Prevalence and service implications of health anxiety in genitourinary medicine clinics

Šalkovskis

et al. 2017

Health Technol Assess

BackgroundHealth anxiety is an under-recognised but frequent cause of distress that is potentially treatable, but there are few studies in secondary care.ObjectiveTo determine the clinical effectiveness and cost-effectiveness of a modified form of cognitive–behaviour therapy (CBT) for health anxiety (CBT-HA) compared with standard care in medical outpatients.DesignRandomised controlled trial.SettingFive general hospitals in London, Middlesex and Nottinghamshire.ParticipantsA total of 444 patients aged 16–75 years seen in cardiology, endocrinology, gastroenterology, neurology and respiratory medicine clinics who scored ≥ 20 points on the Health Anxiety Inventory (HAI) and satisfied diagnostic requirements for hypochondriasis. Those with current psychiatric disorders were excluded, but those with concurrent medical illnesses were not.InterventionsCognitive–behaviour therapy for health anxiety – between 4 and 10 1-hour sessions of CBT-HA from a health professional or psychologist trained in the treatment. Standard care was normal practice in primary and secondary care.Main outcome measuresPrimary – researchers masked to allocation assessed patients at baseline, 3, 6, 12, 24 months and 5 years. The primary outcome was change in the HAI score between baseline and 12 months. Main secondary outcomes – costs of care in the two groups after 24 and 60 months, change in health anxiety (HAI), generalised anxiety and depression [Hospital Anxiety and Depression Scale (HADS)] scores, social functioning using the Social Functioning Questionnaire and quality of life using the EuroQol-5 Dimensions (EQ-5D), at 6, 12, 24 and 60 months, and deaths over 5 years.ResultsOf the 28,991 patients screened over 21 months, 5769 had HAI scores of ≥ 20 points. Improvement in HAI scores at 3 months was significantly greater in the CBT-HA group (mean number of sessions = 6) than in the standard care, and this was maintained over the 5-year period (overallp < 0.0001), with no loss of efficacy between 2 and 5 years. Differences in the generalised anxiety (p = 0.0018) and depression scores (p = 0.0065) on the HADS were similar in both groups over the 5-year period. Gastroenterology and cardiology patients showed the greatest CBT gains. The outcomes for nurses were superior to those of other therapists. Deaths (n = 24) were similar in both groups; those in standard care died earlier than those in CBT-HA. Patients with mild personality disturbance and higher dependence levels had the best outcome with CBT-HA. Total costs were similar in both groups over the 5-year period (£12,590.58 for CBT-HA; £13,334.94 for standard care). CBT-HA was not cost-effective in terms of quality-adjusted life-years, as measured using the EQ-5D, but was cost-effective in terms of HAI outcomes, and offset the cost of treatment.LimitationsMany eligible patients were not randomised and the population treated may not be representative.ConclusionsCBT-HA is a highly effective treatment for pathological health anxiety with lasting benefit over 5 years. It also improves generalised anxiety and depressive symptoms more than standard care. The presence of personality abnormality is not a bar to successful outcome. CBT-HA may also be cost-effective, but the high costs of concurrent medical illnesses obscure potential savings. This treatment deserves further research in medical settings.Trial registrationCurrent Controlled Trials ISRCTN14565822.FundingThis project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 21, No. 50. See the NIHR Journals Library website for further project information.

Section: Fundingmentioning

confidence: 99%

Section: Fundingmentioning

confidence: 99%

Cognitive–behaviour therapy for health anxiety in medical patients (CHAMP): a randomised controlled trial with outcomes to 5 years

Šalkovskis

et al. 2017

Health Technol Assess

“…A score over 27 points was reported as being most reliable for the identification of health anxiety, allowing to accurately distinguish hypochondriasis from other anxiety disorders [30]. Other researchers have proposed less stringent cut-off scores at 15 [31], 18 [32] and 20 points [33]. They did not provide sufficient information on how these scores were identified, however.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of psychometric properties and factor structure of the Polish version of Short Health Anxiety Inventory (SHAI)

