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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 PMCID: PMC11298870 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] [Grants] [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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Petzke TM, Elspaß L, Köteles F, Van den Bergh O, Witthöft M. "And how did that make you feel?" - Repeated symptom queries enhance symptom reports elicited by negative affect. J Psychosom Res 2024; 181:111634. [PMID: 38453590 DOI: 10.1016/j.jpsychores.2024.111634] [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: 12/19/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVE Negative affect, alexithymia, and other predisposing traits (such as health anxiety) can influence an individual's symptom perception. In this study, we used the affective picture paradigm (APP, Bogaerts et al., 2010) to induce symptoms using affective picture stimuli. We aimed to cross-sectionally test the effect of high vs low-frequency symptom queries and analyze the time course of the APP, including interactions with health anxiety and somatic symptom distress. METHODS Participants (N = 124) completed a modified APP and filled out various questionnaires. In the APP, participants were randomized to either a highly-frequent-query condition (18 symptom checklists) or a less-frequent-query condition (6 checklists). Data were analyzed using ANOVAs, cross-lagged panel models, moderation models, and multilevel models. RESULTS Both groups had comparable symptom baseline values, but people in the highly frequent as opposed to less frequent condition reported significantly higher symptom levels once the experiment started (F (1,120) = 14.319, p < .001, η2=.107). Symptom levels stayed stable over the course of the experiment and were best predicted by symptom levels at earlier timepoints in the experiment (β = 0.43 and β = 0.68, both p < .001). Health anxiety levels significantly predicted symptom levels (F(1,121) = 10.054, p = .002, η2=.077) and moderated the relation between condition and symptom levels (F(2,121) = 16.253, p < .001, η2=.212). CONCLUSION In terms of the predictive processing model (e.g.,[1]), repeated symptom queries following negative affective cues may activate prior beliefs about symptoms, resulting in elevated levels of symptom reports in interaction with health anxiety.
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Affiliation(s)
- Tara M Petzke
- Department of Clinical Psychology, Psychotherapy, or Experimental Psychopathology, Johannes-Gutenberg University Mainz, Mainz, Germany.
| | - Lina Elspaß
- Department of Clinical Psychology, Psychotherapy, or Experimental Psychopathology, Johannes-Gutenberg University Mainz, Mainz, Germany.
| | - Ferenc Köteles
- Department of General Psychology and Methodology, Károli Gáspár University of the Reformed Church in Hungary, Budapest, Hungary.
| | | | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, or Experimental Psychopathology, Johannes-Gutenberg University Mainz, Mainz, Germany.
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3
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Rask CU, Duholm CS, Poulsen CM, Rimvall MK, Wright KD. Annual Research Review: Health anxiety in children and adolescents-developmental aspects and cross-generational influences. J Child Psychol Psychiatry 2024; 65:413-430. [PMID: 37909255 DOI: 10.1111/jcpp.13912] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 11/03/2023]
Abstract
Health anxiety involves excessive worries about one's health along with beliefs one has an illness or may contract a serious disease. Concerning evidence suggests that health anxiety is on the rise in society, possibly further fueled by the COVID-19 pandemic. Recent classification systems acknowledge that impairing health-related worries and beliefs can emerge in early childhood with significant levels of symptoms persisting throughout childhood, and possibly continuous with diagnostic considerations in adulthood. This narrative review summarizes recent research advances in health anxiety in children and adolescents, focusing on various developmental aspects of health anxiety and related concepts in youths. Findings suggest that health anxiety symptoms in young age groups are associated with impairment, distress, and increased healthcare use, as well as substantial comorbidity with mainly other emotional problems and disorders. Furthermore, longitudinal studies suggest that childhood health anxiety can persist across adolescence, perhaps with links to chronic courses in adulthood. The growing literature was further reviewed, thus extending our understanding of early risk factors, including the potential role of exposure to serious illness and transgenerational transmission of health anxiety. Learning more about developmental trajectories will be highly relevant to inform strategies for early detection and prevention. While modified cognitive behavioral therapies in adults are successful in treating health anxiety, specific interventions have not yet been tested in youths. Given substantial overlaps with other psychopathology, it could be important to develop and explore more transdiagnostic and scalable approaches that take advantage of common factors in psychotherapy, while also including a wider perspective on potential familiar maladaptive illness cognitions and behaviors.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Martin Køster Rimvall
- Department of Child and Adolescent Psychiatry, Copenhagen University Hospital - Psychiatry Region Zealand, Roskilde, Denmark
- Child and Adolescent Mental Health Center, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Kristi D Wright
- Department of Psychology, University of Regina, Regina, SK, Canada
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4
