The syndrome of hypochondriasis: a cross-national study in primary care
O. GUREJE a1 , T. B. ÜSTÜN a1 and G. E. SIMON a1
a1 From the Department of Psychiatry, University of Ibadan, Nigeria; Division of Mental Health and Prevention of Substance Abuse, World Health Organization, Geneva, Switzerland; and Group Health Co-operative of Puget Sound, Seattle, WA, USA
Background. The nature and correlates of hypochondriasis are still poorly understood, especially in settings other than those in North America and Western Europe.
Methods. A total of 25916 consecutive patients making ambulatory visits to primary care clinics at 15 sites in 14 countries were screened using the 12-item General Health Questionnaire (GHQ-12). Based on the screen-score performance, a stratified sample of 5447 of respondents was evaluated at the second-stage (response rate: 62%). Evaluation consisted of physician-rated physical and psychological health status and self-ratings of overall health, physical disability and GHQ-28. Interviewers conducted assessment of psychiatric status, using the Composite International Diagnostic Interview (CIDI) and occupational disability.
Results. Across the sites, the occurrence of ICD-10 hypochondriasis was 0·8% (95% Confidence Interval, 0·5–1·0%) and over 1·5% at only two sites. A less restrictively-defined form of the disorder had a pooled frequency of 2·2% (95% Confidence Interval, 1·8–2·6%) across the sites. Patients with this abridged hypochondriasis were more likely than those without to have co-morbid major depression and generalized anxiety disorder. They had a poorer perception of their health, were more physically disabled, were more impaired in the performance of occupational role, and were above-average utilizers of health service. Patients with ICD-10 hypochondriasis were no more impaired than those with abridged hypochondriasis.
Conclusion. Even though the ICD-10-defined hypochondriasis is rare, a form consisting of the triad of disease conviction, associated distress and medical help-seeking is present in primary-care settings in different cultures. This syndrome is associated with considerable psychiatric ill-health and functional disability.
Address for correspondence: Dr Oye Gureje, Royal Park Hospital, Private Bag 3, Parkville, VIC 3052, Australia.