Illness fears in the general population

The association between health anxiety, physical disease and cardiovascular risk factors in the general population – a cross-sectional analysis from the Tromsø study: Tromsø 7

Background

Health anxiety (HA) is defined as a worry of disease. An association between HA and mental illness has been reported, but few have looked at the association between HA and physical disease.

Objective

To examine the association between HA and number of diseases, different disease categories and cardiovascular risk factors in a large sample of the general population.

Methods

This study used cross-sectional data from 18,432 participants aged 40 years or older in the seventh survey of the Tromsø study. HA was measured using a revised version of the Whiteley Index-6 (WI-6-R). Participants reported previous and current status regarding a variety of different diseases. We performed exponential regression analyses looking at the independent variables 1) number of diseases, 2) disease category (cancer, cardiovascular disease, diabetes or kidney disease, respiratory disease, rheumatism, and migraine), and 3) cardiovascular risk factors (high blood pressure or use of cholesterol- or blood pressure lowering medication).

Results

Compared to the healthy reference group, number of diseases, different disease categories, and cardiovascular risk factors were consistently associated with higher HA scores. Most previous diseases were also significantly associated with increased HA score. People with current cancer, cardiovascular disease, and diabetes or kidney disease had the highest HA scores, being 109, 50, and 60% higher than the reference group, respectively.

Conclusion

In our general adult population, we found consistent associations between HA, as a continuous measure, and physical disease, all disease categories measured and cardiovascular risk factors.

Health care utilization as a predictor of death anxiety in older adults

The relationship between health care utilization and death anxiety in older adults is underexplored. This secondary analysis of the 2012 Health and Retirement Study examined health care utilization as a predictor of death anxiety in a nationally representative sample of American older adults (N = 3,960). Hierarchical binary logistic regression results revealed that overnight hospitalization, overnight nursing home placement, and outpatient visit were all statistically significant predictors of death anxiety. Outpatient visit was the strongest health care utilization predictor in the model. Increased end-of-life training for providers may improve patient-provider communication and alleviate patients' death anxiety. Future research should explore the directionality between study variables.

'I Would Rather Be Having My Leg Cut off Than a Little Needle': A Supplementary Qualitative Analysis of Dentally Anxious Children's Experiences of Needle Fear

Fear of needles is common in childhood, with up to 50% being affected to some degree. In individuals who are dentally anxious, the prevalence may be as high as 91%. Fear of needles, and therefore intra-oral injections can have negative impacts on children's quality of life and healthcare experiences, including a requirement for pharmacological methods to facilitate dental treatment. The aim of this study is to identify whether dentally anxious children report fear of injections and explore how these children experience a fear of needles in a dental setting. A supplementary analysis of interviews collected as part of two previous studies relating to children with dental anxiety. Five main themes were identified: feelings about needles; the nature of needle fear; the context of the fear, its consequences and how children tried to control the process. Children showed a desire to have control of their healthcare interventions, and wanted to trust the healthcare professionals giving the injections. There is evidence that children with dental anxiety also experience fear of needles, including intra-oral injections. Further primary qualitative research is needed to explore this topic in more depth and to design appropriate child centred interventions to reduce needle fear.

Does how you treat yourself affect your health? The relationship between health-promoting behaviors and self-compassion among a community sample

This study explores the relationship between self-compassion, or treating oneself with kindness and acceptance, using the Self-Compassion Scale, and health-promoting behaviors, using the Health-Promoting Lifestyle Profile II, among a community sample. Canonical correlation results indicate self-compassion and health-promoting behaviors share 76 percent of the variance within the data set. The positive components of self-compassion are strongly positively correlated with health-promoting behaviors, and the negative components of self-compassion are strongly negatively correlated with health-promoting behaviors. Hierarchical linear regression results indicate self-kindness and mindfulness are significant predictors of health-promoting behaviors after controlling for demographics.

