دانلود مقاله ISI انگلیسی شماره 35405
عنوان فارسی مقاله

یک مطالعه اپیدمیولوژیک مبتنی بر جامعه درباره اضطراب سلامتی و اختلال اضطراب فراگیر

کد مقاله سال انتشار مقاله انگلیسی ترجمه فارسی تعداد کلمات
35405 2014 7 صفحه PDF سفارش دهید محاسبه نشده
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عنوان انگلیسی
A community-based epidemiological study of health anxiety and generalized anxiety disorder
منبع

Publisher : Elsevier - Science Direct (الزویر - ساینس دایرکت)

Journal : Journal of Anxiety Disorders, Volume 28, Issue 2, March 2014, Pages 187–194

کلمات کلیدی
اضطراب سلامتی - اضطراب و اندیشه بیهودی راجع بسلامتی خود - اختلال اضطراب فراگیر -
پیش نمایش مقاله
پیش نمایش مقاله یک مطالعه اپیدمیولوژیک مبتنی بر جامعه درباره اضطراب سلامتی و اختلال اضطراب فراگیر

چکیده انگلیسی

This community-based study examined the frequency of worry about personal health in respondents with and without generalized anxiety disorder (GAD), and the impact of health anxiety on the disorder. A random community-based telephone survey of 5118 Chinese respondents aged 18–64 was conducted. A fully structured questionnaire covered the DSM-IV-TR criteria of GAD, major depressive episode (MDE), eight domains of worry, the seven-item Whiteley Index (WI-7), health service use, and socio-demographic information. Worry about personal health ranked fifth (75.6%) among eight domains of worries examined. GAD respondents with high level of health anxiety were significantly older, less educated, and had lower family income. High health anxiety significantly increased the occurrence of one-year MDE, previous persistent worry, previous persistent low mood, number of domains of worries, number of non-core DSM-IV-TR GAD symptoms, health service use, and mistrust of doctors. Health anxiety is common in GAD and may signify greater severity of the disorder.

مقدمه انگلیسی

Although health anxiety is common in both clinical and community settings (Asmundson et al., 2010, Conradt et al., 2006, Ferguson, 2009, Lee et al., 2011c and Rief et al., 2001), the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) (American Psychiatric Association (APA, 2000)) captures pathological worry about personal health by the specific diagnostic category of hypochondriasis. However, estimates of the prevalence of hypochondriasis in clinical settings have yielded variable findings (.8–6.3%; Barsky et al., 1990, Escobar et al., 1998, Faravelli et al., 1997, Fink et al., 1999a and Gureje et al., 1997). Besides, health anxiety has been observed in many other mental disorders (Bouman, 2005 and Sunderland et al., 2013). This may apply especially to anxiety disorders such as panic disorder, generalized anxiety disorder (GAD), and obsessive-compulsive disorder (Taylor & Asmundson, 2004). Of the different types of anxiety disorders, GAD has undergone various diagnostic controversies and changes over the decades (Andrews et al., 2010, APA, 1980, APA, 1987, APA, 1994 and Kessler, 2000). In the DSM-IV-TR, GAD is characterized by the core symptom of pathological and excessive worry about several domains of life (APA, 2000). It may conceivably be associated with health anxiety which is also characterized by excessive worry, specifically on personal health issues. Nonetheless, the DSM-IV-TR describes various sources of worries such as job responsibilities, finances, health of family members, misfortune to children, or miscellaneous minor matters (APA, 2000), but not personal health worry. Likewise, the tenth version of the International Classification of Diseases (ICD-10) (World Health Organization (WHO, 2010)) states that “fears that the patient or a relative will shortly become ill or have an accident are often expressed” in the description of GAD. There is no mention of personal health anxiety. Like the DSM-IV-TR, the ICD-10 includes the diagnostic category of hypochondriasis which captures severe clinical health anxiety. Although empirical studies on the relationship between health anxiety and GAD are limited, we expect them to demonstrate a positive association. Thus, Sunderland et al. (2013) examined the prevalence of health anxiety and its socio-demographic and health risk factors in the Australian general population. Health anxiety was found to be significantly associated with any anxiety or affective disorder. Specifically, GAD, panic disorder, agoraphobia, and bipolar disorder were more likely to be associated with health anxiety. It is worthy of note that respondents with a lifetime history of health anxiety were about six times more likely to experience GAD. This study suggested a close relationship between health anxiety and GAD. Nonetheless, that relationship could not be further examined partly because health anxiety was only assessed by one brief screening question (namely, “have you ever worried a lot about serious illness despite reassurance from a doctor?”). In the only epidemiological study of health anxiety conducted in a Chinese general population (Lee, Ma, & Tsang, 2011a), 78.9% of people with GAD reported worry about personal health. The study also revealed that people with GAD and personal health worry reported a higher number of associated anxiety symptoms and domains of worries, were more likely to exhibit core depressive symptoms, and a higher frequency of treatment seeking. The findings suggested that the clinical profile of GAD with health anxiety might differ from that of GAD without health anxiety, but the study had several limitations. Although health anxiety varies in severity and is dimensional in nature (Conradt et al., 2006, Fink et al., 1999b and Lee et al., 2011c), it was assessed only by a single dichotomous item about its presence or absence. This not only resulted in a large proportion of people with GAD endorsing a positive response but also precluded the further analysis of GAD and non-GAD respondents with different aspects of health anxiety from being made. The study also did not ask about the health of family members and other domains of worries. Therefore, the significance of personal health worry relative to other common worries in GAD remained unclear. Finally, the study assessed the frequency of core depressive symptoms but not the entire set of diagnostic criteria for major depressive episode (MDE). Consequently, the conclusion could not be firmly drawn that GAD respondents with health worry exhibited more comorbidity with depression than those without health worry. This present study aims to examine (1) the frequency of worry about personal health, health of family members and other domains of worries among people with GAD and without GAD; (2) the profile of health anxiety in people with and without GAD using a multidimensional measure of health anxiety; and (3) the socio-demographic profile and severity correlates of GAD with high and low levels of health anxiety.

