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The reliability and validity of the Chinese version of the Metacognitions about Health Questionnaire in college students

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Abstract

Purpose

In order to explain the potential mechanism that might motivate and maintain health anxiety (HA), researchers have developed several measures to assess the level of HA and to identify related cognitions and personality features. However, such instruments typically measure general metacognitions [e.g., the Metacognition Questionnaire-30 (MCQ-30)], thereby compromising the degree of sensitivity and specificity of measurement as applied to HA-related metacognitions. To address that issue, the Metacognitions about Health Questionnaire (MCQ-HA) was designed especially for measuring metacognitive beliefs specific to HA. Because a Chinese version of MCQ-HA may be helpful in improving our understanding of HA in a Chinese population, in the current study we sought to develop a Chinese version of the MCQ-HA (CMCQ-HA).

Methods

We translated the MCQ-HA into Chinese with consideration of cultural diversity. For evaluation of its validity and stability, a sample of 1290 Chinese college students answered the CMCQ-HA, the Short Health Anxiety Inventory, the MCQ-30, and the Neuroticism scale of the Eysenck Personality Questionnaire. 292 students of them answered the CMCQ-HA twice.

Results

Good internal consistency (α = 0.81) and test–retest reliability (ICC = 0.70) of the CMCQ-HA was presented. Exploratory and confirmatory factor analyses indicated a three-factor structure: beliefs about biased thinking, beliefs that thoughts can cause illness, and beliefs that thoughts are uncontrollable. Convergent validity, divergent validity, and incremental validity all were acceptable. Measurement invariance across gender was established.

Conclusions

The CMCQ-HA shows promise for the measurement of specific HA-related metacognitions in Chinese populations.

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References

  1. Abramowitz, J. S., Deacon, B. J., & Valentiner, D. P. (2007). The short health anxiety inventory: Psychometric properties and construct validity in a non-clinical sample. Cognitive Therapy and Research, 31(6), 871–883. https://doi.org/10.1007/s10608-006-9058-1.

    Google Scholar 

  2. Creed, F., & Barsky, A. (2004). A systematic review of the epidemiology of somatisation disorder and hypochondriasis. Journal of Psychosomatic Research, 56(4), 391–408. https://doi.org/10.1016/S0022-3999(03)00622-6.

    Google Scholar 

  3. Salkovskis, P. M., & Warwick, H. M. (1986). Morbid preoccupations, health anxiety and reassurance: A cognitive-behavioural approach to hypochondriasis. Behaviour Research and Therapy, 24(5), 597–602.

    Article  CAS  PubMed  Google Scholar 

  4. Sunderland, M., Newby, J. M., & Andrews, G. (2013). Health anxiety in Australia: Prevalence, comorbidity, disability and service use. The British Journal of Psychiatry, 202(1), 56–61. https://doi.org/10.1192/bjp.bp.111.103960.

    Google Scholar 

  5. Noyes, R., Happel, R. L., & Yagla, S. J. (1999). Correlates of hypochondriasis in a nonclinical population. Psychosomatics, 40, 461–469.

    Article  PubMed  Google Scholar 

  6. Malouff, J. M., Thorsteinsson, E. B., & Schutte, N. S. (2005). The relationship between the five-factor model of personality and symptoms of clinical disorders: A meta-analysis. Journal of Psychopathology and Behavioral Assessment, 27, 101–114.

    Article  Google Scholar 

  7. Cox, B. J., Borger, S. C., Asmundson, G. J. G., & Taylor, S. (2000). Dimensions of hypochondriasis and the five factor model of personality. Personality and individual differences, 29, 99–108.

    Article  Google Scholar 

  8. Williams, P. G. (2004). The psychopathology of self-assessed health: A cognitive approach to health anxiety and hypochondriasis. Cognitive Therapy Research, 28(5), 629–644.

    Article  Google Scholar 

  9. Marcus, D. K., Gurley, J. R., Marchi, M. M., & Bauer, C. (2007). Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review. Clinical Psychology Review, 27(2), 127–139. https://doi.org/10.1016/j.cpr.2006.09.003.

