Nicole M. Alberts

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

INTRODUCTION The Short Health Anxiety Inventory (SHAI) measures health anxiety in medical and non-medical contexts. OBJECTIVE To review the literature pertaining to the psychometric properties of the SHAI in non-clinical, clinical, and medical samples. Meta-analysis was also conducted to examine the strength of associations between the SHAI and other constructs. METHODS Direct search of digital databases for papers that cited the original SHAI publication. RESULTS Seventy-eight papers were identified, with 42 providing relevant information. The SHAI has acceptable Cronbachs alpha scores, strong construct validity, and is sensitive to treatment. Discrepancies have been observed between the findings of factor analytic studies, largely as a result of varying methods used. Overall, there appears to be greatest support for the original two factors, with one factor assessing health anxiety and one factor assessing negative consequences of illness. As expected, individuals with hypochondriasis score higher as compared to non-clinical samples. The strongest association was observed between the SHAI and other measures of health anxiety, followed by measures related to health anxiety vulnerability, and then general anxiety and worry. CONCLUSIONS The SHAI is a psychometrically sound tool for assessing health anxiety across samples. Future studies are needed, however, to assess test-retest reliability, incremental validity, and cut-off scores as well as use of the SHAI among diverse samples.

Health anxiety: comparison of the latent structure in medical and non-medical samples.

The Short Health Anxiety Inventory (SHAI; Salkovskis, Rimes, Warwick, & Clark, 2002) is a self-report measure designed to assess health anxiety in both medical and non-medical samples. The invariance of the factor structure across these samples has not been examined in the 14-item version of the SHAI. In the current study, the SHAI was completed by a community sample with no serious medical conditions (n=232) and a medical sample with multiple sclerosis (n=245). Factor analysis implied the same two-factor solution for both samples, with the two factors labelled: (1) Thought Intrusion, and (2) Fear of Illness. Item loadings were invariant across the medical and non-medical samples, but the two factors were more strongly correlated in the non-medical sample. Implications of the findings as well as directions for future research are discussed.

Parental illness, attachment dimensions, and health beliefs: testing the cognitive-behavioural and interpersonal models of health anxiety

The cognitive-behavioral and interpersonal models of health anxiety propose that parental illness could be a contributory factor to the development of health anxiety but through different mechanisms. The cognitive-behavioral model suggests that exposure to parental illness may lead to health beliefs that could increase health anxiety. In contrast, the interpersonal model proposes that parental illness may contribute to the development of an insecure attachment pattern and consequently health anxiety. To assess the additive value of the models, 116 emerging adults (i.e. aged 18–25) who had a parent diagnosed with a serious medical illness (e.g. cancer, multiple sclerosis) completed measures of health anxiety, adult attachment dimensions, and health beliefs. Attachment anxiety, attachment avoidance, health beliefs, and death of the ill parent were statistically significant predictors of health anxiety. The results provide support for both models of health anxiety. Theoretical implications and directions for future research are discussed.

Cultural Self-Efficacy of Canadian Nursing Students Caring for Aboriginal Patients with Diabetes

Cultural self-efficacy refers to how capable one feels functioning in culturally diverse situations. The purpose of this study was to gain a better understanding of cultural self-efficacy among nursing students, specifically in relation to individuals of Aboriginal ancestry. The authors examined the extent to which intercultural anxiety, intercultural communication, and experience with persons of Aboriginal ancestry predicted two aspects of cultural self-efficacy, namely, knowledge and skills. In this correlational study, non-Aboriginal Canadian nursing students (N = 59) completed a survey assessing these variables. Overall, cultural self-efficacy was rated as moderate by nursing students. Regression analyses indicated that greater intercultural communication skills and experience with persons of Aboriginal ancestry were significant unique predictors of higher cultural knowledge self-efficacy. Greater intercultural communication and lower intercultural anxiety significantly predicted higher cultural skills self-efficacy. The results provide direction to nursing programs interested in facilitating higher levels of cultural self-efficacy among nursing students.

