Objective
Given the prevalence and costs of somatoform disorders, it is important to identify and adequately treat these patients as early as possible. Instruments assessing experiences, perceptions, and behaviors of somatoform disorders are rare. In this study we evaluated the structure and validity of the German version of the Health Attitude Survey (HAS), a multidimensional self-report questionnaire for somatoform disorders.
Methods
This cross-sectional study involved 1452 participants. The sample was randomly split for independent exploratory (EFA) and confirmatory factor analyses (CFA). Each of the two samples (n1 = 726; n2 = 726) included patients with organic vertigo and current mental disorders (somatoform and other mental disorders). Somatic symptom burden was assessed using the Patient Health Questionnaire (PHQ-15).
Results
The CFA did not confirm the original HAS factor structure. The EFA revealed six factors. To enhance the fit of the model, we deleted two factors with the poorest reliability and items with low factor loadings. A modified and shortened version achieved good fit indices (CFI = 0.92; RMSEA = 0.068). It consists of 14 instead of 27 items and four scales (“dissatisfaction with care,” “frustration with ill health,” “high utilization of care,” “excessive health worry”). HAS subscales discriminated among somatoform patients and physically ill and/or patients with a mental but not somatoform disorder, controlled for age, sex and number of (comorbid) mental diagnoses, confirming its construct validity.
Conclusion
A modified shortened version of the HAS appears to be a reliable, valid, and economical instrument for assessing facets of somatoform disorders or of the recently published
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] and [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] and [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] and [12]. In specialized or secondary care-particularly in neurology, gynecology, and gastroenterology-up to 50% of the patients suffer from medically unexplained symptoms [13] and [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] and [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.
