Screening for somatization and hypochondriasis in primary care and neurological in-patients
Abstract
The aim of this study was to investigate the internal and external validity of the Whiteley Index as a screening instrument for somatization illness. A 14-item version of the Whiteley Index for hypochondriacal traits was given to 99 of 191 consecutive primary care patients, aged 18-65 years, and to 100 consecutive patients, aged 18-60 years, admitted for the first time to a neurological ward. The primary care sample was, in addition, interviewed by means of the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) psychiatric interview. The GPs and the neurologists were asked to rate various characteristics of the patients that might indicate somatization. The internal validity of the Whiteley Index was tested by means of latent structure analysis. On this basis, a reduced seven-item scale (Whiteley-7 scale) and two subscales (i.e., an Illness Conviction and Illness Worrying scale, each with three items) were constructed. All three had a high internal validity fitting into the very restricted Rasch statistical model (p>0.05) and an acceptable transferability between most of the subpopulations investigated. In the primary care population, the Whiteley-7 and the Illness Conviction scales at cut-point 0/1 showed 1.00 and 0.87 sensitivity and 0.65 and 0.87 specificity, respectively, using as "gold standard" the fulfillment of criteria for at least one ICD-10 somatoform disorder, and 0.71 and 0.63 sensitivity and 0.62 and 0.87 specificity, respectively, as gold standard for the fulfillment of criteria for at least one DSM-IV somatoform disorder, excluding the NOS diagnostic group. The Illness Worrying subscale showed less impressive performance in this respect. The agreement between the Whiteley-7 scale including the two subscales and neurologists' rating and the GPs' rating and the somatization subscale on the SCL-90 was modest or worse. It may be concluded that the Whiteley-7 scale and the Illness Conviction subscale had acceptable psychometric profiles, and both seem to be promising screening tools for not only hypochondriasis but also for somatoform disorders in general.
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The WI-7 is a frequently used outcome measure that has shown good sensitivity and specificity in screening for health anxiety.
“The WI-7 is a frequently used outcome measure that has shown good sensitivity and specificity in screening for health anxiety [32].”
From Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial (2022) · cites this paper as [32]
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Cao, J., Wei, J., Fritzsche, K., Toussaint, A. C., Li, T., Jiang, Y., Zhang, L., Zhang, Y., Chen, H., Wu, H., et al. (2019) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2019.11.010 · Cited by 87 · see citing works
Acceptance and commitment group therapy (ACT-G) for health anxiety: a randomized controlled trial.
Eilenberg, T., Fink, P., Jensen, J. S., Rief, W., & Frostholm, L. (2016) · Psychological Medicine · doi:10.1017/s0033291715001579 · Cited by 86 · see citing works
“…worry, e.g. ‘Do you worry a lot about your health’, which has demonstrated satisfactory psychometric properties in primary-care samples with high internal validity and impressive external validity for screening DSM-IV somatization disorder and hypochondriasis/health anxiety (Fink et al. 1999).”
BackgroundMethodInfluentialSelf-citationHaig-Ferguson, A., Cooper, K., Cartwright, E., Loades, M. E., & Daniels, J. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465820000636 · Cited by 84 · see citing works
“Other versions Short version (SHAI) – 18 items, total scale range of 0–54 CIAS is a version adapted for ages 8–15 (Wright and Anderson, 2003) Short version – 7 item version (Fink et al., 1999)”
BackgroundRosendal, M., Olesen, F., Fink, P., Toft, T., Sokolowski, I., & Bro, F. (2007) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2007.03.005 · Cited by 84 · see citing works
“Supplementary analyses of somatizing patients diagnosed by their FPs showed that patients in the intervention group improved more on Whiteley-7 and SCL-Som than patients in the control group: for the intervention and control groups, changes were 0.3 (95% CI”
MethodInfluentialSelf-citationBrettschneider, C., König, H., Herzog, W., Kaufmann, C., Schaefert, R., & Konnopka, A. (2013) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-11-3 · Cited by 84 · see citing works
“Whiteley Index 7 (WI-7) The WI-7 is a screening instrument for illness worries representing a cognitive/ emotional approach [19].”
