Illness Attitudes Scale dimensions and their associations with anxiety-related constructs in a nonclinical sample

The Illness Attitudes Scale (IAS) is a self-rated measure that consists of nine subscales designed to assess fears, attitudes and beliefs associated with hypochondriacal concerns and abnormal illness behavior [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger; Kellner, R. (1987). Abridged manual of the Illness Attitudes Scale. Department of Psychiatry, School of Medicine, University of New Mexico]. The purposes of the present study were to explore the hierarchical factor structure of the IAS in a nonclinical sample of young adult volunteers and to examine the relations of each illness attitudes dimension to a set of anxiety-related measures. One-hundred and ninety-seven undergraduate university students (156 F, 41 M; mean age = 21.9 years) completed the IAS as well as measures of anxiety sensitivity, trait anxiety and panic attack history. The results of principal components analyses with oblique (Oblimin) rotation suggested that the IAS is best conceptualized as a four-factor measure at the lower order level (with lower-order dimensions tapping illness-related Fears, Behavior, Beliefs and Effects, respectively), and a unifactorial measure at the higher-order level (i.e. higher-order dimension tapping General Hypochondriacal Concerns). The factor structure overlapped to some degree with the scoring of the IAS proposed by Kellner (1986, 1987), as well as with the factor structures identified in previously-tested clinical and nonclinical samples [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a nonclinical population. Personality and Individual Differences, 18, 463-469; Hadjistavropoulos, H. D. & Asmundson, G. J. G. (1998). Factor analytic investigation of the Illness Attitudes Scale in a chronic pain sample. Behaviour Research and Therapy, 36, 1185-1195; Hadjistavropoulos, H. D., Frombach, I. & Asmundson, G. J. G. (in press). Exploratory and confirmatory factor analytic investigations of the Illness Attitudes Scale in a nonclinical sample. Behaviour Research and Therapy; Speckens, A. E., Spinhoven, P., Sloekers, P. P. A., Bolk, J. H. & van Hemert, A. M. (1996). A validation study of the Whitley Index, the Illness Attitude Scales and the Somatosensory Amplification Scale in general medical and general practice patients. Journal of Psychosomatic Research, 40, 95-104]. The Fears, Beliefs and Effects lower-order factors and the General Hypochondriacal Concerns higher-order factor, were shown to be strongly associated with anxiety sensitivity, even after accounting for trait anxiety and panic history. Implications for understanding the high degree of comorbidity between the diagnoses of panic disorder and hypochondriasis, as well as future research directions for exploring the utility of various IAS dimensions in predicting responses to lab-based bodily symptom-induction procedures, are discussed.     

Benign joint hypermobility syndrome: psychological features and psychopathological symptoms in a sample pain-free at evaluation1

30 subjects with BJHS (Hypermobile) (M age = 32.3 yr., SD = 10.4) and two control groups, 25 healthy subjects (Healthy) (M age = 33.9 yr., SD = 9.3) and 30 fibromyalgic patients (Fibromyalgic) (M age = 32.2 yr., SD=9.4), were given the Symptom Checklist-90-R, the Illness Behavior Questionnaire, the Female Functional Symptoms Frequency (FFF) and the Male Functional Symptoms Frequency (MFF), derived from the DSM-III-R, evaluating functional somatic disturbances and their intensity, and the Symptom Questionnaire. The mean scores for the Hypermobile group showed significant psychological distress and increased frequency and intensity of somatic symptoms. Scores on Anxiety and Somatic Symptoms, General Hypochondriasis, Disease Conviction, Affective Disturbance, Denial, and Irritability were significantly higher in the Hypermobile than in the Healthy group. Elevated scores were found for the Fibromyalgic group on the Illness Behavior Questionnaire subscales for Psychological vs Somatic Focus, Disease Affirmation, and Discriminating Factors when compared with the Hypermobile group. Considerable emotional symptoms were detected which should not be underestimated by physicians when establishing an integrated biopsychosocial therapy.     

