Oral Papers: Collaborative Care & Community C-L I
Background/Significance Patients with pathological illness worries are prevalent in all medical settings and often referred to Consultation-Liaison Psychiatry1. In the DSM- V, a new diagnosis of Illness Anxiety Disorder (IAD) was introduced which, together with Somatic Symptom Disorder (SSD), replaced the DSM-IV Hypochondriasis diagnosis. ICD-11 also introduces a new Hypochondriasis diagnosis called Health Anxiety2. Besides, scientifically based research criteria for Health Anxiety (HAres) have been introduced3.
Little is known about the prevalence of IAD/HA in the general population. Studies have mostly been based on self-report questionnaires, and to our knowledge, no general population studies are based on clinical diagnoses established by standardized diagnostic research interview. The aim of this study is to estimate the prevalence and characteristics of IAD/HA, similarities and differences between diagnostic constructs, and the impact of medical conditions and psychiatric comorbidity on IAD/HA.
Methods The DanFunD Danish general population cohort includes 7493 individuals. A stratified subsample (n = 1590) including a random sample of 1/10 of all individuals and all high scores on the screening questionnaire completed a diagnostic research interview, i.e. a brief version of Schedules of Clinical Assessment in Neuropsychiatry (SCAN), conducted by 3 trained family physicians per telephone. DSM-V IAD and SSD, ICD-11 HA, and HAres diagnostic criteria were applied.
Results The prevalence of HAres was 3.1 % (95 % CI: 2.4-4.1), IA 0.6 % (95 % CI: 0.3-1.3), HA ICD-11 5.4 % (95 % CI: 4.3-6.8), [prevalence of SSD was 0.5 % (95 % CI: 0.3-0.8)]. There was no statistically significant difference across genders and no obvious difference across age groups. Except for IAD, the prevalence was much higher in the less educated part of the population.
Depending on the diagnostic criteria used, between 0% and 20.4% had a comorbid depression, and between 18.8 % and 50.0 % had a comorbid anxiety disorder. Other characteristics of IAD/HA will also be presented.
Discussion The prevalence of IAD/HA/SSD varies greatly in the general population according to the applied diagnostic construct. DSM-V IAD is much less prevalent than the other definitions because patients with somatic symptoms are excluded and given the diagnosis of SSD. ICD-11 HA is the most prevalent which may be due to not including the symptom rumination about ones health, which causes a poor discrimination between patients with health worries caused by a physical disease and non-founded health worries.
Conclusion/Implications Pathological health worries are very common in the general population and affect equally across age and gender. DSM-V IAD is a rare condition in the general population. IAD/HA is impairing and has social consequences for the patients.
1Tyrer P et al. BMJ 2016 2van den Heuvel OA et al. Braz J Psychiatry 2014 3Fink P et al. Am J Psychiatry 2004.