BackgroundMethodInfluentialRask, M. T., Ørnbøl, E., Rosendal, M., & Fink, P. (2017) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000405 · Cited by 81 · see citing works
“The Physical Component Summary (PCS) and the Mental Component Summary (MCS) from the SF-36were used asmeasures of self-rated health (19), and the Whiteley-7 scale as a measure of illness worry (20,21).”
MethodSelf-citationHäuser, W., Hausteiner‐Wiehle, C., Henningsen, P., Brähler, E., Schmalbach, B., & Wolfe, F. (2020) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2020.110111 · Cited by 81 · see citing works
Güleç, M. Y., Güleç, H., Simsek, G. G., Turhan, M., & Sünbül, E. A. (2011) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2011.08.002 · Cited by 79 · see citing works
“Hypochondriacal worry was assessed with a modified version of the WI-7 [16].”
BackgroundMethodInfluentialSkakkebaek, A. H., Gravholt, C. H., Rasmussen, P. M., Bojesen, A., Jensen, J. S., Fedder, J., Laurberg, P., Hertz, J. M., Østergaard, J. R., Pedersen, A. D., et al. (2013) · NeuroImage Clinical · doi:10.1016/j.nicl.2013.10.013 · Cited by 79 · see citing works
“▪ Psychological distress; SCL-8 (mental illness) (Fink et al., 1999; Fink et al., 2004a; Fink et al., 2004b), SCL-DEP6 (depression) (Christensen et al.”
Self-citationHealth anxiety and attentional bias toward virus-related stimuli during the COVID-19 pandemic
Cannito, L., Crosta, A. D., Palumbo, R., Ceccato, I., Anzani, S., Malva, P. L., Palumbo, R., & Domenico, A. D. (2020) · Scientific Reports · doi:10.1038/s41598-020-73599-8 · Cited by 78 · see citing works
Enhanced care by generalists for functional somatic symptoms and disorders in primary care
Rosendal, M., Blankenstein, A. H., Morriss, R. K., Fink, P., Sharpe, M., & Burton, C. D. (2013) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008142.pub2 · Cited by 77 · see citing works
Self-citationMental illness in new neurological patients
Fink, P. (2003) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.74.6.817 · Cited by 75 · see citing works
Self-citationIntrapartum tests for group B streptococcus: accuracy and acceptability of screening
DANIELS, J. P., Gray, J. W., Pattison, H. M., Gray, R. G., Hills, R. K., Khan, K. S., & on behalf of the GBS Collaborative Group (2010) · BJOG An International Journal of Obstetrics & Gynaecology · doi:10.1111/j.1471-0528.2010.02725.x · Cited by 73 · see citing works
Schaefert, R., Kaufmann, C., Wild, B., Schellberg, D., Boelter, R., Faber, R., Szécsényi, J., Sauer, N., Guthrie, E., & Herzog, W. (2012) · Psychotherapy and Psychosomatics · doi:10.1159/000343652 · Cited by 69 · see citing works
Detecting mental disorders in general hospitals by the SCL-8 scale
Fink, P., Ørnbøl, E., Hansen, M. S., Søndergaard, L., & De Jonge, P. (2004) · Journal of Psychosomatic Research · doi:10.1016/s0022-3999(03)00071-0 · Cited by 66 · see citing works
“It included among other things the SCL-8d questionnaire [9,13] and the seven-item Whiteley index [14], measuring illness worrying.”
MethodSelf-citationHüsing, P., Löwe, B., & Toussaint, A. C. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.08.001 · Cited by 64 · see citing works
Carstensen, T. B. W., Frostholm, L., Oernboel, E., Kongsted, A., Kasch, H., Jensen, T. S., & Fink, P. (2008) · Pain · doi:10.1016/j.pain.2008.04.008 · Cited by 65 · see citing works
“Their psychological distress symptoms were assessed with the Whiteley-7 (illness worrying) [18], the SCL-SOM (somatisation) [11], the SCL-OC (obsessive-compulsiveness) [11], the SCL-HOS (hostility) [11], the SCL-8 (mental illness) [19,20], the SCLDEP6 (depression) [9], and the SCL-ANX4 (anxiety) [9].”
