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Guthrie AJ, Paredes-Echeverri S, Bleier C, Adams C, Millstein DJ, Ranford J, Perez DL. Mechanistic studies in pathological health anxiety: A systematic review and emerging conceptual framework. J Affect Disord 2024; 358:222-249. [PMID: 38718945 DOI: 10.1016/j.jad.2024.05.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 04/02/2024] [Accepted: 05/02/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Pathological health anxiety (PHA) (e.g., hypochondriasis and illness anxiety disorder) is common in medical settings and associated with increased healthcare costs. However, the psychological and neurobiological mechanisms contributing to the development and maintenance of PHA are incompletely understood. METHODS We performed a systematic review to characterize the mechanistic understanding of PHA. PubMed, PsycINFO, and Embase databases were searched to find articles published between 1/1/1990 and 12/31/2022 employing a behavioral task and/or physiological measures in individuals with hypochondriasis, illness anxiety disorder, and PHA more broadly. RESULTS Out of 9141 records identified, fifty-seven met inclusion criteria. Article quality varied substantially across studies, and was overall inadequate. Cognitive, behavioral, and affective findings implicated in PHA included health-related attentional and memory recall biases, a narrow health concept, threat confirming thought patterns, use of safety-seeking behaviors, and biased explicit and implicit affective processing of health-related information among other observations. There is initial evidence supporting a potential overestimation of interoceptive stimuli in those with PHA. Neuroendocrine, electrophysiology, and brain imaging research in PHA are particularly in their early stages. LIMITATIONS Included articles evaluated PHA categorically, suggesting that sub-threshold and dimensional health anxiety considerations are not contextualized. CONCLUSIONS Within an integrated cognitive-behavioral-affective and predictive processing formulation, we theorize that sub-optimal illness and health concepts, altered interoceptive modeling, biased illness-based predictions and attention, and aberrant prediction error learning are mechanisms relevant to PHA requiring more research. Comprehensively investigating the pathophysiology of PHA offers the potential to identify adjunctive diagnostic biomarkers and catalyze new biologically-informed treatments.
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Affiliation(s)
- Andrew J Guthrie
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Sara Paredes-Echeverri
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Cristina Bleier
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Caitlin Adams
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel J Millstein
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jessica Ranford
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Department of Occupational Therapy, Massachusetts General Hospital, Boston, MA, USA
| | - David L Perez
- Functional Neurological Disorder Unit, Division of Behavioral Neurology and Integrated Brain Medicine, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA; Division of Neuropsychiatry, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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2
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Kikas K, Werner-Seidler A, Upton E, Newby J. Illness Anxiety Disorder: A Review of the Current Research and Future Directions. Curr Psychiatry Rep 2024; 26:331-339. [PMID: 38748190 PMCID: PMC11211185 DOI: 10.1007/s11920-024-01507-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/23/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE OF REVIEW We review recent evidence on Illness Anxiety Disorder (IAD), including risk factors and precipitants, diagnostic classification, clinical characteristics of the disorder, and assessment and treatment in both children and adults. RECENT FINDINGS IAD places a substantial burden on both individuals and society. Despite its impact, understanding of the disorder is lacking and debates remain about whether IAD should be classified as an anxiety disorder and whether it is distinct from Somatic Symptom Disorder. Cognitive behavioural therapy (CBT) is an effective treatment for IAD and there are multiple validated measures of health anxiety available. However, research on health anxiety in children and youth is limited. IAD is chronic, and debilitating, but when identified, it can be effectively treated with CBT. Research using DSM-5 IAD criteria is lacking, and more research is needed to better understand the disorder, particularly in children and youth.
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Affiliation(s)
- Katarina Kikas
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Aliza Werner-Seidler
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Emily Upton
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Jill Newby
- Black Dog Institute, University of New South Wales, Hospital Road Randwick, Sydney, NSW, 2031, Australia.
- School of Psychology, University of New South Wales, Sydney, Australia.
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3
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Ingeman K, Hulgaard DR, Rask CU. Health anxiety by proxy - through the eyes of the parents. J Child Health Care 2024; 28:22-36. [PMID: 35510964 DOI: 10.1177/13674935221095648] [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] [Indexed: 11/15/2022]
Abstract
Health anxiety by proxy is a newly described phenomenon where parents worry excessively that their child suffers from a serious illness. In a former study, six parents with distressing worries about their child's health were interviewed to develop the Health Anxiety by Proxy Scale. The present study is a secondary analysis of these semi-structured interview data using interpretative phenomenological analysis aiming to explore for the first time the lived experience of parents with health anxiety by proxy. Analysis revealed three main themes: 'Faces of distress' describing various aspects of parents' experienced distress; 'Invasive insecurity and mistrust' portraying how anxiety affects parents' relationship with their children, health professionals and family; and 'Making sense of own worries' covering parents' ambivalence regarding their anxiety and rationalization of their worries. Knowledge about perspectives of parents who suffer from health anxiety by proxy can inform communication in clinical encounters where validation of parents' experiences may be key to forging an alliance for further treatment; and to recognising and potentially lowering barriers to receiving help that lies in parents' potential mistrust in professional help.
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Affiliation(s)
- Katrine Ingeman
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Denmark
| | - Ditte Roth Hulgaard
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Psychiatry Odense, Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Charlotte U Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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4
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Bräscher AK, Brähler E, Häuser W, Witthöft M. Further Evidence for a Dimensional Latent Structure of Health Anxiety: Taxometric Analyses of the Whiteley Index Based on Two German Representative Samples. Assessment 2023:10731911231219802. [PMID: 38159038 DOI: 10.1177/10731911231219802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
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.
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Affiliation(s)
| | - Elmar Brähler
- University Medical Center of the Johannes Gutenberg University Mainz, Germany
- University of Leipzig Medical Center, Germany
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5
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Menzies RE, Menzies RG. Death anxiety and mental health: Requiem for a dreamer. J Behav Ther Exp Psychiatry 2023; 78:101807. [PMID: 36435549 DOI: 10.1016/j.jbtep.2022.101807] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 10/27/2022] [Accepted: 11/12/2022] [Indexed: 11/24/2022]
Abstract
Recently, there has been an increased interest in the role of death anxiety in a broad range of mental health disorders. It has been argued that the fear of death may be a transdiagnostic variable contributing to the development and maintenance of many chronic mental health problems. Further, it has been suggested that death anxiety may be responsible for relapse and the emergence of new disorders in patients that have received successful treatment for earlier conditions in their lives. Given this, the purpose of the present selective review is to: (1) explore contemporary theoretical accounts of the role of death anxiety in a broad range of human behaviours; (2) examine evidence for death anxiety as a key variable in mental health disorders; (3) examine evidence on the treatment of death anxiety in both non-clinical and clinical populations; (4) describe the limitations of the current literature, and; (5) provide a detailed description of the critical future directions for this field.
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Affiliation(s)
| | - Ross G Menzies
- Graduate School of Health, University of Technology Sydney, Australia.
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6
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Abstract
Individual attitudes and behavior related to health and disease are major components of clinical encounters. These factors shape lifestyle, presentation of symptoms, access to patient care, interactions between patients and physicians, adherence to medical advice, and response to treatment. Health attitudes and behavior may range from anxiety and worry about illness to various forms of denial, such as delay of seeking care and lack of adherence to treatment. When attitudes result in health-damaging behavior, they may be particularly difficult to understand and become a source of frustration to both physicians and patients. Devising appropriate responses by health care providers may contribute to improving final outcomes and decrease health care costs. In particular, health behavior is likely to play a major role in the process of convalescence, in self-management of chronic conditions, in determining a state of recovery, and whenever a rehabilitation process is involved. Understanding the spectrum of health attitudes and behavior is also crucial for motivating people to make beneficial changes (lifestyle medicine), as well as for implementing safety procedures in the community.
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7
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Matovic S, Grenier S, Jauvin F, Gravel C, Vasiliadis HM, Vasil N, Belleville S, Rainville P, Dang-Vu TT, Aubertin-Leheudre M, Knäuper B, Dialahy IZ, Gouin JP. Trajectories of psychological distress during the COVID-19 pandemic among community-dwelling older adults in Quebec: A longitudinal study. Int J Geriatr Psychiatry 2023; 38:e5879. [PMID: 36703303 DOI: 10.1002/gps.5879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 01/12/2023] [Indexed: 01/18/2023]
Abstract
OBJECTIVE The COVID-19 pandemic and its associated public health measures may increase the risk for psychological distress among vulnerable older adults. This longitudinal study aimed to identify predictors of psychological distress trajectories among community-dwelling older adults in Quebec, Canada. METHODS The study spanned four time points across 13 months and three waves of the COVID-19 pandemic. The sample included 645 community-dwelling older adults ages 60 years and older in Quebec. Participants completed telephone-based interviews that included the Kessler 6-item Psychological Distress Scale (K6) to assess psychological distress at each time point as well as information on socioeconomic, medical, psychological and COVID-19 related factors. Group-based trajectory modelling was used to identify distinct trajectories of psychological distress across time. RESULTS Three group-based trajectories of psychological distress were identified: the resilient (50.5%), reactive (34.9%), and elevated distress groups (14.6%). Individuals with mobility issues, insomnia symptoms, COVID-19 related acute stress, general health anxiety, increased loneliness symptoms, and those unable to use technology to see others were more likely to be in the reactive and elevated groups than the resilient group. Those with past mental health problems had uniquely increased odds of being in the reactive group compared to the resilient group. Individuals living in poverty and those who reported taking psychotropic medication had increased odds of being in the elevated distress group compared to the resilient group. CONCLUSION These findings characterized distinct trajectories of psychological distress in older adults and identified risk factors for elevated distress levels.
