Short Health Anxiety Inventory HAI-18
Short Health Anxiety Inventory HAI-18 overview
Creator and Context
The Short Health Anxiety Inventory (SHAI, also known as the HAI-18) is a self report measure of health anxiety, from ordinary health concern through to severe health anxiety.
It was developed by Paul Salkovskis, Katharine Rimes, Hilary Warwick and David Clark and published in 2002, as a short form of the 64 item Health Anxiety Inventory.
Presenting Conditions
The instrument has two parts:
14 main items measuring health anxiety, covering preoccupation with health, fear of illness, bodily vigilance and reassurance seeking
4 further items measuring the anticipated negative consequences of becoming ill
Administration
Self administered, covering the past 6 months. Each item presents four statements and the person selects the one that best describes them, scored 0 to 3.
Desired Audience
Adults. It was deliberately designed to be sensitive across the full range, so it works in medical settings as well as psychiatric ones.
Health anxiety drives an enormous volume of unnecessary investigation and consultation, and it rarely gets named as the problem. The SHAI is short, works in medical settings, and gives a service a defensible way of identifying it.
Considerations
The 14 item and 18 item versions are used interchangeably in the literature, but their totals are not comparable. Be explicit about which is in use.
Cut offs differ by version and by purpose. A screening threshold in a psychiatric setting is not the same as one in a general population, and neither is the same as a remission criterion.
It is a screening and severity measure, not a diagnostic instrument.
Copyright is held by the authors. Permission should be confirmed before commercial deployment.
How to score the Short Health Anxiety Inventory HAI-18
Conducting the assessment
The person selects one of four statements for each item, scored 0 to 3, in relation to the past 6 months.
Interpretation
The 14 item main scale scores 0 to 42. The full 18 item version scores 0 to 54.
For the 18 item version, a score of 18 or above is commonly used as the clinical threshold.
For the 14 item version, the best evidenced thresholds come from the Swedish validation (Axelsson et al., 2022):
22 in a psychiatric setting, with sensitivity of 93 percent and specificity of 85 percent
29 in a low prevalence or general population setting
18 against healthy controls, proposed as a remission criterion
Severity bands for the 14 item version from the same study: 0 to 27 none or mild, 28 to 32 moderate, 33 to 42 substantial.
Clinical Considerations
State which version you are using. Applying an 18 item threshold to a 14 item score, or the reverse, will misclassify people.
Choose the threshold to match the setting. In a low prevalence medical population, the lower cut offs generate a great many false positives.
Read the negative consequences items alongside the main scale. They often explain why reassurance does not work.
Short Health Anxiety Inventory HAI-18 use cases
Screening for health anxiety in medical and psychiatric settings
Measuring severity of health anxiety
Tracking treatment response
Research into health anxiety and hypochondriasis
Category
Anxiety
Research Summary
Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & 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 to 853.
Alberts, N. M., Hadjistavropoulos, H. D., Jones, S. L., & Sharpe, D. (2013). The Short Health Anxiety Inventory: A systematic review and meta analysis. Journal of Anxiety Disorders, 27(1), 68 to 78.
Axelsson, E., et al. (2022). The 14 item Short Health Anxiety Inventory used as a screening tool: Appropriate interpretation and diagnostic accuracy of the Swedish version. BMC Psychiatry, 22, 833.
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Note on Assessment licensing
Some assessments are copyright protected and require a licence or the copyright holder's permission for clinical, commercial or digital use. Where that applies, obtaining and maintaining that permission is the responsibility of the practice or organisation using the assessment. Tacklit provides the digital administration, scoring and reporting. We do not grant, transfer or supply rights to the underlying instrument.