Self-citationVedsted, P., Fink, P., Sørensen, H. T., & Olesen, F. (2003) · Social Science & Medicine · doi:10.1016/j.socscimed.2003.11.027 · Cited by 61 · see citing works
Self-citationRosendal, M., Bro, F., Fink, P., Christensen, K. S., & Olesen, F. (2003) · Europe PMC (PubMed Central) · Cited by 64 · see citing works
Self-citationHoffmann, D., Rask, C. U., Hedman-Lagerlöf, E., Jensen, J. S., & Frostholm, L. (2021) · Psychological Medicine · doi:10.1017/s0033291720001312 · Cited by 63 · see citing works
“The primary outcome was changes in self-reported health anxiety symptoms from baseline to 6-MFU measured by the 7-item WI-7 (Fink et al., 1999).”
MethodSelf-citationLeaviss, J., Davis, S., Ren, S., Hamilton, J., Scope, A., Booth, A., Sutton, A., Parry, G. D., Buszewicz, M., Moss-Morris, R. E., et al. (2020) · Health Technology Assessment · doi:10.3310/hta24460 · Cited by 67 · see citing works
Toft, T., Rosendal, M., Ørnbøl, E., Olesen, F., Frostholm, L., & Fink, P. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000313691 · Cited by 59 · see citing works
Self-citationBailey, R., & Wells, A. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.11.035 · Cited by 65 · see citing works
“It has also demonstrated good to excellent reliability and validity (Greeven et al., 2007; Fink et al., 1999; Stewart and Watt, 2000; Speckens, 2001).”
BackgroundHypochondrie in der Allgemeinbevölkerung:
Hinz, A., Rief, W., & Brähler, E. (2003) · Diagnostica · doi:10.1026//0012-1924.49.1.34 · Cited by 62 · see citing works
Albery, I. P., Spada, M. M., & Nikčević, A. V. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2639 · Cited by 60 · see citing works
“The Whiteley Index 7 (WI-7) has demonstrated good reliability and validity across many sample groups (Fink et al., 1999; Welch et al., 2009).”
BackgroundInfluentialMose, S., Kent, P. M., Smith, A. J., Andersen, J. H., & Christiansen, D. H. (2021) · Clinical Epidemiology · doi:10.2147/clep.s323903 · Cited by 61 · see citing works
Tang, L., Fritzsche, K., Leonhart, R., Pang, Y. K., Li, J., Lili, S., Fischer, I., Koch, M., Wünsch, A., Mewes, R., et al. (2017) · Health and Quality of Life Outcomes · doi:10.1186/s12955-017-0803-9 · Cited by 58 · see citing works
“Health-related anxiety was assessed with the 7-item Whiteley-7 index [41].”
MethodPsychological Distress as a Predictor of Frequent Attendance in Family Practice: A Cohort Study
Vedsted, P., Fink, P., Olesen, F., & Munk‐Jørgensen, P. (2001) · Psychosomatics · doi:10.1176/appi.psy.42.5.416 · Cited by 58 · see citing works
Self-citationAssessment 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
Thastum, M. M., Rask, C. U., Næss‐Schmidt, E. T., Tuborgh, A. H., Jensen, J. S., Svendsen, S. W., Nielsen, J. F., & Schröder, A. (2019) · EClinicalMedicine · doi:10.1016/j.eclinm.2019.11.007 · Cited by 54 · see citing works
Self-citationScreening for Hypochondriasis With the Illness Attitude Scales
Weck, F., Bleichhardt, G. M., & Hiller, W. (2010) · Journal of Personality Assessment · doi:10.1080/00223891003670216 · Cited by 52 · see citing works
Carstensen, 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
Self-citationVerkuil, B., BROSSCHOT, J. F., & Thayer, J. F. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.08.010 · Cited by 51 · see citing works
“These items have previously been confirmed to measure general illness worry [52].”