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Affiliation(s)
- Sara Matovic
- Department of Psychology, Concordia University, Montreal, Quebec, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Sébastien Grenier
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Florence Jauvin
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Catherine Gravel
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Helen-Maria Vasiliadis
- Department of Community Health Sciences, Université de Sherbrooke, Montreal, Quebec, Canada
| | - Nancy Vasil
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Sylvie Belleville
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Pierre Rainville
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Stomatology, Université de Montréal, Montreal, Quebec, Canada
| | - Thien Thanh Dang-Vu
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, Quebec, Canada
| | - Mylène Aubertin-Leheudre
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada.,Département des sciences de l'activité physique, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Bärbel Knäuper
- Department of Psychology, McGill University, Montreal, Quebec, Canada
| | - Isaora Zefania Dialahy
- Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Jean-Philippe Gouin
- Department of Psychology, Concordia University, Montreal, Quebec, Canada.,Centre de recherche de l'Institut universitaire de gériatrie de Montréal (CRIUGM), CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montreal, Quebec, Canada
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8
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Interoceptive anxiety-related processes: Importance for understanding COVID-19 and future pandemic mental health and addictive behaviors and their comorbidity. Behav Res Ther 2022; 156:104141. [PMID: 35752013 PMCID: PMC9212258 DOI: 10.1016/j.brat.2022.104141] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 05/18/2022] [Accepted: 06/03/2022] [Indexed: 01/08/2023]
Abstract
The COVID-19 pandemic is associated with an increased prevalence of mental health problems and addictive behaviors. There is a growing theoretical and empirical evidence that individual differences in interoceptive anxiety-related processes are a one set of vulnerability factors that are important in understanding the impact of pandemic-related mental health problems and addictive behavior. However, there has not been a comprehensive effort to explore this rapidly growing body of research and its implications for public health. In this paper, we discuss why interoceptive anxiety-related processes are relevant to understanding mental health and addictive behaviors during the COVID-19 pandemic. We then provide a narrative review of the available COVID-19 literature linking interoceptive fear and anxiety-related processes (e.g., anxiety sensitivity, health anxiety, and COVID-19 anxiety, fear, and worry) to mental health and addictive behaviors. We then propose a novel transdiagnostic theoretical model that highlights the role of interoceptive anxiety-related processes in mental health and addictive behavior in the context of the present and future pandemics. In the final section, we utilize this conceptualization to underscore clinical implications and provide guidance for future research initiatives in the management of COVID-19 mental health and addictive behaviors and inform the public health field for future pandemics.
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9
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Norbye AD, Abelsen B, Førde OH, Ringberg U. Distribution of health anxiety in a general adult population and associations with demographic and social network characteristics. Psychol Med 2022; 52:2255-2262. [PMID: 33183380 PMCID: PMC9527669 DOI: 10.1017/s0033291720004122] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 10/01/2020] [Accepted: 10/20/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Health anxiety (HA) is associated with increased risk of disability, increased health care utilization and reduced quality of life. However, there is no consensus on which factors are important for the level of HA. The aim of this study was to explore the distribution of HA in a general adult population and to investigate whether demographic and social factors were associated with HA. METHODS This study used cross-sectional data from the seventh Tromsø study. A total of 18 064 participants aged 40 years or older were included in the analysis. The six-item Whiteley Index (WI-6) with a 5-point Likert scale was used to measure HA. Sociodemographic factors included age, sex, education, household income, quality of friendship and participation in an organized activity. RESULTS HA showed an exponential distribution among the participants with a median score of 2 points out of 24 points. In total, 75% had a total score of 5 points or less, whereas 1% had a score >14 points. Education, household income, quality of friendship and participation in organized activity were significantly associated with HA. The variable quality of friendship demonstrated the strongest association with HA. CONCLUSION Our study showed an exponential distribution of HA in a general adult population. There was no evident cut-off point to distinguish participants with severe HA based on their WI-6 score, indicating the importance of analysing HA as a complex, continuous construct. HA demonstrated strong associations with quality of friendship and participation in an organized activity.
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Affiliation(s)
- Anja Davis Norbye
- Department of Community Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037 Tromsø, Norway
| | - Birgit Abelsen
- Department of Community Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037 Tromsø, Norway
| | - Olav Helge Førde
- Department of Community Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037 Tromsø, Norway
| | - Unni Ringberg
- Department of Community Medicine, UiT The Arctic University of Norway, Postbox 6050 Langnes, 9037 Tromsø, Norway
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10
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Rady A, Alamrawy RG, Ramadan I, El Raouf MA. Prevalence of Alexithymia in Patients with Medically Unexplained Physical Symptoms: A Cross-sectional Study in Egypt. Clin Pract Epidemiol Ment Health 2021; 17:136-145. [PMID: 34880925 PMCID: PMC8595980 DOI: 10.2174/1745017902117010136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is a high incidence of alexithymia in people who report medically unexplained symptoms. There have been limited studies on the prevalence of alexithymia in patients with medically unexplained physical symptoms (MUPS) in various ethnic and cultural backgrounds. OBJECTIVE This study aimed to estimate the prevalence of alexithymia in patients with MUPS and examine their socio-demographic data. METHODS In this cross-sectional study, 196 patients with MUPS were recruited from tertiary care internal medicine and neuropsychiatry clinics during the first quarter of 2019. Patients completed a structured interview; socio-demographic and medical history data were collected. Somatic symptom severity was assessed using the Arabic version of the Patient Health Questionnaire (PHQ-15). Alexithymia was assessed using the Arabic version of the Toronto Alexithymia Scale. RESULTS General fatigue was the most common complaint observed, followed by headache and dyspepsia. In addition, 73.5% of patients had a high Patient Health Questionnaire score, 17.9% had somatic symptoms of medium severity, while 8% and 0.5% had low and marginal somatic symptoms, respectively. Alexithymia was presented in 49.5%, 22.9% had no alexithymia, and 27.6% had borderline/intermediate alexithymia.A weak positive correlation (r<0.4) was found between somatic symptom severity and alexithymic psychopathology (r=0.277;p<0.05). Only the 'difficulty identifying feelings' dimension of alexithymic psychopathology was positively correlated with the severity of somatic symptoms (r=0.271;p<0.05). CONCLUSION Alexithymia is associated with the development of MUPS.
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Affiliation(s)
- Ahmed Rady
- Department of Psychiatry, Alexandria University, School of Medicine, Alexandria, Egypt
| | - Roa Gamal Alamrawy
- Mamoura Psychiatric Hospital, Secretariat of Mental Health and Addiction Treatment, Alexandria, Egypt
| | - Ismail Ramadan
- Department of Neurology, Alexandria University School of Medicine, Alexandria, Egypt
| | - Mervat Abd El Raouf
- Department of Neurology, Alexandria University School of Medicine, Alexandria, Egypt
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Begum N, Taylor JR, Brown C, Rajan J, Keevil B, Pye E, Rainey T, Jones A. Morning and evening salivary cortisol levels in patients with chronic widespread pain and those at high risk. Eur J Pain 2021; 26:197-206. [PMID: 34437747 DOI: 10.1002/ejp.1854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/15/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hypothalamic-Pituitary-Adrenal (HPA) axis dysregulation has been implicated in chronic widespread pain (CWP); the hallmark of fibromyalgia (FM). This is the first study to compare HPA axis changes in individuals with CWP and those at high risk of symptom development. METHODS We sought to determine differences in morning and evening salivary cortisol levels in FM (n = 19), those at-risk (n = 20) and pain-free controls (n = 17). Risk factors included non-CWP pain, somatic symptoms, illness behaviour and sleep disturbance. We conducted the study in the absence of centrally acting medication, to address limitations of previous research. RESULTS Repeated measures ANOVA revealed significant main effects of group (p = 0.003), and time of day (p = 0.002), with no significant interaction. Cortisol levels were higher in FM (p = 0.027) and at-risk (p = 0.003) groups, compared to controls, but there was no significant difference between FM and at-risk groups. The main effect of group remained significant with sleep problems (p = 0.021) and life events (p = 0.007), but was not significant with anxiety (p = 0.076) or depression (p = 0.098) scores as covariates. With sleep problems as a covariate, cortisol levels remained significantly higher only in the at-risk group (p = 0.017). CONCLUSIONS This study indicates elevated salivary cortisol in FM and those at high risk, and identifies anxiety, depression and sleep problems as potential contributing factors. The results shed light on the dynamic relationship between stress, mood and sleep disorders and the brain's resilience to pain. SIGNIFICANCE This study examines neurobiological changes in chronic widespread pain and high risk individuals. One strength of the study is the absence of centrally acting medication. We found high salivary cortisol common to Fibromyalgia and those at risk and identified contributing factors. Our results offer insight into the early mechanistic changes underlying Fibromyalgia development and open up possibilities for early diagnosis and prevention.
