- Hospital Group Gesundheit Nord, Klinikum Bremen Mitte, Centre for Children and Parents—Prof. Hess Paediatric Clinic, 28205 Bremen, Germany; (M.C.); (N.C.S.)
| | - Jens Berrang
- Hospital Dortmund, Faculty of Health, School of Medicine, Witten/Herdecke University, 44137 Dortmund, Germany;
| | | | - Stephan Buderus
- GFO Clinics Bonn, St. Marienhospital Bonn, 53115 Bonn, Germany;
| | - Lisa-Marie Rau
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (V.N.); (C.H.); (F.L.); (L.E.); (T.B.); (L.-M.R.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
| | - Julia Wager
- German Paediatric Pain Centre, Children’s and Adolescents’ Hospital Datteln, 45711 Datteln, Germany; (V.N.); (C.H.); (F.L.); (L.E.); (T.B.); (L.-M.R.)
- Department of Children’s Pain Therapy and Paediatric Palliative Care, Faculty of Health, School of Medicine, Witten/Herdecke University, 58455 Witten, Germany
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Rask CU, Duholm CS, Poulsen CM, Rimvall MK, Wright KD. Annual Research Review: Health anxiety in children and adolescents-developmental aspects and cross-generational influences. J Child Psychol Psychiatry 2024; 65:413-430. [PMID: 37909255 DOI: 10.1111/jcpp.13912] [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] [Accepted: 09/14/2023] [Indexed: 11/03/2023]
Abstract
Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID-19 pandemic. Recent classification systems acknowledge that impairing health-related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Kristi D Wright
- Department of Psychology, University of Regina, Regina, SK, Canada
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Bradshaw S, Brinkley A, Scanlan B, Hopper L. The burden and impact of recurrent abdominal pain – exploring the understanding and perception of children and their parents. Health Psychol Behav Med 2022; 10:888-912. [PMID: 36186891 PMCID: PMC9518242 DOI: 10.1080/21642850.2022.2121710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Background: Recurrent abdominal pain (RAP) is a common complaint for children and can result in a significantly lower quality of life due to the extent it can interfere with normal life. RAP can also significantly impact the quality of life of parents. This study sought to qualitatively explore parents’ and children’s understanding and perceptions of the burden and impact of RAP. Methods: Semi-structured interviews were conducted with a sample of parent/child dyads or families (N = 5) engaging with a psychology service. Findings: The findings of the inductive thematic analysis revealed four emergent themes common to both parents and children: (1) Perception, understanding and identification of RAP, (2) Contributing factors, (3) Coping mechanisms/pain management strategies, and (4) Impact and burden of RAP. Conclusions: These findings have important clinical implications regarding the identification and management of RAP and may also contribute to improving communication between clinicians, parents and children by providing insight from multiple perspectives into how RAP is experienced.
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Affiliation(s)
- Sam Bradshaw
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Aoife Brinkley
- Children’s Health Ireland (CHI) at Connolly, Dublin, Ireland
| | - Barry Scanlan
- Children’s Health Ireland (CHI) at Connolly, Dublin, Ireland
| | - Louise Hopper
- School of Psychology, Dublin City University, Dublin, Ireland
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Kubb C, Foran HM. Measuring COVID-19 Related Anxiety in Parents: Psychometric Comparison of Four Different Inventories. JMIR Ment Health 2020; 7:e24507. [PMID: 33197233 PMCID: PMC7717922 DOI: 10.2196/24507] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 10/21/2020] [Accepted: 11/05/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 outbreak and the measures to contain the global pandemic can have an impact on the well-being and mental health status of individuals. Parents of young children are particularly at risk for high levels of parental stress due to the current public health crisis, which can impact parenting behaviors and children's well-being. Although different initial scales have been developed to measure COVID-19-related anxiety, they have not yet been tested sufficiently in parent samples. A brief measure of COVID-19-related anxiety is necessary for both quick assessment in practice and in larger epidemiological studies of parents. OBJECTIVE The purpose of this study is to compare the distributions, validities, and reliabilities of four different COVID-19 anxiety scales: Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Pandemic Anxiety Scale, and one subscale of the COVID Stress Scales. Based on the psychometric properties of these scales, we aim to provide recommendations for a brief unidimensional inventory to assess COVID-19-related anxiety among parents. METHODS A cross-sectional web-based survey of 515 German-speaking parents (465 mothers, 90.3%) with at least one child aged 0-6 years was conducted during a 6-week period (June 29 to August 9, 2020). Half of the parents were recruited via Facebook parenting groups, while the other half were recruited through childcare centers. We psychometrically tested 25 items on COVID-19-related anxiety using the framework of classical test theory, including item analysis, correlational analysis of family variables, and exploratory factor analysis. Moreover, an item response theory approach was applied to estimate item discriminations and item difficulties. RESULTS Based on the psychometric properties, three items of the Pandemic Anxiety Scale were identified as a single unidimensional factor. The adapted scale demonstrated acceptable internal consistency (α=.79), moderate to high item discrimination, strong positive intercorrelation with two other COVID-19 anxiety scales, and a small positive association with parenting stress. Mothers and fathers did not differ in total scores (t513=-0.79, P=.42). CONCLUSIONS Factor analysis suggests that existing COVID-19-related anxiety scales measure different latent constructs of anxiety. Furthermore, all scales showed only small to moderate correlations with trait health anxiety, suggesting that COVID-19-related anxiety is distinct from general health anxiety. The adapted "disease anxiety" subscale of the Pandemic Anxiety Scale is an economical measure for assessing COVID-19-related anxiety in parents. Directions for future research are outlined.