BackgroundWollburg, E., Voigt, K., Braukhaus, C., Herzog, A., & Löwe, B. (2012) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2012.09.015 · Cited by 49 · see citing works
“Whiteley-Index, German version, WI [45].”
BackgroundRosendal, M., Fink, P., Bro, F., & Olesen, F. (2005) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813430510015304 · Cited by 45 · see citing works
“the SCLSOM [41] for somatization, the Whiteley index [42] for hypochondriasis and partly the PHQ-15 for somatization [43].”
MethodSelf-citationSocial environment and frequent attendance in Danish general practice.
Vedsted, P., & Olesen, F. (2005) · Europe PMC (PubMed Central) · Cited by 44 · 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
“The WI-7 [33] is a 7-item measure of health anxiety symptoms including items such as “Do you often worry about the possibility that you have a serious illness?””
A general population study of the Chinese Whiteley-7 Index in Hong Kong
Lee, S., Ng, K. L., Ma, Y. L., Tsang, A., & Kwok, K. P. S. (2011) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2011.05.013 · Cited by 43 · see citing works
Niiranen, T., Jula, A., Kantola, I. M., & Reunanen, A. (2006) · Journal of Hypertension · doi:10.1097/01.hjh.0000209982.21112.bc · Cited by 43 · see citing works
Cognitive speed as an objective measure of tinnitus
Das, S. K., Wineland, A., Kallogjeri, D., & Piccirillo, J. F. (2012) · The Laryngoscope · doi:10.1002/lary.23555 · Cited by 42 · see citing works
“Depression was measured using the Patient Health Questionnaire-9 (PHQ-9),(27) and the presence and severity of coexisting functional somatic syndromes were measured using the Whiteley-7 scale.(28) Hearing level was defined as the puretone average of 1,000, 2,000, and 4,000 Hz in the worse ear, and hearing loss was cla…”
MethodSitnikova, K., Dijkstra‐Kersten, S. M. A., Mokkink, L. B., Terluin, B., van Marwijk, H., Leone, S. S., van der Horst, H. E., & van der Wouden, J. C. (2017) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2017.10.005 · Cited by 42 · see citing works
“The items for the somatoform disorder part are taken from the Symptom Checklist (SCL-90) (46)and the Whiteley index (47).”
MethodAsmundson, G. J. G., Carleton, R. N., Bovell, C. V., & Taylor, S. J. (2008) · Journal of Cognitive Psychotherapy · doi:10.1891/0889-8391.22.2.87 · Cited by 41 · see citing works
“There have been six studies published on the factor structure of the WI in clinical samples, four using exploratory factor-analytic (EFA) procedures (Hiller, Rief, & Fichter, 2002; Pilowsky, 1967; Rief, Hiller, Geissner, & Fichter, 1994; Speckens, Spinhoven, Sloekers, Bolk, & van Hemert, 1996), one using confirmatory…”
BackgroundMethodResultInfluentialHall, N. M., Kuzminskyte, R., Pedersen, A. D., Ørnbøl, E., & Fink, P. (2010) · Nordic Journal of Psychiatry · doi:10.3109/08039488.2010.528024 · Cited by 40 · see citing works
Self-citationJørgensen, C. K., Fink, P., & Olesen, F. (2000) · Europe PMC (PubMed Central) · Cited by 40 · see citing works
Self-citationLaferton, J. A. C., Stenzel, N., Rief, W., Klaus, K., Brähler, E., & Mewes, R. (2017) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000530 · Cited by 39 · see citing works
Acceptance and commitment group therapy for health anxiety - Results from a pilot study
Eilenberg, T., Kronstrand, L., Fink, P., & Frostholm, L. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.06.001 · Cited by 38 · see citing works
Self-citationRIFD – A brief clinical research interview for functional somatic disorders and health anxiety
Petersen, M. W., Schröder, A., Jørgensen, T., Ørnbøl, E., Dantoft, T. M., Eliasen, M., & Fink, P. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.04.001 · Cited by 38 · see citing works
Self-citationSomatoform and Substance Use Disorders
Hasin, D. S., & Katz, H. (2007) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31815b00d7 · Cited by 37 · see citing works
“Diagnostic accuracy might be improved by condensing symptom checklists used for somatoform disorder diagnoses (35,36).”