نتیجه گیری انگلیسی

3.1. Sample characteristics The socio-demographic profile of the sample was representative of the Hong Kong adult population (Table 1). 45.5% and 54.5% of the participants were male and female respectively. 21.4%, 22.4%, and 25.3% belonged to the age groups of 25–34 years, 35–44 years, and 45–54 years respectively. About half of the respondents had obtained secondary and post-secondary education. The majority were married or cohabitating. Nearly two-thirds worked full-time. The mean number of family members was 3.4 (SD = 1.20). There were 257 respondents who met the criteria for GAD, giving a 12-month prevalence of 5.04%. Table 1. Socio-demographic profile of total sample, participants with GAD, and participants without GAD. Total sample (N = 5118) With GAD (n = 257) Without GAD (n = 4861) Chi-square (df, p value, phi-coefficient) n % (census% 2011) a n % n % Gender 8.03 (1, .005, .040) Male 2331 45.5 (45.7) 95 37.0 2236 46.0 Female 2787 54.5 (54.3) 162 63.0 2625 54.0 Age 17.00 (4, .002, .058) 18–24 613 12.0 (12.4) 13 5.1 599 12.4 25–34 1095 21.4 (21.4) 55 21.7 1039 21.6 35–44 1145 22.4 (22.4) 61 24.1 1085 22.5 45–54 1297 25.3 (25.5) 62 24.5 1235 25.7 55–64 918 17.9 (18.2) 62 24.5 856 17.8 Education level 34.07 (3, <.001, .082) Elementary school or lower 477 9.3 41 16.1 437 9.0 Secondary Form 1-Form 7 (Equivalent to US Year 6–13) 2648 51.7 154 60.6 2494 51.5 Post-secondary non-tertiary education 450 8.8 17 6.7 433 8.9 Bachelor's degree or more 1519 29.7 42 16.5 1477 30.5 Employment 63.54 (4, <.001, .112) Employed 3526 68.9 153 60.7 3373 69.8 Unemployed 124 2.4 21 8.3 103 2.1 Retired 304 5.9 12 4.8 292 6.0 In education 408 8.0 8 3.2 401 8.3 Take care of the family 723 14.1 58 23.0 665 13.8 Marital status 24.2 (2, <.001, .069) Single 1709 33.4 71 28.1 1638 34.0 Married/cohabited 3087 60.3 151 59.7 2936 60.9 Divorced/widowed 281 5.5 31 12.3 250 5.2 Family monthly income level 49.4 (3, <.001, .105) <9,999b 446 8.7 52 23.0 394 9.3 10,000–30,000 2106 41.1 105 46.5 2001 47.0 30,001–60,000 1317 25.7 47 20.8 1269 29.8 >60,001 612 12.0 22 9.7 590 13.9 a Data from Hong Kong Census and Statistics Department, 2011. b USD1 = HKD 7.8 approximately. Table options 3.2. Domains of worries GAD respondents reported significantly more worry than non-GAD respondents about all domains of worry (Table 2). Family (85.1%) was the most common kind of worry among people with GAD, followed by health of family members (82.4%), increase in daily expenses (79.6%), and finance (78.3%). Worry about personal health ranked fifth (75.6%, n = 195). Among those without GAD, family health was the most common kind of worry (52.4%), with school/job ranking second (42.8%), followed by family (40.2%) and personal health (38.4%). Thus, worry about personal health was about two times more common in GAD than non-GAD respondents. Table 2. Domains of worries by GAD diagnosis. With GAD (n = 257) Without GAD (n = 4861) Chi-square (phi-coefficient) n % n % Increase in daily expenses 205 79.6 1848 38.0 175* (.185) Personal health 195 75.6 1866 38.4 141* (.166) Health of family members 212 