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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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Ingeman K, Wright KD, Frostholm L, Frydendal DH, Ørnbøl E, Rask CU. Measurement properties of the Health Anxiety by Proxy Scale (HAPYS): A new questionnaire to assess parents' worries about their child's health. J Psychosom Res 2024; 176:111555. [PMID: 38039620 DOI: 10.1016/j.jpsychores.2023.111555] [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: 05/09/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE Health anxiety by proxy refers to parents' excessive worries about their child's health. The Health Anxiety by Proxy scale (HAPYS) is a new self-report questionnaire to assess parents' worries and behaviors regarding their child's health. This study aimed to investigate the measurement properties of the HAPYS. METHODS Questionnaires were completed by 204 parents, and a HAPYS score was obtained for 200 parents: 39 parents diagnosed with health anxiety, 33 parents with different anxiety disorders, 33 parents with a Functional Somatic Disorder, and 95 healthy parents. We evaluated the following measurement properties: structural validity, reliability, convergent validity ((pain catastrophizing, parents' reports of child's emotional and physical symptoms), discriminant validity (parental reports of child's well-being), and known-groups validity (see compared groups above). RESULTS HAPYS demonstrated a one factor dimensionality, and excellent internal reliability (α = 0.95; CI: 0.93-0.97) and test-retest reliability after two weeks (ICC = 0.91; CI: 0.87-0.94). Convergent validity with the construct of parental catastrophizing about child pain was good (r = 0.72; CI: 0.64-0.78)). Good known-groups validity was demonstrated by the largest total HAPYS score observed in parents with health anxiety (median = 35; IQR: 9-53) and the lowest score in healthy parents (median = 9; IQR: 5-15) (p < 0.001). CONCLUSION The findings support that HAPYS is a useful measure of health anxiety by proxy. Future research should examine the measurement properties in larger samples and different languages with further statistical analyses of structural validity.
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Affiliation(s)
- Katrine Ingeman
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark; The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 21-23, 8000 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark.
| | - Kristi D Wright
- Department of Psychology, Faculty of Arts, University of Regina, 3737 Wascana Parkway, Regina, SK S4S 0A2, Canada
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 21-23, 8000 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
| | - Ditte Hoffmann Frydendal
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 21-23, 8000 Aarhus, Denmark
| | - Eva Ørnbøl
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Universitetsbyen 21-23, 8000 Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, 8200 Aarhus, Denmark; Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Boulevard 82, 8200 Aarhus, Denmark
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Ingeman K, Frostholm L, Wellnitz KB, Wright K, Frydendal DH, Onghena P, Rask CU. Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study. JMIR Res Protoc 2023; 12:e46927. [PMID: 37999936 DOI: 10.2196/46927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Health anxiety (HA) by proxy is described as parents' obsessive worries that their child is severely ill although this is not medically confirmed. Research on HA by proxy suggests that it is highly distressing for the parent and that the child may be at risk of developing maladaptive symptom coping strategies. No targeted treatment for this group exists. We developed PROXY, an 8-week psychological internet-delivered treatment for parents with HA by proxy. The treatment components of PROXY are informed by cognitive behavioral therapy as well as acceptance and commitment therapy, and it was developed in collaboration with parents experiencing HA by proxy and clinical experts. OBJECTIVE This paper describes the protocol for a study investigating the potential effects of PROXY on parents' worries about their children's health using a single-case experimental design (SCED). METHODS Five parents clinically evaluated as experiencing HA by proxy will be included. A replicated randomized SCED study will be conducted in which each participant will be randomized to receive treatment after a baseline period of between 7 and 26 days (phase A). The treatment phase duration is 8 weeks for all participants (phase B), followed by a follow-up phase lasting between 14 and 33 days (phase C), ensuring that all participants remain in the study for 96 days. Participants will report daily anxiety level by SMS text message throughout the study. They will also answer self-report questionnaires, including questions on HA by proxy and own HA, 4 times during the study. Data will be submitted to structured visual analysis to inspect anxiety level, the variability of anxiety, trends, the overlap of data points among phases, when effects occur, and the consistency of data patterns across participants. Furthermore, randomization tests will be conducted for each participant to test the null hypothesis that PROXY will have no effect on participants' anxiety. RESULTS The recruitment of parents began in June 2022. As of March 2, 2023, a total of 4 parents have been included in the study. Data collection was expected to cease in April 2023. CONCLUSIONS To the best of our knowledge, this protocol describes the only study of treatment for HA by proxy. As the prevalence of this condition is still unknown, a SCED was chosen because this method allows the inclusion of very few participants while still providing information on effects and treatment courses. Conducting the study with a replicated randomized phase design enables methodologically sound testing despite the inclusion of very few participants. The results will inform researchers on individual treatment courses and effects, which may direct future research in terms of the possible mechanisms of change, ideas for how to refine the treatment content, and how the treatment may be offered to patients in the future. TRIAL REGISTRATION ClinicalTrials.gov NCT04830605; https://clinicaltrials.gov/study/NCT04830605. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46927.