    Google Scholar 

  10. Norris, L., A. & Marcus, D. K. (2014). Cognition in health anxiety and hypochondriasis: Recent advances. Current Psychiatry Reviews, 10(1), 44–49.

    Article  Google Scholar 

  11. Barsky, A. J., & Wyshak, G. (1990). Hypochondriasis and somatosensory amplification. The British Journal of Psychiatry, 157(3), 404–409.

    Article  CAS  PubMed  Google Scholar 

  12. Pilowsky, I. (1967). Dimension of hypochondriasis. British Journal of Psychiatry, 113, 89–93.

    Article  CAS  PubMed  Google Scholar 

  13. Salkovskis, P. M., Rimes, K. A., Warwick, H., & Clark, D. M. (2002). The Health Anxiety Inventory: Development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(5), 843–853. https://doi.org/10.1017/S0033291702005822.

    CAS  Google Scholar 

  14. Hadjistavropoulos, H. D., Janzen, J. A., Kehler, M. D., Leclerc, J. A., Sharpe, D., & Bourgault-Fagnou, M. D. (2012). Core cognitions related to health anxiety in self-reported medical and non-medical samples. Journal of Behavioral Medicine, 35(2), 167–178. https://doi.org/10.1007/s10865-011-9339-3.

    Google Scholar 

  15. Bailey, R., & Wells, A. (2016). Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study. Behaviour Research and Therapy, 78, 43–50. https://doi.org/10.1016/j.brat.2016.01.002.

    Google Scholar 

  16. Bailey, R., & Wells, A. (2016). The contribution of metacognitive beliefs and dysfunctional illness beliefs in predicting health anxiety: An evaluation of the metacognitive versus the cognitive models. Clinical Psychologist, 20(3), 129–137. https://doi.org/10.1111/cp.12078.

    Google Scholar 

  17. Bailey, R., & Wells, A. (2015). Metacognitive beliefs moderate the relationship between catastrophic misinterpretation and health anxiety. Journal of Anxiety Disorders, 34, 8–14. https://doi.org/10.1016/j.janxdis.2015.05.005.

    Google Scholar 

  18. Melli, G., Carraresi, C., Poli, A., & Bailey, R. (2016). The role of metacognitive beliefs in health anxiety. Personality and Individual Differences, 89, 80–85. https://doi.org/10.1016/j.paid.2015.10.006.

    Google Scholar 

  19. Wells, A., & Cartwright-Hatton, S. (2004). A short from of the metacognitions questionnaire: Properties of the MCQ-30. Behaviour Research and Therapy, 42(4), 385–396.

    Article  PubMed  Google Scholar 

  20. Bailey, R., & Wells, A. (2015). Development and initial validation of a measure of metacognitive beliefs in health anxiety: The MCQ-HA. Psychiatry Research, 230(3), 871–877. https://doi.org/10.1016/j.psychres.2015.11.035.

    Google Scholar 

  21. Rachman, S. (2012). Health anxiety disorders: A cognitive construal. Behaviour Research and Therapy, 50(7–8), 502–512. https://doi.org/10.1016/j.brat.2012.05.001.

    CAS  Google Scholar 

  22. Fulton, J. J., Marcus, D. K., & Merkey, T. (2011). Irrational health beliefs and health anxiety. Journal of Clinical Psychology, 67(6), 527–538. https://doi.org/10.1002/jclp.20769.

    Google Scholar 

  23. Looper, K. J., & Kirmayer, L. J. (2001). Hypochondriacal concerns in a community population. Psychological Medicine, 31(4), 577–584.

    Article  CAS  PubMed  Google Scholar 

  24. Lee, S., Ng, K. L., Ma, Y. L., Tsang, A., & Kwok, K. P. (2011). A general population study of the Chinese Whiteley-7 index in Hong Kong. Journal of Psychosomatic Research, 71(6), 387–391. https://doi.org/10.1016/j.jpsychores.2011.05.013.