Illness Anxiety Disorder: Psychopathology, Epidemiology, Clinical Characteristics, and Treatment

Illness anxiety disorder is a primary disorder of anxiety about having or developing a serious illness. The core feature is the cycle of worry and reassurance seeking regarding health, as opposed to a focus on relief of distress caused by somatic symptoms (as in Somatic Symptom Disorder). Clinically significant health anxiety is common, with estimates ranging up to 13% in the general adult population. There are evidence-based treatments, including psychopharmacology and cognitive behavioral therapy, that can significantly alleviate symptoms. An understanding of the core psychopathology and clinical features of illness anxiety disorder is essential to fostering a working alliance with patients with health anxiety, as is the maintenance of an empathic, curious, and nonjudgmental stance toward their anxiety. Collaboration between medical providers is essential to avoid the pitfalls of excess testing and medical treatment.

Cost estimate of platelet transfusion in the United States for patients with chronic liver disease and associated thrombocytopenia undergoing elective procedures

AIMS

This study aimed to estimate the cost of platelet transfusion in patients with chronic liver disease (CLD)-associated thrombocytopenia undergoing an elective procedure in the United States.

MATERIALS AND METHODS

The study was conducted in two parts: development of a conceptual framework identifying direct, indirect and intangible costs of platelet transfusion, followed by the estimation of the total cost of platelet transfusion in patients with CLD-associated thrombocytopenia before an elective procedure in the United States using the conceptual framework and cost data obtained from a literature search. The cost of the entire care required to raise a patient's platelet count before the procedure was considered.

RESULTS

The final conceptual framework included the costs of generating the supply of platelets, the platelet transfusion itself, adverse events associated with platelet transfusion and refractoriness to platelet transfusion. When costs were accounted for in all the framework cost categories, the total direct cost of a platelet transfusion in a patient with CLD and associated thrombocytopenia was estimated to be in the range of $5258 to $13,117 (2017 US dollars) in the United States. The largest portion of costs was incurred by the transfusion event itself ($3723 to $4436) and the cost of refractoriness ($874 to $7578), which included the opportunity cost of a delayed procedure and subsequent platelet transfusions with human leukocyte antigen-matched platelets.

LIMITATIONS AND CONCLUSIONS

Although we were unable to include all cost components identified in the conceptual framework in our total cost estimate, thus likely underestimating the true total cost, and despite the data gaps and challenges limiting our estimate of the full cost of a platelet transfusion in patients with CLD-associated thrombocytopenia undergoing an elective procedure in the United States, this study outlines a comprehensive conceptual framework for estimating the cost elements of a platelet transfusion in these patients.

Population Study of Fears in Two Generations of Ukrainians

AIM

Fear is an ancient natural reaction of a human being to a threat and it is also an adaptive feature. Obsessive fear can transfer into phobias, which lead to a clinical problem. In spite of many studies done on fear, many questions are yet not clarified. In the former Soviet Union, research on human behaviour traits was mostly tabooed. The current research will fill some gaps on the 'behavioural map' of Ukraine in relationship to fear distributions in two successive generations of residents of Ukraine.

SUBJECTS AND METHODS

Eight hundred and sixty-seven residents of Ukraine, predominantly residents of Kharkov and Kharkov region participated in the study. All participants were distributed into groups of younger and older generations. Twenty-four emotional states of fear have been studied by Ivleva-Shcherbatyh questionnaire, developed and validated in Slavs samples.

RESULTS

The population analysis of 24 types of fear has shown that sex differences were found mostly among members of the younger generation. The average value of sex differences from the amplitude trait of variation made up approximately 20%. More significant differences between members of different generations have been found in females. The age dynamics of fears within each generation has been detected.

CONCLUSIONS

The population analysis of fears in Ukraine has demonstrated that the strongest fears independently of the generation were related to diseases of relatives and to problems in the case of diseases of relatives.

The development and validation of a Chinese version of the Illness Attitude Scales: an investigation of university students

BACKGROUND

The Illness Attitude Scales (IAS) are considered as one of the most suitable instruments to screen hypochondriasis.

PURPOSE

Whether it has cross-cultural validity in China remains to be determined.

METHODS

In Chinese university students (141 women and 141 men), we have administered the IAS, the Zuckerman-Kuhlman Personality Questionnaire (ZKPQ), and the Plutchik-van Praag Depression Inventory (PVP).