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Affiliation(s)
- Katrine Ingeman
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Kaare Bro Wellnitz
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Kristi Wright
- Department of Psychology, Faculty of Arts, University of Regina, Regina, SK, Canada
| | - Ditte Hoffmann Frydendal
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Patrick Onghena
- Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Charlotte Ulrikka Rask
- Research Unit, Department of Child and Adolescent Psychiatry, Aarhus University Hospital Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Llewelyn-Williams JL, Oliver AM, Wright KD, Runalls S, Lahti DS, Bradley TJ, Kakadekar A, Pharis S, Pockett C, Erlandson MC, Tomczak CR. Health anxiety and associated constructs in school-age children and adolescents with congenital heart disease and their parents: A children's healthy-heart activity monitoring program in Saskatchewan cohort study. J Child Health Care 2023; 27:450-465. [PMID: 35238665 DOI: 10.1177/13674935221075896] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Youth with congenital heart disease (CHD) have been found to experience higher levels of health anxiety and associated constructs than typically developing peers. The association between youth and parent health anxiety has been explored in typically developing youth but this association remains unknown in youth with CHD. This association was explored using a prospective, cross-sectional study that included 36 school-age children and adolescents with CHD (median age =10.5 years, IQR = 4) and 35 parents (median age = 44 years, IQR = 10.5). Participants completed a demographic form and measures of health anxiety, anxiety sensitivity, intolerance of uncertainty, and anxiety disorder symptom categories (youth) or general anxiety (parent). Associations were observed between child and adolescent panic/agoraphobia symptoms and parent state anxiety (r = .41), child and adolescent intolerance of uncertainty and parent state and trait anxiety (r = .37; r = .46, respectively), and child and adolescent anxiety sensitivity and parent state anxiety (r = .40). No association was observed between health anxiety in children and adolescents and parents nor between child and adolescent health anxiety and parent associated constructs. For parents, associations between health anxiety and all measures of associated constructs of interest were observed. Study findings will facilitate improved understanding of the psychological needs of school-age children and adolescents with CHD.
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Affiliation(s)
| | - Amanda M Oliver
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - Kristi D Wright
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - Shonah Runalls
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Dana S Lahti
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Timothy J Bradley
- Department of Pediatric Cardiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Ashok Kakadekar
- Department of Pediatric Cardiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Scott Pharis
- Department of Pediatric Cardiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Charissa Pockett
- Department of Pediatric Cardiology, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marta C Erlandson
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
| | - Corey R Tomczak
- College of Kinesiology, University of Saskatchewan, Saskatoon, SK, Canada
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Ingeman K, Frostholm L, Frydendal DH, Wright KD, Lockhart E, Garralda ME, Kangas M, Rask CU. A new measure of excessive parental worries about children's health: Development of the Health Anxiety by Proxy Scale (HAPYS). Nord J Psychiatry 2021; 75:523-531. [PMID: 33724904 DOI: 10.1080/08039488.2021.1900389] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/19/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Health anxiety by proxy is a newly introduced term to describe parents' experience of excessive and unpleasant worries about their child's health. This article describes the development of a new measure, the Health Anxiety by Proxy Scale (HAPYS), for systematic assessment of health anxiety by proxy. METHOD The development of the HAPYS was performed over three phases. (1) Patients clinically assessed to have health anxiety by proxy participated in semi-structured interviews to elaborate their experience of worries regarding their child's health and their related behaviours, and to examine the face validity of items in an existing questionnaire: 'Illness Worry Scale - parent version'. (2) Based on the findings from Phase 1 the project group and a panel of experts selected and formulated questionnaire items and scoring formats. (3) The HAPYS was pilot-tested twice using cognitive interviewing with healthy parents and parents with health anxiety by proxy followed by further adjustments. RESULTS The final version of HAPYS consists of 26 items characteristic of health anxiety by proxy and of an impact section with five items. CONCLUSION Based on the pilot testing the HAPYS showed good face and content validity. It holds the potential to be a valid questionnaire to help clinicians across health care settings assess parents suffering from health anxiety by proxy.
