Health Anxiety in Preadolescence - Associated Health Problems, Healthcare Expenditure, and Continuity in Childhood

Abstract

Epidemiological data on the distribution, persistence, and clinical correlates of health anxiety (HA) in childhood are scarce. We investigated continuity of HA symptoms and associated health problems and medical costs in primary health services in a general population birth cohort. HA symptoms were assessed in 1886 Danish 11-12 year old children (48 % boys) from the Copenhagen Child Cohort using the Childhood Illness Attitude Scales (CIAS) together with information on socio-demographics and the child's somatic and mental status and healthcare expenditure. Non-parametric statistics and regression analysis were used to compare groups with low (n = 184), intermediate (n = 1539), and high (n = 161) HA symptom scores. The association between HA symptoms assessed at age 5-7 years and HA symptoms at ages 11-12 years was examined by Stuart-Maxwell test. HA symptoms were significantly associated with emotional disorders and unspecific somatic complaints, but not with chronic physical conditions. In regression analyses controlling for gender and physical comorbidity, healthcare expenditure peaked in children with the highest HA symptom score, that is these children used on average approximately 150 Euro more than children with the lowest score during the 2-year period preceding inclusion. HA symptoms at age 5-7 years were significantly associated with HA symptoms at age 11-12 years. We conclude that HA symptoms, including hypochondriacal fears and beliefs, were non-trivial in preadolescents; they showed continuity from early childhood and association with emotional disorders, unspecific somatic complaints, and increased healthcare expenditure. Further research in the clinical significance of childhood HA is required.

Psychotic experiences are associated with health anxiety and functional somatic symptoms in preadolescence

“…The internal consistencies of the three factors were good (fears α = .87, help‐seeking α = .83, and symptom impact α = .74) (Thorisdottir et al., ). No clinically relevant cut‐off points have been established for the CIAS, and we chose to arbitrarily dichotomize the scores into estimated high top 10% and low 90%, in line with our previous study (Rask et al., ).…”

“…HA is often poorly identified in primary health settings, and many patients undergo excessive and futile medical investigations that do not provide relief from the underlying anxiety (Tyrer, Eilenberg, Fink, Hedman, & Tyrer, ). As a result, HA is associated with significantly increased health care expenditure and personal distress (Fink, Ørnbøl, & Christensen, ; Rask et al., ). Furthermore, increasing levels of HA in the population have been reported (Tyrer et al., ), perhaps as a result of increased attention to health‐related issues in society, along with easily accessible information on the internet (Tyrer et al., ).…”

“…However, retrospective reports indicate that symptoms of HA in adults with hypochondriasis were often already present in childhood (Noyes et al., ), and developmentally appropriate assessment of HA have been lacking (Fritz, Fritsch, & Hagino, ; Mohapatra, Deo, Satapathy, & Rath, ; Wright & Asmundson, ). Self‐reported HA symptoms are common in childhood in the general population, and high levels are associated with general emotional distress, increased health care costs and unspecific somatic complaints (Rask et al., ). Unspecific somatic complaints are commonly referred to as functional somatic symptoms (FSS), and may consist of symptoms from a variety of organ systems, such as unspecific musculoskeletal pain, gastro‐intestinal complaints, and neurological symptoms (Campo, ).…”

“…Functional somatic symptoms and HA are associated with depression and anxiety (Campo, ; Janssens, Rosmalen, Ormel, van Oort, & Oldehinkel, ; Rask et al., ; Simon, VonKorff, Piccilnelli, Fullerton, & Ormel, ); however, other domains may play a role in the manifestation of this type of psychopathology. Abnormal bodily sensations and experiences are part of the basic symptom concept in the clinical evaluation of psychosis (Gross, Huber, Klosterkötter, & Linz, ), often referred to as ‘cenesthopathies’.…”

Health anxiety

“…These patients undergo more tests and examinations and use more health service resources than those without health anxiety 2. Although children can experience health anxiety,3 it typically begins in adulthood and follows a chronic but fluctuating course. Having a medical disease or diagnosis does not exclude health anxiety1—many people have both.…”