Health Anxiety in Medically Vulnerable Canadians During Covid-19

This investigation examined attentional biases for illness-related information in persons varying in their degree of health anxiety (HA). Consistent with cognitive behavioural conceptualizations, it was hypothesized that individuals with high HA would be more likely than those with lower levels to exhibit attentional biases to illness-related information when tested using a modified Stroop colour-naming task. Participants were 26 individuals with each of high, medium, and low HA as assessed using the Illness Attitudes Scale (R. Kellner, P. Abbott, W. W. Winslow, & D. Pathak, 1987). Results indicated that participants with high HA, compared to those with lower levels of HA, selectively attend to illness-related but not other categories of emotionally laden stimuli. These findings, indicative of an attentional bias for illness-related cues in high HA, are discussed in the context of cognitive behavioural conceptualizations of HA. Future research directions are outlined.

Do people with and without medical conditions respond similarly to the Short Health Anxiety Inventory? An assessment of differential item functioning using item response theory

The coronavirus disease 2019 (COVID-19) pandemic subjected the global population to a situation that aroused disproportionate Health Anxiety (HA). However, this association has not been explored in a systematic review or meta-analysis. The aim of this systematic review was to assess the prevalence and determining factors of HA in the general adult population during the COVID-19 pandemic. A systematic search was conducted across the databases MEDLINE, PsychINFO, Embase and Web of Science. Observational studies using the 18-item Short Health Anxiety Inventory to measure HA during the pandemic were included. A narrative synthesis and meta-analysis summarised HA levels in the general adult population, subgroups and by associated factors. Out of 4088 studies, 12 met the inclusion criteria. Meta-analyses revealed a mean HA score of 15.16 (SE = 0.415). Significantly higher HA levels were observed among females, unmarried individuals, and those with pre-existing health conditions. The HA score of 15.16 suggests elevated HA during the COVID-19 pandemic compared to pre-pandemic studies. Understanding which groups may be more affected by HA during pandemics and health crises will enable us to develop more tailored public health strategies to mitigate the psychological effects of future public health crises. Further research is needed to establish causal and longitudinal relationships.

Purpose To explore the prevalence of health anxiety in stroke survivors and its relative impact on quality of life. Materials and methods A cross-sectional design was used including between group comparisons of high and low health anxious stroke survivors. Stroke survivors (n = 105) were recruited via online stroke community forums. Participants completed measures of health anxiety (Short Health Anxiety Inventory), general anxiety and depression (Hospital and Anxiety and Depression Scale), disability (WHO Disability Assessment Schedule), and quality of life (Quality of Life Index). Demographics and medical histories were also assessed. Results Thirty percent of the sample scored above the clinical cut off for health anxiety. Stroke survivors with high health anxiety (HiHA) were found to have significantly lower quality of life (p < 0.001) and higher rates of depression (p < 0.001). Regression analysis found health anxiety to be a significant predictor of quality of life (β = –0.12; p < 0.05) in addition to levels of depression (β = –0.33; p < 0.001) and disability (β = –0.53; p < 0.001). Conclusions Almost a third of stroke survivors were experiencing clinical levels of health anxiety, with HiHA significantly associated with lower quality of life. Future research should explore the use of existing evidence based psychological interventions for health anxiety in this population. Implications for rehabilitation Our findings suggest almost one in three stroke survivors residing in the community have clinical levels of health anxiety. High health anxiety in stroke survivors was significantly related to lower levels of quality of life. Given this finding, evidence-based treatments for health anxiety may improve quality of life and reduce distress for a significant proportion of stroke survivors. Rehabilitation approaches aimed at improving overall quality of life for stroke survivors should consider both physical and psychological interventions, with levels of physical disability, depression and anxiety all significantly associated with quality of life.

