Abstract
BackgroundPatients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). The broader concept of health anxiety (HA) can also be applied to patients with a chronic disease. This review was conducted to investigate the conceptual, theoretical, measurement-overlap, and differences between these distinct perspectives. We also aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses.MethodsWe used PsycINFO, PubMED, CINAHL, Web of Science, SCOPUS, and PSYNDEX to conduct a systematic review of studies pertaining to these fears in chronic illness published from January 1996 to October 2017. A total of 401 articles were retained.ResultsThere were commonalities across different conceptualizations and diseases: a high prevalence of clinical levels of fears (>20%), a stable course over time, and a deleterious impact on quality of life. Reviewed studies used definitions, models, and measures that were illness-specific, with only a minority employing a psychiatric perspective, limiting cross-disease generalizability. There appears to be some applicability of DSM-5 disorders to the experience of fear of illness/symptoms in patients with a chronic illness. While conceptualizing HA on a continuum ranging from mild and transient to severe may be appropriate, there is a lack of agreement about when the level of fear becomes ‘excessive.’ The definitions, models, and measures of HA across chronic illnesses involve affective, cognitive, behavioral, and perceptual features.ConclusionsThe concept of HA may offer a unifying conceptual perspective on the fears of illness/symptoms worsening or returning commonly experienced by those with chronic disease.
Highlights
RationaleChronic diseases are long-term conditions that develop slowly and increase in severity over time
Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective, a generic illness perspective, and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder)
A total of 3229 publications were found at Phase I and an additional 1946 at Phase II
Summary
RationaleChronic diseases are long-term conditions that develop slowly and increase in severity over time. Chronic diseases account for 60% of all deaths and 43% of the global burden of disease [2] Those with chronic conditions must cope with the persistence and the unpredictability of their illness. They often report feeling anxious and worried about their condition or its symptoms recurring or worsening. Patients with chronic diseases commonly report fears of illness or symptoms recurring or worsening. These fears have been addressed from an illness-specific perspective (e.g., fear of cancer recurrence), a generic illness perspective (e.g., fear of progression), and a psychiatric perspective (DSM-5 illness anxiety disorder and somatic symptom disorder). We aimed to summarize prevalence, course, and correlates of these fears in different chronic illnesses
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