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Affiliation(s)
- Nayab Begum
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Jason R Taylor
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Christopher Brown
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK.,Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Jonathan Rajan
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Brian Keevil
- Department of Clinical Biochemistry, University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Emily Pye
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Timothy Rainey
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
| | - Anthony Jones
- Division of Neuroscience and Experimental Psychology, Human Pain Research Group, University of Manchester, Manchester, UK
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12
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Hamilton DF, Shim J, Howie CR, Macfarlane GJ. Patients follow three distinct outcome trajectories following total knee arthroplasty. Bone Joint J 2021; 103-B:1096-1102. [PMID: 34058868 DOI: 10.1302/0301-620x.103b6.bjj-2020-1821.r1] [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] [Indexed: 11/05/2022]
Abstract
AIMS Although total knee arthroplasty (TKA) is a highly successful procedure, about 20% of patients remain dissatisfied postoperatively. This proportion is derived from dichotomous models of the assessment of surgical success or failure, which may not reflect the spectrum of outcomes. The aim of this study was to explore differing responses to surgery, and assess whether there are distinct groups of patients with differing patterns of outcome. METHODS This was a secondary analysis of a UK multicentre TKA longitudinal cohort study. We used a group-based trajectory modelling analysis of Oxford Knee Score (OKS) in the first year following surgery with longitudinal data involving five different timepoints and multiple predictor variables. Associations between the derived trajectory groups and categorical baseline variables were assessed, and predictors of trajectory group membership were identified using Poisson regression and multinomial logistic regression, as appropriate. The final model was adjusted for sociodemographic factors (age, sex) and baseline OKS. RESULTS Data from 731 patients were available for analysis. Three distinct trajectories of outcome were identified: "poor" 14.0%, "modest" 39.1%, and "good" 46.9%. The predicted probability of membership for patients assigned to each trajectory group was high (0.89 to 0.93). Preoperative mental, physical health, and psychosocial factors determined which trajectory is likely to be followed. Poor responders were characterized by a comparatively small number of factors, preoperative expectations of pain and limitations, coping strategies, and a lower baseline physical health status, while the good responders were characterized by a combination of clinical, psychosocial, mental health, and quality of life factors. CONCLUSION We identified three distinct response trajectories in patients undergoing TKA. Controlling for baseline score, age, and sex, psychosocial factors such as expectations of pain and limited function and poor coping strategies differentiated the trajectory groups, suggesting a role for preoperative psychosocial support in optimizing the clinical outcome. Cite this article: Bone Joint J 2021;103-B(6):1096-1102.
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Affiliation(s)
- David F Hamilton
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK.,Department of Orthopaedics & Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Joanna Shim
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Colin R Howie
- Department of Orthopaedics & Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Gary J Macfarlane
- Aberdeen Centre for Arthritis and Musculoskeletal Health (Epidemiology Group), School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Svensson SJ, Elntib S. Community cohesion during the first peak of the COVID-19 pandemic: A social antidote to health anxiety and stress. JOURNAL OF APPLIED SOCIAL PSYCHOLOGY 2021; 51:793-808. [PMID: 34219802 PMCID: PMC8237056 DOI: 10.1111/jasp.12800] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 04/16/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022]
Abstract
Social support gained through community ties has been pivotal in dealing with stressful events. A cross-sectional community sample (N = 2,329) was gathered to assess community cohesion buffering against heath anxiety and perceived stress during the first peak of the pandemic in the UK, using structural equation modeling analyses. Community cohesion acted as a protective mechanism against both health anxiety and stress during the first national lockdown. A strong positive association was also found between health anxiety and stress. Stress and health anxiety scores peaked in the first weeks of the imposed quarantine; as the lockdown was extended, participants reported lower stress, health anxiety and community cohesion scores. The reduction of community cohesion scores was greater for those younger than 45 while the positive association between stress and health anxiety was stronger among males during the lockdown. While community cohesion effects against health anxiety were enhanced for females, community's buffering against stress were greater for males. Strengthening citizens' psychological sense of community through the publicization and support of local initiatives and mutual-aid groups and utilizing methodically green (and blue) spaces to boost neighborhood attraction might be viable strategies within which stress and health anxiety can be suppressed. Conversely, allowing community, regional and national cracks to deepen can exacerbate the impact of stressful events experienced during the COVID-19 pandemic.
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Barthels F, Müller R, Schüth T, Friederich HC, Pietrowsky R. Orthorexic eating behavior in patients with somatoform disorders. Eat Weight Disord 2021; 26:135-143. [PMID: 31833044 DOI: 10.1007/s40519-019-00829-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/05/2019] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Although anecdotal reports suggest a relation between orthorexic eating behavior and symptoms of somatoform disorders, this issue has not yet been investigated. The aim of this study was to compare orthorexic eating behavior and other characteristics of disordered eating behavior in patients with somatoform disorders to a sample of healthy controls. METHODS 31 patients with somatoform disorders and 30 matched controls completed eight questionnaires, i.a., the Düsseldorf Orthorexia Scale, three scales of the Eating Disorder Inventory-2, Eating Attitudes Test-26, Multidimensional Inventory of Hypochondriacal Traits, Attitudes Towards Body and Health Questionnaire, and Screening for Somatoform Disorders. RESULTS The patients displayed higher levels of orthorexic eating behavior, drive for thinness, body dissatisfaction, bulimia, and dieting than the control group. In both groups, orthorexic eating behavior was associated with higher levels of somatization in eating and health habits. The control group showed an association of orthorexic eating behavior with catastrophizing cognitions and the perceptual component of health anxiety. CONCLUSION The results support the hypothesis of a connection between orthorexic eating behavior and somatoform disorders. However, patients with somatoform disorders do not seem to be at particular risk for orthorexia. Future studies should investigate causes for the relationship between orthorexic eating behavior and characteristics of somatoform disorders in samples of healthy individuals. LEVEL OF EVIDENCE Level V, descriptive study with matched control group.
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Affiliation(s)
- Friederike Barthels
- Department of Clinical Psychology, Institute of Experimental Psychology, Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
| | - Romina Müller
- Department of Clinical Psychology, Institute of Experimental Psychology, Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Tobias Schüth
- Clinic of Psychosomatic Medicine and Psychotherapy, LVR Hospital Düsseldorf, Düsseldorf, Germany
| | - Hans-Christoph Friederich
- Center of Psychosocial Medicine, Clinic of Internal Medicine and Psychosomatic Medicine, Heidelberg University Hospital, Heidelberg, Germany
| | - Reinhard Pietrowsky
- Department of Clinical Psychology, Institute of Experimental Psychology, Heinrich-Heine-University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
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15
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Zuccala M, Abbott MJ. Social Anxiety Disorder and the Fear of Death: An Empirical Investigation of the Terror Management Approach towards Understanding Clinical Anxiety. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-020-10187-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Choi C, Bum CH. Changes in the Type of Sports Activity Due to COVID-19: Hypochondriasis and the Intention of Continuous Participation in Sports. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17134871. [PMID: 32640684 PMCID: PMC7369974 DOI: 10.3390/ijerph17134871] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 06/17/2020] [Accepted: 07/03/2020] [Indexed: 11/16/2022]
Abstract
This study focused on empirically analyzing sport activity participants' perceptions of hypochondriasis caused by fear of infection and changes in continuous participatory behavior patterns. To this end, a comparative analysis was conducted with a focus on the forms of participation and age of sport activity participants. For the final comparative analysis, a 2 × 3 factorial multivariate analysis of variance was conducted after confirming the validity and reliability of data based on 229 questionnaires collected from healthy respondents who have never been infected with COVID-19. The results showed statistically significant differences between worry about illness, which is a subscale of hypochondriasis, disease phobia, thanatophobia, and intent to continue according to age. Statistically significant differences were also found when considering the type of sport for worry about illness, which is a subscale of hypochondriasis, disease phobia, symptom preoccupation, and intent to continue. Furthermore, interaction effects between the two independent variables, i.e., age and type of sport, were found for disease phobia, a subscale of hypochondriasis, and thanatophobia. In summary, age and type of sport, which are important factors for the COVID-19 infection and symptoms, were found to affect the sport activity patterns. These results proved that COVID-19 may have caused the participants to have different perceptions depending on their characteristics and change their form of continuous participation. These findings will provide useful data for predicting the perception and behavioral patterns of sports participants if diseases like COVID-19 occur in the future. They also show how to live a healthy life through exercise.
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Affiliation(s)
- Chulhwan Choi
- Department of Golf Industry, College of Physical Education, Kyung Hee University, Seocheon-dong 1, Giheung-gu, Yongin-si, Gyeonggi-do 17104, Korea;
| | - Chul-Ho Bum
- Department of Sports Bigtainment, Graduate School of Physical Education, Kyung Hee University, Seocheon-dong 1, Giheung-gu, Yongin-si, Gyeonggi-do 17104, Korea
- Correspondence: ; Tel.: +82-31-201-2737
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17
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Sirri L, Tossani E, Potena L, Masetti M, Grandi S. Manifestations of health anxiety in patients with heart transplant. Heart Lung 2020; 49:364-369. [DOI: 10.1016/j.hrtlng.2019.12.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 02/09/2023]
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18
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Pardue CM, White KS, Gervino EV. The Role of Disease Conviction: Exploring Its Effects on Chest Pain and Anxiety-Related Models of Non-cardiac Chest Pain. J Clin Psychol Med Settings 2020; 26:131-141. [PMID: 29948646 DOI: 10.1007/s10880-018-9572-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The aim of this study was to investigate the role of disease conviction in the chest pain and life interference of patients with non-cardiac chest pain (NCCP), after controlling for anxiety sensitivity and body vigilance. While all three psychological constructs are theoretically implicated and empirically associated with the experience of NCCP, no research has examined the influence of disease conviction in the context of other relevant constructs. The sample included 229 participants with NCCP who were recruited after a medical evaluation failed to elicit an organic explanation for their chest pain. Hierarchical regression analyses revealed that while anxiety sensitivity significantly predicted chest pain severity and interference, only body vigilance contributed significant additional variance to chest pain severity, and only disease conviction contributed significant additional variance to chest pain interference. While anxiety sensitivity, body vigilance, and disease conviction all appear to affect those with NCCP, it seems that their impact is manifest in different domains (i.e., pain perception vs. psychosocial impairment).