Transdiagnostic, internet-delivered cognitive behavior therapy for depression and anxiety: Exploring impact on health anxiety

Drug recalls and lawsuits against pharmaceutical manufacturers are accompanied by announcements emphasizing harmful drug side-effects. Those with elevated health anxiety may be more reactive to such announcements. We evaluated whether health anxiety and financial incentives affect subjective symptom endorsement, and objective outcomes of cognitive and physiological functioning during a mock drug recall. Hundred and sixty-one participants reported use of over-the-counter pain medications and presented with a fictitious medication recall via a mock Food and Drug Administration (FDA) website. The opportunity to join a class-action lawsuit was manipulated. We assessed health anxiety, recalled drug usage, blood pressure, heart rate, and performance on a computerized Trail Making Test (TMT). Symptom endorsement was strongly predicted by health anxiety. When combined, three health anxiety measures explained 28.5% variance (Cohen’s d = 1.26). These effects remain strong after controlling for depression and anxiety. Litigation condition did not predict symptom endorsement. Blood pressure and heart rate were modestly predicted by health anxiety, but not by litigation condition. TMT performance was consistently predicted by health anxiety, with higher scores associated with poorer performance. Although there were no main effects for litigation, interactions consistently emerged for the TMT, with generally poorer performance for those with higher health anxiety in the non-litigation condition; whereas health anxiety was unrelated to performance for the litigation condition. All but one participant joined the litigation when given the opportunity, despite a healthy sample and minimal use of pain medication. Subsequent data from 67 individuals with no mention of the FDA scenario or litigation showed that health anxiety still significantly predicts symptom endorsement (12.6% variance), but the explained variance is less than half that obtained in the FDA scenario. The findings suggest that health anxiety plays a significant role in adverse symptom reporting, beyond anxiety or depression, and this effect is independent of the presence of the FDA recall. The lack of differences for health anxiety and symptom endorsement between litigation and non-litigation conditions rules out malingering. Although it is general practice in drug recalls to list potential adverse side effects caused by medications, this may elicit unintended symptom experiences and health anxious individuals may be more susceptible.

According to cognitive-behavioural theories, attentional biases, especially increased symptom-focused attention, are crucial for the maintenance of health anxiety. Therefore, the attention training technique (ATT) seems to be a promising approach in reducing body-focused attention and hypochondriacal fears in people with high health anxiety. However, previous research has never implemented ATT on its own but always in combination with psychoeducation. The present study experimentally investigates the isolated impact of ATT on self-reported body-focused attention, health anxiety, and attentional bias towards health threatening stimuli. Fifty-four students with elevated health anxiety were randomised into the following conditions: attention training group (ATG), which received ATT; ATGbody, which received a variation of ATT that focused on training attention towards the body; and a control group without intervention. The ATG and ATGbody spent 1 week actively practicing the trainings. Before and after the training phase, we assessed the self-report measures, and attentional bias by using the Emotional Stroop Task. The ATG displayed no effects on self-report measures of body-focused attention or health anxiety. Against our expectations, the ATGbody experienced a significant decrease in the attentional bias (p = .001, Cohen’s d = 0.93). Attention training towards the body in people with elevated health anxiety might, therefore, be beneficial in reducing illness-related attentional bias.

BackgroundUnderstanding the relationship between digital health literacy and health anxiety is increasingly important in the context of digitised health information environments.ObjectivesThe aim of the study was to describe the levels of digital health literacy and health anxiety among Hungarian adults, and to investigate the background factors influencing both.MethodsA total of 314 participants aged 18 years and older completed an online questionnaire. The survey included the eHealth Literacy Scale (eHEALS), the Short Health Anxiety Inventory (SHAI) and a health self-report item from the Hungarian National Health Interview Survey. Descriptive statistics, analysis of variance (ANOVA), independent samples t-tests, Cohen's d, Pearson and Spearman correlations and a significance threshold of p < 0.05 were used.ResultsWomen reported significantly higher health anxiety scores than men (34.8 vs. 33.0; p < 0.005), especially for the subscale ‘perceived likelihood of getting sick’. The strongest gender difference occurred in the 35-64 age group. Health anxiety increased with age, with the highest scores recorded in the 65+ age group (p = 0.008). Self-rated health was strongly correlated with health anxiety: individuals who rated their health as ‘poor’ scored ∼44 points on the SHAI, while those who rated their health as ‘excellent’ scored ∼30 points (ρ = 0.39; p < 0.001). The mean eHEALS score was 30.2 (SD = 6.3). A significant negative correlation was found between digital health literacy and health anxiety (ρ = -0.18; p = 0.001), suggesting that higher digital health literacy was associated with lower health anxiety.ConclusionsAlthough weak, the association between digital health literacy and health anxiety is statistically significant, particularly when comparing extreme groups. Women, older adults and those with poorer self-rated health tended to report higher health anxiety.Key messages• Higher digital health literacy may serve as a protective factor against health anxiety, although the association is weak and influenced by individual characteristics.• Women, older adults and those with poorer self-rated health are?particularly susceptible to increased health anxiety, highlighting the need for targeted mental and digital health promotion.