Relationships among mental health,coping styles,and mood

The present study investigated the relationships between mental health (measured by the General Health Questionnaire--6 factors: General Illness, Somatic Symptoms, Sleep Disturbance, Social Dysfunction, Anxiety and Dysphoria, Suicidal Depression), coping styles (two strategies: Cognitive centered, Emotional centered), and mood (Tense Arousal, Energetic Arousal). 96 students answered questionnaires before their semester test which was a stressor. Analysis showed that (1) Tense Arousal scores correlated positively with overall General Health scores and all General Health factor scores, and Energetic Arousal scores correlated negatively with overall General Health scores and all General Health factor scores except one; (2) Anxiety and Dysphoria scores predicted Tense Arousal scores the best of General Health factor scores, while both Social Dysfunction scores and General Illness scores predicted Energetic Arousal scores. (3) Participants with high Energetic Arousal scores used a Cognitive centered coping strategy much more than an Emotional centered coping strategy. That is, people with low Energetic Arousal scores seem to use the Emotional centered coping strategy and have anxiety/dysphoria, while people with high Energetic Arousal scores seem to use a Cognitive centered coping strategy and have good health and social activity. These results suggest that there are small but significant relationships among mental health, coping styles, and mood.     

Personality correlates of the attitude toward women scale

The full and short versions of the Attitudes Towards Women Scale, the Eysenck Personality Questionnaire, the Trait Anxiety Scale and the Group Embedded Figures Test were administered to 95 freshmen (male and female). Results indicated a relationship between liberal attitudes toward women and emotional stability. Scores on the Attitudes Toward Women Scale also tended to be independent of Lie scores.     

The effects of short- and long-term life review interview on the psychological well-being of young adults

The present study investigates the effects of short- and long-term life review interviews on young adults' psychological well-being. Study 1 investigates mood using the Japanese UWIST adjective checklist (yielding two scores: Tense Arousal which represents low hedonic tone and Energetic Arousal which represents high hedonic tone). Results show that Energetic Arousal significantly increased after life review, although Tense Arousal did not change. Study 2 investigates self-esteem and mental health (measured by the General Health Questionnaire-6 factors: General Illness, Somatic Symptoms, Sleep Disturbance, Social Dysfunction, Anxiety and Dysphoria, Suicidal Depression). Both self-esteem and mental health scores increased after life review. With regard to factors of mental health, General Illness and Anxiety Dysphoria scores were much higher than those on Somatic Symptoms, Sleep Disturbance, Social Dysfunction, and Suicidal Depression. There was also a significant difference between before and after scores on General Illness, Somatic Symptoms, Sleep Disturbance, and Anxiety Dysphoria, but not in Social Dysfunction and Suicidal Depression. That is, short-term life review led to higher hedonic tone scores, and long-term life review led to better mental health scores in healthy young adults. These results suggest that both short- and long-term life review in an interview promote young adults' immediate psychological well-being. Further research is required for young adults who have psychological problems.     

Concurrent Validity of the Multidimensional Health Profile—Health Functioning Scales (MHP-H) in the Pre-operative Assessment of Applicants for Gastric Bypass Surgery

The concurrent validity of a brief screening test, the Multidimensional Health Profile-Health Functioning (MHP-H) was examined in conjunction with a much more lengthy pre-operative assessment procedure in 449 applicants for gastric bypass surgery (GBS). The MHP-H is a 69-item screening inventory that assesses five areas of health functioning: Adult Health History, Health Habits, Health Care Utilization, Health Beliefs and Attitudes, and Response to Illness. The more lengthy procedure included a comprehensive 273-item structured interview plus the Minnesota Multiphasic Personality Inventory-2 (MMPI-2), Basic Personality Inventory (BPI), and Beck Depression Inventory (BDI). The MHP-H showed significant correspondence with the more comprehensive assessment on measures of potential relevance to outcome in GBS, supporting the use of the MHP-H as a low-cost alternative to the more extensive procedure. The utility of the MHP-Psychosocial Functioning (MHP-P), a companion instrument to the MHP-H, was demonstrated in an earlier study.     

Spirituality,Distress and Posttraumatic Growth in Breast Cancer Patients

Breast cancer is the most common type of cancer for women and is associated with increased distress. Spirituality and posttraumatic growth (PTG) have been associated with illness adjustment, but the relationship between these variables is still not well understood. A sample of 100 breast cancer patients completed a demographic and clinical questionnaire, the Posttraumatic Growth Inventory, Spiritual and Religious Attitudes in Dealing with Illness, and the Hospital Anxiety and Depression Scale. Results showed an association between PTG, spirituality and distress. Women with a longer diagnosis and recurrence showed more distress. Younger age, recurrent cancer and spirituality predicted higher PTG. Patients’ spirituality should be part of intervention with breast cancer patients since it seems to be related to greater growth and adjustment to the illness.     

Conspiracy thinking and state-trait anxiety in young Polish adults

The relationships among conspiracy thinking and state and trait anxiety were examined with 118 high school students who were assessed using the Conspiracy Beliefs Scale and the State-Trait Anxiety Inventory. Among boys there was a positive correlation between scores on A-Trait and the conspiracy thinking (r = .39) whereas among girls there was a negative correlation between these scores (r = -.32).     

