Health Anxiety in Patients with Voice Disorders

In a variety of medical disciplines, health anxiety has been linked to poor health outcomes. Among patients with voice disorders, a high prevalence of general anxiety has been noted, with increased anxiety related to worsened voice outcomes. This study aims to understand the prevalence and severity of health anxiety in laryngology patients with voice disorders.

In this prospective study, patients presenting to the laryngology clinic with voice disorders answered the Short Health Anxiety Inventory-14 (SHAI-14) questionnaire (range 0-42; clinical significance ≥ 18) and questions related to their family/occupational history. Wilcoxon rank-sums and Kruskal-Wallis tests were used to quantify associations of interest.

We enrolled 68 subjects (median age: 47 years) with voice disorders, including 23 (34%) with a pre-existing anxiety diagnosis. Across all subjects, median SHAI-14 score was 13, with 14 (21%) subjects having clinically significant health anxiety. Professional voice users were significantly more likely to have health anxiety than those who were not (31% vs. 13%, p = 0.007). Patients with anxiety, depression, or other psychiatric diagnoses were more likely to have health anxiety than those without (48% vs. 9%; 67% vs. 13%; 67% vs. 18%, respectively) (all p < 0.001). Patients with comorbid anxiety and depression were more likely to have health anxiety than those with either diagnosis alone (70% vs. 31%, p = 0.023).

Health anxiety was highly prevalent and significantly increased in those who use their voice professionally, as well as those with anxiety, depression, or other psychiatric diagnoses. Voice patients with comorbid anxiety and depression had significantly greater levels of health anxiety compared with those without comorbidity.