The COVID-19 pandemic continues to be one of the greatest public health challenges faced by the UK. Reported rates of psychiatric difficulties have increased and the mechanisms by which the pandemic has affected mental health requires investigation.
Aims:
The aim of the study was to understand the psychological impact of the COVID-19 pandemic on health anxiety in the general population, with a focus on Oxford Health NHS Foundation Trust, which provides specialist mental health care within Oxfordshire and Buckinghamshire.
Methods:
We invited participants aged 18+ across Oxfordshire and Buckinghamshire to complete an online questionnaire consisting of standardised questionnaires measuring psychological wellbeing, non-standardised questions to provide demographic information, and information about social circumstances and behaviour during the COVID-19 pandemic. Participants were then invited via email to complete a 3-month follow-up questionnaire.
Results:
About 324 participants completed the baseline survey while 199 completed the follow-up. Our analysis demonstrated that higher scores on a health anxiety inventory were related to reports of depression, anxiety, loneliness, poor quality of life and obsessive-compulsive symptoms and panic. We also identified several predictors of health anxiety such as being female, having a pre-existing physical or mental health condition, and poor tolerance of uncertainty. Lifestyle and demographic factors such as changes in financial situation, changes in employment status, having a close relative or friend with COVID-19, being able to do grocery shopping, being a key worker, and ethnicity were not found to predict health anxiety.
Conclusions:
Awareness of the impact of health anxiety on people needs to be consistently high among healthcare professionals, especially in the continuing fallout from the COVID-19 pandemic. The relationship between health anxiety and fatigue, sleep quality, gender and co-morbid mental and physical health difficulties needs to be investigated further to determine areas of intervention.
AbramowitzJ. S.DeaconB. J.ValentinerD. P. (2007). The short health anxiety inventory: Psychometric properties and construct validity in a non-clinical sample. Cognitive Therapy and Research, 31(6), 871–883. https://doi.org/10.1007%2Fs10608-006-9058-1
2.
Al-AjlouniY. A.ParkS. H.AlawaJ.ShamailehG.BawabA.El-SadrW. M.DuncanD. T. (2020). Anxiety and depressive symptoms are associated with poor sleep health during a period of COVID-19-induced nationwide lockdown: A cross-sectional analysis of adults in Jordan. BMJ Open, 10(12), e041995. https://doi.org/10.1136/bmjopen-2020-041995
3.
AlvaroP. K.RobertsR. M.HarrisJ. K. (2013). A systematic review assessing bidirectionality between sleep disturbances, anxiety, and depression. Sleep, 36(7), 1059–1068. https://doi.org/10.5665/sleep.2810
ByrneA.BarberR.LimC. H. (2021). Impact of the COVID-19 pandemic – A mental health service perspective. Progress in Neurology and Psychiatry, 25(2), 27–33. https://doi.org/10.1002/pnp.708
6.
ChenI. J.ChangC. C. (2017). Cognitive load theory: An empirical study of anxiety and task performance in language learning. Electronic Journal of Research in Educational Psychology, 7(18), 729–746. https://doi.org/10.25115/ejrep.v7i18.1369
7.
CooperK.GregoryJ. D.WalkerI.LambeS.SalkovskisP. M. (2017). Cognitive behaviour therapy for health anxiety: A systematic review and meta-analysis. Behavioural and Cognitive Psychotherapy, 45(2), 110–123. https://doi.org/10.1017/S1352465816000527
8.
DennisD.RadnitzC.WheatonM. G. (2021). A perfect storm? Health anxiety, contamination, fears, and COVID-19: Lessons learned from past pandemics and current challenges. International Journal of Cognitive Therapy, 1–17. https://doi.org/10.1007/s41811-021-00109-7
GellatlyR.BeckA. T. (2016). Catastrophic thinking: A transdiagnostic process across psychiatric disorders. Cognitive Therapy and Research, 40, 441–452. https://doi.org/10.1007/s10608-016-9763-3
GrabauskaitėA.BaranauskasM.Griškova-BulanovaI. (2017). Interoception and gender: What aspects should we pay attention to?Consciousness and Cognition, 48, 129–137. https://doi.org/10.1016/j.concog.2016.11.002
14.
HadjistavropoulosH. D.JanzenJ. A.KehlerM. D.LeclercJ. A.SharpeD.Bourgault-FagnouM. D. (2012). Core cognitions related to health anxiety in self-reported medical and non-medical samples. Journal of Behavioural Medicine, 35, 167–178. https://doi.org/10.1007/s10865-011-9339-3
15.
IAPT. (2011). The IAPT data handbook: Guidance on recording and monitoring outcomes to support local evidence-based practice. Department of Health, IAPT National Programme Team.
