Psychometric properties of Internet-administered measures of health anxiety: An investigation of the Health Anxiety Inventory, the Illness Attitude Scales, and the Whiteley Index
Abstract
Background The Health Anxiety Inventory (HAI), the Illness Attitude Scales (IAS), and the Whiteley Index (WI) are three of the most widely used health anxiety measures, but their psychometric properties have not been investigated when administered via the Internet.Methods We investigated the three instruments' test-retest reliability, internal consistency, convergent, and discriminant validity and sensitivity to change using one sample (n=111) of participants with severe health anxiety and one sample of healthy controls (n=92).Results The HAI, IAS, and WI showed high test-retest reliability (rs≥.80), good convergent, and discriminant validity and were sensitive to detect change. The HAI and IAS (αs≥.85), but not the WI (αs≤.60) demonstrated high internal consistency.Conclusions The HAI, IAS, and WI have good psychometric properties, except for the low internal consistency of WI, when used as Internet-administered measures of health anxiety. Using these measures over the Internet offers highly important advantages such as increased ease of administration, reduced attrition, and cost-efficient treatment evaluation.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Online administration of questionnaires is a valid method for measuring symptoms of health anxiety, suggesting that the surprising level of symptom severity cannot be explained by this.
“Online administration of questionnaires has shown to be a valid method for measuring symptoms of health anxiety, which suggests that the surprising level of symptom severity cannot be explained by this [44].”
From Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Pilot Study. (2018) · cites this paper as [44]
Cites
Diagnostic and Statistical Manual of Mental Disorders
Williams, J. B. W., & First, M. B. (2013) · Oxford University Press eBooks · doi:10.1093/acrefore/9780199975839.013.104 · Cited by 109,841 · see citing works
Diagnostic and Statistical Manual of Mental Disorders
(2012) · Springer eBooks · doi:10.1007/springerreference_121117 · Cited by 20,769 · see citing works
Convergent and discriminant validation by the multitrait-multimethod matrix.
Campbell, D. T., & Fiske, D. W. (1959) · Psychological Bulletin · doi:10.1037/h0046016 · Cited by 17,116 · see citing works
Making sense of cronbach’s alpha.
Tavakol, M., & Dennick, R. (2011) · International Journal of Medical Education · doi:10.5116/ijme.4dfb.8dfd · Cited by 15,126 · see citing works
An inventory for measuring clinical anxiety: Psychometric properties.
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.56.6.893 · Cited by 14,407 · see citing works
Diagnostic and Statistical Manual of Mental Disorders ( DSM ‐ IV ‐ TR )
Segal, D. L. (2010) · Wiley eBooks · doi:10.1002/9780470479216.corpsy0271 · Cited by 4,683 · see citing works
Anxiety, sensitivity, anxiety frequency, and the prediction of fearfulness
Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986) · Behaviour Research and Therapy · doi:10.1016/0005-7967(86)90143-9 · Cited by 3,169 · see citing works
SALKOVSKIS, P. M., RIMES, K. A., WARWICK, H. M. C., & CLARK, D. M. (2002) · Psychological Medicine · doi:10.1017/s0033291702005822 · Cited by 1,351 · see citing works
Pilowsky, I. (1967) · British Journal of Psychiatry · doi:10.1192/bjp.113.494.89 · Cited by 865 · see citing works
Svanborg, P., & Åsberg, M. (1994) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.1994.tb01480.x · Cited by 693 · see citing works
Scale Construction and Psychometrics for Social and Personality Psychology
Furr, R. M. (2011) · SAGE Publications Ltd eBooks · doi:10.4135/9781446287866 · Cited by 652 · see citing works
Comparability of telephone and face-to-face interviews in assessing axis I and II disorders