A factorial, reliability, and validity study of the Devereux Elementary School Behavior Rating Scale

This investigation explored the factor structure, reliability, and validity of the Devereux Elementary School Behavior Rating Scale, employing a large (n = 648) sample of children. Factor analysis suggested that the Devereux scale can be described by four factors, which were named Disruptive-Oppositional, Poor Comprehension-Disattention, Cooperative-Initiating, and Performance Anxiety. All four factors showed high internal consistency, and three of the four were stable over a 17-mo. period. Correlations of the four factors with academic achievement, IQ, socioeconomic status, and peer ratings of social competence are presented. All four factors showed significant relations with these variables, with Poor Comprehension-Disattention the strongest of all. Multiple regression analysis indicated that the Poor Comprehension-Disattention factor accounted for significant variance in academic achievement even after IQ was taken into account. Large differences between classroom means on the factor scores suggested that Devereux ratings for individual students may need to be interpreted cautiously.     

Attitude towards euthanasia in relation to death anxiety among a sample of 343 nurses in India

Scores on Attitude towards Euthanasia were correlated with scores on Death Anxiety among 343 female nurses in India using Templer's Death Anxiety Scale and the authors' 24-item attitude scale. No significant correlation was found between the two sets of scores (r = -.09) or a nonlinear score on relation. Age of nurses was not significantly related to Attitude towards Euthanasia (r = .07) or Death Anxiety (r = .11). As measured, death anxiety has no bearing on attitude about euthanasia.     

Perfectionism and Interpersonal Sensitivity in Social Phobia: The Interpersonal Aspects of Perfectionism

We examined perfectionism, interpersonal sensitivity and dysfunctional cognitions in patients with Social Phobia (SP). The sample consisted of a clinical group with a diagnosis of SP (n?=?30) and a non clinical group (n?=?30), matched for age and gender. Both groups were assessed on Frost??s Multidimensional Perfectionism Scale (FMPS), Interpersonal Sensitivity Measure (IPSM), and Dysfunctional Attitudes Scale (DAS). The clinical sample was also assessed on Liebowitz Social Anxiety Scale (LSAS), Beck??s Depression Inventory-II, Eysenck??s Personality Inventory-Neuroticism sub-scale (EPI- N). The two groups were compared on FMPS, IPSM and DAS using t-test. Associations between FMPS, IPSM, DAS and predictors of social anxiety and depression were examined. The clinical group scored higher on perfectionism, interpersonal sensitivity and dysfunctional cognitions. There was no significant association between total scores on FMPS and IPSM. However subscales of IPSM and FMPS were correlated. Doubt about Actions was associated with Separation Anxiety (r?=?0.520) and Timidity (r?=?0.407). Organization was related to Interpersonal Awareness (r?=?0.371) and Separation Anxiety (r?=?0.407). Parental criticism was negatively associated with fragile inner self. DAS was positively correlated with FMPS and IPSM. Interpersonal sensitivity emerged as a significant predictor of social anxiety. Discriminant Functional Analysis indicated that concern over mistakes, organization, fragile inner self, separation anxiety discriminated between the clinical and non-clinical groups.     

Factor analytic investigation of the Illness Attitudes Scale in a chronic pain safmple

The Illness Attitudes Scale (IAS) is a self-report instrument comprising nine subscales designed to assess fears, beliefs and attitudes associated with hypochondriasis and abnormal illness behaviour [Kellner (1986). Somatization and hypochondriasis. New York: Praeger.]. The purpose of the present study was to explore the factor structure of the IAS in a chronic pain sample as a preliminary step toward determining the use of this measure in this sample. Hypochondriacal tendencies have been postulated to play a role in maintaining and exacerbating responses to chronic pain and, therefore, appropriate measurement in this sample is important. In the present study, consecutive chronic pain patients presenting to a pain treatment program (N=198) were administered the IAS. Principal component analysis with oblique (Oblimin) rotation identified that five factors best explain the measure in this population. These factors were (1) fear of illness, (2) effects of symptoms, (3) health habits, (4) disease phobia and conviction and (5) fear of death. The factor structure overlapped to some degree with the scoring of the IAS proposed by Kellner (1986), as well as with the factor structure identified in a non-clinical sample [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a non-clinical population. Personality and Individual Differences, 18, 463–469.]. There were enough discrepancies, however, to suggest an alternative method for scoring the IAS with chronic pain patients. Implications for the use of the measure with chronic pain patients, as well as future research directions for exploring the utility of this measure with chronic pain patients, are discussed.     