RESULTS

For the first time in Chinese culture, we have identified a four-factor structure of the IAS: patho-thanatophobia, symptom effect, treatment seeking, and hypochondriacal belief. Women scored significantly higher on IAS patho-thanatophobia and treatment seeking, on ZKPQ neuroticism-anxiety and activity, and on PVP than men did. The neuroticism-anxiety was significantly correlated with patho-thanatophobia and symptom effect, and PVP was positively correlated with symptom effect in women. Neuroticism-anxiety was significantly correlated with patho-thanatophobia, and impulsive sensation seeking and activity were significantly correlated with symptom effect in men.

CONCLUSION

In Chinese students, we have found a stable four-factor IAS structure.

Blood injury and injection phobia: the neglected one

Blood injury and injection (BII) phobia is a unique phobia associated with a diphasic cardiovascular response. The aim of this survey was to report the prevalence of BII phobia, its heritability, and clinical characteristics among the males and females in the Indian subcontinent. An interview and a survey were conducted using a developed BII phobia 21-item questionnaire among 3261 participant males (n = 1648) and females (n = 1613). Cronbach' alpha (α) of 0.972 of internal consistency was reported. The prevalence of BII phobia and associated fainting in females was slightly more than double in the males with a significant gender related effect. Similar avoidance behaviours involving hospital visits were reported for both males and females. The relative frequency of BII phobia among first and third degree relatives was found to be higher than among second degree relatives. Depression was found highly comorbid with BII phobia while a low rate of obsessive compulsion disorder (OCD) and social anxiety disorder (SAD) was reported. Morbidity associated with BII phobia may increase dramatically when other medical problems coincide with it.

Gratitude lessens death anxiety

This study investigated whether a brief gratitude induction could reduce death anxiety. 83 Chinese older adults (mean age = 62.7, SD = 7.13) were randomly assigned into one of three conditions: gratitude, hassle, and neutral, in which they wrote different types of life events before responding to measures of death anxiety and affect. Participants in the gratitude induction reported lower death anxiety than the hassle and the neutral condition, whereas no difference was observed for the latter two conditions. There was no experimental effect on positive affect, and a significant effect on negative affect but which did not favor the gratitude condition. By reexamining life events with a thankful attitude, people may become less fearful of death due to a sense that life has been well-lived. Because gratitude can be induced using a very brief procedure, there are broad applications in clinical and health-care settings for the relief of death anxiety.

Diagnostic test evaluation by patient-outcome study in homeopathy: balancing of feasibility and validity

BACKGROUND

Signs and symptoms can be considered as diagnostic tests, updating prior odds by applying Bayes' theorem. In homeopathy, signs and symptoms guide the doctor when prescribing appropriate medicines but the powers of these indicators are largely based on common experience.

OBJECTIVE

We want to know whether it is possible to calculate the power of arguments of signs and symptoms indicating homeopathic medicines, expressed in likelihood ratios.

METHODS

An observational patient-outcome study as advocated for diagnostic test evaluation. There was no independent observation of symptoms and results. Instead, observers were extensively trained in assessing each other's cases and the process was regularly monitored.

RESULTS

A total of 4072 prescriptions for 4094 patients were recorded. The relation between six clinical symptoms and outcome was calculated. Variance between observers in assessing symptoms and results were considerable. Some indications of confirmation bias were detected by follow-up, and 48 statistically significant likelihood ratios regarding six symptoms were calculated.

CONCLUSION

A diagnostic patient-outcome study within homeopathy collecting a large amount of data is demonstrated. Results partly confirm clinical practice at a 95% confidence level. This kind of research could validate knowledge from practical experience.

Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management

While there has been a great deal of speculation over the years on the importance of emotional factors in inflammatory bowel disease (IBD), it is only in the last decade or so that studies with stronger designs have been available to clarify the nature of this relationship. This review considers recent evidence on the prevalence of anxiety and depressive disorders in IBD, the role of these disorders as a risk factor for IBD onset, the degree to which they affect the course of the IBD, and the contribution of corticosteroid treatment to psychiatric symptom onset. There is evidence that anxiety and depression are more common in patients with IBD and that the symptoms of these conditions are more severe during periods of active disease. The few studies that address the issue of anxiety and depression as risk factors for IBD do not yet provide enough information to support definite conclusions. There is evidence, however, that the course of the disease is worse in depressed patients. Treatment with corticosteroids can induce mood disorders or other psychiatric symptoms. The second part of the review focuses on patient management issues for those with comorbid anxiety or depression. Practical approaches to screening are discussed, and are recommended for routine use in the IBD clinic, especially during periods of active disease. We review evidence-based pharmacological and psychological treatments for anxiety and depression and discuss practical considerations in treating these conditions in the context of IBD to facilitate overall management of the IBD patient.

