Cited by 314Psychosomatic Disorders and Their TreatmentsAnxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesFibromyalgia and Chronic Fatigue Syndrome Research

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Screening for somatization and hypochondriasis in primary care and neurological in-patients

Fink, Per, Ewald, Henrik, Jensen, Jørgen, Sørensen, Lisbeth, Engberg, Marianne, Holm, Martin, Munk-Jørgensen, Povl·1999·Journal of Psychosomatic Research

DOI 10.1016/s0022-3999(98)00092-0

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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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“Hypochondriacal worry was assessed with a modified version of the WI-7 [16].”
BackgroundMethodInfluential
Neuroanatomical correlates of Klinefelter syndrome studied in relation to the neuropsychological profile
Skakkebaek, 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
“▪ 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-citation
Health 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
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 83
Self-citation
Mental illness in new neurological patients
Fink, P. (2003) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.74.6.817 · Cited by 75
Self-citation
Intrapartum 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
Specific Collaborative Group Intervention for Patients with Medically Unexplained Symptoms in General Practice: A Cluster Randomized Controlled Trial
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 71
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
“It included among other things the SCL-8d questionnaire [9,13] and the seven-item Whiteley index [14], measuring illness worrying.”
MethodSelf-citation
Comparing the diagnostic concepts of ICD-10 somatoform disorders and DSM-5 somatic symptom disorders in patients from a psychosomatic outpatient clinic
Hüsing, P., Löwe, B., & Toussaint, A. C. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.08.001 · Cited by 64
Post-trauma ratings of pre-collision pain and psychological distress predict poor outcome following acute whiplash trauma: A 12-month follow-up study
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
“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-citation
Physical, mental and social factors associated with frequent attendance in Danish general practice. A population-based cross-sectional study
Vedsted, P., Fink, P., Sørensen, H. T., & Olesen, F. (2003) · Social Science & Medicine · doi:10.1016/j.socscimed.2003.11.027 · Cited by 61
Self-citation
Diagnosis of somatisation: effect of an educational intervention in a cluster randomised controlled trial.
Rosendal, M., Bro, F., Fink, P., Christensen, K. S., & Olesen, F. (2003) · Europe PMC (PubMed Central) · Cited by 64
Self-citation
Efficacy of internet-delivered acceptance and commitment therapy for severe health anxiety: results from a randomized, controlled trial.
Hoffmann, D., Rask, C. U., Hedman-Lagerlöf, E., Jensen, J. S., & Frostholm, L. (2021) · Psychological Medicine · doi:10.1017/s0033291720001312 · Cited by 63
“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-citation
Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews and economic evaluation
Leaviss, 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 71
Training General Practitioners in the Treatment of Functional Somatic Symptoms: Effects on Patient Health in a Cluster-Randomised Controlled Trial (the Functional Illness in Primary Care Study)
Toft, T., Rosendal, M., Ørnbøl, E., Olesen, F., Frostholm, L., & Fink, P. (2010) · Psychotherapy and Psychosomatics · doi:10.1159/000313691 · Cited by 59
Self-citation
Development and initial validation of a measure of metacognitive beliefs in health anxiety: The MCQ-HA
Bailey, R., & Wells, A. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2015.11.035 · Cited by 65
“It has also demonstrated good to excellent reliability and validity (Greeven et al., 2007; Fink et al., 1999; Stewart and Watt, 2000; Speckens, 2001).”
Background
Hypochondrie in der Allgemeinbevölkerung:
Hinz, A., Rief, W., & Brähler, E. (2003) · Diagnostica · doi:10.1026//0012-1924.49.1.34 · Cited by 62
The COVID‐19 anxiety syndrome and selective attentional bias towards COVID‐19‐related stimuli in UK residents during the 2020–2021 pandemic
Albery, I. P., Spada, M. M., & Nikčević, A. V. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2639 · Cited by 60
“The Whiteley Index 7 (WI-7) has demonstrated good reliability and validity across many sample groups (Fink et al., 1999; Welch et al., 2009).”
BackgroundInfluential
Trajectories of Musculoskeletal Healthcare Utilization of People with Chronic Musculoskeletal Pain – A Population-Based Cohort Study
Mose, S., Kent, P. M., Smith, A. J., Andersen, J. H., & Christiansen, D. H. (2021) · Clinical Epidemiology · doi:10.2147/clep.s323903 · Cited by 62
Emotional distress and dysfunctional illness perception are associated with low mental and physical quality of life in Chinese breast cancer patients
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
“Health-related anxiety was assessed with the 7-item Whiteley-7 index [41].”
Method
Psychological 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
Self-citation
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
Novel interdisciplinary intervention, GAIN, vs. enhanced usual care to reduce high levels of post-concussion symptoms in adolescents and young adults 2–6 months post-injury: A randomised trial
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 60
