Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Achenbach, T. M., McConaughy, S. H., & Howell, C. T. (1987). Child/adolescent behavioral and emotional problems: Implications of cross-informant correlations for situational specificity. Psychological Bulletin, 101, 213–232.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders (4th edn, text rev.). Washington, DC.

  • Andersen, J. S., Olivarius, N. F., & Krasnik, A. (2011). The Danish national health service register. Scandinavian Journal of Public Health, 39, 34–37.

    Article  PubMed  Google Scholar 

  • Asmundson, G. J., Abramowitz, J. S., Richter, A. A., & Whedon, M. (2010). Health anxiety: current perspectives and future directions. Current Psychiatry Reports, 12, 306–312.

    Article  PubMed  Google Scholar 

  • Barsky, A. J., Ahern, D. K., Bailey, E. D., Saintfort, R., Liu, E. B., & Peekna, H. M. (2001). Hypochondriacal patients’ appraisal of health and physical risks. American Journal of Psychiatry, 158, 783–787.

    Article  PubMed  Google Scholar 

  • Bisht, J., Sankhyan, N., Kaushal, R. K., Sharma, R. C., & Grover, N. (2008). Clinical profile of pediatric somatoform disorders. Indian Pediatrics, 45, 111–115.

    PubMed  Google Scholar 

  • Choudhury, M. S., Pimentel, S. S., & Kendall, P. C. (2003). Childhood anxiety disorders: Parent–child (dis)agreement using a structured interview for the DSM-IV. Journal of American Academy of Child and Adolescent Psychiatry, 42, 957–964.

    Article  Google Scholar 

  • Cole, T. J., Flegal, K. M., Nicholls, D., & Jackson, A. A. (2007). Body mass index cut offs to define thinness in children and adolescents: International survey. British Medical Journal, 335, 194.

    Article  PubMed  PubMed Central  Google Scholar 

  • Creed, F., & Barsky, A. (2004). A systematic review of the epidemiology of somatisation disorder and hypochondriasis. Journal of Psychosomatic Research, 56, 391–408.

    Article  PubMed  Google Scholar 

  • Deacon, B., & Abramowitz, J. (2008). Is Hypochondriasis related to obsessive-compulsive disorder, panic disorder, or both? An empirical evaluation. Journal of Cognitive Psychotherapy, 22, 115–127.

    Article  Google Scholar 

  • Efron, B., & Tibshirani, R. (2003). An Introduction to the Bootstrap. New York: Chapman & Hall/CRC.

    Google Scholar 

  • Eminson, M., Benjamin, S., Shortall, A., Woods, T., & Faragher, B. (1996). Physical symptoms and illness attitudes in adolescents: An epidemiological study. Journal of Child Psychology and Psychiatry, 37, 519–528.

    Article  PubMed  Google Scholar 

  • Essau, C. A. (2007). Course and outcome of somatoform disorders in non-referred adolescents. Psychosomatics, 48, 502–509.

    Article  PubMed  Google Scholar 

  • Fink, P., Ornbol, E., Toft, T., Sparle, K. C., Frostholm, L., & Olesen, F. (2004). A new, empirically established hypochondriasis diagnosis. American Journal of Psychiatry, 161, 1680–1691.

    Article  PubMed  Google Scholar 

  • Fink, P., Ornbol, E., & Christensen, K. S. (2010). The outcome of health anxiety in primary care. A two-year follow-up study on health care costs and self-rated health. PLoS One, 5, e9873.

    Article  PubMed  PubMed Central  Google Scholar 

  • Fritz, G. K., Fritsch, S., & Hagino, O. (1997). Somatoform disorders in children and adolescents: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1329–1338.

    Article  PubMed  Google Scholar 

  • Goodman, R., Ford, T., Richards, H., Gatward, R., & Meltzer, H. (2000). The Development and Well-Being Assessment: Description and initial validation of an integrated assessment of child and adolescent psychopathology. Journal of Child Psychology and Psychiatry, 41, 645–655.

    Article  PubMed  Google Scholar 

  • Jeppesen, P., Clemmensen, L., Munkholm, A., Rimvall, M. K., Rask, C. U., Jorgensen, T., Larsen, J. T., Petersen, L., van OS, J., & Skovgaard, A. M. (2015). Psychotic experiences co-occur with sleep problems, negative affect and mental disorders in preadolescence. Journal of Child Psychology and Psychiatry, 56, 558–565.

    Article  PubMed  Google Scholar 

  • Lieb, R., Pfister, H., Mastaler, M., & Wittchen, H. U. (2000). Somatoform syndromes and disorders in a representative population sample of adolescents and young adults: Prevalence, comorbidity and impairments. Acta Psychiatrica Scandinavica, 101, 194–208.

    Article  PubMed  Google Scholar 

  • Looper, K. J., & Kirmayer, L. J. (2001). Hypochondriacal concerns in a community population. Psychological Medicine, 31, 577–584.

    Article  PubMed  Google Scholar 

  • Marshall, T., Jones, D. P., Ramchandani, P. G., Stein, A., & Bass, C. (2007). Intergenerational transmission of health beliefs in somatoform disorders: Exploratory study. British Journal of Psychiatry, 191, 449–450.

    Article  PubMed  Google Scholar 

  • Martin, A., & Jacobi, F. (2006). Features of hypochondriasis and illness worry in the general population in Germany. Psychosomatic Medicine, 68, 770–777.