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Affiliation(s)
- Caleb M Pardue
- Department of Psychological Sciences, University of Missouri-St Louis, One University Blvd., St. Louis, MO, 63121, USA.
| | - Kamila S White
- Department of Psychological Sciences, University of Missouri-St Louis, One University Blvd., St. Louis, MO, 63121, USA
| | - Ernest V Gervino
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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19
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Kosic A, Lindholm P, Järvholm K, Hedman-Lagerlöf E, Axelsson E. Three decades of increase in health anxiety: Systematic review and meta-analysis of birth cohort changes in university student samples from 1985 to 2017. J Anxiety Disord 2020; 71:102208. [PMID: 32172210 DOI: 10.1016/j.janxdis.2020.102208] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 02/05/2020] [Accepted: 03/02/2020] [Indexed: 01/20/2023]
Abstract
Health anxiety can be defined as a multifaceted trait that is primarily characterised by a fear of, or preoccupation with, serious illness. Whereas low levels of health anxiety can be helpful, clinically significant levels are associated with personal suffering and substantial societal costs. As general anxiety is probably on the rise, and the Internet has increased access to health-related information, it is commonly speculated that health anxiety has increased over the past decades. We tested this hypothesis based on a systematic review and meta-analysis of birth cohort mean health anxiety in Western university student samples from 1985 to 2017. Sixty-eight studies with 22 413 student participants were included. The primary analysis indicated that the mean score on the Illness Attitudes Scales had increased by 4.61 points (95 % CI: 1.02, 8.20) from 1985 to 2017. The percentage of general population Internet users in the study year of data collection was not predictive of student mean health anxiety. In conclusion, this study corroborates the hypothesis of an increase in health anxiety, at least in the student population, over the past decades. However, this increase could not be linked to the introduction of the Internet.
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Affiliation(s)
- Amanda Kosic
- Department of Psychology, Lund University, Lund, Sweden
| | - Peo Lindholm
- Department of Psychology, Lund University, Lund, Sweden
| | | | - Erik Hedman-Lagerlöf
- Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
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Affiliation(s)
- Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Peter Tyrer
- Centre for Psychiatry, Imperial College, London, UK
| | | | - Helen Tyrer
- Centre for Psychiatry, Imperial College, London, UK
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21
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Pan B, Zhang Q, Tsai H, Zhang B, Wang W. Hypochondriac concerns and correlates of personality styles and affective states in bipolar I and II disorders. BMC Psychiatry 2018; 18:398. [PMID: 30577769 PMCID: PMC6303968 DOI: 10.1186/s12888-018-1988-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/13/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Hypochondriac concerns are associated with the treatment-difficulty of bipolar disorder, which might be due to the personality styles and affective states. METHODS We invited outpatients with bipolar I disorder (BD I, n = 87), bipolar II disorder (BD II, n = 92) and healthy volunteers (n = 129) to undergo the Illness Attitude Scales and Parker Personality Measure tests, and measurements of concurrent affective states. RESULTS Compared to healthy volunteers, BD I and BD II patients scored significantly higher on mania, hypomania and depression. BD I and BD II patients also scored significantly higher on Symptom Effect and Treatment Seeking, and BD II patients scored higher on Patho-thanatophobia and Hypochondriacal Belief. BD II in addition scored higher on Patho-thanatophobia than BD I did. In controls, the Dependent style predicted Patho-thanatophobia and Symptom Effect, Schizoid with Hypochondriacal Belief; in BD I, Narcissistic (-) with Hypochondriacal Belief, Histrionic with Patho-thanatophobia and Hypochondriacal Belief, depression with Hypochondriacal Belief, and hypomania with Symptom Effect and Hypochondriacal Belief; in BD II, depression with Symptom Effect and Hypochondriacal Belief, mania with Symptom Effect. CONCLUSIONS Bipolar disorder, especially BD II, is associated with greater hypochondriac concerns, which relates to personality disorder functioning styles and concurrent affective states.
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Affiliation(s)
- Bing Pan
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Zhejiang, 310058 Hangzhou China
| | - Qing Zhang
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Huitzong Tsai
- Department of Psychiatry, Second Affiliated Hospital, Zhejiang University College of Medicine, Hangzhou, China
| | - Bingren Zhang
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Zhejiang, 310058 Hangzhou China
| | - Wei Wang
- Department of Clinical Psychology and Psychiatry/ School of Public Health, Zhejiang University College of Medicine, Zhejiang, 310058 Hangzhou China
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22
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Death anxiety and its association with hypochondriasis and medically unexplained symptoms: A systematic review. J Psychosom Res 2018; 115:58-65. [PMID: 30470318 DOI: 10.1016/j.jpsychores.2018.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/08/2018] [Accepted: 10/09/2018] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To systematically review of the available literature to (1) examine the association between death anxiety and hypochondriasis and (2) examine the association between death anxiety and medically unexplained symptoms (MUS). METHODS A systematic literature search was conducted in Embase, PsycINFO, Pubmed and Ovid databases and reference lists of selected articles. Articles were included when the research population concerned people with hypochondriasis and/or MUS in who death anxiety was assessed by a validated research method. Two independent reviewers verified that the studies met the inclusion criteria, assessed the quality of the studies and extracted relevant characteristics and data. The data were descriptively analysed. RESULTS Of the 1087 references identified in the search, six studies on the association between death anxiety and hypochondriasis and three studies on the association between death anxiety and MUS met inclusion criteria. All studies found a positive association of death anxiety with hypochondriasis and/or MUS. The design of all studies was cross-sectional and the overall quality of the studies was low. The influence of age or sex on these associations was not analysed in any of the studies. Given the diversity in setting, population, study design, and methods used, a meta-analysis was not possible. CONCLUSION All studies found a positive association of death anxiety with hypochondriasis and/or MUS. Acknowledging that death anxiety may play a prominent role in hypochondriasis/MUS populations, future research should address (potentially modifiable) determinants of death anxiety in these populations.
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Abstract
PURPOSE OF REVIEW To examine the diagnosis of health anxiety, its prevalence in different settings, public health significance, treatment, and outcome. RECENT FINDINGS Health anxiety is similar to hypochondriasis but is characterized by fear of, rather than conviction of, illness. Lifetime prevalence rates are 6% in the population and as high as 20% in hospital out-patients, leading to greater costs to health services through unnecessary medical contacts. Its prevalence may be increasing because of excessive internet browsing (cyberchondria). Drug treatment with antidepressants has some efficacy but is not well-liked, but psychological treatments, including cognitive behavior therapy, stress management, mindfulness training, and acceptance and commitment therapy, given either individually, in groups, or over the Internet, have all proved efficacious in both the short and longer term. Untreated health anxiety leads to premature mortality. Health anxiety has become an increasing clinical and public health issue at a time when people are being formally asked to take more responsibility in monitoring their own health. More attention by health services is needed.
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24
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Shim J, Mclernon DJ, Hamilton D, Simpson HA, Beasley M, Macfarlane GJ. Development of a clinical risk score for pain and function following total knee arthroplasty: results from the TRIO study. Rheumatol Adv Pract 2018; 2:rky021. [PMID: 30506023 PMCID: PMC6251482 DOI: 10.1093/rap/rky021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 04/27/2018] [Indexed: 12/27/2022] Open
Abstract
Objectives The aim was to develop and validate a simple clinical prediction model, based on easily collected preoperative information, to identify patients at high risk of pain and functional disability 6 months after total knee arthroplasty (TKA). Methods This was a multicentre cohort study of patients from nine centres across the UK, who were undergoing a primary TKA for OA. Information on sociodemographic, psychosocial, clinical and quality-of-life measures were collected at recruitment. The primary outcome measure for this analysis was the Oxford knee score (OKS), measured 6 months postoperatively by postal questionnaire. Multivariable logistic regression was used to develop the model. Model performance (discrimination and calibration) and internal validity were assessed, and a simple clinical risk score was developed. Results Seven hundred and twenty-one participants (mean age 68.3 years; 53% female) provided data for the present analysis, and 14% had a poor outcome at 6 months. Key predictors were poor clinical status, widespread body pain, high expectation of postoperative pain and lack of active coping. The developed model based on these variables demonstrated good discrimination. At the optimal cut-off, the final model had a sensitivity of 83%, specificity of 61% and positive likelihood ratio of 2.11. Excellent agreement was found between observed and predicted outcomes, and there was no evidence of overfitting in the model. Conclusion We have developed and validated a clinical prediction model that can be used to identify patients at high risk of a poor outcome after TKA. This clinical risk score may be an aid to shared decision-making between patient and clinician.