Backgroundde Waal, M. W. M., Arnold, I. A., Spinhoven, P., Eekhof, J. A., Assendelft, W. J., & van Hemert, A. M. (2008) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-008-0410-5 · Cited by 36 · see citing works
“illness worry or functional impairments [8, 11].”
Leonhart, R., Tang, L., Pang, Y. K., Li, J., Lili, S., Fischer, I., Koch, M., Wünsch, A., Fritzsche, K., & Schaefert, R. (2016) · Psycho-Oncology · doi:10.1002/pon.4203 · Cited by 36 · see citing works
Berens, S., Schaefert, R., Baumeister, D., Gauss, A., Eich, W., & Tesarz, J. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.109836 · Cited by 35 · see citing works
Psychological and clinical correlates of functional somatic complaints in depression
Chakraborty, K., Avasthi, A., Kumar, S., & Grover, S. (2010) · International Journal of Social Psychiatry · doi:10.1177/0020764010387065 · Cited by 35 · see citing works
“Similarly, studies using a different measure of anxiety from the Western and Asian countries have reported a positive correlation between anxiety levels in depressed patients and functional somatic complaints (Fink et al., 1999; Haug et al., 2004; Kroenke and Price, 1993; Simon and Vonkorff, 1991).”
BackgroundThe FIP study: a randomised, controlled trial of screening and recognition of psychiatric disorders.
Christensen, K. S., Toft, T., Frostholm, L., Ørnbøl, E., Fink, P., & Olesen, F. (2003) · Europe PMC (PubMed Central) · Cited by 35 · see citing works
Self-citationBerens, S., Engel, F., Gauss, A., Tesarz, J., Herzog, W., Niesler, B., Stroe-Kunold, E., & Schaefert, R. (2020) · Gastroenterology Research and Practice · doi:10.1155/2020/9086340 · Cited by 35 · see citing works
- Authors
- Fink, P., Ewald, H., Jensen, J., Sørensen, L., Engberg, M., Holm, M., & Munk-Jørgensen, P.
- Affiliations
- Aarhus University Hospital (DK)
- Corresponding author
- Fink, Per
- Venue
- Journal of Psychosomatic Research
- Publisher
- Elsevier BV
- Published
- 1999-03
- Volume
- 46
- Issue
- 3
- Pages
- 261-273
- ISSN
- 0022-3999 (ISSN-L)
- OpenAlex
- W146236585
- Cited by
- 314
- References
- 38
- Citations by year
- 2026: 11 · 2025: 15 · 2024: 15 · 2023: 14 · 2022: 18 · 2021: 15 · 2020: 22 · 2019: 22 · 2018: 10 · 2017: 19 · 2016: 11 · 2015: 8 · 2014: 14 · 2013: 13 · 2012: 12
- FWCI
- 3.33
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Psychosomatic Research (publishedVersion)
- PubMed (publishedVersion)
- Scopus (Elsevier) (submittedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Health Sciences › Medicine › Psychiatry and Mental health › Fibromyalgia and Chronic Fatigue Syndrome Research
- Keywords
- somatization, health anxiety, Whiteley Index, somatoform disorders, screening tool, internal validity, generalizability, neurology inpatients, primary care patients, SCL-90, Rasch model, latent structure analysis, sensitivity and specificity
- MeSH terms
- Adolescent, Adult, Aged, Family Practice, Female, Humans, Male, Mass Screening, Middle Aged, Neurology, Predictive Value of Tests, Primary Health Care, Psychiatric Status Rating Scales, Psychometrics, Surveys and Questionnaires, Sensitivity and Specificity, Somatoform Disorders, Reproducibility of Results
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