Kocjan¹

2016

Arch Psych Psych

SummaryObjectives: The aim of the study was to adapt the English language version of the Short Health Anxiety Inventory (SHAI) developed by Salkovskis et al. to the Polish language and to investigate its psychometric properties and factor structure in clinical and non-clinical samples.Method: A total of 296 individuals participated in the study: 172 in the clinical sample (46% females and 54% males; mean age: 57.29 ± 13.01 years) and 124 in the non-clinical sample (51% females and 49% males; mean age: 54.45 ± 13.63). They completed the Polish language version of an 18-item SHAI and the Hamilton Anxiety Rating Scale (HAM-A). To assess psychometric properties, internal consistency, test-retest reliability, item-total statistics, construct and convergent validity, an analysis of ROC curves was performed.Results: Both samples had excellent internal consistency (Cronbach's α 0.91 and 0.92) and test-retest reliability (r=0.91 and r=0.94). Correlational analysis revealed a significant relationship of anxiety to SHAI total score and to each of the two SHAI subscales. Factor analysis revealed a two-factors solution, which accounted for 48% and 49% of the variance. A cut-off score of 20 was optimal for detecting a severe form of health anxiety in the clinical and non-clinical sample, providing the best balance between specificity and sensitivity.Discussion: Despite the widespread application of SHAI, a Polish language version has not yet been created. The psychometric properties of the scale confirmed a high reliability and accuracy of the proposed solutions. Conclusions:Our findings confirm that the SHAI-Polish version is a reliable and valid instrument for detecting health anxiety. hypochondriasis, health anxiety, Short Health Anxiety Inventory

“…7,8 For example, the risk of suicide in men with prostate cancer is over 4 times that of a similarly aged man without prostate cancer. 9 Patients with lower urinary tract symptoms (LUTS) experience elevated levels of psychosocial distress, with depression rates of 6% to 21% and anxiety rates of 3% to 10%.…”

Section: Men's Mental Healthmentioning

confidence: 99%

“…6 Specific to urologic diseases/disorders, such as urologic cancers, lower urinary tract symptoms and erectile dysfunction (ED), men experience elevated levels of anxiety and depression. 7,8 For example, the risk of suicide in men with prostate cancer is over 4 times that of a similarly aged man without prostate cancer. 9 Patients with lower urinary tract symptoms (LUTS) experience elevated levels of psychosocial distress, with depression rates of 6% to 21% and anxiety rates of 3% to 10%.…”

Section: Men's Mental Healthmentioning

confidence: 99%

Men’s mental health: Connection to urologic health

Matthew¹

2014

CUAJ

Historically,thespecialtyofurologyhasfocusedonsingle-systemdiseases.Inrecentyears,however,therehasbeenincreasingrecognition oftheinterconnectivitybetweenthevarioussystems,suchascardiovasculardisease,metabolicsyndrome,erectiledysfunctionandprostatecancer.Thisconstellationofdisease/syndromeanddysfunction mayplaceurologistsatthecentreofmen'soverallhealthconcerns. Asurologistsconsideringtakingonaleadershiproleinmen'shealth, theyshouldalsoconsidertheirpotentialinhelpingmensufferingfrom thesignificantburdenofamentalhealthdisorder.Urologistsmay haveauniqueopportunitytoidentifymentalhealthissuesintheir malepatients,influencehealthybehaviourchange,andsuccessfully refermen,whomightotherwisenotseekhelp,toappropriatemedical/ psychologicalcare. Men's mental healthAn estimated 3.4 million Canadian men are currently living with mental illness. 1 This number is likely an underestimation given that a large proportion of men experiencing symptoms of mental illness do not seek the help of a professional. [2][3][4] This gap in care has grave outcomes as Canadian men are at least 3 times more likely to die by suicide than Canadian women 5 -a figure that increases to 7 times among elderly men.6 Specific to urologic diseases/disorders, such as urologic cancers, lower urinary tract symptoms and erectile dysfunction (ED), men experience elevated levels of anxiety and depression. 7,8 For example, the risk of suicide in men with prostate cancer is over 4 times that of a similarly aged man without prostate cancer. 9 Patients with lower urinary tract symptoms (LUTS) experience elevated levels of psychosocial distress, with depression rates of 6% to 21% and anxiety rates of 3% to 10%. 10 An estimated 10% of men with ED suffer from depression, and 2.5% to 37% suffer from anxiety.11 Given the relationship between mental health and overall health-related quality of life, it is clear that increasing numbers of men in general, and men with urologic disease, are suffering a significant burden and that most of this burden remains untreated by healthcare professionals. Barriers to accessing mental health services include stigma, differences in expression of emotional problems (compared to women), maladaptive coping, and lack of awareness of support services in the community. StigmaResults suggest that the most prominent barrier to seeking and accessing mental health services is stigma.12,13 Seeking mental healthcare services remains a secretive and shameful activity for many individuals.14 The anticipation of social consequences and discrimination is often enough to force men into silence. While mental health stigma is not exclusively a male issue, men face a disproportionate amount of stigma, which is often perpetuated by masculine ideals of strength and self-reliance. A firm belief in stoicism and the need to control emotions may lead some men with anxiety and depression to perceive emotional distress as shameful, and hide their symptoms from others. 13,15 Differences in expression of emotional problemsAnother factor that may complicate se...