Older Adults Have Increased Risk for Health Anxiety

The risk for health anxiety (HA), a disorder characterized by a preoccupation with physical health and/or somatic/body symptoms, is increased in older adults, per a study from the Baylor University, in Waco Texas.

The study, led by Thomas A. Fergus (pictured), PhD, with the Department of Psychology and Neuroscience at Baylor University, in Waco, Texas, suggests that assessing older adult patients for HA could be "particularly important" for patients who frequently utilize medical services as a means to diagnose and treat HA symptoms and break cognitive-behavioral patterns.

Fergus asserted that "cognitive-behavioral models suggest that medical utilization is a safety behavior used by individuals experiencing health anxiety" and that although medical utilization can temporarily reduce health anxiety, those services can actually increase HA in patients when they receive no diagnosis or treatment for the underlying causes of HA. Fergus and colleagues argued that a repetitive cycle can develop in undiagnosed patients with HA.

The study noted that previous studies focused on links between HA, particularly severe HA — patients scoring higher than 20 on the Short Health Anxiety Inventory (SHAI) a questionnaire that measures HA — and increased medical utilization have determined that nearly 20% of clinic-attending patients suffer from HA.

Fergus and colleagues theorized that there are further connections between age and HA, with older adults (age ≥ 63) having significantly more HA than younger adults (≤63).

The study of 538 primary care patients looked at the connection between age, HA, medical utilization and other sociodemographic variables. The sample patients between 18—90 years of age (median 45.5) were selected from a single community health center.

Patients were assessed using a 6-item, 5-point scale version of the Whitley Index for assessing HA with a focus on both health worry and preoccupation with bodily symptoms. Patients medical records, including clinic visits, medications, testing and clinical morbidity were assessed for 2 years to determine patterns of utilization. As patients were regularly assessed for depression using the Patient Health Questionnaire-2 (PHQ-2) at the clinic, the study also included that information as a variable.

Analysis of variance (ANOVA) for data revealed there were significant group differences in HA based primarily on age. Although there were slight differences between HA and medical utilization between racial groups—black, latino, and white—those differences "in health anxiety and medical utilization were absent, small in magnitude or attributable to age differences," according to the authors.

Fergus reported "as predicted, health anxiety (WI-6 total scale) correlated with each index of medical utilization" with a stronger correlation between patients diagnosed with the somatic/body preoccupation aspect of HA and number of clinical visits and medications. The data showed an insignificant interaction between health worry and age in all 3 criteria: clinic visits over the past 2 years, medications, and lab test history.

However, there was a significant relationship seen in the data linking somatic/body preoccupation across the same 3 variables. Fergus and colleagues stated the "moderating effect of age was not attributable to shared variance with a number of covariates, including gender, race/ethnicity, medical morbidity and elevated depression symptoms."

Fergus and colleagues referenced a 2013 study, "Health anxiety disorders in older adults: Conceptualizing complex conditions in late life" which shows that older adults had a tendency to not seek out mental health care professionals for anxiety. Fergus and colleagues suggested that routine assessments for HA in older adults in primary care settings could help diagnose and treat HA.

"[Hopefully] the study findings will draw attention to the possibility that older adults who frequently seek out medical services and report anxiety focused on bodily/somatic complaints may benefit from screening for health anxiety and potential treatment," Fergus told MD Magazine.

Fergus also stated that there are currently several easy to use diagnostic/screening tools for HA available for use by primary care physicians.

"At present, 1 of the briefest screening tools to assess health anxiety in primary care clinics, that I am aware of, is 7 items (e.g., Fink et al., 1999)," Fergus said. "I am reminded as to the use of 2-item screening instruments for depression (e.g., Kroenke et al., 2003), with longer follow-up assessment measures used for individuals screening positive. A similar approach may be used for health anxiety if 7 items or so are viewed as too burdensome or impractical for routine use."

Fergus remarked there is an increased understanding of HA in primary care settings "in terms of its defining features and maintaining factors," and further studies "may encourage a more regular assessment for health anxiety" and intervention for those suffering from HA, particularly for older adult patients who have an increased risk of HA.

"Health anxiety and medical utilization: The moderating effect of age among patients in primary care" appears in the June 2017 issue of the Journal of Anxiety Disorders.

Related Coverage

WHO Improves ICD-11 Focus on Mental Health Care in Primary Care Settings

Many Primary Care Patients with Depression Doing Poorly after Ten Years

Genetics May Play Role in Response to Antidepressant Therapy