Rohde, P., Lewinsohn, P. M., & Seeley, J. R. (1997) · American Journal of Psychiatry · doi:10.1176/ajp.154.11.1593 · Cited by 522 · see citing works
Svanborg, P., & Åsberg, M. (2001) · Journal of Affective Disorders · doi:10.1016/s0165-0327(00)00242-1 · Cited by 481 · see citing works
Reliability of DSM-III Anxiety Disorder Categories Using a New Structured Interview
Nardo, P. A. D. (1983) · Archives of General Psychiatry · doi:10.1001/archpsyc.1983.01790090032005 · Cited by 377 · see citing works
Carlbring, P., Brunt, S., Bohman, S., Austin, D., Richards, J., Öst, L.-G., & Andersson, G. (2007) · Computers in Human Behavior · doi:10.1016/j.chb.2005.05.002 · Cited by 319 · see citing works
Self-citationSpeckens, A. E. M., Spinhoven, P., Sloekers, P. P. A., Bolk, J. H., & van Hemert, A. M. (1996) · Journal of Psychosomatic Research · doi:10.1016/0022-3999(95)00561-7 · Cited by 303 · see citing works
Dear, B. F., Titov, N., Sunderland, M., McMillan, D., Anderson, T., Lorian, C., & Robinson, E. (2011) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2011.582138 · Cited by 282 · see citing works
Health anxiety in Australia: prevalence, comorbidity, disability and service use
Sunderland, M., Newby, J. M., & Andrews, G. (2013) · British Journal of Psychiatry · doi:10.1192/bjp.bp.111.103960 · Cited by 280 · see citing works
The Short Health Anxiety Inventory: A systematic review and meta-analysis
Alberts, N. M., Hadjistavropoulos, H. D., Jones, S. L., & Sharpe, D. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2012.10.009 · Cited by 267 · see citing works
Fears, Beliefs, and Attitudes in DSM-III Hypochondriasis
KELLNER, R., ABBOTT, P., WINSLOW, W. W., & PATHAK, D. (1987) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-198701000-00004 · Cited by 258 · see citing works
Hedman, E., Ljótsson, B., Kaldo, V., Hesser, H., El Alaoui, S., Kraepelien, M., Andersson, E., Rück, C., Svanborg, C., Andersson, G., et al. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2013.10.023 · Cited by 224 · see citing works
Self-citationHedman, E., Ljótsson, B., Rück, C., Furmark, T., Carlbring, P., Lindefors, N., & Andersson, G. (2010) · Computers in Human Behavior · doi:10.1016/j.chb.2010.01.010 · Cited by 220 · see citing works
Self-citationInternet-based cognitive-behavioural therapy for severe health anxiety: randomised controlled trial
Hedman, E., Andersson, G., Andersson, E., Ljótsson, B., Rück, C., Asmundson, G. J. G., & Lindefors, N. (2011) · British Journal of Psychiatry · doi:10.1192/bjp.bp.110.086843 · Cited by 212 · see citing works
Self-citationPrevalence of health anxiety problems in medical clinics
Tyrer, P., Cooper, S., Crawford, M., Dupont, S., Green, J., Murphy, D., Salkovskis, P., Smith, G., Wang, D., Bhogal, S., et al. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.07.004 · Cited by 192 · see citing works
A taxometric analysis of health anxiety
Ferguson, E. (2009) · Psychological Medicine · doi:10.1017/s0033291708003322 · Cited by 183 · see citing works
Hedman, E., Ljótsson, B., Rück, C., Bergström, J., Andersson, G., Kaldo, V., Jansson, L., Andersson, E., Andersson, E., Blom, K., et al. (2013) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12079 · Cited by 144 · see citing works
Self-citationA Prospective 4- to 5-Year Study of DSM-III-R Hypochondriasis
BARSKY, A. J., Fama, J. M., Bailey, E. D., & Ahern, D. K. (1998) · Archives of General Psychiatry · doi:10.1001/archpsyc.55.8.737 · Cited by 137 · see citing works
Sirri, L., Grandi, S., & Fava, G. A. (2008) · Psychotherapy and Psychosomatics · doi:10.1159/000151387 · Cited by 131 · see citing works
Conradt, M., Cavanagh, M., Franklin, J., & Rief, W. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2005.07.003 · Cited by 104 · see citing works
Hedman, E., Axelsson, E., Görling, A., Ritzman, C., Ronnheden, M., Alaoui, S. E., Andersson, E., Lekander, M., & Ljótsson, B. (2014) · British Journal of Psychiatry · doi:10.1192/bjp.bp.113.140913 · Cited by 103 · see citing works
