Prevalence of health anxiety problems in medical clinics

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Abstract

Objectives

To determine the prevalence of significant health anxiety (hypochondriasis) in patients aged 16–75 in cardiology, respiratory medicine, neurological, endocrine and gastrointestinal clinics in general hospitals in London, Middlesex and North Nottinghamshire.

Method

The Health Anxiety Inventory (HAI) (short form) was administered to patients attending the five clinics over a 21 month period and all those who scored 20 or more invited to take part in a further assessment for a randomised controlled trial.

Results

Of 43,205 patients attending the clinics 28,991 (67.1%) were assessed and of these, after exclusion of ineligible patients 5747 (19.8%) had significant health anxiety. 444 subsequently agreed to take part in a randomised controlled trial of treatment. The prevalence levels varied by clinic with neurology (24.7%) having the highest prevalence followed by respiratory medicine (20.9%), gastroenterology (19.5%), cardiology (19.1%), and endocrinology (17.5%).

Conclusion

Abnormal health anxiety is common and a significant problem in those attending medical clinics and deserves greater awareness.

Introduction

Excessive health anxiety – and its older synonym, hypochondriasis – is relatively common in both primary care (between 0.8 and 3.05%) [1], [2], [3] and some secondary medical care settings (4.2% and 10%) [4], [5], has a generally poor outcome with less than 50% recovery [6] and also places a substantial burden on health services [7]. As many of the unnecessary investigations and tests associated with health anxiety are carried out in medical out-patients it is not surprising that there is a higher prevalence in these settings, but there is limited knowledge of the extent of this condition in general hospital settings. As an initial part of a large multi centre randomised controlled trial to determine the effectiveness of treatment of abnormal health anxiety we determined the prevalence of the condition pathological health anxiety in five types of clinic at six hospitals in London, Middlesex and North Nottinghamshire over a 21 month period.

Section snippets

Method

The data were collected as the first phase of the CHAMP study (Cognitive behaviour therapy for Health Anxiety in Medical Patients); a randomised controlled trial (ISRCTN14565822) comparing the effectiveness of health anxiety directed cognitive behaviour therapy and normal treatment in the clinic in reducing health anxious and associated symptoms over two years, and also improving the social function and quality of life of those with pathological health anxiety [8]. The costs of care in each of

Procedure

At the beginning of the study at each of the six hospitals the consultants in cardiology, respiratory medicine, gastroenterology and endocrinology were approached and asked to approve the study in principle at their clinics. Neurology clinics were also included from September 2009. Once clinics were identified the relevant staff were seen and agreement for the best procedure for approaching patients for screening with the Health Anxiety Inventory reached. Research assistants, helped by Clinical

Analysis of data

The definition of significant health anxiety was determined by a score of 20 on the HAI. Although it was recognised that some of these individuals might not satisfy the diagnostic requirements for hypochondriasis they nonetheless had significant health anxiety that was causing genuine distress and other symptoms and so all these individuals were included. To compare the prevalence rates across different types of clinics, a generalised linear model was employed. The estimated difference and its

Results

The patients were recruited between October 2008 and July 2010. Of a total of 57,902 attendances at the clinics of 107 consultants over a 21 month period between October 2008 and July 2010, 28,991 patients were given the HAI. 5769 (19.9%) of these scored 20 or more on the Health Anxiety Inventory and so were regarded as having significant health anxiety. The prevalence rates and the results from the generalised linear model analysis are presented in Table 1. The regression analysis showed a

Discussion

The results indicate that a significant, and numerically large, proportion of patients attending medical out-patient clinics have significant pathological worries about their health. The size of the study suggests that these figures are representative but they have some limitations. The numbers refer to attendances and although many patients were approached more than once and said they had already filled in the questionnaire others may have completed it twice or more. One patient who was seen

Acknowledgments

This project was funded by the NIHR Health Technology Assessment programme (project number 07/01/26). The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the HTA programme, NIHR, NHS or the Department of Health. We particularly thank the Mental Health Research Network (East Midlands and North London hubs) and Sandra O’Sullivan, for adopting, supporting and promoting the trial.

References (15)

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