Economic resources can influence many parts of someone’s health and the treatment they receive. But new research suggests it may also affect how much healthy anxiety someone feels, too.
Researchers at the University Medical Center Hamburg-Eppendorf in Germany are among the first to systematically study the links between health anxiety and social inequities.
Health anxiety can exist at any point on a spectrum and can include deeply distressful concerns about one’s health, even when medical professionals do not reflect those concerns.
They found that social determinants of health, like a patient’s socioeconomic status, do contribute to health anxiety, which could be due to many factors. For example, folks with fewer economic resources already face higher rates of morbidity due to medical and mental health conditions, more difficult experiences with illness and death, and higher barriers to health care (such as cost) than people from wealthier backgrounds.
“I find health inequality deeply troubling, especially insofar as it is caused by economic inequality,” Lewis Anderson, PhD, a postdoctoral research fellow at the University of Oxford’s department of sociology, told Verywell via email. Although Anderson was not involved with the current research, he studies health inequalities.
“When differences in resources and status translate into one person experiencing more pain, mental anguish, and ultimately a shorter life, then it has gone too far,” Anderson said.
The research was published in the Journal of Psychosomatic Research in December.
To analyze health anxiety and socioeconomic status, researchers sorted through previous studies linking the two. They wanted to find out if social determinants of health, which are known to affect other health conditions, also play a role among people with health anxiety.
In total, 37 previous studies including almost 28,000 individuals were analyzed for trends. Of the studies, 27 screened for health anxiety using validated self-rating scales, while the rest measured it via diagnostic interview. Socioeconomic status was determined via indicators such as education, income, and occupation.
In examining trends among these studies, the researchers concluded that social determinants of health—like a patient’s socioeconomic status—do contribute to health anxiety.
But the trend is difficult to unpack because it could be due to a number of factors. Folks with fewer economic resources already are more likely to get sick, so they may have more anxiety about illness. Struggles to access health care access can also compound these feelings. There might also be a link between people’s negative experiences with health care and the anxiety they’re facing.
Regardless of the combination, the authors name all of these factors and more. At the end of the day, health anxiety, whether it’s linked to a diagnosable/treatable physical medical ailment or not, can have a major impact on someone’s quality of life.
And beyond the distress it can bring to a person’s life and relationships, health anxiety can also lead to a significant economic burden if people are continuously seeking care that is unneeded or above what is medically necessary.
They may also go beyond the healthcare system—which places them at risk—or not have the education (or access to it) necessary to safely navigate these pursuits.
People who struggle with health anxiety used to be called “hypochondriacs.” The term as fallen out of use in the medical field due to its pejorative connotations.
Now, illness anxiety disorder (IAD) or somatic symptom disorder (SSD) can be diagnosed when preoccupations with getting a serious illness cause distress and persist—even when they’re deemed medically unfounded. This might look like someone interpreting a common bodily sensation, such as a slight headache, to be a sign of grave illness, such as brain cancer.
But these types of preoccupations are=difficult to measure.
“Health anxiety is an extremely slippery concept, to begin with,” Anderson said. It brings up all sorts of questions, such as:
Despite the inherent difficulty in measuring health anxiety, Anderson said, the study provides a clear summary of the evidence on how health anxiety and socioeconomic status are linked. For example, it shows us that given the research that’s already out there, “it’s much more common to find higher health anxiety among people of lower socioeconomic status, just as low socioeconomic status is linked to just about every other aspect of poor health,” he said.
But the studies don’t use the same measurement techniques. They use different health anxiety scales and interview formats, which means they might unintentionally be measuring different things.
“It’s very hard to say the studies analyzed here are all investigating the same thing,” Anderson said.
Regardless of what the link between socioeconomic status and health anxiety actually is, this study has shed another light on the catastrophes that arise when quality healthcare is linked to wealth.
Researchers have already suggested that the average health of a population depends on the degree of inequality in income distribution. Less of a gap between the lowest and highest earners, then, would mean higher average health in the population as a whole.
“The resources, status, political power, and health of different groups are all closely linked,” Anderson said, whether it seems like it or not.
Bridging the gap will likely take plenty of policy, regulation, and redistribution of wealth, according to Anderson. But following these steps “might help enable a healthcare system that provides a good standard of care, regardless of one’s socioeconomic status,” he added.