Assessment of psychological aspects of somatoform disorders: A study on the German version of the Health Attitude Survey (HAS)
Introduction
Somatoform disorders are characterized by persistent or recurrent physical symptoms that cannot be explained fully by a general medical condition (e.g., Hiller et al. [1]). Patients with medically unexplained symptoms are psychologically burdened by these symptoms, have a substantially reduced quality of life, show elevated health anxiety, over-interpret minor physical symptoms as possible signs of illness, and have stable alexithymia and neuroticism [2], [3], [4], [5], [6], [7]. Moreover, they use medical care to a great extent, and thus, cause high costs for the health care system, independent of psychiatric or medical comorbidity [8], [9], [10]. Physicians often try to “normalize” medically unexplained symptoms and inadvertently offend the patient by offering insufficient explanations, leading the patient to seek additional physical examinations and medical help and to identify new physical symptoms [11]. Somatoform disorders are the most common mental disorder in primary care with prevalence rates of 10% to 26% [5], [12]. In specialized or secondary care-particularly in neurology, gynecology, and gastroenterology-up to 50% of the patients suffer from medically unexplained symptoms [13], [14].
Given the prevalence and costs of somatoform disorders, it is important to identify and adequately treat these patients as early as possible. Hence, proper assessment and screening instruments are needed for both clinical work and research. Currently there are two types of instruments assessing or screening somatoform disorders: symptom oriented and psychologically oriented. Symptom-oriented questionnaires assess bodily symptoms (e.g., dizziness, pain, and gastrointestinal complaints); examples include the Patient Health Questionnaire (PHQ-15) [5], the Screening Instrument for Somatoform Symptoms (SOMS) [15], and the Somatic Symptom Inventory [16]. Psychologically oriented questionnaires comprise specific behaviors, experiences, and perceptions of somatoform disorders, such as the Whiteley Index (WI) [2], [17], the Illness Behaviour Questionnaire (IBQ) [18], the Cognitions About Body and Health Questionnaire (CABAH) [2], the Scale for the Assessment of Illness Behaviour (SAIB) [19], and the Health Attitude Survey (HAS) [20]. Compared to the SAIB and IBQ which have been suggested for assessing different aspects of illness behavior [e.g., “verification of diagnosis” (SAIB), “expression of symptoms” (SAIB), “denial” (IBQ), or “general hypochondriasis” (IBQ)] and to the CABAH which captures cognitive aspects of somatisation and hypochondriasis (e.g., “catastrophizing interpretation of bodily complaints” or “autonomic sensations”), the Health Attitude Survey (HAS) comprises cognitions, feelings, and behaviors of patients with a somatoform disorder. In its original validation study, the HAS was shown to be a valid instrument for assessing attitudes and perceptions of patients with a somatoform disorder [20]. Furthermore, the HAS accurately differentiates between somatoform patients, patients with severe medical diseases (e.g., cancer), and controls without a somatoform disorder. In a study by Hausteiner et al. [21] the HAS predicted somatoform disorder in patients with suspected allergies. However, its psychometric properties and validity require further study.
The aim of the current study was to investigate the structure and validity of the German version of the HAS.
Section snippets
Study design and samples
This cross-sectional study was conducted between May 2010 and June 2011 and involved 1452 participants, including patients with mental disorders and physically ill patients suffering from an organic vertigo. All patients were recruited through outpatient routine care, i.e., diagnostic (first-time) appointments including the discussion of further procedure and treatment options, at either the outpatient department of the German Center for Vertigo and Balance Disorders (IFBLMU) at the University
Factor analyses
Firstly, we conducted CFA with subsample 1 (n1 = 726) to test the original factor structure allowing for six latent variables and one underlying latent construct (see Appendix, Figure A.1). The original six-factor structure with the 27 items by Noyes et al. [20] did not fit the data (CFI = .079; NFI = 0.74; RMSEA = 0.070) (see Table 2).
Therefore, we performed EFA (principal components extraction) with Varimax rotation on the 27 items of the HAS for subsample 2 (n2 = 726). The Kaiser–Meyer–Olkin measure
Discussion
Somatoform disorders are a prevalent and costly problem in the health care system. In this study our goal was to identify an adequate diagnostic and screening instrument for somatoform disorders by evaluating the structure, psychometric properties, and validity of the HAS, a multidimensional questionnaire that comprises cognitions, feelings, and behaviors of patients with a somatoform disorder [20].
Our primary finding was that a shortened and more economic version of the HAS showed good
Acknowledgment
We would like to thank Katrin Book for her help with the backward translation.
References (51)
- et al.
Management of functional somatic syndromes
Lancet
(2007) Stability of neuroticism and alexithymia in somatization
Compr Psychiatry
(2003)- et al.
Predictors of remission in DSM hypochondriasis
Compr Psychiatry
(2000) - et al.
Lower decision threshold for doctor visits as a predictor of health care use in somatoform disorders and in the general population
Gen Hosp Psychiatry
(2008) - et al.
Course and prediction of somatoform disorder and medically unexplained symptoms in primary care
Gen Hosp Psychiatry
(2011) - et al.
Medically unexplained symptoms. An epidemiological study in seven specialities
J Psychosom Res
(2001) - et al.
Somatoform disorders among first-time referrals to a neurology service
Psychosomatics
(2005) - et al.
A new approach to the assessment of the treatment effects of somatoform disorders
Psychosomatics
(2003) - et al.
The development of a screening method for abnormal illness behaviour
J Psychosom Res
(1979) - et al.
A new approach to assess illness behaviour
J Psychosom Res
(2003)
Health Attitude Survey—a scale for assessing somatizing patients
Psychosomatics
Vestibular paroxysmia: vascular compression of the eighth nerve?
Lancet
Somatoform disorder and the DSM-V Workgroup's interim proposals: two central issues
Psychosomatics
Construct validity and descriptive validity of somatoform disorders in light of proposed changes for the DSM-5
J Psychosom Res
Depression, anxiety and somatization in primary care: syndrome overlap and functional impairment
Gen Hosp Psychiatry
Somatization in the population: from mild bodily misperceptions to disabling symptoms
Soc Psychiatry Psychiatr Epidemiol
Cognitive aspects of hypochondriasis and the somatization syndrome
J Abnorm Psychol
Somatization, somatosensory amplification, attribution styles and illness behaviour: a review
Int Rev Psychiatry.
The PHQ-15: validity of a new measure for evaluating the severity of somatic symptoms
Psychosom Med
Somatization increases medical utilization and costs independent of psychiatric and medical comorbidity
Arch Gen Psychiatry
Association of mental distress with health care utilization and costs: a 5-year observation in a general population
Soc Psychiatry Psychiatr Epidemiol
Preventing somatization
Psychol Med
Hypochondriasis: an evaluation of the DSM-III criteria in medical outpatients
Arch Gen Psychiatry
Hypochondriasis in the general population: psychometric properties and norm values of the Whiteley Index
Diagnostica
Psychobehavioral predictors of somatoform disorders in patients with suspected allergies
Psychosom Med
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Conflict of interest: The authors declare that they have no competing interests.
Funding source: Parts of this project were supported by funds from the German Federal Ministry of Education and Research under grant code 01 EO 0901. The authors bear full responsibility for the content of this publication.