Continuity of health anxiety from childhood to adolescence and associated healthcare costs: a prospective population-based cohort study

Martin K. Rimvall*, Pia Jeppesen, Anne Mette Skovgaard, Frank Verhulst, Else Marie Olsen, Charlotte Ulrikka Rask

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

3 Citations (Scopus)


Background: Severe health anxiety (HA) is characterized by excessive and impairing worry and preoccupation with health issues and can cause increased and unnecessary medical examinations. HA in childhood and adolescence is scarcely explored, hindering the potential for prevention and early intervention. Methods: HA was assessed in 1,278 children/youths at two time points at ages 11 and 16 years in a general population-based birth cohort. Register-based data on costs related to nonhospital-based primary and secondary somatic health services were obtained over the follow-up period. The presence of functional somatic symptoms, emotional disorders and chronic somatic illness at baseline were included as covariates. Results: High HA (top 10% score) at age 11 predicted high HA at age 16 (relative risk [RR] 2.03, 95% CI: 1.26–3.31). The group with persistent HA was small (n = 17, 1.3%), resulting in broad confidence intervals. The statistical effect of HA at age 11 on HA at age 16 was heavily reduced after adjustment for sex and all covariates (RR: 1.49, 95% CI: 0.85–2.60). In the adjusted model, somatic illness at age 11 (RR: 1.91, 95% CI: 1.22–2.98) and female sex (RR: 3.33, 95% CI: 2.01–5.50) were independently associated with HA at age 16. Persistent HA was associated with approximately doubled healthcare costs compared to the group with consistently low HA. Incident HA at age 16 was associated with increased costs over follow-up. The increased costs were not explained by chronic somatic illness. Conclusions: A small subgroup of children had persistent high levels of HA from late childhood to adolescence and displayed increased healthcare costs. Female sex and chronic somatic disorders at age 11 were independent risk factors of HA at age 16. These findings provide potential means of early identification and of therapeutic levers. Further intervention development and evaluation are needed.

Original languageEnglish
Pages (from-to)441-448
Number of pages8
JournalJournal of Child Psychology and Psychiatry and Allied Disciplines
Issue number4
Publication statusPublished - Apr 2021

Bibliographical note

The authors thank the funding sources of the study: TrygFonden (J. nr. 7‐10‐0189, 7‐11‐0341 and 109903), Lundbeckfonden (J. nr. R54‐A5843) and Øster‐Jørgensen og Rønhild Andersen Fonden. M.K.R. was funded by a PhD grant from the Mental Health Services of the Capital Region of Denmark. The authors also thank Jens Søndergaard Jensen (Msc) for contributing to the statistical analyses and Anja Munkholm (PhD), Lars Clemmensen (PhD), Anne Dorothee Müller (MbSc), Maja Gregersen (MSc) and Kia Elten (Msc) for contributions to the data collection. F.V. publishes the Dutch translations of ASEBA materials from which he receives remuneration. The remaining authors have declared that they have no competing or potential conflicts of interest. Key points

Publisher Copyright: © 2020 Association for Child and Adolescent Mental Health


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