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Affiliation(s)
- Joanna Shim
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
| | - David J Mclernon
- Medical Statistics Team, Institute of Applied Health Sciences, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen
| | - David Hamilton
- Department of Orthopaedics & Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Hamish A Simpson
- Department of Orthopaedics & Trauma, School of Clinical Sciences, University of Edinburgh, Edinburgh, UK
| | - Marcus Beasley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
| | - Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen
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25
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Hedman E, Hesser H, Andersson E, Axelsson E, Ljótsson B. The mediating effect of mindful non-reactivity in exposure-based cognitive behavior therapy for severe health anxiety. J Anxiety Disord 2017; 50:15-22. [PMID: 28528015 DOI: 10.1016/j.janxdis.2017.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Revised: 04/20/2017] [Accepted: 04/26/2017] [Indexed: 01/26/2023]
Abstract
Exposure-based cognitive behavior therapy (CBT) has been shown to be effective in the treatment of severe health anxiety, but little is known about mediators of treatment effect. The aim of the present study was to investigate mindful non-reactivity as a putative mediator of health anxiety outcome using data from a large scale randomized controlled trial. We assessed mindful non-reactivity using the Five Facets Mindfulness Questionnaire-Non-Reactivity scale (FFMQ-NR) and health anxiety with the Short Health Anxiety Inventory (SHAI). Participants with severe health anxiety (N=158) were randomized to internet-delivered exposure-based CBT or behavioral stress management (BSM) and throughout the treatment, both the mediator and outcome were measured weekly. As previously reported, exposure-based CBT was more effective than BSM in reducing health anxiety. In the present study, latent process growth modeling showed that treatment condition had a significant effect on the FFMQ-NR growth trajectory (α-path), estimate=0.18, 95% CI [0.04, 0.32], p=.015, indicating a larger increase in mindful non-reactivity among participants receiving exposure-based CBT compared to the BSM group. The FFMQ-NR growth trajectory was significantly correlated with the SHAI trajectory (β-path estimate=-1.82, 95% CI [-2.15, -1.48], p<.001. Test of the indirect effect, i.e. the estimated mediation effect (αβ) revealed a significant cross product of -0.32, which was statistically significant different from zero based on the asymmetric confidence interval method, 95% CI [-0.59, -0.06]. We conclude that increasing mindful non-reactivity may be of importance for achieving successful treatment outcomes in exposure-based CBT for severe health anxiety.
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Affiliation(s)
- Erik Hedman
- Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erland Axelsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
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Subramanian K, Manohar H, Menon V. Family accommodation in somatoform disorders-its effects on diagnosis and management: A case report. Asian J Psychiatr 2017; 27:147-148. [PMID: 28558890 DOI: 10.1016/j.ajp.2017.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 03/01/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Karthick Subramanian
- Senior Resident, Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvanthri Nagar, Puducherry, India.
| | - Harshini Manohar
- Senior Resident, Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvanthri Nagar, Puducherry, India.
| | - Vikas Menon
- Senior Resident, Department of Psychiatry, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), Dhanvanthri Nagar, Puducherry, India.
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French C, Greenauer N, Mello C. A Multifactorial Approach to Predicting Death Anxiety: Assessing the Role of Religiosity, Susceptibility to Mortality Cues, and Individual Differences. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2017; 13:151-172. [PMID: 28613993 DOI: 10.1080/15524256.2017.1331181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Death anxiety is not only experienced by individuals receiving end-of-life care, but also by family members, social workers, and other service providers who support these individuals. Thus, identifying predictors of individual differences in experienced death anxiety levels may have both theoretical and clinical ramifications. The present study assessed the relative influence of religiosity, susceptibility to mortality cues, state and trait anxiety, and demographic factors in the experience of death anxiety through an online survey distributed to members of two online communities related to end-of-life care. Results indicated that cognitive and emotional susceptibility to mortality cues, as well as gender, predicted differences in death anxiety. Conversely, religiosity and age did not increase the predictive power of the model. Thus, death anxiety may be a function of emotional, cognitive, and sociocultural factors that interact in complex, but predictable, ways to modulate the response to mortality cues that occur in one's life.
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Affiliation(s)
- Carrie French
- a Applied Psychology Program , The Pennsylvania State University , Berks, Reading , Pennsylvania , USA
| | - Nathan Greenauer
- a Applied Psychology Program , The Pennsylvania State University , Berks, Reading , Pennsylvania , USA
| | - Catherine Mello
- b Rehabilitation and Human Services/Applied Psychology Program , The Pennsylvania State University , Berks, Reading , Pennsylvania , USA
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28
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Atakere DK, Baker TA. Predictors of perceived vulnerability to cancer diagnoses among adult Black males. J Health Psychol 2017; 24:1676-1686. [PMID: 28810421 DOI: 10.1177/1359105317695426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
As much as the significance of age, education, masculinity, illness attitude, and self-esteem to preventive health have been reported, much less is known on how these factors predict perceived vulnerability to cancer diagnosis. This study aimed to determine the association between identified demographic, health, and social factors and perceived vulnerability to cancer diagnosis among adult Black males. Data reveal that incidences of cancer among Black men are contingent upon a myriad of psychological, social, and behavioral factors that are not exclusive but rather coexisting determinants of health.
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Abstract
Recently, death anxiety, or dread of death, has been proposed as a key transdiagnostic process underlying the anxiety disorders, depressive disorders, somatic disorders, and trauma and stressor-related disorders. In fact, it has been argued that death anxiety underlies all psychopathology, and is more fundamental than perfectionism, a process which was previously considered the root of mental illness. However, there has been a paucity of research examining the relationship between death anxiety and the eating disorders, although these conditions have been found to be strongly related to perfectionism. The present study therefore aimed to examine whether death anxiety is related to disordered eating, and whether death anxiety is a better predictor of disordered eating than perfectionism. A sample of 164 participants (132 female), average age 33.55 years (SD= 15.45 years), completed an online survey comprising background questions (age, sex, diagnosed psychiatric disorder), the Eating Attitudes Test — 26 item version (EAT-26), the Almost Perfect Scale — Revised (APS-R), the Rosenberg Self-Esteem Scale (RSES), and the Death Anxiety Scale (DAS). The findings of a hierarchical multiple regression analysis with EAT-26 as the dependent variable, age entered at Step 1, the RSES and APS-R entered at Step 2, and the DAS entered at Step 3 showed that only death anxiety and self-esteem were independent predictors of disordered eating at Step 3. A simultaneous multiple regression analysis was subsequently run with age and the APS-R alone as predictors of EAT-26 scores. This analysis showed that perfectionism was only a predictor of disordered eating when death anxiety and self-esteem were not included in the regression model. Death anxiety and self-esteem both appear to be important transdiagnostic processes.
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30
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Norton PJ, Sears Edwards K. Anxiety Sensitivity or Interoceptive Sensitivity. EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2017. [DOI: 10.1027/1015-5759/a000269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Abstract. The construct of anxiety sensitivity (AS) – the fear of anxiety-related symptoms – has been highly influential in current conceptualizations of anxiety disorders in general, and panic disorder specifically. However, given documented associations between AS and both non-anxiety psychological disorders as well as medical/health conditions, the extent to which measures of AS are assessing a specific fear or anxiety symptoms versus a broader fear of interoceptive or bodily sensations is unclear. Confirmatory factor analysis of data from 373 participants failed to suggest whether fears of anxiety-related symptoms were factorially distinct from fears of non-anxiety-related bodily sensations, although analyses indicated that while fears of anxiety-related symptoms were more closely associated with panic disorder severity than were fears of non-anxiety-related symptoms, both were similarly and strongly associated with hypochondriacal fears. Implications for the construct of AS, and the broader construct of somatic fears, are discussed.
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Hedman E, Ljótsson B, Axelsson E, Andersson G, Rück C, Andersson E. Health anxiety in obsessive compulsive disorder and obsessive compulsive symptoms in severe health anxiety: An investigation of symptom profiles. J Anxiety Disord 2017; 45:80-86. [PMID: 27988419 DOI: 10.1016/j.janxdis.2016.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 11/23/2016] [Accepted: 11/24/2016] [Indexed: 11/17/2022]
Abstract
Severe health anxiety (SHA) shares features with obsessive-compulsive disorder (OCD) and in recent years there has been a debate as to whether the two disorders may represent two facets of the same condition. Few studies have however investigated the overlap and differences in symptom profiles between the disorders. The primary aim of the present study was to investigate these aspects using one sample of participants with a principal diagnosis of SHA and one sample of participants with a principal OCD diagnosis. The second aim was to examine differences in improvement trajectories on measures of health anxiety and OCD symptoms in patients with SHA receiving treatment with exposure and response prevention. We compared persons participating in clinical trials with a principal diagnosis of SHA (N=290) to persons with a principal diagnosis of OCD (n=95) on measures of health anxiety, OCD symptoms, and depressive symptoms. A subsample of SHA participants (n=99) received exposure and response prevention (ERP) for SHA over 12 weeks and was assessed at baseline and post-treatment. The results showed large and significant differences between SHA and OCD patients on measures of health anxiety (ds=2.99-3.09) and OCD symptoms (ds=1.64-2.14), while they had equivalent levels of depressive symptoms (d=0.19, 95% CI [-0.04, 0.43]). In the SHA sample 7.6% had comorbid OCD, and in the OCD sample 9.5% had SHA. For participants with a principal diagnosis of SHA, ERP led to large reductions of health anxiety, but effects on OCD symptoms were small to moderate. Among participants with comorbid OCD, effect sizes were large on measures of health anxiety and moderate to large on OCD measures. We conclude that SHA and OCD are separate psychiatric disorders with limited overlap in symptom profiles.
