Health anxiety is a broad concept, encompassing mild sub-clinical health-related worry through to severe clinical hypochondriasis. It can stand alone or be a symptom of generalized anxiety disorder, major depressive disorder, or delusional disorder. Health anxiety may also occur in people with mild cognitive impairment, dementia, or delirium. Health anxiety is a key element of the diagnostic criteria for DSM-5 Illness Anxiety Disorder and is an optional component of the diagnostic criteria for Somatic Symptom Disorder. DSM-5 Illness Anxiety Disorder retains only some features of DSM-IV Hypochondriasis. Importantly, it does not require the presence or misinterpretation of bodily symptoms.
In analyses based on an Australian national population survey sample of 8,841 persons aged 16–85 years, Sunderland et al. (Reference Sunderland, Newby and Andrews2013) found that approximately 5.7% of the population met the criteria for lifetime health anxiety and 3.4% met the criteria for current health anxiety. Health anxiety was reported more frequently by those who were out of the labor force, current or former smokers, and those who reported the presence of one or more co-morbid physical conditions. There was an inverted U relationship between age and health anxiety, with middle-aged persons reporting more health anxiety than younger or older persons. Sunderland et al. (Reference Sunderland, Newby and Andrews2013) found that health anxiety was associated with increased general psychological distress, greater functional impairment, more disability days, and greater use of mental health services. These associations suggest that health anxiety might be a clinically important phenomenon, although it was not clear how health anxiety as defined in their analysis intersects with the diagnostic entities of Illness Anxiety Disorder and Somatic Symptom Disorder. In an analysis based on data from a sample of 3,735 pervasive worriers derived from the same Australian national population survey, Gonçalves and Byrne (Reference Gonçalves and Byrne2013) found that persons aged 65–85 years reported fewer overall worries than persons aged 16–29 years and worried less about their own health (OR = 0.65, p < 0.05) and more about the health and welfare of loved ones (OR = 2.46, p < 0.01).
In this issue of the journal, Yang et al. (Reference Yang2022) report their investigation of health-related anxiety in community-residing individuals aged 60 years and over residing in the city of Chengdu in the Sichuan province of south-western China. Cluster sampling was undertaken from four local communities in the Jinjiang district. Of the 893 individuals in the study population, 514 (57.6%) agreed to participate, had an MMSE score of 17 or greater, and had no missing data. Health anxiety was measured on a Chinese version of the Short Health Anxiety Inventory (SHAI), an 18-item self-report measure generating scores between 0 and 54, with higher scores indicating greater health anxiety. Health anxiety was said to be present if a participant scored 15 or greater on the SHAI. Using this definition, the researchers found that 49 of 514 (9.5%) participants had health anxiety. In a logistic regression model, the number of chronic diseases was positively associated with the odds of having health anxiety.
In another recent report, Norbye et al. (Reference Norbye, Abelsen, Førde and Ringberg2022) used data from 18,967 persons aged 40 years and older participating in the seventh Tromsø study in Norway, to investigate the cross-sectional relationship between current health anxiety and health service usage over the previous 12 months. They measured health anxiety on the Whiteley index-6 (WI-6), a brief self-report measure, and found progressively increased use of primary, secondary and mental healthcare with each one-point rise in WI-6 score.
Thus, health anxiety appears to be related both to the number of reported chronic diseases and to health services utilization. It may also be related to contextual factors, including personality traits, health literacy, and access to health care. Health anxiety has been linked, at several levels, to responses to the COVID-19 pandemic (Asmundson and Taylor, Reference Asmundson and Taylor2020).
Although approaches to health anxiety could arguably be broader than individual psychotherapy, Newby et al. (Reference Newby, Smith, Uppal, Mason, Mahoney and Andrews2018) have demonstrated the efficacy of 6-session, clinician-guided, Internet-based CBT for Illness Anxiety Disorder and Somatic Symptom Disorder with health anxiety in comparison with a psychoeducation control condition. The participants were young and predominantly female. Health services usage was not reported. Clinical trials in middle-aged and older people, and in males, are awaited.