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Affiliation(s)
- Katrine Ingeman
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Ditte Hoffmann Frydendal
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Kristi D Wright
- Department of Psychology, Faculty of Arts, University of Regina, Regina, Canada
| | | | - M Elena Garralda
- Division of Psychiatry, Imperial College London, Burlington Danes, The Hammersmith Hospital, London, UK
| | - Maria Kangas
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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9
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Ludot M, Merlo M, Ibrahim N, Piot MA, Lefèvre H, Carles ME, Harf A, Moro MR. ["Somatic symptom disorders" in adolescence. A systematic review of the recent literature]. Encephale 2021; 47:596-604. [PMID: 34538623 DOI: 10.1016/j.encep.2021.04.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 04/02/2021] [Accepted: 04/18/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Body expression of mental disorders is common in adolescence. Only two literature reviews over the last five years have been identified about somatoform disorders in children., The present article provides a systematic review of articles in English, which concern "Somatic Symptom and Related Disorders" according to the DSM-5 (Diagnostic and Statistical Manual - 5th Edition) among adolescents. METHODS The article search was made on Medline, Psychinfo, Google Scholar, BiomedCentral, Central and tripdatabase (for grey literature) according to PRISMA criteria and with the items "somatoform disorders" or "somatic symptom disorders". An age filter was applied for "adolescents", and a selection was done from the last five years. All articles concerning adolescents (often associated with children) were initially included, except for articles concerning eating disorders, dysmorphic disorders or adult population. Comments, editorials, opinion or descriptive articles were also excluded. The authors then carried out an analysis of the main topics, themes and questions covered in the selected publications and presented a descriptive synthesis. RESULTS A total of seventy-seven publications were included in the analysis, from three hundred and seventy-two publications. First, the terms used to refer to these "somatic symptom disorders" were varied, such as "somatization", "somatic complaints/symptoms", "functional disorder", "unexplained symptoms" and "somatoform disorders". Then, studies related just to adolescents were limited: most of studies included children and adolescents in their methodologies; and some of them questioned somatic symptoms from a developmental perspective. Case reports were the most represented articles among all medical specialties, with clinical descriptions about "functional neurological symptom disorder", "factitious disorder" and "somatic symptom disorder" with a medical disease, among children and adolescents. We sometimes observed a controversial borderline between psychological and somatic disorders. Various explanatory models appeared, especially the trauma path; familial and social environment was also pointed out, with a possible peer group effect; neurocognitive theories were finally described. The literature highlights the effectiveness of psychosocial therapies (especially the cognitive-behavioral therapy) and the importance of multidisciplinary management. Finally, a few studies with a qualitative methodology are represented. CONCLUSIONS Only nine articles included "somatic symptom disorder" in their titles, despite a terminology valued by many authors (compared to "somatoform disorders" from the DSM-IV). The heterogeneity of terminologies, case reports and explanatory models witness a lack of connexions between medical specialties. This could explain in part the wandering of adolescents and their families in the health care system. It could also contribute to the delay before diagnosis, especially when neurological symptoms exist, and a late referral for psychiatric consultation. Further studies are needed to understand difficulties to use a clinical pathway among medical specialties, when the benefit of amultidisciplinary approach seems to be unanimous.
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Affiliation(s)
- M Ludot
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France.
| | - M Merlo
- Maison de Solenn, hôpital Cochin, 75014 Paris, France
| | - N Ibrahim
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France; Groupe français de recherche en médecine et santé de l'adolescent, maison de Solenn, hôpital Cochin, 75014 Paris, France
| | - M-A Piot
- Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France; Faculté de santé, UFR de médecine, université de Paris, 75006 Paris, France; Service de psychiatrie de l'enfant, de l'adolescent et du jeune adulte, institut mutualiste Montsouris, 75014 Paris, France
| | - H Lefèvre
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France; Groupe français de recherche en médecine et santé de l'adolescent, maison de Solenn, hôpital Cochin, 75014 Paris, France
| | - M-E Carles
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France
| | - A Harf
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France
| | - M R Moro
- Maison de Solenn, hôpital Cochin, 75014 Paris, France; PCPP, université de Paris, 92100 Boulogne-Billancourt, France; Inserm, CESP, Team DevPsy, UVSQ, université Paris-Saclay, 94807 Villejuif, France
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10
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Selinheimo S, Lampi J, Pekkanen J. Parent's self-reported indoor environment-related symptoms and health worry increase symptom reports among their children at school-Study in two independent populations. INDOOR AIR 2021; 31:1298-1307. [PMID: 33955596 DOI: 10.1111/ina.12836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 03/12/2021] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
Little is known whether parent's indoor environment quality (IEQ)-related symptoms or health perceptions influence the risk of self- or parent-reported symptoms in their children. We assessed (i) the association of parents' IEQ-related symptoms with IEQ-related symptoms in their children at school and (ii) whether parental IEQ-related health worry increases the risk for children's symptoms. We used two Finnish studies: a national, population-based survey of indoor air and related health problems (n = 611 parents) and a subset of survey for all primary school pupils (grade 3-6) and their parents in Helsinki, which also included school IEQ-related symptoms reported by children (n = 1617 parent-child dyads). In the school survey, parent's own symptoms increased strongly their reporting of their children's symptoms at school (aOR 4.0, 95% CI 2.7-6.0 for parents experiencing a lot of symptoms) and also symptoms reported by the child itself (aOR 2.2, 95% CI 1.5-3.1). Similar, but slightly weaker associations were seen with parental IEQ-related health worries. Results remained unchanged when adjusted for the IEQ of school buildings or parental and children's allergic diseases. Similar associations were seen in the national survey between parent's symptoms at work and child's symptoms at school. The results suggest that parents' health perceptions may increase the reporting of children's IEQ-related symptoms even more than is typically seen for many indoor air contaminants.