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Affiliation(s)
- Erik Hedman
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Stockholm, Sweden.
| | - Brjánn Ljótsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
| | - Erland Axelsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
| | - Gerhard Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Christian Rück
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Erik Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
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Trevis KJ, McLachlan NM, Wilson SJ. Psychological mediators of chronic tinnitus: The critical role of depression. J Affect Disord 2016; 204:234-40. [PMID: 27391257 DOI: 10.1016/j.jad.2016.06.055] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/18/2016] [Accepted: 06/20/2016] [Indexed: 01/05/2023]
Abstract
BACKGROUND Maintenance of chronic tinnitus has been proposed to result from a vicious cycle of hypervigilance occurring when a phantom sound is associated with anxiety and limbic system overactivity. Depression, obsessive-compulsiveness, illness attitudes and coping strategies are known to impact tinnitus, but their relationship with the vicious cycle is unknown. As such, we aimed to identify psychological mediators of the vicious cycle. We also examined the relationship between coping strategies and any identified mediators to facilitate the translation of our research to treatment settings. METHODS We comprehensively assessed a heterogeneous community sample of 81 people with chronic tinnitus who completed measures assessing their tinnitus and psychological wellbeing. Specifically, we examined the mediating role of depressive symptoms, illness attitudes, and obsessive-compulsiveness in the vicious cycle. RESULTS While the predicted relationship between tinnitus handicap and anxiety was observed, this was fully mediated by depressive symptoms. In addition, we identified avoidant behaviours and self-blame as maladaptive coping strategies in people with chronic tinnitus and depressive symptoms, identifying potential new treatment targets. LIMITATIONS This work requires replication in a clinical cohort of people with chronic tinnitus, and further investigations of the role of coping strategies. CONCLUSIONS These results extend our understanding of the complex role of psychology in the experience of tinnitus, highlighting the importance of depressive symptoms that may be underpinned by functional disruption of specific neurocognitive networks. We have also identified depressive symptoms and maladaptive coping strategies as new treatment targets to improve the health wellbeing of people with chronic tinnitus.
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Affiliation(s)
- Krysta J Trevis
- Psychological Sciences, The University of Melbourne, Victoria, Australia.
| | - Neil M McLachlan
- Psychological Sciences, The University of Melbourne, Victoria, Australia
| | - Sarah J Wilson
- Psychological Sciences, The University of Melbourne, Victoria, Australia
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Fears, Coping Styles, and Health Behaviors: A Comparison of Patients With Hypochondriasis, Panic Disorder, and Depression. J Nerv Ment Dis 2016; 204:778-786. [PMID: 27441462 DOI: 10.1097/nmd.0000000000000566] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Research into correlates of illness anxiety disorder (formerly hypochondriasis) rarely applies comprehensive assessments of health behavior. Moreover, studies on phenomenological varieties of clinical health anxiety are scarce. We examined health behavior, fear, and acceptance of death and dying, and coping with a hypothetical bodily disease in patients with hypochondriasis, panic disorder, depression, and healthy controls (all groups n = 30) using self-rated questionnaires. ANOVA with Dunnett-T3 post hoc tests revealed no group differences in health behavior. The hypochondriasis and panic disorder groups showed more fear and less acceptance of death and dying than patients with depression and controls. Groups did not differ concerning coping strategies. Patients with hypochondriasis ruminated more when confronted with their most feared rather than another disease. Patients apparently overestimate the danger of a specific disease, but without underestimating their coping abilities. A therapeutic focus on fear of death and dying via cognitive interventions and exposure is recommended.
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Morales A, Reis S, Espada JP, Orgilés M. Portuguese validation of the Short Health Anxiety Inventory: Factor structure, reliability, and factor invariance. J Health Psychol 2016; 23:1872-1883. [PMID: 27682334 DOI: 10.1177/1359105316669859] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The Short Health Anxiety Inventory is a brief instrument to assess health anxiety widely used across countries; however, no validated version is available for Portuguese-speaking population. Factorial structure, reliability, and equivalency factor with the Spanish version were analyzed with Portuguese adolescents aged 14-18 years. A Portuguese adolescent cohort ( N = 629) and a comparative Spanish adolescent cohort ( N = 1502) were evaluated. The original two-factor version was the best fitting model for the Portuguese version. The reliability was excellent. Complete measurement invariance across both countries was supported. The Portuguese version of the Short Health Anxiety Inventory is a valid screening inventory to assess health anxiety in adolescents.
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Bravo IM, Arrufat O. The Illness Attitude Scales: Adaptation and Translation Into Spanish for Use With Older Adults. J Appl Gerontol 2016. [DOI: 10.1177/0733464805278133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The Illness Attitude Scales (IAS) were simplified from a 5-point Likert-type scale to a yes-or-no format and translated into Spanish using Brislin’s method. Because of the linkage between hypochondriasis and depression, the new version was administered to immigrant, Hispanic, older adults suffering from major depressive disorder (MDD) (n= 21) and their controls (n = 21), and to non-Hispanic older adults with MDD (n = 32) and their controls (n = 32). Both versions of the IAS were equivalent and had adequate internal consistency. As hypothesized, Hispanic immigrants with MDD endorsed more hypochondriacal beliefs and were more concerned about the effect of their symptoms than controls. Non-Hispanics were more concerned about pain than controls. The two IAS simplified versions will be useful in the assessment of English- and Spanish-speaking older adults in both clinical and research settings.
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Macfarlane GJ, Beasley M, Prescott G, McNamee P, Keeley P, Artus M, McBeth J, Hannaford P, Jones GT, Basu N, Norrie J, Lovell K. The Maintaining Musculoskeletal Health (MAmMOTH) Study: Protocol for a randomised trial of cognitive behavioural therapy versus usual care for the prevention of chronic widespread pain. BMC Musculoskelet Disord 2016; 17:179. [PMID: 27113442 PMCID: PMC4845348 DOI: 10.1186/s12891-016-1037-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) has been shown to improve outcomes for patients with fibromyalgia, and its cardinal feature chronic widespread pain (CWP). Prediction models have now been developed which identify groups who are at high-risk of developing CWP. It would be beneficial to be able to prevent the development of CWP in these people because of the high cost of symptoms and because once established they are difficult to manage. We will test the hypothesis that among patients who are identified as at high-risk, a short course of telephone-delivered CBT (tCBT) reduces the onset of CWP. We will further determine the cost-effectiveness of such a preventative intervention. METHODS The study will be a two-arm randomised trial testing a course of tCBT against usual care for prevention of CWP. Eligible participants will be identified from a screening questionnaire sent to patients registered at general practices within three Scottish health boards. Those returning questionnaires indicating they have visited their doctor for regional pain in the last 6 months, and who have two of, sleep problems, maladaptive behaviour response to illness, or high number of somatic symptoms, will be invited to participate. After giving consent, participants will be randomly allocated to either tCBT or usual care. We aim to recruit 473 participants to each treatment arm. Participants in the tCBT group will have an initial assessment with a CBT therapist by telephone, then 6 weekly sessions, and booster sessions 3 and 6 months after treatment start. Those in the usual care group will receive no additional intervention. Follow-up questionnaires measuring the same items as the screening survey questionnaire will be sent 3, 12 and 24 months after start of treatment. The main outcome will be CWP at the 12 month questionnaire. DISCUSSION This will be the first trial of an intervention aimed at preventing fibromyalgia or CWP. The results of the study will help to inform future treatments for the prevention of chronic pain, and aetiological models of its development. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT02668003URL: Please check that the following URLs are working. If not, please provide alternatives: NCT02668003Alternative is: https://www.clinicaltrials.gov/ct2/show/NCT02668003> . Date registered: 28-Jan-2016.
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Affiliation(s)
- Gary J Macfarlane
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Marcus Beasley
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK. .,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK.
| | - Gordon Prescott
- Medical Statistics Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Paul McNamee
- Health Economics Research Unit, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Philip Keeley
- Department of Health Sciences, University of Huddersfield, Huddersfield, UK
| | - Majid Artus
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, UK
| | - John McBeth
- Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, UK
| | - Philip Hannaford
- Centre of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Gareth T Jones
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- Epidemiology Group, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK.,Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - John Norrie
- Centre for Healthcare Randomised Trials (CHaRT), Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Karina Lovell
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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Sirri L, Ricci Garotti MG, Grandi S, Tossani E. Adolescents' hypochondriacal fears and beliefs: Relationship with demographic features, psychological distress, well-being and health-related behaviors. J Psychosom Res 2015. [PMID: 26209878 DOI: 10.1016/j.jpsychores.2015.07.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE There is little previous literature on hypochondriacal attitudes in teens. We examined the relationship between adolescents' hypochondriacal fears and beliefs, demographic features, psychological distress and well-being, and health-related behaviors. METHODS Nine hundred and forty-eight students (53.4% males), aged 14-19years (mean 15.8±1.3years), completed the Illness Attitude Scales, the Symptom Questionnaire, and the Psychological Well-Being scales. Demographic features and health-related behaviors (smoking, alcohol consumption, illicit substance use, and sedentary, eating and sleep habits) were also collected. RESULTS Hypochondriacal concerns were significantly higher among females and correlated with increased psychological distress and reduced well-being. One hundred and forty-nine participants (15.7% of the sample) reached the threshold of the "hypochondriacal responses", identified by Kellner as a screening method for clinically significant hypochondriacal symptoms. The "hypochondriacal responses" were significantly associated with higher levels of psychological distress, decreased well-being, and some unhealthy behaviors: smoking, use of illicit substances, physical inactivity, and short sleep. Female gender, physical inactivity, and higher levels of hostility independently predicted the "hypochondriacal responses" pattern. CONCLUSIONS A substantial percentage of adolescents experience significant concerns about health. Excessive illness fears are associated with less healthy behaviors. A thorough assessment of illness-related concerns may be crucial for the prevention of both the development of more structured forms of abnormal illness behavior (e.g., severe health anxiety) and the engagement in some unhealthy lifestyles in adolescents. However, it may also be that unhealthy behaviors lead to increased preoccupation with one's own health through adolescents' implicit knowledge about possible consequences of such behaviors.