    Google Scholar 

  25. Su, X., Li, Z., Jiang, C., & Ma, Y. (2016). The cognitive characteristics of hypochondriasis and the development of related measurements. Journal of Psychiatry, 29(6), 477–480.

    Google Scholar 

  26. Markus, H. R., & Kitayama, S. (1991). Culture and the self: Implications for cognition, emotion, and motivation. Psychological Review, 98(2), 224–253.

    Article  Google Scholar 

  27. Beaton, D. E., Bombardier, C., Guillemin, F., & Ferraz, M. B. (2000). Guidelines for the process of cross-cultural adaptation of self-report measures. Spine (Phila Pa 1976), 25(24), 3186–3191.

    Article  CAS  Google Scholar 

  28. Yuan, Y., Zhang, Y., Liu, R., Li, G., & Mao, S. (2015) The reliability and validity of a Chinese-version Short Health Anxiety Inventory: An investigation of university students. Neuropsychiatric Disease and Treatment, 11, 1739. https://doi.org/10.2147/NDT.S83501.

    Google Scholar 

  29. Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusions: The metacognitions questionnaire and its correlates. Journal of Anxiety Disorders, 24(3), 318–325.

    Google Scholar 

  30. Carciofo, R., Song, N., Du, F., Wang, M. M., & Zhang, K. (2017). Metacognitive beliefs mediate the relationship between mind wandering and negative affect. Personality and Individual Differences, 107, 78–87. https://doi.org/10.1016/j.paid.2016.11.033.

    Google Scholar 

  31. Eysenck, S. B. G., Eysenck, H. J., & Barrett, P. (1985). A revised version of the psychoticism scale. Personality and Individual Differences, 6(1), 21–29.

    Article  Google Scholar 

  32. Mingyi, Q., Guocheng, W., Rongchun, Z., & Shen, Z. (2000). Development of the revised Eysenck Personality Questionnaire Short Scale for Chinese (EPQ-RSC). Acta Psychologica Sinica, 32(3), 317–323.

    Google Scholar 

  33. Naunnally, J. C., & Bernstein, I. H. (1994). Psychometric Theory (3rd ed.). New York: McGraw-Hill.

    Google Scholar 

  34. Shrout, P. E., & Fleiss, J. L. (1979). Intraclass correlations: Uses in assessing rater reliability. Psychological bulletin, 86(2), 420–428.

    Article  CAS  PubMed  Google Scholar 

  35. Tabachnick, B. G., & Fidell, L. S. (2007). Using Multivariate Statistics (5th ed.). New York: Allyn and Bacon.

    Google Scholar 

  36. O’Connor, B. P. (2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, 32(3), 396–402.

    Article  Google Scholar 

  37. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55.

    Article  Google Scholar 

  38. Samuel, D. B., South, S. C., & Griffin, S. A. (2015). Factorial invariance of the five-factor model rating form across gender. Assessment, 22(1), 65–75. https://doi.org/10.1177/1073191114536772.

    Google Scholar 

  39. Kline, R. B. (2005). Principles and practice of structural equation modeling. New York: Guilford.

    Google Scholar 

  40. Ambrosio, L., Portillo, M. C., Rodriguez-Blazquez, C., Martinez-Castrillo, J. C., Rodriguez-Violante, M., & Serrano-Duenas, M., et al. (2016). Satisfaction with Life Scale (SLS-6): First validation study in Parkinson’s disease population. Parkinsonism Related Disorders, 25, 52–57. https://doi.org/10.1016/j.parkreldis.2016.02.012.

    Google Scholar 

  41. Zwaanswijk, W., Veen, V. C., & Vedder, P. (2016). The youth psychopathic traits inventory: A bifactor model, dimensionality, and measurement invariance. Assessment. https://doi.org/10.1177/1073191116632340.

    Google Scholar 

  42. Shrout, P. E. (1998). Measurement reliability and agreement in psychiatry. Statistical Methods in Medical Research, 7(3), 301–317.