Background. A previous study suggests that health anxiety, or preoccupation and fears about ill health, is elevated during pregnancy. However, replication of this result is needed given several methodological weaknesses of the previous research. The current study refined earlier work by assessing health anxiety using two distinct measures and comparing scores to a control group and to established norms for healthy controls. The relationship of health anxiety to background variables such as parity and pregnancy complications was also explored.Methods. A total of 252 women in the third trimester of pregnancy and 45 similarly aged non-pregnant women completed the Illness Attitudes Scale (IAS) and the newly developed Short Health Anxiety Inventory (SHAI).Results. Compared to the non-pregnant sample and established scores for healthy controls, health anxiety was not elevated during pregnancy. Health anxiety was higher in women who experienced complications during pregnancy but was unrelated to other background variables. The IAS identified more individuals as health anxious than the SHAI.Conclusions. Contrary to previous research, health anxiety was not elevated during pregnancy. The IAS appeared to be susceptible to identifying women as health anxious due to greater health care utilization by pregnant women rather than higher health anxiety. Clinical recommendations and future directions for the assessment of health anxiety are outlined.

Background: Health anxiety and medically unexplained somatic distress(MSD)are common among medical students and may vary by demographic, academic, and psychosocial factors. This study examined the relationships between health anxiety, MSD, and academic performance across different stages of medical training. Methods: A cross-sectional study was conducted among 403 medical students using the Short Health Anxiety Inventory (SHAI-18) and standardized MSD measures. Associations with demographic variables, academic year, and grade point average (GPA) were analyzed using comparative statistics and Pearson correlation. Results: Health anxiety and MSD perception and distress were highest in early academic years and declined significantly with progression through medical training. Female sex, marital status, academic year, and lower academic performance were associated with higher health anxiety, although effect sizes were small. GPA showed very weak negative correlations with SHAI-18 (r = 0.017) and MSD scores (r = 0.158), indicating limited practical relevance. In contrast, SHAI-18 and MSD scores demonstrated a moderate positive correlation (r = 0.330, p &lt; 0.001), suggesting a meaningful association between illness-related anxiety and somatic distress. Conclusion: Health anxiety and MSD symptoms are most pronounced in early years and decline with advancing training, while the strong link between health anxiety and MSD highlights the need for targeted psychological interventions. Early, curriculum-integrated mental health support is recommended to mitigate illness anxiety and somatic distress during medical education.

Objectives Prevalence of health anxiety is highly varied based on different settings and samples studied. This study aimed to assess the prevalence of health anxiety among outpatients attending neurology and psychiatry outpatient setting in tertiary care hospital and understand the clinical correlates.Participants and Methods This was a cross-sectional study conducted in the outpatient settings including participants fulfilling study criteria. The assessments included semi-structured proforma for demographic and clinical details, general hypochondriasis subscale of Illness Behavior Questionnaire, and Short Health Anxiety Inventory. Data were collected in Epi-info and data analysis was done using STATA12.Results The health anxiety was reported to be 25% and 19% among psychiatry and neurology outpatients, respectively. Higher education level positively correlated with health anxiety. Skilled workers tend to have higher health anxiety than semiskilled workers. Patients with diagnosis of somatoform disorder and multiple diagnosis scored higher on health anxiety in both the settings.Conclusion Health anxiety appears to be common in psychiatry and neurology settings and needs further evaluation to understand its impact on consultation and health resource usages.