Examination of an Internet-Delivered Cognitive Behavioural Pain Management Course for Adults with Fibromyalgia: A Randomized Controlled Trial.

Abstract Fibromyalgia (FM) is a common and often debilitating chronic pain condition. Research shows that symptoms of depression and anxiety are present in up to 3 quarters of individuals with FM. Of concern, most adults with FM cannot access traditional face-to-face cognitive behavioural pain management programs, which are known to be beneficial. Given known difficulties with treatment access, the present study sought to explore the efficacy and acceptability of a previously developed Internet-delivered cognitive behavioural pain management course, the Pain Course, for adults with FM. The five-lesson course was delivered over 8 weeks and was provided with brief weekly contact, via telephone and secure email, with a guide throughout the course. Participants were randomized either to the Pain Course (n = 30) or to a waiting-list control group (n = 30). Symptoms were assessed at pre-treatment, post-treatment and 4-week follow-up. Completion rates (87%) and satisfaction ratings (86%) were high. Improvements were significantly greater in treatment group participants compared to waiting-list group participants on measures of FM (Cohens d = 0.70; 18% reduction), depression (Cohens d = 0.63-0.72; 20%-28% reduction), pain (Cohens d = 0.87; 11% improvement) and fear of pain (Cohens d = 1.61; 12% improvement). Smaller effects were also observed on measures of generalized anxiety and physical health. The changes were maintained at 4-week follow-up. The current findings add to existing literature and highlight the specific potential of Internet-delivered cognitive behavioural pain management programs for adults with FM, especially as a part of stepped-care models of care. Future research directions are described.

Dementia anxiety among older adult caregivers: an exploratory study of older adult caregivers in Canada

BACKGROUND Although caring for individuals with dementia is known to result in increased burden and depression among caregivers, little research has investigated caregivers anxiety or concern about eventually developing dementia themselves (i.e. dementia anxiety). Existing research reports mixed findings regarding variables (e.g. relationship to care recipient, sex, education) that predict dementia anxiety among caregivers and non-caregivers. Potential relationships among burden, depression and dementia anxiety have not been extensively examined. The present study explored caregiver and care recipient factors as predictors of dementia anxiety in older adult caregivers. METHODS A sample of 116 older adult caregivers answered demographic/background questions and completed a series of self-report measures assessing dementia anxiety, caregiver burden, depression, and the physical disability of the care recipient. RESULTS The majority of caregivers were female, Caucasian, and reported caring for a spouse. Analyses revealed that background variables were generally not related to dementia anxiety, while depression and caregiver burden were significantly associated. Using linear regression analysis, it was found that a diagnosis of dementia in the care recipient and caregiver depression were both significant predictors of caregiver dementia anxiety. CONCLUSION Health care providers should be aware that dementia anxiety is associated with caring for individuals with dementia as well as with depression. Dementia anxiety may place additional strain on caregivers of individuals who have dementia and are suffering from depression and thus should be the focus of future research.

Internet-delivered cognitive-behaviour therapy for recent cancer survivors: a feasibility trial.

An important subset of individuals experience clinical levels of anxiety and depression following cancer treatment [1]. Psychological treatments such as cognitivebehaviour therapy (CBT) result in large reductions in anxiety and depression among cancer patients and survivors [2]. Numerous barriers to treatment have been identified (e.g., cost, stigma and distance from providers), however, less than half of patients receive psychological treatment [3]. Internet-delivered CBT (ICBT) programs employ the same principles as face-to-face CBT but are administered via a computer and the internet. There is now a considerable body of research showing ICBT is efficacious for treating depression and anxiety [4], but most studies focus on single disorders and have not examined use with cancer survivors. Transdiagnostic treatments are designed to simultaneously treat symptoms of both depression and anxiety [5]. The potential of transdiagnostic ICBT for cancer survivors is considerable given the frequent co-morbidity of depression and anxiety and their association with poorer quality of life [6]. The present feasibility study explored an ICBT program for cancer survivors experiencing symptoms of anxiety or depression. It was hypothesized that participants would report: (a) significant improvements in symptoms of depression, anxiety, quality of life, pain and fatigue and (b) high levels of satisfaction with the program.