82.4 2552 52.4 88.2* (.131) School/work 179 69.4 2082 42.8 70.8* (.118) Family 219 85.1 1952 40.2 205* (.200) Interpersonal relationship 137 53.3 1005 20.7 151* (.172) Finance 202 78.3 1703 35.0 196* (.196) Unspecified source of worry 183 71.0 768 15.8 495* (.311) * df = 1, p < .001. Table options 3.3. WI-7 scores and item distribution The mean WI-7 score of the whole sample was 2.16 (SD = 2.05). Based on the cut-off of 3 (Conradt et al., 2006), 37.3% scored in the range of clinical health anxiety. People who reported worry about personal health based on the single dichotomous item scored significantly higher on the WI-7 (M = 3.55, SD = 2.02) than those did not report such worry (M = 1.23, SD = 1.46), t (5116) = 47.83, p < .001, d = 1.32. The great majority (89.4%) of respondents who scored in the clinical health anxiety range of the WI-7 (≥3) (37.3%, n = 1911) did not meet the criteria for GAD. GAD respondents had significantly higher health anxiety levels (M = 4.46, SD = 2.08) than non-GAD respondents (M = 2.04, SD = 1.98), t (281.66) = 18.24, p < .001, d = 1.19. While GAD respondents showed a significantly higher endorsement frequency of every WI-7 item, the same profile of endorsement of WI-7 items was found between the two groups, with “worrying a lot about one's health” (84.1% vs. 50.7%) ranking first, followed by “worrying about getting the disease oneself if it is brought to his/her attention” (67.5% vs. 39.8%) and “bothered by many different pains and aches” (67.4% vs. 31.5%). Table 3 summarizes the logistic regression analysis of the relationship between GAD status and the endorsement of each WI-7 item. The results indicated that items 1, 2, 3, 4 and 7 of the WI-7 were significantly associated with GAD status, whereas personal health worry was the fifth most significant predictor of GAD. Table 3. Summary of logistic regression analysis for each WI-7 item in relation to GAD status after controlling for socio-demographic variables. β SE Wald's χ2 df p Adjusted odds ratio (95% confidence interval) Collinearity statistics Tolerance VIF 1. Do you think there is something seriously wrong with your body? .593 .177 11.2 1 .001 1.81 (1.28–2.56) .693 1.44 2. Do you worry a lot about your health? .470 .217 4.70 1 .030 1.60 (1.05–2.45) .714 1.40 3. Is it hard for you to believe the doctor when he or she tells you there is nothing to worry about? .812 .158 26.6 1 <.001 2.25 (1.65–3.07) .887 1.13 4. Do you often worry about the possibility that you have a serious illness? .536 .183 8.55 1 .003 1.71 (1.19–2.45) .622 1.61 5. Are you bothered by many different pains and aches? .328 .190 2.99 1 .084 1.39 (.957–2.01) .642 1.56 6. If a disease is brought to your attention (e.g., on TV, radio, the newspapers, or by someone you know), do you worry about getting it yourself? .182 .176 1.06 1 .303 1.20 (.849–1.69) .745 1.34 7. Do you find that you are bothered by many different symptoms? .638 .194 10.8 1 .001 1.89 (1.30–2.77) .600 1.67 Constant −4.36 .544 64.3 1 <.001 .013 χ2 df p Goodness of fit test Hosmer & Lemeshow 4.85 8 .77 Note: Controls were gender, age, education