Self-citation
Screening 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
Detection of illness worry in the general population: A specific item on illness rumination improves the Whiteley Index
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
Self-citation
A sensitive body or a sensitive mind? Associations among somatic sensitization, cognitive sensitization, health worry, and subjective health complaints
Verkuil, B., BROSSCHOT, J. F., & Thayer, J. F. (2007) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2007.08.010 · Cited by 51
“These items have previously been confirmed to measure general illness worry [52].”
Background
Construct validity and descriptive validity of somatoform disorders in light of proposed changes for the DSM-5
Wollburg, 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
“Whiteley-Index, German version, WI [45].”
Background
Somatization, heartsink patients, or functional somatic symptoms? Towards a clinical useful classification in primary health care
Rosendal, M., Fink, P., Bro, F., & Olesen, F. (2005) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813430510015304 · Cited by 45
“the SCLSOM [41] for somatization, the Whiteley index [42] for hypochondriasis and partly the PHQ-15 for somatization [43].”
MethodSelf-citation
Social environment and frequent attendance in Danish general practice.
Vedsted, P., & Olesen, F. (2005) · Europe PMC (PubMed Central) · Cited by 44
Development and Feasibility Testing of Internet-Delivered Acceptance and Commitment Therapy for Severe Health Anxiety: Pilot Study.
Hoffmann, D., Rask, C. U., Hedman-Lagerlöf, E., Ljótsson, B., & Frostholm, L. (2018) · JMIR Mental Health · doi:10.2196/mental.9198 · Cited by 40
“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 44
Prevalence and determinants of isolated clinic hypertension in the Finnish population: the Finn-HOME study
Niiranen, T., Jula, A., Kantola, I. M., & Reunanen, A. (2006) · Journal of Hypertension · doi:10.1097/01.hjh.0000209982.21112.bc · Cited by 43
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
“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…”
Method
Systematic review of measurement properties of questionnaires measuring somatization in primary care patients
Sitnikova, 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 45
“The items for the somatoform disorder part are taken from the Symptom Checklist (SCL-90) (46)and the Whiteley index (47).”
Method
Comparison of Unitary and Multidimensional Models of the Whiteley Index in a Nonclinical Sample: Implications for Understanding and Assessing Health Anxiety
Asmundson, 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
“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…”
BackgroundMethodResultInfluential
The relationship between cognitive functions, somatization and behavioural coping in patients with multiple functional somatic symptoms
Hall, 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
Self-citation
Psychological distress and somatisation as prognostic factors in patients with musculoskeletal illness in general practice.
Jørgensen, C. K., Fink, P., & Olesen, F. (2000) · Europe PMC (PubMed Central) · Cited by 40
Self-citation
Screening for DSM-5 Somatic Symptom Disorder: Diagnostic Accuracy of Self-Report Measures Within a Population Sample
Laferton, J. A. C., Stenzel, N., Rief, W., Klaus, K., Brähler, E., & Mewes, R. (2017) · Psychosomatic Medicine · doi:10.1097/psy.0000000000000530 · Cited by 39
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
Self-citation
RIFD – 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
Self-citation
Somatoform and Substance Use Disorders
Hasin, D. S., & Katz, H. (2007) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31815b00d7 · Cited by 37
“Diagnostic accuracy might be improved by condensing symptom checklists used for somatoform disorder diagnoses (35,36).”
Background
The role of comorbidity in the detection of psychiatric disorders with checklists for mental and physical symptoms in primary care
de 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
“illness worry or functional impairments [8, 11].”
Physical and psychological correlates of high somatic symptom severity in Chinese breast cancer patients
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
Does symptom activity explain psychological differences in patients with irritable bowel syndrome and inflammatory bowel disease? Results from a multi-center cross-sectional study
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 37
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
“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).”
Background
The 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
Self-citation
Patients with multiple functional gastrointestinal disorders (FGIDs) show increased illness severity: a cross-sectional study in a tertiary care FGID specialty clinic
Berens, 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

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
ORCID: Fink, Per
Jensen, Jørgen
Sørensen, Lisbeth
Venue: Journal of Psychosomatic Research
Publisher: Elsevier BV
Published: 1999-03
Volume: 46
Issue: 3
Pages: 261-273
ISSN: 0022-3999 (ISSN-L)
DOI: 10.1016/s0022-3999(98)00092-0
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
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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Screening for somatization and hypochondriasis in primary care and neurological in-patients

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