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Affiliation(s)
| | - Jussi Lampi
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
| | - Juha Pekkanen
- Environmental Health Unit, National Institute for Health and Welfare, Kuopio, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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11
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Haig-Ferguson A, Cooper K, Cartwright E, Loades M, Daniels J. Practitioner review: health anxiety in children and young people in the context of the COVID-19 pandemic. Behav Cogn Psychother 2021; 49:129-143. [PMID: 32829718 PMCID: PMC7503041 DOI: 10.1017/s1352465820000636] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 08/04/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
Health-related fear is a normal and common response in the face of the global pandemic of COVID-19. Children and young people are frequently being exposed to messages about the threat to health, including from the media and authorities. Whilst for most, their anxiety will be proportionate to the threat, for some, existing pre-occupation with physical symptoms and illness will become more problematic. There is a growing body of evidence that health anxiety may occur in childhood, however much of the literature is taken from research using adult samples. This practitioner review aims to give an overview of the assessment and treatment of health-related worries in children and young people in the context of the COVID-19 pandemic. This review is based on the limited existing evidence in this population and the more substantial evidence base for treating health anxiety in adults. We consider the adaptations needed to ensure such interventions are developmentally appropriate.
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Affiliation(s)
| | - K. Cooper
- Department of Psychology, University of Bath, Bath, UK
- Oxford Health NHS Foundation Trust, Oxford, UK
| | - E. Cartwright
- Department of Psychology, University of Bath, Bath, UK
| | - M.E. Loades
- Department of Psychology, University of Bath, Bath, UK
- Bristol Medical School, University of Bristol, Bristol, UK
| | - J. Daniels
- Department of Psychology, University of Bath, Bath, UK
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12
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Köteles F, Szemerszky R, Witthöft M, Nordin S. No evidence for interactions between modern health worries, negative affect, and somatic symptom distress in general populations. Psychol Health 2020; 36:1384-1396. [DOI: 10.1080/08870446.2020.1841761] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Renáta Szemerszky
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Mainz, Germany
| | - Steven Nordin
- Department of Psychology, Umeå University, Umeå, Sweden
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13
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Association between somatic symptoms and modern health worries. J Psychosom Res 2020; 135:110163. [PMID: 32559520 DOI: 10.1016/j.jpsychores.2020.110163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/11/2020] [Accepted: 05/26/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Modern health worries (MHWs) refer to perceived risk to personal health from technological changes and features of modern life, and is associated with health outcomes. The present objective was to test the hypotheses of (i) associations between MHWs and a global measure of typical somatization symptoms, referred to as somatic symptom distress, and (ii) associations between MHWs and a broad range of specific typical somatization symptoms and eye/skin and airway symptoms. METHODS Cross-sectional population-based data were used. Validated instruments were used to assess MHWs (Modern Health Worries Scale), typical somatization symptoms (Patient Health Questionnaire 15-item Somatic Symptom Severity Scale, PHQ-15), eye/skin and airway symptoms (Environmental Hypersensitivity Symptom Inventory), depression and anxiety (Hospital Anxiety and Depression Scale). Multivariate linear regression analyses were conducted with MHWs as dependent variable, symptoms as independent variables, and background variables, anxiety and depression as confounding variables. RESULTS When controlled for background variables, MHWs were statistically significantly, but only very weakly, associated with global PHQ-15 score, most of the specific typical somatization symptoms, and eye/skin and airway symptoms. When controlled also for depression and anxiety, the associations were statistically significant, but even more weakly associated with global PHQ-15 score and most of the specific symptoms. CONCLUSIONS The results suggest a very small increased risk of somatic symptom distress and related specific symptoms in MHW, and that depression and anxiety are confounding variables in these associations.
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14
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Rask CU, Gehrt TB, Rimvall MK, Frostholm L. Health Anxiety. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2020. [DOI: 10.1027/2151-2604/a000407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Health anxiety, characterized by excessive concern about one’s health, is a serious and costly public health problem. The disorder might become chronic if left untreated. Unfortunately many patients do not receive timely or proper treatment due to sparse treatment resources. Also, existing treatment programs, though effective for many, do not work for all. This paper discusses the conceptualization of health anxiety and future directions based on novel research findings. These include: (i) the content and characteristics of autobiographical memories and episodic future thoughts in severe health anxiety, (ii) related concepts such as cyberchondria with excessive Internet browsing on health issues and health anxiety by proxy, where parents display and might confer health anxiety towards their children, (iii) an epidemiological perspective on the association between health anxiety and subclinical psychotic experiences in preadolescence. Exploring these new dimensions could have important implications for the further development of preventive strategies and effective treatment.
