Validation of the Hwa-Byung Scale and its relationship with cardiovascular autonomic function

Abstract

IntroductionHwa-byung (HB) is a Korean culture-related syndrome characterized as a feeling of stuffiness in the chest, hot flashes, anger and anxiety. This study validates the Hwa-byung Scale (HBS) and examines the relationship of HB with cardiovascular autonomic function. MethodThe electronic medical records of all 98 outpatients that visited the Hwa-Byung and Stress Clinic of the Kyung Hee University Oriental Medical Hospital at Gangdong were reviewed in this study. The outpatients completed the personality- and symptom-related subscales of the HBS (HBS-P, HBS-S) and to undergo heart rate variability (HRV) tests. Two neuropsychiatrists interviewed each outpatient and screened for HB. We conducted reliability and construct validity tests, and receiver operating characteristic curve analysis of the HBS-P and HBS-S. We also examined whether HBS-P and HBS-S scores were partially related to cardiovascular autonomic function, as estimated by HRV. ResultsThe HBS-S had satisfactory reliability (α=0.922) and construct validity (% of total variance=68.1%), and a suitable cut-off score (28 points). Multiple regression analysis indicated that toleration and victimization personality traits were predictive of HB (β=0.235–0.485). Further, toleration and victimization, heat-sensation- and fatigue-related items were negatively correlated with the standard deviation of R-R intervals, root of the mean squared differences of successive R-R intervals, total power, very low frequency, low frequency, and low-frequency/high-frequency ratio (−0.305<r<−0.207). ConclusionsIt appears that the HBS-S is a reliable and valid screening tool for HB, and that HB may be partially related to decreased cardiovascular autonomic function.