Self-citationHedman, E., Andersson, E., Lindefors, N., Andersson, G., Rück, C., & Ljótsson, B. (2013) · Psychological Medicine · doi:10.1017/s0033291712001079 · Cited by 98 · see citing works
Self-citationMeasuring health anxiety: Moving past the dichotomous response option of the original Whiteley Index
Welch, P. G., Carleton, R. N., & Asmundson, G. J. G. (2009) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2009.05.006 · Cited by 88 · see citing works
Wheaton, M. G., Berman, N. C., Franklin, J. C., & Abramowitz, J. S. (2010) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-010-9179-4 · Cited by 77 · see citing works
Core cognitions related to health anxiety in self-reported medical and non-medical samples
Hadjistavropoulos, H. D., Janzen, J. A., Kehler, M. D., Leclerc, J., Sharpe, D., & Bourgault-Fagnou, M. D. (2011) · Journal of Behavioral Medicine · doi:10.1007/s10865-011-9339-3 · Cited by 73 · see citing works
Health anxiety: Comparison of the latent structure in medical and non-medical samples
Alberts, N. M., Sharpe, D., Kehler, M. D., & Hadjistavropoulos, H. D. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.01.011 · Cited by 70 · see citing works
Hadjistavropoulos, H. D., Frombach, I. K., & Asmundson, G. J. G. (1999) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(98)00159-4 · Cited by 67 · see citing works
Assessment of somatoform disorders: a review of strategies and instruments
Hiller, W., & Janča, A. (2003) · Acta Neuropsychiatrica · doi:10.1034/j.1601-5215.2003.00031.x · Cited by 56 · see citing works
Irrational health beliefs and health anxiety
Fulton, J. J., Marcus, D. K., & Merkey, T. (2011) · Journal of Clinical Psychology · doi:10.1002/jclp.20769 · Cited by 48 · see citing works
Fetzner, M. G., Asmundson, G. J. G., Carey, C., Thibodeau, M. A., Brandt, C., Zvolensky, M. J., & Carleton, R. N. (2014) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2014.929170 · Cited by 38 · see citing works
Repetitive Thought and Health Anxiety: Tests of Specificity
Fergus, T. A. (2013) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-013-9340-y · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Hedman, E., Axelsson, E., Andersson, E., Lekander, M., & Ljótsson, B. (2016) · British Journal of Psychiatry · doi:10.1192/bjp.bp.116.181396 · Cited by 119 · see citing works
Self-citationAxelsson, E., & Hedman-Lagerlöf, E. (2019) · Expert Review of Pharmacoeconomics & Outcomes Research · doi:10.1080/14737167.2019.1703182 · Cited by 96 · see citing works
Self-citationAxelsson, E., Lindsäter, E., Ljótsson, B., Andersson, E., & Hedman-Lagerlöf, E. (2017) · JMIR Mental Health · doi:10.2196/mental.7497 · Cited by 79 · see citing works
Self-citationKosic, A., Lindholm, P., Järvholm, K., Hedman-Lagerlöf, E., & Axelsson, E. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102208 · Cited by 77 · see citing works
Self-citationHedman‐Lagerlöf, E., Lekander, M., Ljótsson, B., Lindefors, N., Rück, C., Andersson, G., & Andersson, E. (2015) · PLoS ONE · doi:10.1371/journal.pone.0123412 · Cited by 75 · see citing works
Self-citationAxelsson, E., Andersson, E., Ljótsson, B., Wallhed Finn, D., & Hedman, E. (2016) · Cognitive Behaviour Therapy · doi:10.1080/16506073.2016.1161663 · Cited by 60 · see citing works
Self-citationCarstensen, T. B. W., Ørnbøl, E., Fink, P., Pedersen, M. M., Jørgensen, T., Dantoft, T. M., Benros, M. E., & Frostholm, L. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110245 · Cited by 51 · see citing works
Hoffmann, D., Rask, C. U., Hedman-Lagerlöf, E., Ljótsson, B., & Frostholm, L. (2018) · JMIR Mental Health · doi:10.2196/mental.9198 · Cited by 40 · see citing works
“Online administration of questionnaires has shown to be a valid method for measuring symptoms of health anxiety, which suggests that the surprising level of symptom severity cannot be explained by this [44].”