    Article  CAS  PubMed  Google Scholar 

  43. Kaiser, H. F. (1970). A second generation little jiffy. Psychometrika, 35(4), 401–415.

    Article  Google Scholar 

  44. Dancey, C., & Reidy, J. (2004). Statistics without maths for psychology: Using SPSS for windows. London: Prentice Hall.

    Google Scholar 

  45. Enns, M. W., & Cox, B. J. (1997). Personality dimensions and depression: Review and commentary. The Canadian Journal of Psychiatry, 42(3), 274–284. https://doi.org/10.1177/070674379704200305.

    CAS  Google Scholar 

  46. Steiger, J. H. (1980). Tests for comparing elements of a correlation matrix. Psychological Bulletin, 87, 245–251.

    Article  Google Scholar 

  47. Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9(2), 233–255. https://doi.org/10.1207/S15328007SEM0902_5.

    Google Scholar 

  48. Schmitt, N., & Kuljanin, G. (2008). Measurement invariance: Review of practice and implications. Human Resource Management Review, 18(4), 210–222.

    Article  Google Scholar 

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Funding

This research was supported by the New Xiangya Talent Project of the Third Xiangya Hospital of Central South University (Grant No. 20150302).

Author information

Authors and Affiliations

  1. Department of Psychiatry, The Third Xiangya Hospital, Central South University, Changsha, 410013, China

    Lisha Dai & Yunlong Deng

  2. School of Health, BB235, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK

    Robin Bailey

Authors
  1. Lisha Dai
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  2. Robin Bailey
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  3. Yunlong Deng
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Corresponding author

Correspondence to Yunlong Deng.

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Conflict of interest

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

The Institutional Review Board of the Third Xiangya Hospital in Hunan approved the study (2017-S208).

Appendix

Appendix

The Metacognitions about Health Questionnaire

Items

Do not agree

Agree slightly

Agree moderately

Agree very much

1. Thinking of illness could change my health

1

2

3

4

2. I cannot have peace of mind so long as I have physical symptoms

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3. I will be punished for thinking I am in good health

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4. Thinking negatively can increase my chances of disease

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5. Worrying about illness is likely to make it happen

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6. Some thoughts have the power to make me ill

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7. Dwelling on thoughts of illness is uncontrollable

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8. Thinking the worse about symptoms will keep me safe

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9. Worrying about my health will damage my body

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10. If I think positively about physical symptoms I will be caught off guard

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11. Worrying about my health will help me cope

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12. I have no control over thinking about my health

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13. Only if I have a diagnosis will I be able to stop worrying

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14. Thinking positively about my health will tempt fate and I will become ill

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4

健康焦虑元认知量表中文版

条目

不同意

有点同意

基本同意

完全同意

1. 对疾病的思考会影响我的健康状况。

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2. 只要我有身体症状,我就不能保持平和心态。

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3. 如果我认为自己健康状况很好,那么可能会发生一些不好的事。

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4. 消极地思考会增加我患病的可能性。

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5. 对疾病的担心有可能引发疾病。

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6. 有些与疾病有关的想法会导致我生病。

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7. 思考与疾病有关的想法是我无法控制的。

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8. 我把症状想得更严重就会更安全

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9. 对自己健康的担忧会损害我的身体健康

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10. 如果我太乐观地看待我的身体症状, 我将会意识不到疾病的存在

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11. 对疾病的担忧会帮助我应对疾病。

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12. 我无法控制自己对自身健康的思考。

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13. 只有当我得到了一个诊断, 我才能停止对自己身体状况的担忧。

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14. 如果我对自身健康持乐观的想法,我是会因此生病的

1

2

3

4

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Dai, L., Bailey, R. & Deng, Y. The reliability and validity of the Chinese version of the Metacognitions about Health Questionnaire in college students. Qual Life Res 27, 1099–1108 (2018). https://doi.org/10.1007/s11136-017-1780-5

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