Linking Illness in Parents to Health Anxiety in Offspring: Do Beliefs about Health Play a Role?

BACKGROUND The cognitive behavioural (CB) model of health anxiety proposes parental illness leads to elevated health anxiety in offspring by promoting the acquisition of specific health beliefs (e.g. overestimation of the likelihood of illness). AIMS Our study tested this central tenet of the CB model. METHOD Participants were 444 emerging adults (18-25-years-old) who completed online measures and were categorized into those with healthy parents (n = 328) or seriously ill parents (n = 116). RESULTS Small (d = .21), but significant, elevations in health anxiety, and small to medium (d = .40) elevations in beliefs about the likelihood of illness were found among those with ill vs. healthy parents. Mediation analyses indicated the relationship between parental illness and health anxiety was mediated by beliefs regarding the likelihood of future illness. CONCLUSIONS Our study incrementally advances knowledge by testing and supporting a central proposition of the CB model. The findings add further specificity to the CB model by highlighting the importance of a specific health belief as a central contributor to health anxiety among offspring with a history of serious parental illness.

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

OBJECTIVE Individuals with medical conditions are likely to have elevated health anxiety; however, research has not demonstrated how medical status impacts response patterns on health anxiety measures. Measurement bias can undermine the validity of a questionnaire by overestimating or underestimating scores in groups of individuals. We investigated whether the Short Health Anxiety Inventory (SHAI), a widely-used measure of health anxiety, exhibits medical condition-based bias on item and subscale levels, and whether the SHAI subscales adequately assess the health anxiety continuum. METHODS Data were from 963 individuals with diabetes, breast cancer, or multiple sclerosis, and 372 healthy individuals. Mantel-Haenszel tests and item characteristic curves were used to classify the severity of item-level differential item functioning in all three medical groups compared to the healthy group. Test characteristic curves were used to assess scale-level differential item functioning and whether the SHAI subscales adequately assess the health anxiety continuum. RESULTS Nine out of 14 items exhibited differential item functioning. Two items exhibited differential item functioning in all medical groups compared to the healthy group. In both Thought Intrusion and Fear of Illness subscales, differential item functioning was associated with mildly deflated scores in medical groups with very high levels of the latent traits. Fear of Illness items poorly discriminated between individuals with low and very low levels of the latent trait. CONCLUSIONS While individuals with medical conditions may respond differentially to some items, clinicians and researchers can confidently use the SHAI with a variety of medical populations without concern of significant bias.

Factors influencing risk-based care of the childhood cancer survivor in the 21st century

The population of adult survivors of childhood cancer continues to grow as survival rates improve. Although it is well established that these survivors experience various complications and comorbidities related to their malignancy and treatment, this risk is modified by many factors that are not directly linked to their cancer history. Research evaluating the influence of patient‐specific demographic and genetic factors, premorbid and comorbid conditions, health behaviors, and aging has identified additional risk factors that influence cancer treatment‐related toxicity and possible targets for intervention in this population. Furthermore, although current long‐term follow‐up guidelines comprehensively address specific therapy‐related risks and provide screening recommendations, the risk profile of the population continues to evolve with ongoing modification of treatment strategies and the emergence of novel therapeutics. To address the multifactorial modifiers of cancer treatment‐related health risk and evolving treatment approaches, a patient‐centered and risk‐adapted approach to care that often requires a multidisciplinary team approach, including medical and behavioral providers, is necessary for this population. CA Cancer J Clin 2018;68:133‐152.