Self-citationHedman, E., Lekander, M., Karshikoff, B., Ljótsson, B., Axelsson, E., & Axelsson, J. (2016) · Journal of Abnormal Psychology · doi:10.1037/abn0000195 · Cited by 30 · see citing works
Self-citationHedman, E., Ljótsson, B., Axelsson, E., Andersson, G., Rück, C., & Andersson, E. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2016.11.007 · Cited by 20 · see citing works
Self-citationAxelsson, E., Andersson, E., Ljótsson, B., & Hedman-Lagerlöf, E. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.06.002 · Cited by 19 · see citing works
Self-citationHedman, E., Hesser, H., Andersson, E., Axelsson, E., & Ljótsson, B. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.04.007 · Cited by 17 · see citing works
Self-citationÖsterman, S., Axelsson, E., Lindefors, N., Hedman‐Lagerlöf, E., Hedman‐Lagerlöf, M., Kern, D., Svanborg, C., & Ivanov, V. Z. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04367-3 · Cited by 18 · see citing works
Self-citationManifestations of health anxiety in patients with heart transplant
Sirri, L., Tossani, E., Potena, L., Masetti, M., & Grandi, S. (2020) · Heart & Lung · doi:10.1016/j.hrtlng.2019.12.006 · Cited by 15 · see citing works
Leonidou, C., Pollatos, O., & Panayiotou, G. (2019) · Biological Psychology · doi:10.1016/j.biopsycho.2019.107812 · Cited by 11 · see citing works
Psychometric Evaluation of the Whiteley Index-8 in Chinese Outpatients in General Hospitals
Chen, Y., Fink, P., Wei, J., Toussaint, A.-K., Zhang, L., Zhang, Y., Hua, C., Ma, X., Li, W., Ren, J., et al. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.557662 · Cited by 13 · see citing works
Gehrt, T. B., Frostholm, L., Obermann, M., & Berntsen, D. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10058-3 · Cited by 11 · see citing works
Alshayea, A. K. (2020) · Journal of Experimental Psychopathology · doi:10.1177/2043808720912629 · Cited by 9 · see citing works
O’Bryan, E. M., McLeish, A. C., Norr, A. M., Ely, S., Bass, Z., Davies, C. D., Capron, D. W., Schmidt, N. B., & Mano, K. E. J. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102425 · Cited by 8 · see citing works
Österman, S., Axelsson, E., Forsell, E., Svanborg, C., Lindefors, N., Hedman‐Lagerlöf, E., & Ivanov, V. Z. (2024) · Internet Interventions · doi:10.1016/j.invent.2024.100780 · Cited by 7 · see citing works
Self-citationMorales, A., Reis, S., Espada, J. P., & Orgilés, M. (2016) · Journal of Health Psychology · doi:10.1177/1359105316669859 · Cited by 6 · see citing works
Do metacognitions contribute to pathological health anxiety? A systematic review and meta-analysis
Ivan, L., Foerster, P., Bermpohl, F., Gerlach, A., & Pohl, A. (2025) · PLoS ONE · doi:10.1371/journal.pone.0325563 · Cited by 2 · see citing works
L’anxiété centrée sur la santé : une autre épidémie à laquelle il faut se préparer
Cathébras, P. J., Kohout, E., Savall, A., & Goutte, J. (2024) · La Revue de Médecine Interne · doi:10.1016/j.revmed.2024.03.002 · Cited by 3 · see citing works
Feasibility Study of Group Cognitive Behavioral Therapy for Severe Health Anxiety
Skjernov, M., Fink, P., Fallon, B. A., Rasmussen, F., & Simonsen, E. H. (2018) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.32.4.223 · Cited by 4 · see citing works