level, employment, marital status, and family monthly income (omitted from the table). Table options 3.4. GAD with high vs. low health anxiety 41.2% and 30.4% of GAD respondents were classified into high (75th percentile, WI-7 = 6) and low health anxiety (25th percentile, WI-7 = 3) groups respectively. The “high health anxiety” group was significantly older (χ2 (4, N = 184) = 14.51, p = .006, φ = .28), less educated (χ2 (3, N = 184) = 9.06, p = .029, φ = .23), and had lower monthly income (χ2 (3, N = 184) = 21.50, p < 001, φ = .36) ( Table 4). GAD with high health anxiety was significantly associated with higher number of domains of worries and non-core GAD symptoms, increased occurrence of MDE, more persistent worry/anxiety and persistent low mood/energy, increased distrust of doctors, and more frequent health service use ( Table 5). Table 4. Frequency distribution of demographic variables among GAD with high vs. low health anxiety. WI-7 ≤ 3 (n = 78) n (%) WI-7 ≥ 6 (n = 106) n (%) Chi-square (df, p value, phi-coefficient) Gender .25 (1, .62, .037) Male 29 (37.2) 36 (33.5) Female 49 (62.8) 71 (66.5) Age 14.5 (4, .0058, .28) 18–24 6 (7.2) 5 (4.7) 25–34 19 (24.7) 11 (10.3) 35–44 20 (25.6) 22 (20.2) 45–54 21 (27.2) 29 (27.2) 55–64 11 (14.0) 38 (35.7) Education level 9.06 (3, .029, .23) Elementary school or lower 5 (6.8) 24 (22.7) Secondary Form 1-Form 7 (Equivalent to US Year 6–13) 44 (56.3) 54 (50.8) Post-secondary non-tertiary education 12 (15.1) 12 (11.1) Bachelor's degree or above 15 (19.5) 15 (14.5) Employment p = .71 * Employed 44 (56.4) 61 (57.6) Unemployed 8 (10.2) 11 (10.4) Full-time students 3 (4.3) 2 (2.3) Home-makers 21 (26.9) 21 (19.9) Marital status 2.48 (2, .29, .12) Single 26 (32.9) 24 (22.5) Married/living together 42 (53.6) 65 (61.4) Divorced/widowed 10 (12.5) 16 (15.2) Family monthly income level 21.5 (3, <001, .36) <9999** 10 (13.4) 33 (31.0) 10,000–30,000 27 (34.8) 47 (44.3) 30,001–60,000 18 (23.3) 15 (13.7) >60,001 11 (14.2) 1 (.6) * Fisher's Exact test was used because cell number was smaller than 5. ** USD 1 = HKD 7.8 approximately. Table options Table 5. Frequency distribution of severity correlates among GAD with high vs. low health anxiety. WI-7 ≤ 3 (n = 78) % WI-7 ≥ 6 (n = 106) % Adjusted odds ratios (95% confidence interval) Collinearity statistics Tolerance VIF Major depression episode 41.9 76.3 5.81 (2.59–13.0) 55 1.81 Persistent worry/anxiety 79.7 91.7 3.54 (1.15–10.9) 86 1.16 Persistent low mood/energy 41.1 84.1 6.66 (2.78–16.0) 47 2.13 Mistrust of doctors 16.6 69.4 2.57 (1.08–6.13) 86 1.16 Health service use 56.1 85.2 8.80 (3.42–22.6) 91 1.10 WI-7 ≤ 3 (N = 78) Mean (SD) WI-7 ≥ 6 (N = 106) Mean (SD) Adjusted odds ratios (95% confidence interval) Collinearity statistics Tolerance VIF Number of domains of worries 4.55 (1.74) 5.50 (1.44) 1.44 (1.08–1.91) .90 1.12 Number of associated anxiety symptoms 4.95 (.97) 5.31 (.80) 2.22 (1.14–4.32) .90 1.12 Note: Controls included gender, age, education level, employment, marital status, and family monthly income (not shown in the table).

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