Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates

Lebel, Sophie; Mutsaers, Brittany; Tomei, Christina; Leclair, Caroline Séguin; Jones, Georden; Petricone-Westwood, Danielle; Rutkowski, Nicole; Ta, Viviane; Trudel, Geneviève; Laflamme, Simone Zofia; Lavigne, Andrée-Anne; Dinkel, Andreas

doi:10.1371/journal.pone.0234124

Cited by 107 publications

(83 citation statements)

References 278 publications

(370 reference statements)

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“…Therefore, given these findings, it can be suggested that HA, unlike other constructs, may show characteristics of both transient distress and psychopathology depending on the level of effect on self-concept. In contrast, a recent review on the correlates of FCR found that this concept was on the whole rather stable, or perhaps could initially decrease then stabilize (Lebel et al, 2020). Worry was uniquely related to the theoretical attribute of self-focused attention.…”

Section: Overview Of Unique Attributesmentioning

confidence: 79%

“…Finally, one trigger, unmet information needs, was identified in both FCR and uncertainty and is consistent with the literature. Insufficient and inaccurate information about cancer prognosis and recurrence risks are known to contribute to fear and uncertainty among breast cancer survivors (Lebel et al, 2014(Lebel et al, , 2018(Lebel et al, , 2020.…”

Section: Overlapping Attributesmentioning

confidence: 99%

“…In part, this practice reflects a lack of clarity on their categorical distinctions. For example, health anxiety has been used to describe the fear and worry in response to living with a chronic illness (Asmundson et al, 2010;Lebel et al, 2020); similarly, fear and worry have also been used to characterize FCR (Lebel et al, 2016b). To further muddle the distinctions among these four constructs, uncertainty in illness has been defined as the phenomenological experience of anxiety arising from unpredictable real or unreal health issues (Grupe and Nitschke, 2013), using terms often found in the other studied constructs.…”

Section: Introductionmentioning

confidence: 99%

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Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research

et al. 2021

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Objective: Fear of Cancer Recurrence (FCR), Health Anxiety (HA), worry, and uncertainty in illness are psychological concerns commonly faced by cancer patients. In survivorship research, these similar, yet different constructs are frequently used interchangeably and multiple instruments are used in to measure them. The lack of clear and consistent conceptualization and measurement can lead to diverse or contradictory interpretations. The purpose of this scoping review was to review, compare, and analyze the current conceptualization and measurements used for FCR, HA, worry, and uncertainty in the breast cancer survivorship literature to improve research and practice.Inclusion Criteria: We considered quantitative, qualitative, and mixed methods studies of breast cancer survivors that examined FCR, HA, worry, or uncertainty in illness as a main topic and included a definition or assessment of the constructs.Methods and Analysis: The six-staged framework was used to guide the scoping review process. Searches of PubMed, CINAHL, and PsycINFO databases were conducted. The principle-based qualitative analysis and simultaneous content analysis procedures were employed to synthesize and map the findings.Findings: After duplicate removal, the search revealed 3,299 articles, of which 82 studies met the inclusion criteria. Several critical attributes overlapped the four constructs, for example, all were triggered by internal somatic and external cues. However, several unique attributes were found (e.g., a sense of loss of security in the body is observed only among survivors experiencing FCR). Overall, findings showed that FCR and uncertainty in illness are more likely to be triggered by cancer-specific factors, while worry and HA have more trait-like in terms of characteristics, theoretical features, and correlates. We found that the measures used to assess each construct were on par with their intended constructs. Eighteen approaches were used to measure FCR, 15 for HA, 8 for worry, and 4 for uncertainty.Conclusion: While consensus on the conceptualization and measurement of the four constructs has not yet been reached, this scoping review identifies key similarities and differences to aid in their selection and measurement. Considering the observed overlap between the four studied constructs, further research delineating the unique attributes for each construct is warranted.