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Affiliation(s)
- Laura Sirri
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy.
| | - Maria Grazia Ricci Garotti
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - Silvana Grandi
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
| | - Eliana Tossani
- Laboratory of Psychosomatics and Clinimetrics, Department of Psychology, University of Bologna, Bologna, Italy
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Abstract
The relationship between health behavior and hypochondriasis has not yet been sufficiently examined, as previous studies investigated only individual dimensions of health behavior. In the present study, we extend current literature by examining multiple dimensions of health behavior. One hundred twenty-six participants, consisting of 40 participants with a primary diagnosis of hypochondriasis, 41 participants with a primary diagnosis of anxiety disorder, and 45 healthy controls, completed a multidimensional questionnaire for the assessment of health behavior and other measures for the evaluation of general psychopathology, illness anxiety, depression, and general anxiety. Patients with hypochondriasis revealed a less active way of life (d = 0.89) and lower hygiene (d = 0.60) than healthy controls, but did not differ from healthy controls regarding their compliance to medical recommendations. No differences were found in substance avoidance, security orientation, and diet. Hypochondriasis-specific behavior should be monitored in the treatment of the disorder.
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Hedman E, Lekander M, Ljótsson B, Lindefors N, Rück C, Andersson G, Andersson E. Optimal cut-off points on the health anxiety inventory, illness attitude scales and whiteley index to identify severe health anxiety. PLoS One 2015; 10:e0123412. [PMID: 25849477 PMCID: PMC4388630 DOI: 10.1371/journal.pone.0123412] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 02/28/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Health anxiety can be viewed as a dimensional phenomenon where severe health anxiety in form of DSM-IV hypochondriasis represents a cut-off where the health anxiety becomes clinically significant. Three of the most reliable and used self-report measures of health anxiety are the Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS) and the Whiteley Index (WI). Identifying the optimal cut-offs for classification of presence of a diagnosis of severe health anxiety on these measures has several advantages in clinical and research settings. The aim of this study was therefore to investigate the HAI, IAS and WI as proximal diagnostic instruments for severe health anxiety defined as DSM-IV hypochondriasis. METHODS We investigated sensitivity, specificity and predictive value on the HAI, IAS and WI using a total of 347 adult participants of whom 158 had a diagnosis of severe health anxiety, 97 had obsessive-compulsive disorder and 92 were healthy non-clinical controls. Diagnostic assessments were conducted using the Anxiety Disorder Interview Schedule. RESULTS Optimal cut-offs for identifying a diagnosis of severe health anxiety was 67 on the HAI, 47 on the IAS, and 5 on the WI. Sensitivity and specificity were high, ranging from 92.6 to 99.4%. Positive and negative predictive values ranged from 91.6 to 99.4% using unadjusted prevalence rates. CONCLUSIONS The HAI, IAS and WI have very good properties as diagnostic indicators of severe health anxiety and can be used as cost-efficient proximal estimates of the diagnosis.
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Affiliation(s)
- Erik Hedman
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Stockholm, Sweden
| | - Mats Lekander
- Karolinska Institutet, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Stockholm, Sweden
- Stockholm University, Stress Research Institute, Stockholm, Sweden
| | - Brjánn Ljótsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
| | - Nils Lindefors
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Christian Rück
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
| | - Gerhard Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
- Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Erik Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden
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Hedman E, Ljótsson B, Andersson E, Andersson G, Lindefors N, Rück C, Axelsson E, Lekander M. Psychometric properties of Internet-administered measures of health anxiety: an investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index. J Anxiety Disord 2015; 31:32-7. [PMID: 25723780 DOI: 10.1016/j.janxdis.2015.01.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 01/24/2015] [Accepted: 01/30/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND The Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS), and the Whiteley Index (WI) are three of the most widely used health anxiety measures, but their psychometric properties have not been investigated when administered via the Internet. METHODS We investigated the three instruments' test-retest reliability, internal consistency, convergent, and discriminant validity and sensitivity to change using one sample (n=111) of participants with severe health anxiety and one sample of healthy controls (n=92). RESULTS The HAI, IAS, and WI showed high test-retest reliability (rs≥.80), good convergent, and discriminant validity and were sensitive to detect change. The HAI and IAS (αs≥.85), but not the WI (αs≤.60) demonstrated high internal consistency. CONCLUSIONS The HAI, IAS, and WI have good psychometric properties, except for the low internal consistency of WI, when used as Internet-administered measures of health anxiety. Using these measures over the Internet offers highly important advantages such as increased ease of administration, reduced attrition, and cost-efficient treatment evaluation.
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Affiliation(s)
- Erik Hedman
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden.
| | - Brjánn Ljótsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Erik Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Gerhard Andersson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden; Stockholm University, Stress Research Institute, Stockholm, Sweden
| | - Nils Lindefors
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Christian Rück
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychiatry, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Erland Axelsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden
| | - Mats Lekander
- Karolinska Institutet, Department of Clinical Neuroscience, Osher Center for Integrative Medicine, Stockholm, Sweden; Linköping University, Department of Behavioural Sciences and Learning, Linköping, Sweden; Stockholm University, Stress Research Institute, Stockholm, Sweden
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Kim S, Lee JH. Time course of attentional bias for health-related information in individuals with health anxiety. J Health Psychol 2014; 21:1527-35. [PMID: 25476571 DOI: 10.1177/1359105314557976] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study examined whether particular coping strategies influence attentional bias in individuals with health anxiety. A total of 84 participants were divided into four groups on the basis of their health-anxiety level (high/low) and coping strategy (monitor/blunter). The participants were shown screens displaying health-related pictures paired with non-health-related pictures. As a result, the high health-anxiety group was more attentive to health stimuli than the low health-anxiety group, regardless of the coping strategy. When maintaining attention, the high health-anxiety blunter shifted attention away from health stimuli, whereas the high health-anxiety monitor shifted attention toward the stimuli. These results indicated differences in how individuals manage attention processing according to their coping strategy.
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Affiliation(s)
- Sujin Kim
- Chung-Ang University, Republic of Korea
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42
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Smits FT, Brouwer HJ, Zwinderman AH, Mohrs J, Schene AH, van Weert HCPM, ter Riet G. Why do they keep coming back? Psychosocial etiology of persistence of frequent attendance in primary care: a prospective cohort study. J Psychosom Res 2014; 77:492-503. [PMID: 25217448 DOI: 10.1016/j.jpsychores.2014.08.003] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 07/21/2014] [Accepted: 08/12/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients who visit their General Practitioner (GP) very frequently over extended periods of time often have multimorbidity and are costly in primary and specialist healthcare. We investigated the impact of patient-level psychosocial and GP-level factors on the persistence of frequent attendance (FA) in primary care. METHODS Two-year prospective cohort study in 623 incident adult frequent attenders (>90th attendance centile; age and sex-adjusted) in 2009. Information was collected through questionnaires (patients, GPs) and GPs' patient data. We used multilevel, ordinal logistic regression analysis, controlling for somatic illness and demographic factors with FA in 2010 and/or 2011 as the outcome. RESULTS Other anxiety (odds ratio (OR) 2.00; 95% confidence interval from 1.29 to 3.10) over 3years and the number of life events in 3years (OR 1.06; 1.01-1.10 per event; range of 0 to 12) and, at baseline, panic disorder (OR 5.40; 1.67-17.48), other anxiety (OR 2.78; 1.04-7.46), illness behavior (OR 1.13; 1.05-1.20 per point; 28-point scale) and lack of mastery (OR 1.08; 1.01-1.15 per point; 28-point scale) were associated with persistence of FA. We found no evidence of synergistic effects of somatic, psychological and social problems. We found no strong evidence of effects of GP characteristics. CONCLUSION Panic disorder, other anxiety, negative life events, illness behavior and lack of mastery are independently associated with persistence of frequent attendance. Effective intervention at these factors, apart from their intrinsic benefits to these patients, may reduce attendance rates, and healthcare expenditures in primary and specialist care.
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Affiliation(s)
- Frans T Smits
- Department of General Practice, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands.
| | - Henk J Brouwer
- Department of General Practice, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Aeilko H Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Jacob Mohrs
- Department of General Practice, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Aart H Schene
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands; Department of Psychiatry, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henk C P M van Weert
- Department of General Practice, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
| | - Gerben ter Riet
- Department of General Practice, Academic Medical Center, University of Amsterdam, 1100 DD Amsterdam, The Netherlands
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Fionda S, Furnham A. Hypochondriacal attitudes and beliefs, attitudes towards complementary and alternative medicine and modern health worries predict patient satisfaction. JRSM Open 2014; 5:2054270414551659. [PMID: 25408919 PMCID: PMC4229056 DOI: 10.1177/2054270414551659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To investigate how hypochondriacal attitudes and beliefs, attitudes towards complementary and alternative medicine (CAM) and modern health worries (MHWs) related to patient satisfaction with their general practitioner. Design Participants completed a five-part questionnaire anonymously which measured satisfaction with one’s doctor, hypochondriacal beliefs, attitudes to CAM, MHWs and personality. Setting England Participants Included 215 adults from a variety of cultural backgrounds. Main outcome measure The Illness Attitudes Scales measuring the attitudes, fears and beliefs associated with hypochondriasis; Worry about Illness; Concerns about Pain, Health Habits, Hypochondriacal beliefs; Thanatophobia, Disease phobia, Bodily preoccupations; Treatment experience and Effects of symptoms. Results Correlations (around r = .10 to .25) and Regressions (R square from .06 to .09) showed demographic and personality variables only modestly related to patient satisfaction. Hypochondriasis, CAM and MHWs were associated with greater patient dissatisfaction as predicted with the former as the most powerful correlate. Conclusion The study indicates the different needs of potential patients in a typical medical consultation. It is important to ascertain patients’ health beliefs and practices with regard to medical history, attitudes to CAM and MHWs to increase consultation satisfaction.
