Abstract
Background DSM-5 introduced illness anxiety disorder and somatic symptom disorder, which commonly fall under the term health anxiety (HA). HA is clinically significant worry about health. The prevalence of HA is higher in general hospital (medical) clinics than in the community.
Firstly, there are limited studies on the proactive identification (screening) of HA in medical clinics. Secondly, there is little understanding of the treatment preferences, if any, of those living with HA attending such clinics. Much of the literature on the management of HA in the medical setting is extrapolated from patients in the community setting. Some patients do not benefit from, nor wish to undertake, the main interventions of psychotherapy and/or pharmacotherapy. There is little literature on a team-based management strategy.
Objectives Firstly, to understand the acceptability of digital screening in patients attending medical clinics; and to assess its feasibility in identifying patients with HA in medical clinics. Secondly, to evaluates the preference, uptake, and initial outcomes of two different management options; a collaborative multidisciplinary team (MDT) approach offering exercise and social work in addition to the traditional interventions; or a clinician guided internet cognitive behavioural therapy (iCBT) course. The outcomes of both parts may allow better understanding for any future randomised trial.
Methods The pilot study was designed with lived experience advisors. Firstly, digital screening in four medical clinics was undertaken using a measure for HA (Whitely Index-6 (WI-6) and a measure for general anxiety. Those with WI-6 ≥18 (likely HA) were invited to partake in treatment (MDT or iCBT). MDT participants underwent diagnostic interviews. Pre-post measures were undertaken.
Results 422/4,040 completed screening (10.4%), of which 160 (37.9%) scored WI-6 ≥18. 124 (77.5%) initially agreed to further contact, yet only 52 (41.9%) completed further consent to partake in treatment. Of those, 39 chose MDT with 24 (61%) of those receiving a confirmatory HA diagnosis. 8 chose iCBT, with 50% completing the course. Participants who sought treatment had significant symptom burden with an average 2.7 chronic medical illnesses, comorbid general anxiety and depression, and high levels of social and personality dysfunction. Pilot pre-post MDT results showed significant reduction on measures of HA, generalised anxiety, depression, and frequency of doctor visits.
Conclusion HA digital screening in hospital clinics is feasible and acceptable and could be used again for trial recruitment. The high drop off rate of engagement warrants further consideration. Approximately half of those identified with clinical HA symptoms wish to engage in management, of which most prefer MDT (including exercise and social work) over iCBT. Despite complex health and social needs, MDT management showed benefits to patients and likely to the hospital. Due to preference and a possible early trends, further research should focus on MDT management.
The trial was registered on the Australian New Zealand Clinical Trials Registry (ANZCTR), number ACTRN12621001023842. Registered 05 August 2021, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382131&isReview=true