Tests · health anxiety
Health Anxiety Test (SHAI)
The Short Health Anxiety Inventory (SHAI; Salkovskis and colleagues, 2002) measures how much worry about your health is affecting you. Each item is a group of four statements. Pick the one that best describes how you have felt over the past 6 months.
- 18 questions
- Salkovskis et al., 2002
- About this test
Answer all 18 questions.
What next
Health anxiety tends to feed on checking your body, searching symptoms online, and seeking reassurance. Each one calms things for a moment and then makes the worry stronger. In a meta-analysis of 13 randomized trials, CBT for health anxiety beat control conditions after treatment, though the gap was smaller at follow-up (Olatunji et al., 2014). It works on exactly these habits: checking, searching, and seeking reassurance. The AI assistant, exercises, and journal here can help you practice that.
About the SHAI
How much worry about your health and possible illness takes up your attention, and how bad you expect an illness would be.
- Subscales
- Illness likelihood (questions 1 to 14, 0 to 42) and negative consequences (questions 15 to 18, 0 to 12)
- Asks about
- The past six months on the commonly used English form
- Developed by
- P. M. Salkovskis, K. A. Rimes, H. M. C. Warwick and D. M. Clark, 2002
Where it comes from
The SHAI comes from a 2002 paper in Psychological Medicine by Salkovskis, Rimes, Warwick and Clark. The team wanted a self-rated measure that works from ordinary health concern up to severe health anxiety (hypochondriasis). It also had to separate people with health anxiety from people who are physically ill but not overly worried. They built a 64-item Health Anxiety Inventory first. They tested it in patients with hypochondriasis, panic disorder or social phobia and in non-patient controls. Then they developed a shorter version and tested it in similar samples and in people seeking medical help for physical illness.
The short form has 18 items. The first 14 cover worry about illness, awareness of body sensations and relief after a doctor says nothing is wrong. The last four ask you to imagine a serious illness and say how bad it would be. Each item is four statements, and you choose the one that fits best.
What the research found
In the paper's first study, patients with hypochondriasis scored significantly higher than patients with panic disorder, patients with social phobia and non-patient controls. The authors called the scales reliable and valid. They said the inventory is likely to be useful as a brief screening tool, because a short form correlates highly with the longer version. The abstract reports no cut-off.
A 2013 review in the Journal of Anxiety Disorders covered 42 papers that used the SHAI. It found acceptable Cronbach's alpha scores, strong construct validity and sensitivity to treatment, with the most support for the original two factors. The reviewers said test-retest reliability, cut-off scores and use in diverse samples needed more study. A 2007 study of university students found three factors: likelihood, severity and body vigilance.
Cut-offs come from later papers and depend on the version and the setting. A 2022 Swedish study tested the 14-item main scale in 1,729 psychiatric patients and 85 healthy controls. Its best cut-offs were 22 in a psychiatric clinic (sensitivity 93%, specificity 85%), 29 in a low-prevalence setting and 18 against healthy controls. For the 18-item total, the same paper cites an earlier study. There, a cut-off of 27 gave sensitivity of 85.7% and specificity of 77.9% against patients with other anxiety disorders.
How scoring works
| Score | Label | What it means |
|---|---|---|
| 0 to 17 | Low | Below 18, a cut-off proposed in 2006 for clinically significant health anxiety. A 2022 Swedish paper said it knew of no empirical basis for it, then found that 18 best separated patients from healthy controls on the 14-item scale. |
| 18 to 27 | Higher health anxiety | A page convention. The best cut-off in a Swedish psychiatric clinic was 22, and 27 was reported for separating patients with hypochondriasis from patients with other anxiety disorders, on different versions of the scale. |
| 28 to 54 | High | A page convention close to the 27 cut-off reported for the 18-item total. Not a diagnosis. |
The 2002 abstract gives no cut-offs, and the 2013 review said cut-offs needed more study. The 18 and 28 on our page are conventions near published numbers. No source we opened defines these three bands for the 18-item total.
What it can't tell you
Every cut-off above comes from studies that enrolled psychiatric or clinic patients. The 14-item and 18-item totals can't be compared, because the four extra items add up to 12 points. The Swedish authors also note that a brief self-report scale doesn't cover every symptom, so a diagnosis needs a fuller assessment.
The scale was built to work whether or not you have a physical illness. A high score doesn't tell you that your symptoms are imaginary or that they're serious. The 2013 review found the strongest links with other health anxiety measures and weaker ones with general anxiety and worry, so some overlap with broader anxiety is expected.
How to use your result
Read the result as a snapshot of the past six months. If you retake it after a few weeks, compare the two totals. Your last four answers show how bad you expect an illness would be, so watch those too. Bring the result to a doctor or therapist if health worry fills much of your day. The same goes for checking your body, searching symptoms online, or reassurance from a doctor that doesn't last. A new or worsening symptom still deserves a doctor's visit, whatever your score.
Our guide to health anxiety covers the checking and symptom-searching loop. The page on safety behaviors covers reassurance seeking.
More on this topic: Health anxiety: the symptom-searching loop, Safety behaviors in anxiety, Intolerance of uncertainty, Fear of doctors.
Your answers
Your answers are scored in your browser and aren't sent or saved anywhere. Close the page and they're gone.
Sources 8
- Salkovskis, Rimes, Warwick and Clark, 2002, Psychological Medicine (PubMed): Abstract only. Three studies, the group comparison and the screening claim.
- Arnáez et al., 2019, International Journal of Clinical and Health Psychology (PMC): Describes the 64-item inventory, the 18-item SHAI, the 14 + 4 item split and the four statements per item. This Spanish study scored items 1 to 4, unlike the 0 to 3 scoring on our page.
- Alberts et al., 2013, Journal of Anxiety Disorders (PubMed): Abstract of a review of 42 papers: alpha, validity, factor structure and the call for work on cut-offs. Abstract only.
- Österman et al., 2022, BMC Psychiatry (PMC): Cut-offs of 22, 29 and 18 on the 14-item scale in 1,729 psychiatric patients and 85 healthy controls, the 27 cut-off for the 18-item scale, and the authors' note that they knew of no empirical basis for an earlier cut-off of 18. Swedish version and treatment-seeking sample.
- Abramowitz, Deacon and Valentiner, 2007, Cognitive Therapy and Research (PubMed): Abstract only. Three factors in medically healthy university students.
- Abramowitz, Olatunji and Deacon, 2007, Behavior Therapy (PubMed): Abstract only. Supports screening with empirically derived cut scores. The figure of 27 is taken from Österman et al., not from this abstract.
- NovoPsych, Short Health Anxiety Inventory form: A commercial site's reproduction of the 18 items with 0 to 3 scoring, the 14 + 4 split and the six-month instruction. Used only to compare item order and wording.
- Olatunji et al., 2014, Behaviour Research and Therapy (PubMed): Abstract: 13 randomized trials, 1,081 participants; CBT beat control conditions after treatment (Hedges' g 0.95) with a smaller gap at follow-up (0.34). Used for the sentences on the result page about CBT for health anxiety.
Related: smartphone addiction test, uncertainty test.