A taxometric analysis of health anxiety

BACKGROUND

A long-standing issue in the health anxiety literature is the extent to which health anxiety is a dimensional or a categorical construct. This study explores this question directly using taxometric procedures.

METHOD

Seven hundred and eleven working adults completed an index of health anxiety [the Whiteley Index (WI)] and indicated their current health status. Data from those who were currently healthy (n=501) and receiving no medical treatment were examined using three taxometric procedures: mean above minus below a cut (MAMBAC), maximum eigenvalue (MAXEIGEN) and L-mode factor analysis (L-MODE).

RESULTS

Graphical representations (comparing actual to simulated data) and fit indices indicate that health anxiety is more accurately represented as a dimensional rather than a categorical construct.

CONCLUSIONS

Health anxiety is better represented as a dimensional construct. Implications for theory development and clinical practice are examined.

Health anxiety moderates the daytime cortisol slope

OBJECTIVES

Edwards et al. argue that a steeper daytime cortisol slope indicates increased symptom awareness [Edwards S, Hucklebridge F, Clow A, Evans P. Components of the diurnal cortisol cycle in relation to upper respiratory symptoms and perceived stress. Psychosom Med, 2003;65:320-7]. Theory suggests that health anxiety (HA) is associated with increased symptom awareness. Therefore, this study tests the hypothesis that higher levels of HA are associated with a steeper daytime cortisol slope and is the first to examine the daytime diurnal cortisol slope for HA.

METHODS

Forty-two healthy working adults completed measures of HA and neuroticism as well as indices to measure the severity and frequency of symptom reporting. Participants also provided eight consecutive days of salivary cortisol data. Two cortisol measures were taken each day -- once prior to lunch and once in the early evening -- the timing of these was synchronized to waking times. The data were analyzed using multilevel modeling.

RESULTS

The hypothesis was supported, with those scoring higher on HA showing a steeper daytime cortisol slope. There were no significant relationships between cortisol (average production and slope) and either neuroticism or symptom reporting (severity and frequency).

CONCLUSIONS

The results are interpreted as consistent with theories of HA that emphasis increased awareness of nonspecific symptoms.

Explaining medically unexplained symptoms-models and mechanisms

We summarize the psychological mechanisms that have been linked to the development and maintenance of medically unexplained symptoms (MUS). Many models postulate that patients with MUS misinterpret physical sensations and show other cognitive abnormalities (e.g., an over-exclusive concept of health) that play a major role in symptom development. While there is strong evidence for the role of cognitive aspects, there is less evidence for their interaction with perceptual features (e.g., perceptual sensitivity, lowered perceptual threshold). Modern neuroimaging techniques show that the expectation of symptoms leads to the activation of brain areas corresponding to symptom perception, while distraction from symptoms reduces brain activity in perception areas. The frequently postulated monocausal organic attribution for physical sensations by patients with MUS needs to be modified, as many patients report multiple symptom attributions, including psychological. Symptom attributions and causal models depend on memorized concepts, and so memory processes need to be investigated in more detail. Aberrations in memory processes not only offer a link to understanding perceptual processes, but are also involved in doctor-patient interaction. This encounter is characterized by unsuccessful medical reassurance, which again involves memory processes. We conclude that psychological mechanisms such as expectation, distraction, and memory processes need to be integrated with biological models to aid understanding of MUS.

Memory bias in health anxiety is related to the emotional valence of health-related words

OBJECTIVES

A model based on the associative strength of object evaluations is tested to explain why those who score higher on health anxiety have a better memory for health-related words.

METHOD

Sixty participants observed health and nonhealth words. A recognition memory task followed a free recall task and finally subjects provided evaluations (emotionality, imageability, and frequency) for all the words. Hit rates for health words, d', c, and psychological response times (PRTs) for evaluations were examined using multi-level modelling (MLM) and regression.

