The association between health anxiety and non-communicable physical diseases, and implications for physiotherapists

To examine the association between HA and common NCDs in a large sample of the general population.

We used cross-sectional data from 17 997 participants aged 40 years or older who participated in the seventh survey of the Tromsø study. HA was measured using a revised version of the Whiteley Index-6 (WI-6-R), a validated measurement tool with a total score ranging 0-24. Participants self-reported status of a variety of previous and current NCDs: Cancer, rheumatism, migraine, cardiovascular-, diabetes/kidney-, and respiratory disease. We used exponential regression analyses to examine the association, looking at the different disease categories in comparison to a self-reported healthy reference group. Disease in close relatives, socioeconomic- and demographic factors were included as confounders.

The mean HA score was low with 3.3 points out of 24 in our whole population. Compared to the healthy reference group, all disease categories were consistently associated with higher HA scores. Except for diabetes/kidney disease and rheumatism, those reporting previous diseases had a significantly 12-32% higher HA score. People with current cancer, cardiovascular disease, and diabetes/kidney disease had the highest HA scores; 109, 50, and 60% higher than the reference group, respectively.

In our general adult population, we found consistent associations between NCDs and higher HA, indicating that HA can be an additional burden to disease. Future work should examine whether this association affects the use of physiotherapy treatment, and explore what physiotherapist do to address HA as an additional burden in the therapy setting.

As most research on this topic has been conducted on hypochondriasis and in mental health settings, little is known about the distribution of HA outside these contexts. As higher HA is associated with lower quality of life and increased reassurance-seeking behaviour, the relationship between HA and NCDs is increasingly relevant as the prevalence of NCDs increases in an ageing population. This places a responsibility to healthcare personnel in contact with people living with NCDs. Physiotherapists often deliver a close and long-lasting follow-up, and are therefore relevant healthcare personnel to address and assess the burden of HA in the presence of physical disease.