A simultaneous test of the relationship between identified psychosocial risk factors and recurrent events in coronary artery disease patients

Psychosocial factors are increasingly recognized as risk indicators for coronary artery disease (CAD) prognosis and they are likely interrelated. The objective of this study is to simultaneously test the relationship between key psychosocial constructs as independent factor scores and recurrent events in CAD patients. There were 1268 CAD outpatients of 97 cardiologists surveyed at two points. Recurrent events or hospitalization in the intervening nine months were reported. Factor analysis of items from the Hospital Anxiety and Depression Scale, Perceived Stress Scale, the ENRICHD Social Support Inventory, and Hostile Attitudes Scale was performed to generate orthogonal factor scores. With adjustment for prognostic variables, logistic regression analysis was performed to examine the relationship between these factor scores and recurrent events. Factor analysis resulted in a six-factor solution: hostility, stress, anxiety, depressive symptoms, support, and resilience. Logistic regression revealed that functional status and anxiety, with a trend for depressive symptoms, were related to experiencing a recurrent event. In this simultaneous test of psychosocial constructs hypothesized to relate to cardiac prognosis, anxiety may be a particularly hazardous psychosocial factor. While replication is warranted, efforts to investigate the potential benefits of screening and to investigate treatments are needed.     

Psychometric Evaluation of the Spanish Versions of the Perceived Religious Influence on Health Behavior Scale and the Illness as Punishment for Sin Scale in a Sample of Churchgoing Latinas

The present study evaluated the psychometric properties of the Spanish versions of the Perceived Religious Influence on Health Behavior scale and the Illness as Punishment for Sin scale in a sample of churchgoing Latina women (N = 404). For the Perceived Religious Influence on Health Behavior scale, confirmatory factor analysis provided support for the expected one-factor model, internal consistency reliability was good, and there was evidence of convergent validity. For the Illness as Punishment for Sin scale, confirmatory factor analysis provided support for the expected one-factor model, but on a revised seven-item version of the measure. Internal consistency reliability and convergent validity for this revised version were good. It is recommended that future studies use the Perceived Religious Influence on Health Behavior scale and the revised Illness as Punishment for Sin scale when examining these constructs among Latina women.     

Psychometric Analyses of the Test Anxiety Scale for Elementary Students (TAS-E) Scores among Singapore Primary School Students

The psychometric properties of the Test Anxiety Scale for Elementary Students (TAS-E) scores were examined among Singapore primary school students. In Study 1, an exploratory factor analysis (EFA) was performed to determine the factor structure of the TAS-E in a sample of 540 Singapore students. In Study 2, a confirmatory factor analysis (CFA) was performed on the TAS-E scores in another sample of 540 Singapore students to determine whether the findings would support the factor structure reported in Study 1. The results of the EFA and Schmid-Leiman transformation in Study 1 and the CFA in Study 2 suggest that the TAS-E has four factors (Physiological Hyperarousal, Social Concerns, Task Irrelevant Behavior, and Worry) and a higher-order factor, the Total Test Anxiety factor. These findings are similar to the results reported in validation studies of the TAS-E scores with U.S. elementary students. In addition, the test score stability and convergent and discriminant validity of the TAS-E scores were examined in Study 3 among 1,080 Singapore primary school students. The results indicated that the TAS-E scores appear to have adequate test score stability over a 2-week test-retest period. Evidence supporting the convergent and discriminant validity of the TAS-E scores was also found. Implications of the findings of the three studies are discussed.     

Exploratory and confirmatory factor analytic investigations of the Illness Attitudes Scale in a nonclinical sample.

The Illness Attitudes Scale (IAS) assesses fears, beliefs and attitudes associated with hypochondriasis [Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger Publishers.]. Recent factor analytic investigations of the IAS in non-clinical samples have suggested a number of different factor solutions. In study 1, we used principal components analysis with both orthogonal and oblique rotation to better explore the structure of this measure. Using a random selection of 390 participants from a larger pool of 780, a five-factor solution was identified: (1) fear of illness, death, disease and pain, (2) effects of symptoms, (3) treatment experiences, (4) disease conviction and (5) health habits. In study 2, confirmatory factor analysis (CFA) of responses from the remaining 390 students evaluated: (a) a single-factor model, (b) Kellner's original nine-factor model, (c) a four-factor model proposed by Ferguson and Daniel [Ferguson, E. & Daniel, E. (1995). The Illness Attitudes Scale (IAS): a psychometric evaluation on a nonclinical population. Personality and Individual Differences, 18, 463-469.], (d) a different four-factor model proposed by Stewart and Watt [Stewart, S. H. & Watt, M. C. (1998). A psychometric investigation of the Illness Attitudes Scale (IAS) in a nonclinical young adult sample. Submitted for publication.] and (e) the five-factor model derived in study 1. Of these models, greatest support was obtained for our five-factor model. However, it was also clear that this model could be improved. Based on the results of the CFA, as well as previous research and theoretical considerations, we tested a revised model in which the health habits factor was deleted. Analysis of the revised model showed that it received the greatest support and could be conceptualized as either four distinct factors or as hierarchical in nature, with four lower-order factors loading on a single higher-order factor. Future directions for research as well as suggestions for scoring and using the IAS with nonclinical samples are discussed.     

