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Health Anxiety and Disability Pension Award: The HUSK Study

From the Faculty of Psychology (A.M., O.H., K.E., S.Ø.), Research Section for Mental Health Epidemiology, Research Centre for Health Promotion, University of Bergen, Bergen, Norway; Norwegian Institute of Public Health (A.M.), Division of Mental Health, Oslo, Norway; The Department of Public Health and Primary Health Care (J.G.M.), University of Bergen, Bergen, Norway; Sydney University (N.G.), Sydney, Australia; and Institute of Medicine (I.W.), University of Bergen, Bergen, Norway.

Address correspondence and reprint requests to Arnstein Mykletun, Research Centre for Health Promotion, University of Bergen, N-5020 Bergen, Norway. E-mail: arnstein.mykletun{at}uib.no

Objective: To examine the hypothesized effect of health anxiety on subsequent disability pension award. Mental disorders are consistently underrecognized in general health care, leading to underestimation of its effects on related social security expenditures. According to medicolegal diagnoses for disability pension award, there are almost no awards of disability benefits for health anxiety or hypochondriasis. There are no empirical longitudinal population-based studies on occupational disability in health anxiety or the extreme of hypochondriasis.

Methods: Using a historical cohort design, we utilized a unique link between a large epidemiological cohort study (n = 6819) and a comprehensive national database of disability benefits to examine the effect of health anxiety on subsequent disability pension award (n = 277) during 1.0 to 6.6 years of follow-up. The data sources were merged after informed consent, using the national personal identification number.

Results: Health anxiety was a strong predictor of disability pension award, exceeding the effect of general anxiety, and comparable to the effect of depression. This effect was partly accounted for by adjustment for income and level of education, and comorbid mental, psychosomatic, or physical conditions. The effect was not limited to high symptom levels, but followed a dose-response association. Despite the robust effect in this prospective study, health anxiety or hypochondriasis was not recognized as medicolegal diagnosis for any awards of disability pension, and was not accounted for by other mental disorders.

Conclusions: Health anxiety is a strong, independent, and yet underrecognized risk factor for disability pension award.

Key Words: health anxiety • hypochondriasis • occupational medicine • common mental disorders • public health • disability pension

Abbreviations: ICD-10 = International Statistical Classification of Diseases and Related Health Problems, 10th Revision; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; CBT = cognitive-behavioral treatment; HUSK = Hordaland Health Study; HADS = Hospital Anxiety and Depression Scale; ICPC = International Classification for Primary Care; ATC = Anatomical Therapeutic Chemical Classification of drugs.