Journal Article Annotations
2023, 4th Quarter
Annotations by Sharvari Shivanekar, MD.
This large Swedish matched-cohort study illustrates a paradox, whereby individuals with an ICD-10 diagnosis of hypochondriasis (also known as health/illness anxiety disorder) have an increased risk of death despite their pervasive fears of illness and death. The researchers found that people with the diagnosis have an increased risk of death from both natural and unnatural causes, particularly suicide. In the study, the risk of suicide was more than four times higher for those diagnosed with hypochondriasis compared to the general population.
Strength and weaknesses:
This study was both the largest study of individuals with clinically diagnosed hypochondriasis ever done, and the first study to examine the causes of death in this population. Strengths include a large nationwide cohort, mean follow up time of nearly eight years, adjustment for important sociodemographic variables and lifetime psychiatric comorbidities. Some limitations include hypochondriasis being underdiagnosed in Sweden, thus underestimating the excess mortality in these individuals. Data from primary care was not included, nor was an adjustment made for somatization disorder.
C-L psychiatrists should be aware of the increased risk of suicide in this population. This is particularly true if the patient has a lifetime history of depression and anxiety, and this risk remains statistically significant even after systematic adjustment for lifetime psychiatric disorders. This study illustrates the importance of thorough lethality risk assessment in these individuals who are often dismissed by health professionals and bear the burden of a highly stigmatized diagnosis.