RESULTS

Health words had a higher hit rate, which was greater for those with higher levels of health anxiety. The higher hit rate for health words is partly mediated by the extent to which health words are evaluated as emotionally unpleasant, and this was stronger for (moderated by) those with higher levels of health anxiety. Consistent with the associative strength model, those with higher levels of health anxiety demonstrated faster PRTs when making emotional evaluations of health words compared to nonhealth words, while those lower in health anxiety were slower to evaluate health words.

CONCLUSIONS

Emotional evaluations speed the recognition of health words for high health anxious individuals. These findings are discussed with respect to the wider literature on cognitive processes in health anxiety, automatic processing, implicit attitudes, and emotions in decision making.

Fear of blood/injection in healthy and unhealthy adults admitted to a teaching hospital

Blood/injury phobia is one of the specific phobias. The aim of this study was to determine the fear of injection and blood in patients and healthy people. This study was carried out at Tepecik Hospital, Clinical Biochemistry Laboratory and Blood Center. Data were collected from 1500 adults who agreed to participate in the study (237 patients with chronic diseases and 1263 healthy people) during the period from January 2003 to February 2005. All participants completed two self-administered questionnaires (17-item Symptom Questionnaire and 20-item Blood/Injection Fear Scale) after giving blood samples by blood donation. 30.1% of the patients and 19.5% of the healthy adults reported that they had fear of blood/injection. Symptoms related to having blood drawn or injection were more frequently reported among women than men. Patients' educational level was also associated with the Symptom Questionnaire and fear of blood/injection scores. Fear of blood/injection was significantly higher in patients with chronic diseases. Fear of blood/injection should be considered by healthcare professionals as it is important for assessing the treatment-seeking individuals.

Körperbeschwerden und Gesundheitsangst in der Primärmedizin

Zusammenfassung. Patienten mit erhöhter Gesundheitsangst verursachen erhebliche Kosten für das Gesundheitssystem. Die durchgeführten medizinischen Untersuchungen und Behandlungen sind häufig unangemessen, denn in etwa der Hälfte der Fälle liegt den Krankheitsbefürchtungen keine organische Erkrankung zugrunde. Im Rahmen der kontrollierten cluster-randomisierten Studie FUNKTIONAL wurden in 29 Hausarztpraxen bei 1751 Patienten systematisch Gesundheitsangst (Whiteley-7), körperliche und psychische Symptome (PHQ-D) sowie die ärztliche Einschätzung des Hausarztes erfasst. Es fand sich eine verstärkte psychische und globale Funktionsbeeinträchtigung bei Patienten mit erhöhter Gesundheitsangst, die auf Patient- und Arztseite angegeben wird. Psychosoziale Faktoren werden vom Behandler häufiger als für die Erkrankung relevant betrachtet, wenn Patienten erhöhte Gesundheitsangst zeigen. Die Erkennung und Reduktion von Gesundheitsangst in der Allgemeinarztpraxis stellt sich also als relevanter Behandlungsaspekt dar, auch wenn keine hypochondrische Erkrankung im engeren Sinne vorliegt.

Features of hypochondriasis and illness worry in the general population in Germany

OBJECTIVE

Although hypochondriasis is considered to be of high relevance in the healthcare sector, its prevalence in the general population has been investigated in few studies. The aims of this study were to estimate prevalence rates of hypochondriasis and of subthreshold conditions and to describe their associated features such as quality of life and healthcare utilization in a representative community sample.

METHODS

Analyses of the present study are based on the German Health Interview and Examination Survey-Mental Health Supplement (N = 4181, representative for the German population from 18-65 years). The assessment included interviews for somatic conditions and mental disorders and self-report ratings on health-related quality of life, healthcare utilization, disability days, and physical activity.

RESULTS

Only three cases (0.05%) were identified as meeting full criteria of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) hypochondriasis. The prevalence rate of the less restrictively defined form of hypochondriasis, ("subthreshold hypochondriasis") was 0.58% and an additional 2.12% reported having had illness worries for at least 6 months but did not meet further hypochondriasis criteria. The two subthreshold diagnostic groups provided strong evidence of difference from the nonhypochondriac controls: comorbidity with psychiatric and medical disorders and healthcare utilization were higher, and quality of life was markedly reduced.

