The syndrome of hypochondriasis: a cross-national study in primary care.
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 25,916 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.


CONCLUSIONS
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.
Gureje
O
O
Department of Psychiatry, University of Ibadan, Nigeria.
Ustün
T B
TB
Simon
G E
GE
D000293:Adolescent; D000328:Adult; D000368:Aged; D001008:Anxiety Disorders / Q000150:complications; D001294:Attitude to Health; D016009:Chi-Square Distribution; D016001:Confidence Intervals; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005260:Female; D014943:Global Health; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D006998:Hypochondriasis / Q000175:diagnosis / Q000453:epidemiology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012803:Sick Role; D009626:Terminology as Topic