16.
JohnsonE. O.RothT.BreslauN. (2006). The association of insomnia with anxiety disorders and depression: Exploration of the direction of risk. Journal of Psychiatric Research, 40(8), 700–708. https://doi.org/10.1016/j.jpsychires.2006.07.008
17.
KibbeyM. M.FedorenkoE. J.FarrisS. G. (2021). Anxiety, depression, and health anxiety in undergraduate students living in initial US outbreak “hotspot” during COVID-19 pandemic. Cognitive Behaviour Therapy, 50(5), 409–421. https://doi.org/10.1080/16506073.2020.1853805
18.
KroenkeK.SpitzerR. L.WilliamsJ. B. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
19.
MangrioE.ZdravkovicS.Sjögren ForssK. (2020). The association between self-perceived health and sleep-quality and anxiety among newly arrived refugees in Sweden: A quantitative study. Journal of Immigrant and Minority Health, 22(1), 82–86. https://doi.org/10.1007/s10903-019-00871-z
20.
MarcusD. K.HughesK. T.ArnauR. C. (2008). Health anxiety, rumination, and negative affect: A mediational analysis. Journal of Psychosomatic Research, 64(5), 495–501. https://doi.org/10.1016/j.jpsychores.2008.02.004
21.
McLeanC. P.AsnaaniA.LitzB. T.HofmannS. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, 45(8), 1027–1035. https://doi.org/10.1016/j.jpsychires.2011.03.006
22.
MihashiM.OtsuboY.YinjuanX.NagatomiK.HoshikoM.IshitakeT. (2009). Predictive factors of psychological disorder development during recovery following SARS outbreak. Health Psychology, 28(1), 91–100. https://doi.org/10.1037/a0013674
23.
MurphyD. L.TimpanoK. R.WheatonM. G.GreenbergB. D.MiguelE. C. (2010). Obsessive-compulsive disorder and its related disorders: A reappraisal of obsessive-compulsive spectrum concepts. Dialogues in Clinical Neuroscience, 12(2), 131–148. https://doi.org/10.31887/DCNS.2010.12.2/dmurphy
O’BryanE. M.McLeishA. C. (2017). An examination of the indirect effect of intolerance of uncertainty on health anxiety through anxiety sensitivity physical concerns. Journal of Psychopathology and Behavioral Assessment, 39(4), 715–722. https://doi.org/10.1007/s10862-017-9613-y
26.
ÖzdinS.ÖzdinS. B. (2020). Levels and predictors of anxiety, depression and health anxiety during COVID-19 pandemic in Turkish society: The importance of gender. International Journal of Social Psychiatry, 66(5), 504–511. https://doi.org/10.1177%2F0020764020927051
27.
PriebeS.HuxleyP.KnightS.EvansS. (1999). Application and results of the Manchester short assessment of quality of life (MANSA). International Journal of Social Psychiatry, 45(1), 7–12. https://doi.org/10.1177/002076409904500102
28.
PropperC.StoyeG.ZarankoB. (2020). The wider impacts of the coronavirus pandemic on the NHS. Fiscal Studies. Advance online publication. https://doi.org/10.1111/1475-5890.12227
29.
RussellD. W. (1996). UCLA loneliness scale (version 3): Reliability, validity, and factor structure. Journal of Personality Assessment, 66, 20–40. https://doi.org/10.1207/s15327752jpa6601_2
30.
SchimmentiA.BillieuxJ.StarcevicV. (2020). The four horsemen of fear: An integrated model of understanding fear experiences during the COVID-19 pandemic. Clinical Neuropsychiatry: Journal of Treatment Evaluation, 17(2), 41–45. https://doi.org/10.36131/CN20200202
31.
SpitzerR. L.KroenkeK.WilliamsJ. B. W.LöweB. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
32.
StarcevicV.BerleD. (2013). Cyberchondria: Towards a better understanding of excessive health-related Internet use. Expert Review of Neurotherapeutics, 13(2), 205–213. https://doi.org/10.1586/ern.12.162
33.
The National Collaborating Centre for Mental Health. (2018). The improving access to psychological therapies manual. www.england.nhs.uk
34.
WangP. S.LaneM.OlfsonM.PincusH. A.WellsK. B.KesslerR. C. (2005). Twelve-month use of mental health services in the United States: Results from the National Comorbidity Survey replication. Archives of General Psychiatry, 62(6), 629–640. https://doi.org/10.1001/archpsyc.62.6.629
World Health Organization (WHO). (2016). International statistical classification of diseases and related health problems (10th ed.). World Health Organization. https://icd.who.int/browse10/2016/en