CONCLUSIONS

The results provide additional support to not only consider "full" DSM-IV hypochondriasis, which is a very rare disorder in the general population, but also to include less restrictive hypochondriac conditions--associated with a clinically relevant degree of psychological and physical impairment--into clinical and scientific considerations.

After going through chemotherapy I can't see another needle

Needle anxiety not only impacts on a patient's quality of life but can delay or prevent future medical care. Our survey of women with breast cancer indicated that 78/208 women (37.5%) reported feeling anxious about injections. Patients who reported needle anxiety were significantly younger (t(206)=3.72; P<0.01), with a lower body mass index (BMI) (t(182)=2.16; P<0.05), experience of chemotherapy (chi(2)(1)=8.29; P<0.01), a lower internal health locus of control (t(187)=2.28; P<0.05) and higher levels of state (t(197)=-3.58; P<0.01) and trait anxiety (t(197)=-2.30; P<0.05). Patients repeatedly highlighted the experience of chemotherapy as having caused their needle anxiety. Patient discourse suggests that chemotherapy related needle anxiety is a result of physical (e.g. finding a suitable vein) and environmental (e.g. the chemotherapy room) factors. Patients with cancer require psychosocial support during all stages of care, this should include the application of techniques to prevent or ameliorate the development of anxiety caused by certain aspects of cancer treatments, such as the development of chemotherapy-related needle anxiety.

Number of bodily symptoms predicts outcome more accurately than health anxiety in patients attending neurology, cardiology, and gastroenterology clinics

BACKGROUND

In consecutive new outpatients, we aimed to assess whether somatization and health anxiety predicted health care use and quality of life 6 months later in all patients or in those without demonstrable abnormalities.

METHOD

On the first clinic visit, participants completed the Illness Perception Questionnaire (IPQ), the Health Anxiety Questionnaire (HAQ), and the Hospital Anxiety and Depression Scale (HADS). Outcome was assessed as: (a) the number of medical consultations over the subsequent 6 months, extracted from medical records, and (b) Short-Form Health Survey 36 (SF36) physical component score 6 months after index clinic visit.

RESULTS

A total of 295 patients were recruited (77% response rate), and medical consultation data were available for 275. The number of bodily symptoms was associated with both outcomes in linear fashion (P<.001), and this was independent of anxiety and depression. Similar associations were found in people with or without symptoms due to demonstrable structural abnormalities. Health anxiety was associated only with health-related quality of life in patients with symptoms explained by demonstrable abnormalities.

CONCLUSION

The number of bodily symptoms and degree of health anxiety have different patterns of association with outcome, and these need to be considered in revising the diagnoses of somatization and hypochondriasis.

Can DSM-V facilitate productive research into the somatoform disorders?

OBJECTIVE

To highlight key research issues relevant to the diagnostic classification of somatoform disorders and assess whether DSM-V can facilitate research.

METHODS

A selective review of recent research findings in relation to the diagnostic categories of somatization disorder and hypochondriasis.

RESULTS

The DSM-IV criteria have been ignored by researchers as they were either too restrictive or too broad to study the associated features of somatization and hypochondriasis. In view of the linear relationship between number of bodily symptoms and impairment, the appropriate cutoff point has yet to be established. Ongoing research highlights the perceptual and cognitive aspects of these disorders, which need to be researched further in order to improve management.

CONCLUSION

DSM-IV did not facilitate research. Its successor should enable longitudinal studies to further elucidate the causes and perpetuating factors of somatization and illness worry rather than limit such studies by producing artificial criteria that may not be supported by subsequent research.

Specific phobia of illness: search for a new subtype

Specific phobia of illness makes its appearance in DSM-IV as a new diagnostic subtype, separate from hypochondriasis. A review of the literature indicates that, while there is some support for this new category, studies have not as yet been done that could provide validation. Illness phobia appears to be a significant problem; it is prevalent in the general population and is associated with distress and impairment, including interference with medical care. It appears to be associated with older age, physical illness, and female gender. Group comparisons are needed showing that persons with this phobia can be distinguished from hypochondriasis on the basis of these and other demographic and illness features. We outline a research agenda for demonstrating this separation.

A systematic review of the epidemiology of somatisation disorder and hypochondriasis

BACKGROUND

This paper reviews current knowledge regarding the prevalence and associated features of somatisation disorder and hypochondriasis in population-based and primary care samples.