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Affiliation(s)
- Charlotte U. Rask
- Department of Child and Adolescent Psychiatry, Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tine B. Gehrt
- Center on Autobiographical Memory Research, Aarhus University, Aarhus, Denmark
| | - Martin K. Rimvall
- Child and Adolescent Mental Health Center, Mental Health Services, Capital Region of Denmark, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Frostholm
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
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15
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Dömötör Z, Nordin S, Witthöft M, Köteles F. Modern health worries: A systematic review. J Psychosom Res 2019; 124:109781. [PMID: 31443819 DOI: 10.1016/j.jpsychores.2019.109781] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 07/17/2019] [Accepted: 07/18/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Modern health worries (MHWs) refer to people's concerns about possible harmful effects of modern technologies, and are widespread in the developed countries. The aim of the present work was to provide comprehensive, yet integrated understanding for MHWs and associated factors. METHODS Following the PRISMA guideline, a systematic review was conducted based on 48 empirical articles published between 2001 and 2018 (Prospero registration number: CRD42018103756). All empirical studies were included that (1) were published between 2001 and 2018 in peer-reviewed scientific journals in English, German, or Hungarian, (2) used the Modern Health Worries Scale or any of its sub-scales, and (3) assessed associations between MHWs and other constructs and/or compared criterion groups (i.e. purely psychometric studies were excluded). RESULTS The results from the review suggest that female gender, age, somatic symptom distress and idiopathic environmental intolerances, holistic thinking, and paranoid beliefs are positively associated with MHWs, whereas educational qualification and the five major dimensions of personality appear not to be. CONCLUSION Scientific inquiry on the MHWs phenomenon is still in its descriptive-explorative phase; more rigorously designed studies are needed. The presented theoretical framework integrates illness-related and holistic thinking-related aspects of MHWs as a starting point to guide further research in this area.
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Affiliation(s)
- Zsuzsanna Dömötör
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary.
| | | | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy and Experimental Psychopathology, Johannes Gutenberg-University of Mainz, Germany.
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Hungary.
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16
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Bilani N, Jamali S, Chahine A, Zorkot M, Homsi M, Saab M, Saab R, Nabulsi M, Chaaya M. Illness cognition and health anxiety in parents of children with cancer. J Psychosoc Oncol 2019; 37:713-728. [DOI: 10.1080/07347332.2019.1600629] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Affiliation(s)
- Nadeem Bilani
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Sarah Jamali
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | - Maya Zorkot
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mouafak Homsi
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Michael Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Raya Saab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
- Lebanon Children’s Cancer Center of Lebanon, American University of Beirut, Beirut, Lebanon
| | - Mona Nabulsi
- Department of Pediatrics and Adolescent Medicine, American University of Beirut, Beirut, Lebanon
| | - Monique Chaaya
- Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
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17
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Modern health worries: Deriving two measurement invariant short scales for cross-cultural research with Ant Colony Optimization. PLoS One 2019; 14:e0211819. [PMID: 30730928 PMCID: PMC6366774 DOI: 10.1371/journal.pone.0211819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 01/21/2019] [Indexed: 11/19/2022] Open
Abstract
Worries about possible harmful effects of new technologies (modern health worries) have intensely been investigated in the last decade. However, the comparability of translated self-report measures across countries is often problematic. This study aimed to overcome this problem by developing psychometrically sound brief versions of the widely used 25-item Modern Health Worries Scale (MHWS) suitable for multi-country use. Based on data of overall 5,176 individuals from four European countries (England, Germany, Hungary, Sweden), Ant Colony Optimization was used to identify the indicators that optimize model fit and measurement invariance across countries. Two scales were developed. A short (12-item) version of the MHWS that represents the four-factor structure of the original version and an ultra-short (4-item) scale that only measures the general construct. Both scales show that overall levels of health worries were highest in England and Hungary, but that the main reason for concern (e.g. electromagnetic radiation or food related fears) differs considerably between these countries. This study also shows that even if measurement invariance of translated self-report instruments across countries is problematic, it can be optimized by using adequate item selection procedures. Differences of modern health worries across countries and recommendations for cross-cultural research are discussed.