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Affiliation(s)
- Christian Kubb
- Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Klagenfurt, Austria
| | - Heather M Foran
- Health Psychology Unit, Institute of Psychology, Universität Klagenfurt, Klagenfurt, Austria
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Bilani N, Jamali S, Chahine A, Zorkot M, Homsi M, Saab M, Saab R, Nabulsi M, Chaaya M. Illness cognition and health anxiety in parents of children with cancer. J Psychosoc Oncol 2019; 37:713-728. [DOI: 10.1080/07347332.2019.1600629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Nadeem Bilani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Sarah Jamali
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Maya Zorkot
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mouafak Homsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Michael Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Raya Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
- Lebanon Children’s Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
| | - Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Monique Chaaya
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
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Newton E, Schosheim A, Patel S, Chitkara DK, van Tilburg MAL. The role of psychological factors in pediatric functional abdominal pain disorders. Neurogastroenterol Motil 2019; 31:e13538. [PMID: 30729663 DOI: 10.1111/nmo.13538] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 12/07/2018] [Accepted: 12/07/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Pediatric functional abdominal pain disorders (FAPDs) are disorders of brain-gut dysregulation. Psychological factors are known to be related to etiology, maintenance, and exacerbation of pediatric FAPDs. With the evolving literature in the past two decades, a better understanding has emerged of precisely which psychological factors are associated with childhood FAPDs. PURPOSE This narrative literature review summarizes the literature of both child and parent psychological factors in pediatric FAPD. Where anxiety and depression were major targets in the older literature, present-day focus is increasingly on pain-specific cognitions and coping strategies including disease threat and catastrophizing. In addition, parental reaction to a child's pain is increasingly recognized as an important moderator of a child's outcomes and has become an area for clinical intervention. Screening for these factors and integrative treatment approaches are recommended in childhood FAPD.
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Affiliation(s)
- Emily Newton
- Department of Clinical Research, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, North Carolina
| | - Alex Schosheim
- Department of Pediatric Gastroenterology, Stony Brook University Hospital, Stony Brook, New York
| | - Samit Patel
- Department of Pediatric Gastroenterology, Arnold Palmer Hospital, Orlando, Florida
| | - Denesh K Chitkara
- Department of Pediatric Gastroenterology, Saint Peters University Hospital, New Brunswick, New Jersey
| | - Miranda A L van Tilburg
- Department of Clinical Research, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, North Carolina
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
- School of Social work, University of Washington, Seattle, Washington
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Effects of maternal health anxiety on children's health complaints, emotional symptoms, and quality of life. Eur Child Adolesc Psychiatry 2017; 26:591-601. [PMID: 27909834 DOI: 10.1007/s00787-016-0927-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
Little is known about family risk factors and intergenerational transmission of psychological disturbance in the development of health anxiety (HA). This study investigated HA and related concepts in 8- to 17-year-old children who had been exposed to different maternal health status. Using a family case-control design, three family groups were included: (1) 50 case children of mothers with severe (HA); (2) 49 control children of mothers with rheumatoid arthritis (RA); and (3) 51 control children of healthy mothers. Children and mothers completed a battery of standardised questionnaires. Case children reported significantly higher level of HA symptoms than children of mothers with RA but not compared to children of healthy mothers. There was no significant difference between the children's self-reports in the three groups with regard to anxiety symptoms in general, physical complaints, or quality of life. In contrast, mothers with HA reported their children as having more emotional and physical symptoms than mothers in one or both control groups. Compared to mothers with RA but not healthy mothers, mothers with HA also reported more visits to the general practitioner with their children during the past year. The findings suggest that maternal HA only weakly affects children's own report of HA and thereby may not be a strong risk factor for the development of HA symptoms in childhood. However, mothers with severe HA seem to conceive their children as more ill and present them more often in the health care system which could, therefore, be an important target for intervention in adult patients.
