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Hypochondriacs have higher risk of death, suicide – Swedish study

Researchers have linked hypochondria to an 84% higher risk for death, and a four-fold increased risk for suicide, with the findings of their population-based data suggesting a need for more clinical screening and treatment of hypochondriasis – known as health anxiety disorder.

The prevalent psychiatric disorder is characterised by persistent preoccupation about having one or more serious and progressive physical disorders. The peoccupation is accompanied by hypervigilance and a catastrophic interpretation of bodily signs, resulting in repetitive and excessive checking and reassurance-seeking behaviour or maladaptive avoidance.

The investigators used several Swedish population-based registers to identify people who received a diagnosis of hypochondriasis between January 1997 and December 2020, reports Medscape.

Each individual diagnosed with hypochondriasis (n = 4 129; 2342 women; median 34.5 years at diagnosis) was age- and sex-matched with 10 people without the disorder (n = 41,290).

For those who died during the study period, cause of death was categorised as natural (neoplasms; diseases of the nervous system, circulatory system, or respiratory system) or unnatural (primarily suicide).

The study, led by David Mataix-Cols, PhD, of the Karolinska Institutet, Stockholm, found that those with hypochondriasis had an 84% higher risk for all-cause mortality during the study period than those without it (adjusted hazard ratio [aHR], 1.84; 95% CI, 1.60-2.10), including a higher risk for both natural (aHR, 1.60; 95% CI, 1.38-1.85) and unnatural death (aHR, 2.43; 95% CI, 1.61-3.68).

Most of the individuals with hypochondriasis were diagnosed with at least one additional psychiatric disorder (primarily anxiety-related and depressive disorders) vs the group without hypochondriasis (86% vs 20%, respectively; P < .001).

The risk for suicide – the most common unnatural cause of death – was four times higher in those with hypochondriasis (aHR, 4.14; 95% CI, 2.44-7.03).

When investigators limited analyses to include only psychiatric comorbidities recorded before the first diagnosis of hypochondriasis, suicide risk was attenuated but remained statistically significant.

“Taken together, these findings illustrate a paradox, whereby individuals with hypochondriasis have an increased risk for death despite their pervasive fears of illness and death,” the authors wrote. “In this study, most deaths could be classified as potentially preventable.

“Dismissing these individuals’ somatic symptoms as imaginary may have dire consequences.”

The study was published online in JAMA Psychiatry.

Limitations

Hypochondriasis is thought to be under-diagnosed in Sweden, with only about 4 000 cases registered within two decades. Study investigators also noted that they did not obtain data from primary care, the setting where the majority of hypochondriasis cases are diagnosed.

Study details

All-cause and cause-specific mortality among individuals with hypochondriasis

David Mataix-Cols,  Kayoko Isomura, Anna Sidorchuk,   et al

Published in JAMA Psychiatry on on 13 December 2023

Key Points

Question Are individuals with hypochondriasis at increased risk of death due to natural and unnatural causes?

Findings In this Swedish nationwide matched-cohort study of 4129 individuals with a diagnosis of hypochondriasis and 41 290 demographically matched individuals without hypochondriasis, those with hypochondriasis had an increased risk of death from both natural and unnatural causes, particularly suicide.

Meaning This study suggests that individuals with hypochondriasis have an increased risk of mortality, mainly from potentially preventable causes.

Abstract

Importance  
Hypochondriasis, also known as health anxiety disorder, is a prevalent, yet under-diagnosed psychiatric disorder characterised by persistent preoccupation about having serious and progressive physical disorders. The risk of mortality among individuals with hypochondriasis is unknown.

Objective
To investigate all-cause and cause-specific mortality among a large cohort of individuals with hypochondriasis.

Design, Setting, and Participants
This Swedish nationwide matched-cohort study included 4129 individuals with a validated International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) diagnosis of hypochondriasis assigned between January 1, 1997, and December 31, 2020, and 41 290 demographically matched individuals without hypochondriasis. Individuals with diagnoses of dysmorpho phobia (body dysmorphic disorder) assigned during the same period were excluded from the cohort. Statistical analyses were conducted between May 5 and September 27, 2023.

Exposure
Validated ICD-10 diagnoses of hypochondriasis in the National Patient Register.

Main Outcome and Measures
All-cause and cause-specific mortality in the Cause of Death Register. Covariates included birth year, sex, county of residence, country of birth (Sweden vs abroad), latest recorded education, civil status, family income, and lifetime psychiatric comorbidities. Stratified Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) and 95% CIs of all-cause and cause-specific mortality.

Results
Of the 4129 individuals with hypochondriasis (2342 women [56.7%]; median age at first diagnosis, 34.5 years [IQR, 26.3-46.1 years]) and 41 290 demographically matched individuals without hypochondriasis (23 420 women [56.7%]; median age at matching, 34.5 years [IQR, 26.4-46.2 years]) in the study, 268 individuals with hypochondriasis and 1761 individuals without hypochondriasis died during the study period, corresponding to crude mortality rates of 8.5 and 5.5 per 1000 person-years, respectively. In models adjusted for sociodemographic variables, an increased rate of all-cause mortality was observed among individuals with hypochondriasis compared with individuals without hypochondriasis (HR, 1.69; 95% CI, 1.47-1.93). An increased rate was observed for both natural (HR, 1.60; 95% CI, 1.38-1.85) and unnatural (HR, 2.43; 95% CI, 1.61-3.68) causes of death. Most deaths from unnatural causes were attributed to suicide (HR, 4.14; 95% CI, 2.44-7.03). The results were generally robust to additional adjustment for lifetime psychiatric disorders.

Conclusions and Relevance
This cohort study suggests that individuals with hypochondriasis have an increased risk of death from both natural and unnatural causes, particularly suicide, compared with individuals from the general population without hypochondriasis. Improved detection and access to evidence-based care should be prioritised.

 

JAMA Network Open article – All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis (Open access)

 

Medscape article – Hypochondriasis Linked to Increased Risk for All-Cause Mortality, Suicide (Open access)

 

See more from MedicalBrief archives:

 

US health panel calls for routine anxiety screening in adults

 

Analysis challenges theory that depression, anxiety boost cancer risk

 

Mental health disorders to affect half the world by 75 – large global study

 

 

 

 

 

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