title: Somatic symptom burden and health anxiety in the population and their correlates.
abstract: OBJECTIVE
  Somatic symptom burden and health anxiety demonstrate overlapping clinical characteristics but their relationship in the general population is unclear. This study examined the association between these dimensions after adjustment for confounders and their respective correlation with outcome measures.
  
  
  METHODS
  A randomly selected population-based sample of 3014 respondents aged 15-65 was interviewed by telephone using a structured questionnaire that included the 15-item Patient Health Questionnaire (PHQ-15), Whiteley-7, Kessler-6, Sheehan Disability Scale, socio-demographic variables and items regarding health care utilization. Respondents who scored 10 or above on PHQ-15 and 4 or above on Whiteley-5 were regarded as having high somatic symptom burden and high health anxiety respectively.
  
  
  RESULTS
  Somatic symptom burden and health anxiety are moderately correlated after adjustment for confounders (p<.001). Both have important effects on psychological distress, functional impairment and health care utilization independent of each other (ps<.001). A considerable number of respondents (5.7%) reported both high somatic symptom burden and high health anxiety and this group showed the greatest general psychological distress, functional impairment and health care utilization.
  
  
  CONCLUSIONS
  This study demonstrates the close association of somatic symptom burden and health anxiety but also their independent association with psychological distress, functional impairment and health care utilization. The findings support the concept of the DSM-5 category of somatic symptom disorder, but also demonstrate that individuals with high somatic symptom burden or high health anxiety alone may merit separate diagnoses. More sophisticated studies of the relationship between somatic symptom burden and health anxiety are needed.
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China; Hong Kong Mood Disorders Center, The Chinese University of Hong Kong, Hong Kong, China. Electronic address: singlee@cuhk.edu.hk.
authors.forename: Sing
authors.initials: S
authors.lastname: Lee
authors.affiliation: School of Community-based Medicine, The University of Manchester, United Kingdom.
authors.forename: Francis H
authors.initials: FH
authors.lastname: Creed
authors.affiliation: Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Yee-Ling
authors.initials: YL
authors.lastname: Ma
authors.affiliation: Hong Kong Mood Disorders Center, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Candi Mc
authors.initials: CM
authors.lastname: Leung
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000209:etiology*; D017281:Cost of Illness; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D012494:Sampling Studies; D011795:Surveys and Questionnaires
keywords: Health anxiety; Health care utilization; Impairment; Psychological distress; Somatic symptom burden