Does the Illness Behavior Questionnaire measure abnormal illness behavior?

Abnormal illness behavior (AIB) has been proposed as a construct measuring the inappropriate or maladaptive modes of responding to one's state of health, and the Illness Behavior Questionnaire (BQ; Pilowsky, 1975) was designed to measure this construct. Previous studies using small samples have failed to agree on the factor structure of this questionnaire. The present paper examines the factor structure of the Illness Behavior Questionnaire and critically evaluates the interpretation of its dimensions as well as the construct of AIB. A factor analysis of responses from 1,061 health care and nonhealth care seeking subjects yielded six interpretable factors which substantially replicated Pilowsky's previous results. Six scales were calculated and correlated with several personality measures. The results indicated that the Illness Behavior Questionnaire is saturated with neuroticism, a dimension known to be related to excessive medical complaints. But excessive medical complaints cannot be equated with hypochondriasis or AIB in the absence of objective medical information. In the absence of evidence for the discriminant validity of the IBQ, its use as a diagnostic device is unwarranted. Treating elevated IBQ scores as indicators of abnormal illness behavior without corroborating medical information may be more misleading than accepting patients' symptom reports at face value.     

Pilot assessment of pain of orthopaedic patients in Hong Kong

This pilot study examined the internal consistency and concurrent validity of the Chinese version of the Acute Lower Back Pain Screening Questionnaire. A sample of 45 acute low back pain patients (27 men and 18 women; mean age = 47.8) were recruited from the Department of Orthopaedics and Traumatology of the Tuen Mun Hospital in Hong Kong. Three items of the original questionnaire were excluded from the analyses because response was low by 30 of the 45 patients. The questionnaire showed good internal reliability (Cronbach alpha = .88) and correlated significantly with other test scores: the Faces Pain Scale-Revised (alpha = .74), the Chinese (Hong Kong) SF-12 Health Survey (Mental subscale, alpha = -.47; Physical subscale alpha = -.62), and the Chinese Hospital Anxiety and Depression Scale (Anxiety subscale, alpha = .42; Depression subscale, alpha = .43). The questionnaire could be used in research and clinical work to provide data on the multicomponents of a pain experience as well as psychosocial risk factors related to pain among the Chinese. Researchers might examine the course of change in chronic pain.     

Eating attitudes and their psychological correlates among Turkish adolescents

This study examined the eating attitudes and psychological characteristics of Turkish late adolescents. Seven hundred eighty-three university students were administered the Eating Attitudes Test, Rosenberg Self-Esteem Scale, State-Trait Anxiety Inventory, and Social Physique Anxiety Scale. More than one in ten (9.2% of the males and 13.1% of the females) had abnormal eating attitude scores. Chi-square analysis revealed that there were no significant differences in the prevalance of abnormal eating behaviors based on gender. Analysis of covariance indicated that participants who had disturbed eating attitudes had lower self-esteem, higher social physique anxiety, and higher trait anxiety than those who had normal eating attitudes. It was concluded that the prevalence of disturbed eating attitudes was high among these Turkish late adolescents, and that disturbed eating attitudes were related to several psychological characteristics.     

Factorial structure of the Kuwait University Anxiety Scale in a large sample of college students: rejoinder

Recently a study by Lester of American college students found a different factor structure for the Kuwait University Anxiety Scale than studies with students from Arab countries. Thus, a large sample of college students (N=3064) was recruited from 10 Arab countries to examine the replicability of the factors previously extracted from the Kuwait University Anxiety Scale. Three factors, identified in the present sample, were compatible with those in the prior larger sample (N=9031). These were labeled Cognitive/Affective Anxiety, Subjective Anxiety or Nervousness, and Somatic Anxiety. The factorial pattern of the scale has been verified by both large samples.