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Section: Overview Of Unique Attributesmentioning

confidence: 79%

Section: Overlapping Attributesmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research

et al. 2021

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“…Fear of progression (FoP) is a common experience for people with chronic illness. 53 , 54 The current FCR definition 1 refers not only to fear of recurrence experienced by cancer survivors with no evidence of disease but also to FoP experienced by patients with active cancer. One of the arguments for this broad definition has been that the distinction between “patients” and “survivors” is far from clear-cut, not only in the clinical oncology setting, but also in how people diagnosed with cancer view themselves.…”

Section: Resultsmentioning

confidence: 99%

Spotlight on the Fear of Cancer Recurrence Inventory (FCRI)

Smith¹,

Costa²,

Galica³

et al. 2020

PRBM

Self Cite

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Fear of cancer recurrence (FCR) is a pervasive concern for people living with cancer. The rapidly expanding FCR literature has been weakened somewhat by use of miscellaneous FCR measures of varying quality. The Fear of Cancer Recurrence Inventory (FCRI) has been widely used in observational and intervention studies and the FCRI severity subscale, also known as the FCRI-Short Form (FCRI-SF), is often used to identify potential cases of clinically significant FCR. Given the FCRI’s increasing use in research and clinical practice, we aimed to provide an overview, critique, and suggested improvements of the FCRI. Studies citing the original FCRI validation paper were identified and synthesised using narrative and meta-analytic methods. The 42-item FCRI has demonstrated a reasonably robust 7-factor structure across evaluations in multiple languages, although certain subscales (eg, Coping) demonstrate sub-optimal reliability. Confirmation of the cross-cultural equivalence of several FCRI translations is needed. Meta-analysis of FCRI-SF scores revealed a combined weighted mean score of 15.7/36, a little above the lowest proposed cut-off score (≥13) for clinical FCR. Depending on the FCRI-SF cut-off used, between 30.0% and 53.9% of the cancer population (ie, patients and survivors) appear to experience sub-clinical or clinical FCR. Higher FCRI scores were associated with younger age and female gender, pain/physical symptoms and psychological morbidity, consistent with the FCR literature generally. Issues regarding the application and interpretation of the FCRI remain. Whether the FCRI is well suited to assessing fear of progression as well as recurrence is unclear, the meaningfulness of the FCRI total score is debatable, and the use of the FCRI-SF to screen for clinical FCR is problematic, as items do not reflect established characteristics of clinical FCR. Refinement of the FCRI is needed for it to remain a key FCR assessment tool in future research and clinical practice.

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“…However, this response is exacerbated in vulnerable groups, in whom perceived life threat is known to be associated with negative mental health outcomes during epidemics (23). Persons with chronic disease often live with health‐related anxiety in general (24), and the threat of COVID‐19 infection has the potential to exacerbate this anxiety. According to the CDC, persons taking immunosuppressant medication (such as many patients with autoimmune diseases) might be at increased risk of severe illness from COVID‐19 infection (19).…”

Section: Methodsmentioning

confidence: 99%

Exploring the Mental Health Needs of Persons With Autoimmune Diseases During the Coronavirus Disease 2019 Pandemic: A Proposed Framework for Future Research and Clinical Care

Bingham

Rozenbojm

Chong-East³

et al. 2020

ACR Open Rheumatology

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Although the coronavirus disease 2019 (COVID‐19) pandemic has been associated with increased psychological distress globally, it poses unique challenges to persons who are potentially more vulnerable to its effects, including patients with autoimmune disease. In this article, we review the published literature and media reports to determine factors that may contribute to mental health challenges in persons with autoimmune disease. We then explore existing mental health interventions that have been developed for use in COVID‐19 and in patients with autoimmune disorders in general. We identified several potential contributors to psychological distress in patients with autoimmune disease during the pandemic, as follows: feelings of discrimination related to societal response to COVID‐19, fear of infection and uncertainty related to immunosuppressive medication, diminished access to usual care and resources, previous health‐related trauma, and the exacerbating effect of social isolation. Drawing from existing literature, we synthesize the identified evidence to develop a proposed framework for researching and managing mental health challenges in autoimmune disease during the pandemic and its aftermath.

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Health anxiety and illness-related fears across diverse chronic illnesses: A systematic review on conceptualization, measurement, prevalence, course, and correlates

Cited by 107 publications

References 278 publications

Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research

Fear of Cancer Recurrence, Health Anxiety, Worry, and Uncertainty: A Scoping Review About Their Conceptualization and Measurement Within Breast Cancer Survivorship Research

Spotlight on the Fear of Cancer Recurrence Inventory (FCRI)

Exploring the Mental Health Needs of Persons With Autoimmune Diseases During the Coronavirus Disease 2019 Pandemic: A Proposed Framework for Future Research and Clinical Care

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