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Affiliation(s)
- Sofia Fionda
- Research Department of Clinical, Educational and Health Psychology, University College London, 26 Bedford Way, London WC1H 0AP, UK
| | - Adrian Furnham
- Research Department of Clinical, Educational and Health Psychology, University College London, 26 Bedford Way, London WC1H 0AP, UK
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The development and validation of a Chinese version of the Illness Attitude Scales: an investigation of university students. Int J Behav Med 2014; 21:638-45. [PMID: 24500642 DOI: 10.1007/s12529-014-9391-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Illness Attitude Scales (IAS) are considered as one of the most suitable instruments to screen hypochondriasis. PURPOSE Whether it has cross-cultural validity in China remains to be determined. METHODS In Chinese university students (141 women and 141 men), we have administered the IAS, the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), and the Plutchik-van Praag Depression Inventory (PVP). RESULTS For the first time in Chinese culture, we have identified a four-factor structure of the IAS: patho-thanatophobia, symptom effect, treatment seeking, and hypochondriacal belief. Women scored significantly higher on IAS patho-thanatophobia and treatment seeking, on ZKPQ neuroticism-anxiety and activity, and on PVP than men did. The neuroticism-anxiety was significantly correlated with patho-thanatophobia and symptom effect, and PVP was positively correlated with symptom effect in women. Neuroticism-anxiety was significantly correlated with patho-thanatophobia, and impulsive sensation seeking and activity were significantly correlated with symptom effect in men. CONCLUSION In Chinese students, we have found a stable four-factor IAS structure.
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Death anxiety and its role in psychopathology: Reviewing the status of a transdiagnostic construct. Clin Psychol Rev 2014; 34:580-93. [DOI: 10.1016/j.cpr.2014.09.002] [Citation(s) in RCA: 179] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 08/15/2014] [Accepted: 09/16/2014] [Indexed: 11/22/2022]
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Veddegjærde KEF, Sivertsen B, Wilhelmsen I, Skogen JC. Confirmatory factor analysis and item response theory analysis of the Whiteley Index. Results from a large population based study in Norway. The Hordaland Health Study (HUSK). J Psychosom Res 2014; 77:213-8. [PMID: 25149031 DOI: 10.1016/j.jpsychores.2014.06.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 06/20/2014] [Accepted: 06/22/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The Whiteley Index (WI) is a widely used screening instrument for health anxiety/hypochondriasis. Several studies have previously explored the psychometric properties of the WI, but with mixed findings concerning both item composition and factor structure. The main aim of the current study was to examine different factor structures as identified from previous studies using data from a large general population based study. We also wanted to provide gender specific norms. METHODS Data were taken from a large population-based study in Norway, the Hordaland Health Study (HUSK N=7274). Confirmatory factor analysis (CFA) of several models of the WI was conducted. Item response theory (IRT) analysis was performed on the model with the best goodness-of-fit. RESULTS CFA of all previously proposed factor models of the WI revealed clearly inadequate model fits. The IRT analysis suggested that a six-item model best described the data, and CFA confirmed an adequate goodness-of-fit across indices. CONCLUSION The current study found evidence for a six-item, single-factor model of the WI. Our findings suggest that this abbreviated version has the best factor structure compared to previously proposed factor models. We recommend that the factor structure identified in this study should be investigated further in independent samples.
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Affiliation(s)
- Kari-Elise Frøystad Veddegjærde
- Department of Clinical Science, University of Bergen, Bergen, Norway; Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway; Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway.
| | - Børge Sivertsen
- Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway; Uni Health, Uni Research, Bergen, Norway; Department of Psychiatry, Helse Fonna HF, Haugesund, Norway
| | - Ingvard Wilhelmsen
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medicine, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Jens Christoffer Skogen
- Division of Mental Health, Norwegian Institute of Public Health, Bergen, Norway; Uni Health, Uni Research, Bergen, Norway; Alcohol and Drug Research Western Norway, Stavanger University, Hospital Stavanger, Stavanger, Norway
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Aggarwal V, Macfarlane G, Tajar A, Mulvey M, Power A, Ray D, McBeth J. Functioning of the hypothalamic-pituitary-adrenal and growth hormone axes in frequently unexplained disorders: Results of a population study. Eur J Pain 2013; 18:447-54. [DOI: 10.1002/j.1532-2149.2013.00413.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 11/09/2022]
Affiliation(s)
- V.R. Aggarwal
- School of Dentistry; Manchester Biomedical Research Centre; University of Manchester; UK
| | - G.J. Macfarlane
- Aberdeen Pain Research Collaboration (Epidemiology Group); Institute of Applied Health Sciences; University of Aberdeen, School of Medicine and Dentistry; Foresterhill UK
| | - A. Tajar
- Centre for Statistics in Medicine; University of Oxford; UK
| | - M.R. Mulvey
- Academic Unit of Palliative Care; Leeds Institute of Health Sciences; University of Leeds; UK
| | - A. Power
- School of Translational Medicine; University of Manchester; UK
- Human Pain Research Group; Salford Royal NHS Foundation Trust; UK
| | - D. Ray
- Centre for Endocrinology and Diabetes; Institute of Human Development; University of Manchester, and Manchester Academic Health Sciences Centre; UK
| | - J. McBeth
- Arthritis Research UK Primary Care Centre; Primary Care Sciences; Keele University; UK
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Health anxiety disorders in older adults: conceptualizing complex conditions in late life. Clin Psychol Rev 2013; 33:1096-105. [PMID: 24091001 DOI: 10.1016/j.cpr.2013.08.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 07/31/2013] [Accepted: 08/05/2013] [Indexed: 11/21/2022]
Abstract
Health anxiety disorders (e.g., hypochondriasis) are prevalent but understudied in older adults. Existing research suggests that severe health anxiety has a late age of onset, perhaps because of comorbidity with physical health conditions that are more likely to occur with aging. Despite being under diagnosed in later life due to a lack of age-appropriate diagnostic criteria, significant positive associations with age suggest that health anxiety disorders are more prevalent in older than younger adults. Preliminary research also highlights the complexity of these disorders in older adults and the potential importance of medical morbidity as a risk factor. This review explores the complexities of health anxiety disorders in later life with a focus on understanding defining features, prevalence rates, correlates, assessment, diagnosis, and treatment. We offer a theoretical model of the development of severe health anxiety among older adults to encourage further research on this important and under-studied topic.
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Rafanelli C, Gostoli S, Roncuzzi R, Sassone B. Psychological correlates of vasovagal versus medically unexplained syncope. Gen Hosp Psychiatry 2013; 35:246-52. [PMID: 23415579 DOI: 10.1016/j.genhosppsych.2013.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Psychiatric morbidity is quite common in vasovagal syncope (VVS), but findings are sometimes contradictory. Among patients with suspected VVS, up to 40% has a negative response to Head-Up Tilt test (HUT), the cause of syncope remaining unexplained (US). The authors evaluated and compared the psychological and psychosomatic profile in patients with positive (VVS) and negative HUT (US). METHOD A consecutive series of 67 patients with suspected VVS underwent HUT: 45 patients had a positive HUT, 22 negative. They were evaluated by means of observer- and self-rated measures. RESULTS Of the total sample, 95.5% had at least one Diagnostic and Statistical Manual of Mental Disorders diagnosis or one psychosomatic syndrome, such as specific and social phobias, illness denial and demoralization. Comparing VVS and US patients, no statistical differences on diagnoses' frequencies were found. However, the US group had significantly poorer health habits, lower levels of well-being and higher psychological distress. They also reported to be more anxious, depressed and hostile. VVS patients were significantly more blood and social phobic than US patients. CONCLUSION Despite similar and remarkable observer-rated psychopathology, US patients reported higher self-perceived psychological distress than VVS patients. Psychological evaluation of patients undergoing HUT should incorporate both clinical and subclinical methods to better address syncope management.
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Affiliation(s)
- Chiara Rafanelli
- Department of Psychology, University of Bologna, 40127 Bologna, Italy.
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Characteristics of neurasthenia: examination and cross-cultural applicability of ICD-10 Diagnostic Criteria for Research. Eur Psychiatry 2012; 11:289-97. [PMID: 19698469 DOI: 10.1016/s0924-9338(96)89897-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/1995] [Accepted: 03/05/1996] [Indexed: 10/18/2022] Open
Abstract
The purpose of this study was to examine characteristics of Yugoslav patients with neurasthenia diagnosed according to the ICD-10 Diagnostic Criteria for Research (ICD-10-DCR), and to examine the ICD-10-DCR symptoms of neurasthenia and applicability of the corresponding diagnostic criteria to Yugoslav patients with this condition. Thirty-four patients with the ICD-10-DCR neurasthenia and 31 patients with mixed anxiety and depressive disorder were compared in terms of demographic variables, results of several questionnaires, symptom profiles and comorbidity with other mental disorders. Patients with neurasthenia were less educated and more often held jobs as unskilled and semiskilled workers; they had a more chronic course of illness, tended to report more symptoms, manifested more hostility, somatization and hypochondriacal tendencies and received a comorbid diagnosis of hypochondriasis more frequently. In addition to exhaustion and weakness, the most prominent features of neurasthenia were irritability, anger, nervousness, various somatic symptoms and tension. An ICD-10-DCR diagnosis of neurasthenia could not be made in slightly over one-third of patients who would have otherwise met criteria for this diagnosis because of the imposed diagnostic hierarchy, ie, due to current comorbidity with affective disorders and generalized anxiety disorder in such patients. It is concluded that the ICD-10-DCR concept of neurasthenia is generally suitable for Yugoslav patients, except for the diagnostic hierarchy requirement. The diagnostic criteria therefore require revision in order to reflect more accurately the variability in clinical presentation of neurasthenia in different countries.
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