The Short Health Anxiety Inventory: A systematic review and meta-analysis

Health anxiety (HA) is an overlooked area in paediatric research. Little is known about the occurrence of HA symptoms in a child and adolescent psychiatric setting, and there are no age-appropriate diagnostic criteria and only limited number of assessment tools. It is therefore likely that HA is seen as part of obsessive-compulsive disorder (OCD) due to construct overlap and the diagnostic uncertainty of HA in this age group. In the present study, the extent of HA symptoms was investigated in 94 children and adolescents with a primary ICD-10 diagnosis of OCD. Self-reported HA symptoms were assessed using the Childhood Illness Attitude Scales. Clinician-rated OCD symptoms and severity were measured using the Children's Yale Brown Obsessive Compulsive Scale. Information on socio-demographics was obtained from the child's/adolescent's medical record. The distribution of HA symptoms resembled a normal curve shifted to the right compared with a normal population of Danish children, and 30% presented with high HA symptoms. Chi-squared tests were used to examine the proportion of children and adolescents with high HA symptoms in relation to various clinical characteristics. Clinician-rated illness worries and comorbid anxiety disorder were associated with high self-reported HA symptoms. The results contribute to the understanding of how HA and OCD overlap conceptually in young patients and bring attention to the need for improved recognition of OCD patients dominated by illness worries. Further research in the description of childhood HA is important in order to understand whether HA is a distinct disorder early in life.

BackgroundHealth anxiety among adolescents is understudied yet concerning. Health-related internet use (HRIU) is a common coping strategy, but disconcerting content may heighten, rather than mitigate, the health anxiety. While research has been conducted, within-person evidence for long-term fluctuations is lacking. Furthermore, adolescents with different base-level (initial) health anxiety may react differently to health-related content, making the effect dependent on health anxiety level compared to others.ObjectiveThis study focused on the longitudinal relationship between HRIU and health anxiety on the within-person level in adolescents. We also considered their initial health anxiety, comparing adolescents with low, medium, and high base-level health anxiety.MethodsWe analyzed data from 2500 Czech adolescents, aged 11-16 years (mean 13.43, SD 1.69 years; 1250/2500, 50% girls in Wave 1). Health anxiety was measured by the affective subscale of the Multidimensional Inventory of Hypochondriacal Traits, and HRIU was captured by 6 items reflecting health-related behaviors (eg, reading articles or watching videos with health-related content). The level of health anxiety in Wave 1 also served as a grouping factor. The data were collected in 3 waves, 6 months apart from June 2021 to June 2022, and analyzed using a random intercept cross-lagged panel model, chosen for its ability to separate within- and between-person effects.ResultsOn the between-person level, adolescents with higher base-level health anxiety were more frequent health-related internet users (β=.52; P<.001). On the within-person level, change in health anxiety did not predict change in HRIU, or vice versa, for those with high base-level health anxiety. In contrast, for adolescents with medium health anxiety, change in HRIU positively predicted health anxiety with large effects across all waves (β=.16; P=.03 from Wave 1 to Wave 2; β=.18; P=.01 from Wave 2 to Wave 3), and increase in health anxiety affected HRIU from Wave 2 to Wave 3 (β=.15; P=.03). For adolescents with low base-level health anxiety, change in their HRIU had large positive effect on changes in health anxiety from Wave 1 to Wave 2 (β=.17; P<.001), and health anxiety positively affected HRIU with medium effect from Wave 2 to Wave 3 (β=.11; P=.03).ConclusionsAdolescents with lower, rather than high, health anxiety are susceptible to the negative long-term effects of HRIU. For adolescents with high health anxiety, HRIU neither worsens nor relieves health anxiety over time, suggesting that counselors should recommend other coping strategies besides HRIU. Adolescents with medium to low health anxiety should be guided toward mindful HRIU to prevent increased health anxiety after HRIU. This includes fostering eHealth literacy (eg, recognizing personally irrelevant information and awareness of sensationalism in media) and coping mechanisms (eg, time or topic limits, or intentional rather than compulsive searching).

The aim of this study is to assess clinical correlates and prevalence of health anxiety in psychiatry and neurology outpatient clinic. A Prospective study was carried out at Neurology and psychiatry Department of Nishtar Medical Hospital from July 2020 to July 2021. Demographic data, clinical symptoms, comorbidities and diagnosis was recorded. Patients were given general hypochondriasis subscale of Illness Behavior Questionnaire and Short Health Anxiety Inventory (SHAI). Epi-info 7.013 was used for data entry and Stata 12.14 was used for data analysis. The prevalence of health anxiety in neurology and psychiatry was 18% and 26%, and overall prevalence was 21%. Higher health anxiety was reported in subjects with higher education, it may be due to increased awareness about illness. Health anxiety was higher in skilled workers as compared to semi skilled. The health anxiety was higher in subjects with more than one diagnosis as compared to those with single diagnosis Health anxiety is common in neurology and psychiatry settings. Further evaluation is needed to evaluate its effects on health consultation.