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Health anxiety is a broad concept, encompassing mild sub-clinical health-related worry through to severe clinical hypochondriasis. It can stand alone or be a symptom of generalized anxiety disorder, major depressive disorder, or delusional disorder. Health anxiety may also occur in people with mild cognitive impairment, dementia, or delirium. Health anxiety is a key element of the diagnostic criteria for DSM-5 Illness Anxiety Disorder and is an optional component of the diagnostic criteria for Somatic Symptom Disorder. DSM-5 Illness Anxiety Disorder retains only some features of DSM-IV Hypochondriasis. Importantly, it does not require the presence or misinterpretation of bodily symptoms.
In analyses based on an Australian national population survey sample of 8,841 persons aged 16–85 years, Sunderland et al. (Reference Sunderland, Newby and Andrews2013) found that approximately 5.7% of the population met the criteria for lifetime health anxiety and 3.4% met the criteria for current health anxiety. Health anxiety was reported more frequently by those who were out of the labor force, current or former smokers, and those who reported the presence of one or more co-morbid physical conditions. There was an inverted U relationship between age and health anxiety, with middle-aged persons reporting more health anxiety than younger or older persons. Sunderland et al. (Reference Sunderland, Newby and Andrews2013) found that health anxiety was associated with increased general psychological distress, greater functional impairment, more disability days, and greater use of mental health services. These associations suggest that health anxiety might be a clinically important phenomenon, although it was not clear how health anxiety as defined in their analysis intersects with the diagnostic entities of Illness Anxiety Disorder and Somatic Symptom Disorder. In an analysis based on data from a sample of 3,735 pervasive worriers derived from the same Australian national population survey, Gonçalves and Byrne (Reference Gonçalves and Byrne2013) found that persons aged 65–85 years reported fewer overall worries than persons aged 16–29 years and worried less about their own health (OR = 0.65, p < 0.05) and more about the health and welfare of loved ones (OR = 2.46, p < 0.01).
In this issue of the journal, Yang et al. (Reference Yang2022) report their investigation of health-related anxiety in community-residing individuals aged 60 years and over residing in the city of Chengdu in the Sichuan province of south-western China. Cluster sampling was undertaken from four local communities in the Jinjiang district. Of the 893 individuals in the study population, 514 (57.6%) agreed to participate, had an MMSE score of 17 or greater, and had no missing data. Health anxiety was measured on a Chinese version of the Short Health Anxiety Inventory (SHAI), an 18-item self-report measure generating scores between 0 and 54, with higher scores indicating greater health anxiety. Health anxiety was said to be present if a participant scored 15 or greater on the SHAI. Using this definition, the researchers found that 49 of 514 (9.5%) participants had health anxiety. In a logistic regression model, the number of chronic diseases was positively associated with the odds of having health anxiety.
In another recent report, Norbye et al. (Reference Norbye, Abelsen, Førde and Ringberg2022) used data from 18,967 persons aged 40 years and older participating in the seventh Tromsø study in Norway, to investigate the cross-sectional relationship between current health anxiety and health service usage over the previous 12 months. They measured health anxiety on the Whiteley index-6 (WI-6), a brief self-report measure, and found progressively increased use of primary, secondary and mental healthcare with each one-point rise in WI-6 score.
Thus, health anxiety appears to be related both to the number of reported chronic diseases and to health services utilization. It may also be related to contextual factors, including personality traits, health literacy, and access to health care. Health anxiety has been linked, at several levels, to responses to the COVID-19 pandemic (Asmundson and Taylor, Reference Asmundson and Taylor2020).
Although approaches to health anxiety could arguably be broader than individual psychotherapy, Newby et al. (Reference Newby, Smith, Uppal, Mason, Mahoney and Andrews2018) have demonstrated the efficacy of 6-session, clinician-guided, Internet-based CBT for Illness Anxiety Disorder and Somatic Symptom Disorder with health anxiety in comparison with a psychoeducation control condition. The participants were young and predominantly female. Health services usage was not reported. Clinical trials in middle-aged and older people, and in males, are awaited.