    Article  PubMed  Google Scholar 

  • Noyes, R., Jr., Stuart, S., Langbehn, D. R., Happel, R. L., Longley, S. L., & Yagla, S. J. (2002). Childhood antecedents of hypochondriasis. Psychosomatics, 43, 282–289.

    Article  PubMed  Google Scholar 

  • Olde Hartman, T. C., Borghuis, M. S., Lucassen, P. L., van de Laar, F. A., Speckens, A. E., & van Weel, C. (2009). Medically unexplained symptoms, somatisation disorder and hypochondriasis: Course and prognosis. A systematic review. Journal of Psychosomatic Research, 66, 363–377.

    Article  PubMed  Google Scholar 

  • Rachman, S. (2012). Health anxiety disorders: A cognitive construal. Behaviour Research and Therapy, 50, 502–512.

    Article  PubMed  Google Scholar 

  • Rask, C. U., Christensen, M. F., Borg, C., Søndergaard, C., Thomsen, P. H., & Fink, P. (2009). The Soma Assessment Interview: New parent interview on functional somatic symptoms in children. Journal of Psychosomatic Research, 66, 455–464.

    Article  PubMed  Google Scholar 

  • Rask, C. U., Elberling, H., Skovgaard, A. M., Thomsen, P. H., & Fink, P. (2012). Parental-reported health anxiety symptoms in 5- to 7-year-old children: The Copenhagen Child Cohort CCC 2000. Psychosomatics, 53, 58–67.

    Article  PubMed  Google Scholar 

  • Schmidt, M., Pedersen, L., & Sorensen, H. T. (2014). The Danish Civil Registration System as a tool in epidemiology. European Journal of Epidemiology, 29, 541–549.

    Article  PubMed  Google Scholar 

  • Schulte, I. E., & Petermann, F. (2011). Somatoform disorders: 30 years of debate about criteria! What about children and adolescents? Journal of Psychosomatic Research, 70, 218–228.

    Article  PubMed  Google Scholar 

  • Sirri, L., Grandi, S., & Fava, G. A. (2008). The Illness Attitude Scales. A clinimetric index for assessing hypochondriacal fears and beliefs. Psychotherapy and Psychosomatics, 77, 337–350.

    Article  PubMed  Google Scholar 

  • Skovgaard, A. M., Olsen, E. M., Houmann, T., Christiansen, E., Samberg, V., Lichtenberg, A., & Jorgensen, T. (2005). The Copenhagen County child cohort: Design of a longitudinal study of child mental health. Scandinavian Journal of Public Health, 33, 197–202.

    Article  PubMed  Google Scholar 

  • Sunderland, M., Newby, J. M., & Andrews, G. (2013). Health anxiety in Australia: Prevalence, comorbidity, disability and service use. British Journal of Psychiatry, 202, 56–61.

    Article  PubMed  Google Scholar 

  • Walker, L. S., Beck, J. E., Garber, J., & Lambert, W. (2009). Children’s Somatization Inventory: Psychometric properties of the revised form (CSI-24). Journal of Pediatric Psychology, 34, 430–440.

    Article  PubMed  PubMed Central  Google Scholar 

  • Wright, K. D., & Asmundson, G. J. (2003). Health anxiety in children: Development and psychometric properties of the Childhood Illness Attitude Scales. Cognitive Behavioural Therapy, 32, 194–202.

    Article  Google Scholar 

  • Wright, K. D., & Asmundson, G. J. (2005). Brief report: factor structure of the Childhood Illness Attitude Scales (CIAS). Journal of Pediatric Psychology, 30, 213–218.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The following individuals contributed to the data collection and/or assessments: Anne Dorothee Müller BA, Maja Gregersen MSc Psych, Anne-Lise Olsen MD, Nina Staal MD, Else Marie Olsen MD, PhD, and Hanne Elberling MD, PhD. Troels Græsholdt Knudsen BA helped with data preparation for the analyses on health care use. The work was supported by the Tryg Foundation (grant number FL-37) and Mrs. C Hermansens Memorial Fund (grant number 00962–001).

Conflict of Interest

The authors declare that they have no conflict of interest

Author information

Authors and Affiliations

  1. The Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Noerrebrogade 44, DK-8000, Aarhus C, Denmark

    Charlotte Ulrikka Rask & Eva Ørnbøl

  2. Child and Adolescent Psychiatric Center Risskov, Aarhus University Hospital, Aarhus, Denmark

    Charlotte Ulrikka Rask

  3. Child and Adolescent Mental Health Center, Mental Health Services, the Capital Region of Denmark, Glostrup, Denmark

    Anja Munkholm, Lars Clemmensen, Martin K. Rimvall & Pia Jeppesen

  4. Faculty of Health Science, University of Copenhagen, Copenhagen, Denmark

    Pia Jeppesen

  5. Institute of Public Health, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark

    Anne Mette Skovgaard

Authors
  1. Charlotte Ulrikka Rask
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Anja Munkholm
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lars Clemmensen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martin K. Rimvall
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Eva Ørnbøl
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pia Jeppesen
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Anne Mette Skovgaard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Charlotte Ulrikka Rask.

Electronic supplementary material

Below is the link to the electronic supplementary material.

ESM 1

(DOCX 16 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Rask, C.U., Munkholm, A., Clemmensen, L. et al. Health Anxiety in Preadolescence - Associated Health Problems, Healthcare Expenditure, and Continuity in Childhood. J Abnorm Child Psychol 44, 823–832 (2016). https://doi.org/10.1007/s10802-015-0071-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-015-0071-2

Keywords

Search

Navigation