A Clinician-Administered Severity Rating Scale for Illness Anxiety: Development, Reliability, and Validity of the H-Ybocs-M

Abstract

Background Clinician-administered measures to assess severity of illness anxiety and response to treatment are few. The authors evaluated a modified version of the hypochondriasis-Y-BOCS (H-YBOCS-M), a 19-item, semistructured, clinician-administered instrument designed to rate severity of illness-related thoughts, behaviors, and avoidance. Methods The scale was administered to 195 treatment-seeking adults with DSM-IV hypochondriasis. Test–retest reliability was assessed in a subsample of 20 patients. Interrater reliability was assessed by 27 interviews independently rated by four raters. Sensitivity to change was evaluated in a subsample of 149 patients. Convergent and discriminant validity was examined by comparing H-YBOCS-M scores to other measures administered. Item clustering was examined with confirmatory and exploratory factor analyses. Results The H-YBOCS-M demonstrated good internal consistency, interrater and test–retest reliability, and sensitivity to symptom change with treatment. Construct validity was supported by significant higher correlations with scores on other measures of hypochondriasis than with nonhypochondriacal measures. Improvement over time in response to treatment correlated with improvement both on measures of hypochondriasis and on measures of somatization, depression, anxiety, and functional status. Confirmatory factor analysis did not show adequate fit for a three-factor model. Exploratory factor analysis revealed a five-factor solution with the first two factors consistent with the separation of the H-YBOCS-M items into the subscales of illness-related avoidance and compulsions. Conclusions H-YBOCS-M appears to be valid, reliable, and appropriate as an outcome measure for treatment studies of illness anxiety. Study results highlight “avoidance” as a key feature of illness anxiety—with potentially important nosologic and treatment implications.

Cost-effectiveness and long-term follow-up of three forms of minimal-contact cognitive behaviour therapy for severe health anxiety: Results from a randomised controlled trial

“…Dimensional assessment of health anxiety is typically, though not always [58][59][60] , based on selfrated questionnaires [61][62][63][64][65][66][67][68][69][70] or continuous visual analogue scales 71,72 . One of the first scales to gain recognition as a valid measure of health anxiety was the Whiteley Index (WI).…”

A Randomized Controlled Trial of Medication and Cognitive-Behavioral Therapy for Hypochondriasis

“…The Whiteley Index deals primarily with illness-related fears and beliefs rather than behaviors, and is similar to the obsession subscale of the H-YBOCS-M. The illness obsession subscale of the H-YBOCS-M is more sensitive to change than are its two behavior subscales (20). This difference may explain the greater sensitivity of the Whiteley Index compared to the H-YBOCS-M total score.…”

“…The baseline research battery was re-administered by the same independent evaluators at 6, 12, and 24 weeks (the study endpoint). At 12 weeks, subjects with less than minimal improvement (defined as less than 15% improvement over baseline on the H-YBOCS-M (20)) were removed from the protocol and offered alternative treatment.…”

“…Hypochondriacal symptoms were assessed with the Whiteley Index (23, 24) and the H-YBOCS-M (20). The Whiteley Index is a 14-item self-report questionnaire whose sensitivity to change, validity, internal consistency, and test-retest reliability have been demonstrated (23–25).…”

“…The Whiteley Index is a 14-item self-report questionnaire whose sensitivity to change, validity, internal consistency, and test-retest reliability have been demonstrated (23–25). The H-YBOCS-M is a well-standardized, sensitive, and reliable semi-structured interview rating of hypochondriacal thoughts, behaviors, avoidance, and insight (20). Somatization was assessed with the Patient Health Questionnaire-15 (26).…”