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18
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Cheng Q, Xie L, Hu Y, Hu J, Gao W, Lv Y, Xu Y. Gender differences in the prevalence and impact factors of hysterical tendencies in adolescents from three eastern Chinese provinces. Environ Health Prev Med 2018; 23:5. [PMID: 29415649 PMCID: PMC5803911 DOI: 10.1186/s12199-018-0695-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 01/31/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have attempted to compare the differences in the prevalence and impact factors of hysterical tendencies (HTs) in adolescents. Thus, the aim of this study was to examine gender differences in the prevalence and impact factors of adolescents' HTs across three eastern Chinese provinces (Anhui, Jiangsu, and Zhejiang). METHODS A multicenter, school-based, cross-sectional study was conducted in three provinces (Anhui, Jiangsu, and Zhejiang) in China in 2014. The sample included 10,131 middle-school students aged 13-18 years who were randomly selected using a multiphase, stratified, cluster sampling technique. A two-stage appraisal procedure was used to determine the adolescents' HTs. We also designed a multicenter, school-based, case control (1329 cases with 2661 control individuals) study to collect data on the common factors affecting this population using a common protocol and questionnaire. RESULTS An overall positive rate of HTs among adolescents across the three eastern Chinese provinces studied was found at 13.1% (95% confidence interval (CI) 12.5-13.8%), at 14.5% (95% CI 13.3-15.7%) for females, and at 12.2% (95% CI 11.1-13.4%) for males. Gender-stratified, multiple conditional regression analyses revealed that superstitious beliefs pertaining to life, somatotype, teacher-student satisfaction, and family achievement orientation were significantly linked to HTs only in males, while left-behind adolescents, emotional and social adaptation, teacher-student support, family cohesion, and the Hospital Anxiety and Depression Scale - depression scores were significantly associated with female HTs only. The models indicated that of all the independent variables studied, family medical history was the strongest impact factor for both male HTs (adjusted matched odds ratio (amOR) = 2.92, 95% CI = 1.84-4.86) and female HTs (amOR = 2.74, 95% CI = 1.59-4.98). CONCLUSIONS HTs are prevalent among adolescents in the three eastern Chinese provinces studied. Gender differences in the prevalence and impact factors of HTs are significant in adolescents, and HTs seem to affect more females than males. Therefore, sex-specific intervention programs against HTs in adolescents should be considered to reduce HT prevalence in adolescents by modifying influential social, school, and family factors.
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Affiliation(s)
- Qinglin Cheng
- Department of Adolescents and Children’s Health, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123 China
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Li Xie
- Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Yunkai Hu
- Fuyang New Rural Cooperative Medical Office, Fuyang, China
| | - Jinfeng Hu
- Shangcheng District Center for Disease Control and Prevention, Hangzhou, China
| | - Wei Gao
- Mingguang Health and Family Planning Commission, Mingguang, China
| | - Yongxiang Lv
- Jin’an District Center for Disease Control and Prevention, Lu’an, China
| | - Yong Xu
- Department of Adolescents and Children’s Health, School of Public Health, Medical College of Soochow University, Suzhou, Jiangsu 215123 China
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19
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Oliver AM, Wright KD, Kakadekar A, Pharis S, Pockett C, Bradley TJ, Tomczak CR, Erlandson MC. Health anxiety and associated constructs in children and adolescents with congenital heart disease: A CHAMPS cohort study. J Health Psychol 2018; 25:1355-1365. [PMID: 29402140 DOI: 10.1177/1359105318755263] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
This study explored health anxiety and associated constructs in children and adolescents with congenital heart disease and typically developing children and adolescents. A total of 84 participants (7-16 years) completed measures of health anxiety, intolerance of uncertainty, anxiety sensitivity, and DSM-IV anxiety disorder symptom categories. Results demonstrated that children and adolescents with congenital heart disease experienced significantly higher levels of health anxiety and associated constructs compared to typically developing children and adolescents. Our findings highlight a specific chronic physical health population who may be at risk of clinical levels of health anxiety and related psychopathology and require appropriate intervention.
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20
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Köteles F, Witthöft M. Somatosensory amplification - An old construct from a new perspective. J Psychosom Res 2017; 101:1-9. [PMID: 28867412 DOI: 10.1016/j.jpsychores.2017.07.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 10/19/2022]
Abstract
The paper reviews and summarizes the history and the development of somatosensory amplification, a construct that plays a substantial role in symptom reports. Although the association with negative affect has been supported by empirical findings, another key elements of the original concept (i.e. body hypervigilance and the tendency of focusing on mild body sensations) have never been appropriately addressed. Recent findings indicate that somatosensory amplification is connected with phenomena that do not necessarily include symptoms (e.g. modern health worries, or expectations of symptoms and medication side effects), and also with the perception of external threats. In conclusion, somatosensory amplification appears to refer to the intensification of perceived external and internal threats to the integrity of the body ("somatic threat amplification") rather than amplification of perceived or actual bodily events only. Practical implications of this new approach are also discussed.
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Affiliation(s)
- Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, ELTE Eötvös Loránd University, Bogdánfy Ödön u. 10, H-1117 Budapest, Hungary.
