Hypochondriasis is a rarely used diagnosis in clinical practice despite studies having reported prevalence between 0.8–9.5% in primary care [1-3]. This may be because the disorder is not taken seriously, but rather is viewed as an imaginary illness or a phenomenon secondary to another psychiatric disorder [4-5]. Hypochondriasis is also considered a stigmatizing label, and the designation ‘Health Anxiety’ has been suggested as replacement and is used in this paper. Check the end of this report for a link to download the original, freely available study.
Background (continued)
There is some evidence that numerous somatic symptoms or illness worry may be associated with impairment and high health care utilization [3, 6-14]. However, most studies have used self-report questionnaires and/or layman interviews which does not allow for the establishment of clinical diagnoses. Also, with a few exceptions, the studies are retrospective in design and comorbidity with other mental or physical disorders has not been taken into account. The authors were also not aware of any longitudinal studies on health care costs or self-rated health that followed up patients with a Hypochondriasis diagnosis according to Diagnostic and Statistical Manual (DSM-IV) or International Classification of Diseases (ICD-10). Relatively little is thus known about Hypochondriasis’ impact on self-rated functioning related to mental and physical health and longitudinal outcome [15-17].
Methodology
1785 consecutive primary care patients aged 18–65 who were consulting with their family physicians for a new illness were followed-up for two years in this randomized controlled trial (RCT). All patients filled in a screening questionnaire in the waiting room. This questionnaire included, among others, the eight-item version of the Symptom Check List (SCL-8d) [22], [23] that assesses anxiety and depression, the seven-item Whiteley scale [24] that measures worry and conviction of illness, the somatization subscale of the SCL-90 (SCL-SOM) that checks for 12 common physical symptoms [25], and the Cutting down, Annoyance by Criticism, Guilty feeling, Eye Openers Questionnaire (CAGE) that screens for alcohol abuse [26]. The patients also filled in the Medical Outcome Study’s Short Form (SF-36) [27]. A stratified subsample of 701 patients was assessed by the Schedules for Clinical Assessment in Neuropsychiatry interview. Patients with Hypochondriasis according to the DSM-IV (N = 59) and with mild (N = 21) and severe Health Anxiety (N = 81) were compared to a control group of patients who had a well-defined medical condition according to their family physician and a low score on the screening questionnaire (N = 968). Self-rated health was measured by questionnaire at baseline and at 3, 12, and 24 months, and health care use was extracted from patient registers.
Principal Findings
The 81 severe Health Anxiety patients and the 59 DSM-IV Hypochondriasis patients continued during follow-up to manifest significantly more Health Anxiety (Whiteley-7 scale) when compared with the 968 patients with well-defined medical conditions. They also continued to have significantly worse self-rated functioning related to physical and mental health (component scores of the SF-36). The severe Health Anxiety patients used a total of about 41–78% more health care per year, both during the 3 years preceding inclusion and during follow-up, whereas the DSM-IV Hypochondriasis patients did not have statistically significantly higher total use. A poor outcome of Health Anxiety was not explained by comorbid depression, anxiety disorder, or well-defined medical condition. Patients with mild Health Anxiety did not have a worse outcome on physical health and incurred significantly less health care costs than the group of patients with a well-defined medical condition.
Conclusions/Significance
This study suggests that severe Health Anxiety has significant long-term impact on the patients’ self-rated functioning related to mental and physical health and on health care costs, and the patients persistently report high levels of Health Anxiety measured on Whiteley-7. Health anxiety in its mild form, however, seems not to have any significant negative impact on physical health and health care costs. In addition, this study supports the validity of recently introduced new criteria for Health Anxiety.
Citation:
Material adapted By CFisher from:
Fink P, Ørnbøl E, Christensen KS (2010). The Outcome of Health Anxiety in Primary Care. A Two-Year Follow-up Study on Health Care Costs and Self-Rated Health. PLoS ONE 5(3): e9873. doi:10.1371/journal.pone.0009873
References:
Please see the original open access article for the extensive reference list. Numbered references in this current article match the references in the original article.
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