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Chronic Abdominal Pain in Children and Adolescents: Parental Threat Perception Plays a Major Role in Seeking Medical Consultations. Pain Res Manag 2016; 2016:3183562. [PMID: 28003776 PMCID: PMC5143725 DOI: 10.1155/2016/3183562] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Revised: 10/19/2016] [Accepted: 11/08/2016] [Indexed: 01/23/2023]
Abstract
Background. Pain symptoms, associated impairment, and parental perception of threat are reported to be predictors of health care utilization (HCU) in childhood chronic abdominal pain (CAP). However, mediating variables and their interrelations have not yet been systematically studied. Objectives. This study aims to identify mediating pathways of influence between child's abdominal pain and the number of pain-related medical visits. Methods. In a multicenter study, we recruited N = 151 parent-child dyads with children aged 6-17 years suffering from CAP. A composite measure of pain symptoms was defined as predictor and the number of pain-related medical visits as outcome variable. This relation was analyzed by serial mediation, including child- and parent-reported impairment and parental threat perception as mediators. Results. Only parental threat perception significantly linked child's pain symptoms to the number of medical visits. Measures of impairment did not have a significant effect. Conclusions. Parental pain-related threat perception is strongly related to health care seeking in childhood CAP. Addressing threat perception might be a fruitful parent-centered approach in clinical practice.
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Easter G, Sharpe L, Hunt CJ. Systematic Review and Meta-Analysis of Anxious and Depressive Symptoms in Caregivers of Children With Asthma. J Pediatr Psychol 2015; 40:623-32. [PMID: 25829528 DOI: 10.1093/jpepsy/jsv012] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Accepted: 02/02/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To provide a review of the literature comparing anxious and depressive symptoms in caregivers of children with asthma with caregivers of healthy children. METHOD A systematic search identified 25 studies from 17 articles, reporting outcomes on 4,300 caregivers of children with asthma and 25,064 caregivers of healthy children. RESULTS Overall, anxious (d = 0.50) and depressive symptoms (d = 0.44) were higher in caregivers of children with asthma compared with caregivers of healthy children. Age, site of recruitment, and whether the asthma diagnosis was medically confirmed were included as potential moderators. The relationship between parental psychopathology and asthma was stronger in those with medically confirmed asthma and participants recruited from clinical settings. Other moderators were not significant. CONCLUSIONS Caregivers of children with asthma appear to have greater anxious and depressive symptoms than caregivers of healthy children, but the reasons are unclear. More research that investigates modifiable factors that may moderate this association is urgently needed.
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Functional abdominal pain in childhood: background studies and recent research trends. Pain Res Manag 2013; 17:413-7. [PMID: 23248815 DOI: 10.1155/2012/960104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The present review summarizes many of the major research trends investigated in the past five years regarding pediatric functional abdominal pain, and also summarizes the primary related findings from the authors' research program. Specific areas discussed based on work within the authors' group include familial illness patterns, genetics, traits, and mechanisms or processes related to abdominal pain. Topics covered from research published in the past five years include prevalence and cost, longitudinal follow-up, overlap with other disorders, etiology and mechanisms behind functional abdominal pain and treatment studies. It is hoped that findings from this work in abdominal pain will be interpreted as a framework for understanding the processes by which other pain phenomena and, more broadly, reactions to any physical state, can be developed and maintained in children. The present article concludes with recommendations for clinical practice and research.
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Alberts NM, Hadjistavropoulos HD, Jones SL, Sharpe D. The Short Health Anxiety Inventory: a systematic review and meta-analysis. J Anxiety Disord 2013; 27:68-78. [PMID: 23247202 DOI: 10.1016/j.janxdis.2012.10.009] [Citation(s) in RCA: 158] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2011] [Revised: 10/13/2012] [Accepted: 10/14/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Short Health Anxiety Inventory (SHAI) measures health anxiety in medical and non-medical contexts. OBJECTIVE To review the literature pertaining to the psychometric properties of the SHAI in non-clinical, clinical, and medical samples. Meta-analysis was also conducted to examine the strength of associations between the SHAI and other constructs. METHODS Direct search of digital databases for papers that cited the original SHAI publication. RESULTS Seventy-eight papers were identified, with 42 providing relevant information. The SHAI has acceptable Cronbach's alpha scores, strong construct validity, and is sensitive to treatment. Discrepancies have been observed between the findings of factor analytic studies, largely as a result of varying methods used. Overall, there appears to be greatest support for the original two factors, with one factor assessing health anxiety and one factor assessing negative consequences of illness. As expected, individuals with hypochondriasis score higher as compared to non-clinical samples. The strongest association was observed between the SHAI and other measures of health anxiety, followed by measures related to health anxiety vulnerability, and then general anxiety and worry. CONCLUSIONS The SHAI is a psychometrically sound tool for assessing health anxiety across samples. Future studies are needed, however, to assess test-retest reliability, incremental validity, and cut-off scores as well as use of the SHAI among diverse samples.
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Pass L, Arteche A, Cooper P, Creswell C, Murray L. Doll Play Narratives About Starting School in Children of Socially Anxious Mothers, and Their Relation to Subsequent Child School-Based Anxiety. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2012; 40:1375-84. [DOI: 10.1007/s10802-012-9645-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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