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21
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Thorgaard MV, Frostholm L, Rask CU. Childhood and family factors in the development of health anxiety: A systematic review. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2017.1318390] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mette Viller Thorgaard
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Lisbeth Frostholm
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark
- Centre for Child & Adolescent Psychiatry, Research Department, Aarhus University Hospital, Risskov, Denmark
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22
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Effects of maternal health anxiety on children's health complaints, emotional symptoms, and quality of life. Eur Child Adolesc Psychiatry 2017; 26:591-601. [PMID: 27909834 DOI: 10.1007/s00787-016-0927-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 11/25/2016] [Indexed: 10/20/2022]
Abstract
Little is known about family risk factors and intergenerational transmission of psychological disturbance in the development of health anxiety (HA). This study investigated HA and related concepts in 8- to 17-year-old children who had been exposed to different maternal health status. Using a family case-control design, three family groups were included: (1) 50 case children of mothers with severe (HA); (2) 49 control children of mothers with rheumatoid arthritis (RA); and (3) 51 control children of healthy mothers. Children and mothers completed a battery of standardised questionnaires. Case children reported significantly higher level of HA symptoms than children of mothers with RA but not compared to children of healthy mothers. There was no significant difference between the children's self-reports in the three groups with regard to anxiety symptoms in general, physical complaints, or quality of life. In contrast, mothers with HA reported their children as having more emotional and physical symptoms than mothers in one or both control groups. Compared to mothers with RA but not healthy mothers, mothers with HA also reported more visits to the general practitioner with their children during the past year. The findings suggest that maternal HA only weakly affects children's own report of HA and thereby may not be a strong risk factor for the development of HA symptoms in childhood. However, mothers with severe HA seem to conceive their children as more ill and present them more often in the health care system which could, therefore, be an important target for intervention in adult patients.
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23
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Szemerszky R, Dömötör Z, Berkes T, Köteles F. Attribution-Based Nocebo Effects. Perceived Effects of a Placebo Pill and a Sham Magnetic Field on Cognitive Performance and Somatic Symptoms. Int J Behav Med 2016; 23:204-13. [PMID: 26420517 DOI: 10.1007/s12529-015-9511-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Negative non-specific (nocebo-like) effects of medications and electromagnetic fields are often described as results of mistaken attribution. PURPOSE The current study aimed to find empirical evidence supporting this theory. METHOD Participants completed questionnaires assessing modern health worries, health anxiety, and somatosensory amplification, were assigned to one of three conditions (placebo pill with sedative information, sham magnetic field, or control), and completed a 14-min vigilance task. Changes in physiological arousal (heart rate, heart rate variability, and skin conductance) and reported symptoms were also measured. Finally, causal attributions concerning cognitive performance and reported symptoms were assessed. RESULTS No increase in symptom reports and physiological arousal was measured in the two intervention groups. A perceived negative effect on cognitive performance was attributed to both sham conditions, and attributions were connected to modern health worries. A proportion of reported symptoms was ascribed to the placebo pill but not to the sham magnetic field. Symptom attributions were not related to any assessed psychological variables. CONCLUSIONS An aroused physiological state is not necessary for the automatic causal attribution process. Negative effects attributed to medication and environmental factors can be regarded as unavoidable side effects of human cognitive-emotional functioning; they might be alleviated, but cannot be completely eradicated.
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Affiliation(s)
- Renáta Szemerszky
- Institute of Health Promotion and Sport Sciences, Eötvös Loránd University, Bogdánfy Ödön u. 10., Budapest, 1117, Hungary
| | - Zsuzsanna Dömötör
- Doctoral School of Psychology and Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Tímea Berkes
- Institute of Health Promotion and Sport Sciences, Eötvös Loránd University, Bogdánfy Ödön u. 10., Budapest, 1117, Hungary
| | - Ferenc Köteles
- Institute of Health Promotion and Sport Sciences, Eötvös Loránd University, Bogdánfy Ödön u. 10., Budapest, 1117, Hungary.
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24
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Palmquist E, Petrie KJ, Nordin S. Psychometric Properties and Normative Data for a Swedish Version of the Modern Health Worries Scale. Int J Behav Med 2016; 24:54-65. [PMID: 27324490 DOI: 10.1007/s12529-016-9576-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Köteles F, Simor P, Czető M, Sárog N, Szemerszky R. Modern health worries - the dark side of spirituality? Scand J Psychol 2016; 57:313-20. [DOI: 10.1111/sjop.12297] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 04/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Ferenc Köteles
- Institute of Health Promotion and Sport Sciences; Eötvös Loránd University; Budapest Hungary
| | - Péter Simor
- Department of Cognitive Sciences; Budapest University of Technology and Economics; Hungary
- Nyírő Gyula Hospital National Institute of Psychiatry and Addictions; Hungary
| | | | - Noémi Sárog
- Institute of Psychology; Eötvös Loránd University; Hungary
| | - Renáta Szemerszky
- Institute of Health Promotion and Sport Sciences; Eötvös Loránd University; Budapest Hungary
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26
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Wright KD, Reiser SJ, Delparte CA. The relationship between childhood health anxiety, parent health anxiety, and associated constructs. J Health Psychol 2015; 22:617-626. [DOI: 10.1177/1359105315610669] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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