METHOD

A systematic review of the literature, which used a standardised definition of somatisation disorder or hypochondriasis and which examined the characteristics and associated features of these disorders in population-based samples or primary care settings.

RESULTS

In population-based studies the prevalence of somatisation disorder and hypochondriasis was too low to examine associated features reliably. In studies using abridged criteria, a clear female predominance was not found in either disorder; there was a consistent relationship with few years of education. There was a close relationship with anxiety and depressive disorders, with a linear relationship between numbers of somatic and other symptoms of distress in several studies, including longitudinal studies. No studies showed that these symptom clusters fulfil the criteria of characteristic onset, course and prognosis required to merit the status of discrete psychiatric disorders.

CONCLUSIONS

On existing evidence, somatisation disorder and hypochondriasis cannot be regarded as definite psychiatric disorders. There is some evidence that numerous somatic symptoms or illness worry may be associated with impairment and high health care utilisation in a way that cannot be solely explained by concurrent anxiety and depression, but further research using population-based samples is required.

Personality as a predictor of hypochondriacal concerns: results from two longitudinal studies

OBJECTIVES

To explore the extent to which the domains of the Big 5 are risk factors for hypochondriacal concerns (HCs).

METHODS

Two longitudinal studies, one using blood donors (over a 16-17-month period) and one using undergraduate students (over a 2.5-month period), were used to collect data on the Big 5 and HCs.

RESULTS

Univariate analyses indicated that: (1) emotional stability predicted future levels of HCs once baseline levels of HCs were controlled, and (2) reductions in HCs over time were predicted primarily by increases in conscientiousness and emotional stability scores. Structural modelling of cross-lagged effects indicated that emotional stability was related to future levels of hypochondriacal concerns by contributing to initial levels of HCs. Regression analysis indicated that those who become more conscientious become less health anxious.

CONCLUSIONS

Emotional stability and conscientiousness have predictive roles with respect to HCs.

Specific phobia of illness in the community

This study evaluated the prevalence, risk factors and morbidity associated with specific phobia of illness. Subjects were from a random, community telephone survey of 500 persons age 40 to 65 who lived in Johnson County, Iowa, USA. Forty-three subjects reported that illness fears substantially bothered them personally or affected their medical care, work, or social life. Twenty-one of these subjects could be contacted and agreed to a semistructured interview designed to diagnose specific phobia of illness and screen for other common psychiatric disorders. Based on the interview, 10 subjects met the criteria for specific phobia of illness, 10 for major depressive disorder, 5 for obsessive-compulsive disorder, 5 for generalized anxiety disorder, 4 for hypochondriasis, 4 for panic disorder and 4 for specific phobia other than illness. Assuming subjects not interviewed were similar to subjects who were, the community prevalence of specific phobia of illness is 4.0%. Among the 10 subjects with specific phobia of illness, 7 had prior negative experiences with illness and 8 had comorbid Axis I disorders. The phobia interfered with medical care as well as social functioning for many subjects. These results suggest a prevalence rate and risk factors that will be useful for additional studies of illness phobia.

Somatization symptoms and hypochondriacal features in the general population

OBJECTIVE

The principal goal of this study is to examine the base rates of somatoform symptoms and of hypochondriacal features in the general population.

METHODS

A representative sample of 2050 persons in Germany was examined by use of screening for somatoform symptoms and the Whiteley Index.

RESULTS

The most frequent somatoform symptoms were back pain, joint pain, pain in extremities, and headache, as well as abdominal symptoms (bloating or intolerance of several foods) and cardiovascular symptoms (palpitation). People reported a mean of two somatization symptoms of DSM-IV somatization disorder (SD) during the prior 2 years. Strong age and medium gender effects were found for most somatoform symptoms, as well as for composite indices. However, the sex ratio suggested in DSM-IV for SD seems to be an overestimation. Hypochondriacal features showed only small sex differences but, again, pronounced age effects. In contrast to low rates for SD, the base rates for somatization and hypochondriacal features were high and represented the health care relevance of subthreshold syndromes.

CONCLUSION

We present base rates of hypochondriacal and somatization features that may be important facets in the development of classification criteria and in the interpretation of health care expenditure.