All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis, 2023, Mataix-Cols et al.

[SNT Gatchaman]

All-Cause and Cause-Specific Mortality Among Individuals With Hypochondriasis
David Mataix-Cols; Kayoko Isomura; Anna Sidorchuk; Daniel Rautio; Volen Z. Ivanov; Christian Rück; Susanna Österman; Paul Lichtenstein; Henrik Larsson; Ralf Kuja-Halkola; Zheng Chang; Isabell Brickell; Erik Hedman-Lagerlöf; Lorena Fernández de la Cruz

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

Objectives
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 validatedInternational 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 dysmorphophobia (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
ValidatedICD-10diagnoses 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
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 prioritized.


Link | PDF (JAMA Psychiatry)

 

[SNT Gatchaman]

With the Kafkaesque article in the Guardian: ‘This should not be ridiculed’: the link between hypochondria and early death

The study, which appeared in JAMA Psychiatry, examined records on about 45,000 people, comparing death rates among those with diagnosed hypochondriasis (about 4,000 people) against those without it (about 41,000 demographically similar individuals). They found people with the disorder were 84% more likely to die in the study period, and that they died an average of five years younger than those without the diagnosis, at 70 versus 75 years old.

Subjects with the disorder died at higher rates of both natural and unnatural causes, with most of the unnatural deaths a result of suicide. [...] As for natural causes, the researchers noted that anxiety is associated with cardiovascular diseases, and Mataix-Cols says some subjects with the condition also struggled with chronic stress, as well as drugs and alcohol.

Ideally, doctors aren’t telling patients to take solace in the idea that “it’s all in your head”. Instead, they’re recognizing mental health challenges as part of the bigger picture.

It all gets at the heart of anxiety more broadly: the struggle to live with not knowing. “Hypochondria is, in some ways, a challenge to medicine’s need for certainty,” says Dr Catherine Belling, an associate professor of medical education at Northwestern University. The best doctor in the world can’t be 100% sure that there’s nothing physically wrong with a patient. Not only does the patient have to tolerate that, the doctor does, too.

“In the case of something like illness anxiety, where it’s pretty clear that there’s not an underlying serious disease, it’s also the case that being very worried about your health can actually cause significant health concerns, as is evident in this study,” she says.

 

[SNT Gatchaman]

 

[rvallee]

Hypochondriasis, also known as health anxiety disorder, is a prevalent, yet underdiagnosed psychiatric disorder

Over. Under. What are words, really?

It all gets at the heart of anxiety more broadly: the struggle to live with not knowing. “Hypochondria is, in some ways, a challenge to medicine’s need for certainty,” says Dr Catherine Belling, an associate professor of medical education at Northwestern University. The best doctor in the world can’t be 100% sure that there’s nothing physically wrong with a patient. Not only does the patient have to tolerate that, the doctor does, too.

So close to getting it. And yet so far.

 

[Arnie Pye]

Ideally, doctors aren’t telling patients to take solace in the idea that “it’s all in your head”.

Is this suggesting that some doctors think they are comforting or reassuring patients when they say a problem is all in the patient's head? If that is the case it suggests to me that some doctors don't understand people.

I do remember a time when I saw a doctor about some health problem, although I can't remember what it was. The doctor said she would give me blood tests. What I actually got was a Full Blood Count and nothing else, and the results were declared to be all "normal". I never saw them, so I don't know how true this was.

Anyway, having being told my results were all normal the doctor gave me a big smile and made it clear she expected me to leave but I was hesitating. She then scowled and said something like "You should be pleased because you're healthy". I couldn't understand why she didn't understand that I was still unwell and in pain, and she had just fobbed me off. But then doctors these days rarely ask about symptoms, only the blood tests matter - and if the results are normal then the patient's problems are all in their heads.

I have never read that an FBC, no matter what the results, can diagnose everything.

I have another issue with a diagnosis of hypochondriasis. What if the patient's problem(s) is/are - eventually - identified and treated. The diagnosis of hypochondriasis will not be removed from the patient's records and they will continue to be suspected of hypochondriasis every time they have any contact with the medical profession until they die.

 

[Wonko]

If people are dying at an increased rate from 'controls' then wouldn't that suggest that they may in fact have something wrong with them, in short that they are not imagining it, that it, whatever it is, is real?

 

[bobbler]

If people are dying at an increased rate from 'controls' then wouldn't that suggest that they may in fact have something wrong with them, in short that they are not imagining it, that it, whatever it is, is real?

INdeed what I thought.

The classic 'if you don't look for it you don't find it' combined with 'if you don't know what you are looking for and aren't curious to look for what might be out of place'.

On top of that I wonder whether even if something that could be specific when described in an open-text box was found, like too much in the medical world's collecting of data/information, you can't log it and it gets categorised as 'natural' unless it fits under any of the other drop-down menu options.

 

[Sean]

In the case of something like illness anxiety, where it’s pretty clear that there’s not an underlying serious disease,

Spot the age-old problem with that logic.

Of course the whole thing depends on how robust is the diagnosis of hypochondriasis. Which it isn't. Not even close.

 

[alktipping]

such labels are all about the doctors those who are only interested in ticking boxes in order to fill broken system requirements.

 

[EndME]

If people are dying at an increased rate from 'controls' then wouldn't that suggest that they may in fact have something wrong with them, in short that they are not imagining it, that it, whatever it is, is real?

The idea here will be that things such as chronic stress lead to more negative health outcomes. It's very reasonable that, that will be true to some degree especially if there are higher suidice rates, as is the case here.

Of course there will be significant confounders as well, such as misdiagnoses of someone with a physiological illness as a hypochondriac or a simple blood test for basic vitamins, which is what many doctors seem to be believe to be sufficient, not being able to find most illnesses.

To study this with some rigor requires an evaluation of the accuracy of the diagnosis of being a hypochondriac, which would be quite tricky and at least requires quite a bit of work including long-term follow-ups. That however doesn't mean that hypochondriacs don't exist and that they can't have worse health outcomes due to stress related things.

 

[rvallee]

Is this suggesting that some doctors think they are comforting or reassuring patients when they say a problem is all in the patient's head? If that is the case it suggests to me that some doctors don't understand people.

It's one of the most common frustration I see expressed in the LC community. Doctors seem to think that we want to be told that there is something wrong, but we know there is, what we want to know is what's wrong, and being told that they can't find it when there clearly is is never going to be OK with anyone, but they'd have to experience it for themselves to understand this. All those doctors facing something similar with, say a broken computer that a technician insists is working fine, would call them idiots and go someplace else, but they can't see a false attribution error when they commit one. Like most people.

As you say, they really have a poor understanding of human behavior and motivation. Which is ironic, considering that psychosomatic ideology was created out of the specialty of medicine dealing with behavior and motivation, and evolved with the help of psychologists studying the same. If there's anything they actually got correct in there, it's probably by accident, they really haven't much clue about how any of this works.