Axelsson, E., Österman, S., & Hedman‐Lagerlöf, E. (2023) · BMC Psychiatry · doi:10.1186/s12888-023-05151-7 · Cited by 5 · see citing works
Self-citationHedman‐Lagerlöf, E., & Axelsson, E. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-811806-1.00005-6 · Cited by 4 · see citing works
Self-citationLeonidou, C., & Panayiotou, G. (2020) · Journal of Health Psychology · doi:10.1177/1359105320967435 · Cited by 3 · see citing works
Blampied, M., Bell, C., Gilbert, C., Boden, J. M., Nicholls, R. J., & Rucklidge, J. J. (2018) · Medicines · doi:10.3390/medicines5020056 · Cited by 2 · see citing works
Rahmani, N., Teymuri, S., Bayazi, M. H., & Rajaei, A. R. (2021) · Current Psychology · doi:10.1007/s12144-021-02423-x · Cited by 1 · see citing works
Thompson, A., Dierick, N. R., Heiniger, L. E., & Kostalas, S. N. (2024) · World Journal of Clinical Oncology · doi:10.5306/wjco.v16.i2.97107 · Cited by 1 · see citing works
Quantitative assessment of anxiety about their health in patients with first-ever stroke
Ma, S. (2020) · Neurology Bulletin · doi:10.17816/nb16436
Are you a health care and information seeker or avoider? A new assessment toolPreprint
Leonidou, C., & Panayiotou, G. (2021) · doi:10.31234/osf.io/vwn87
Experience of mTBI-like symptoms in a sample without brain injury in Aotearoa/New Zealand
Chua, J., & Theadom, A. (2024) · Brain Impairment · doi:10.1071/ib23070
Trends and insights in health anxiety studies (2000–2025): a bibliometric analysis
Imani, M., shabani, M. J., Pirmoradi, M., & Mohsenabadi, H. (2025) · Journal of Public Health · doi:10.1007/s10389-025-02475-4
Interdisciplinary Pain Treatment
Brose, W. G., You, D. S., Cooley, C., Schmeissing, A., & Cao, F. (2025) · Springer eBooks · doi:10.1007/978-3-031-86057-7_26
Axelsson, E., Österman, S., & Hedman-Lagerlöf, E. (2023) · Figshare · doi:10.6084/m9.figshare.24098310
Self-citationAxelsson, E., Österman, S., & Hedman-Lagerlöf, E. (2023) · Figshare · doi:10.6084/m9.figshare.24098313
Self-citationAxelsson, E., Österman, S., & Hedman-Lagerlöf, E. (2023) · Figshare · doi:10.6084/m9.figshare.24098307
Self-citationZucchelli, M. M., Pira, G. L., Ruini, C., & Nori, R. (2026) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2026.101122
- Authors
- Hedman, E., Ljótsson, B., Andersson, E., Andersson, G., Lindefors, N., Rück, C., Axelsson, E., & Lekander, M.
- Affiliations
- Linköping University (SE)
- ORCID
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2015-04
- Volume
- 31
- Pages
- 32-37
- ISSN
- 0887-6185 (ISSN-L)
- OpenAlex
- W1968637496
- Cited by
- 39
- References
- 40
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 4 · 2023: 4 · 2022: 1 · 2021: 4 · 2020: 6 · 2019: 4 · 2018: 4 · 2017: 2 · 2016: 5 · 2015: 1
- FWCI
- 6.03
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Keywords
- health anxiety, psychometric properties, Health Anxiety Inventory, Whiteley Index, test-retest reliability, internal consistency, convergent validity, discriminant validity, sensitivity to change
- MeSH terms
- Adult, Anxiety, Anxiety Disorders, Attitude to Health, Female, Humans, Hypochondriasis, Male, Personality Inventory, Psychometrics, Reproducibility of Results, Case-Control Studies, Internet
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
