Health anxiety by proxy – through the eyes of the parents

Ingeman, Katrine; Hulgaard, Ditte Roth; Rask, Charlotte Ulrikka

doi:10.1177/13674935221095648

Cited by 7 publications

(2 citation statements)

References 45 publications

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“…HA by proxy is a novel research area where much still remains to be investigated. Recent studies suggest that parents experiencing this type of anxiety struggle with how to cope with their health-related worries about their child [ 4 ]. When a parent directs special attention toward bodily symptoms and demonstrates health worries regarding their child, research suggests negative consequences for the child, such as negative illness perception and maladaptive symptom coping [ 5 , 6 , 67 , 68 ].…”

Section: Discussionmentioning

confidence: 99%

“…A recent qualitative study investigating the lived experiences of parents with HA by proxy found that these parents experience significant distress as a result of their anxiety, and they struggle with finding the right balance in worrying about their child’s health [ 4 ]. Furthermore, the parent’s relationships with their child, other parent, and health professionals are affected [ 4 ].…”

Section: Introductionmentioning

confidence: 99%

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Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study

Ingeman,

Frostholm,

Wellnitz

et al. 2023

JMIR Res Protoc

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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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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study

Ingeman,

Frostholm,

Wellnitz

et al. 2023

JMIR Res Protoc

Self Cite

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Measurement properties of the Health Anxiety by Proxy Scale (HAPYS): A new questionnaire to assess parents' worries about their child's health

Ingeman,

Wright,

Frostholm

et al. 2024

Journal of Psychosomatic Research

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Health anxiety by proxy among parents: Measuring health anxiety for self, child and partner and its associations with family functioning

Kubb,

Foran

2024

Health Psychology Open

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Health-related worries can be either self-directed or occur in close relationships by proxy (e.g., among parents, couples, or pet owners). Our aim was to test the feasibility of assessing health anxiety by proxy in parents and to examine the relationship of health anxiety with family well-being. Health anxiety by proxy was measured between parent-child and parent-partner relationships with adapted versions of the modified Short Health Anxiety Inventory. Parents reported significantly higher levels of health anxiety by proxy regarding their child than for themselves, t (585) = −3.61, p < .001. Exploratory factor analysis showed that each health anxiety questionnaire formed a distinct latent factor. Parenting stress and poorer family functioning had small associations with health anxiety towards one’s self, child, and partner ( r = 0.15 to r = 0.20). Further research is needed to determine clinical relevance and its impact on health behaviors and functioning within the family unit.

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Health anxiety by proxy – through the eyes of the parents

Cited by 7 publications

References 45 publications

Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study

Internet-Delivered Therapy for Parents With Health Anxiety by Proxy: Protocol for a Single-Case Experimental Design Study

Measurement properties of the Health Anxiety by Proxy Scale (HAPYS): A new questionnaire to assess parents' worries about their child's health

Health anxiety by proxy among parents: Measuring health anxiety for self, child and partner and its associations with family functioning

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