Document Type : Original Article


1 Assistant Professor of Community and Preventive Medicine, Department of Community Medicine, School of Medicine, Arak University of Medical Sciences, Arak, Iran

2 Student of General Medicine, Students Research Committee, Arak University of Medical Sciences, Arak, Iran

3 Professor of Infectious Diseases, Department of Infectious Diseases, Infectious Diseases Research Center, School of Medicine, Arak University of Medical Sciences, Arak, Iran

4 PhD Student of Biostatistics, Department of Biostatistics and Epidemiology, School of Health, Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran


Background and aims: The prevalence of coronavirus disease 2019 (COVID-19) resulted in health anxiety among general population and unreasonable referring to health centers. This study aimed to assess health anxiety related to COVID-19 in individuals referring to healthcare centers of Arak, Iran in 2020.
Methods: Using convenient sampling method, the participants of this cross-sectional study were selected from 16 urban health centers of Arak. Salkovskis 18-item Health Anxiety Inventory (HAI-18) was completed by 392 participants. The collected data entered in SPSS software version 24 and was analyzed by Mann-Whitney U and Kruskal-Wallis tests.
Results: Mean ± SD of total score of health anxiety was 28.96 ± 7.62. Most participants (74.7%) had medium anxiety and 19.1% had high anxiety. The mean of total score of health anxiety was higher in the 30-59 age range, higher education, single people and students. Participants with chronic diseases and symptoms of cold and people who referred to health centers due to COVID-19 screening had a higher anxiety level.
Conclusion: Most people referring to health centers of arak had moderate anxiety. COVID-19-related health anxiety was higher in middle age range, higher education, students, people with chronic diseases, and people with symptoms of common cold.


Main Subjects

1. Nargesi F, Izadi F, Kariminejad K, Rezaei Sharif A. The investigation of the reliability and validity of Persian version of health anxiety questionnaire in students of Lorestan University of Medical Sciences. Quarterly of Educational Measurement. 2017;7(27):147-60. [Persian]. 
2. Abramowitz JS, Olatunji BO, Deacon BJ. Health anxiety, hypochondriasis, and the anxiety disorders. Behav Ther. 2007;38(1):86-94. doi: 10.1016/j.beth.2006.05.001. 
3. Tang NK, Salkovskis PM, Poplavskaya E, Wright KJ, Hanna M, Hester J. Increased use of safety-seeking behaviors in chronic back pain patients with high health anxiety. Behav Res Ther. 2007;45(12):2821-35. doi: 10.1016/j.brat.2007.05.004. 
4. Tyrer P, Tyrer H. The departure of hypochondriasis is no loss. Aust N Z J Psychiatry. 2014;48(8):772-3. doi: 10.1177/0004867414540755. 
5. Ray A, Gulati K, Rai N. Stress, anxiety, and immunomodulation: a pharmacological analysis. Vitam Horm. 2017;103:1-25. doi: 10.1016/bs.vh.2016.09.007. 
6. Tyrer P, Cooper S, Tyrer H, Salkovskis P, Crawford M, Green J, et al. CHAMP: cognitive behaviour therapy for health anxiety in medical patients, a randomised controlled trial. BMC Psychiatry. 2011;11:99. doi: 10.1186/1471-244x-11-99. 
7. Tyrer P, Cooper S, Tyrer H, Wang D, Bassett P. Increase in the prevalence of health anxiety in medical clinics: possible cyberchondria. Int J Soc Psychiatry. 2019;65(7-8):566-9. doi: 10.1177/0020764019866231. 
8. Sunderland M, Newby JM, Andrews G. Health anxiety in Australia: prevalence, comorbidity, disability and service use. Br J Psychiatry. 2013;202(1):56-61. doi: 10.1192/bjp. bp.111.103960. 
9. Rode S, Salkovskis P, Dowd H, Hanna M. Health anxiety levels in chronic pain clinic attenders. J Psychosom Res. 2006;60(2):155-61. doi: 10.1016/j.jpsychores.2005.07.005. 
10. Alsubaie S, Hani Temsah M, Al-Eyadhy AA, Gossady I, Hasan GM, Al-Rabiaah A, et al. Middle East Respiratory Syndrome Coronavirus epidemic impact on healthcare workers’ risk perceptions, work and personal lives. J Infect Dev Ctries. 2019;13(10):920-6. doi: 10.3855/jidc.11753. 
11. Zhang WR, Wang K, Yin L, Zhao WF, Xue Q, Peng M, et al. Mental health and psychosocial problems of medical health workers during the COVID-19 epidemic in China. Psychother Psychosom. 2020;89(4):242-50. doi: 10.1159/000507639. 
12. Zhang R, Jiang T, Li N, Wang Z, Liu B, Fang L, et al. [The negative psychology for the public in Zhejiang province during the epidemic of human H7N9 avian influenza]. Zhonghua Yu Fang Yi Xue Za Zhi. 2015;49(12):1073-9. 
13. Xiao C. A novel approach of consultation on 2019 novel coronavirus (COVID-19)-related psychological and mental problems: structured letter therapy. Psychiatry Investig. 2020;17(2):175-6. doi: 10.30773/pi.2020.0047. 
14. Zandifar A, Badrfam R. Iranian mental health during the COVID-19 epidemic. Asian J Psychiatr. 2020;51:101990. doi: 10.1016/j.ajp.2020.101990. 
15. Ahmadi K, Ramezani MA. Iranian emotional experience and expression during the COVID-19 crisis. Asia Pac J Public Health. 2020;32(5):285-6. doi: 10.1177/1010539520937097. 
16. Salkovskis PM, Rimes KA, Warwick HM, Clark DM. The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychol Med. 2002;32(5):843-53. doi: 10.1017/s0033291702005822. 
17. Moghanibashi-Mansourieh A. Assessing the anxiety level of Iranian general population during COVID-19 outbreak. Asian J Psychiatr. 2020;51:102076. doi: 10.1016/j.ajp.2020.102076. 
18. Jungmann SM, Witthöft M. Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: which factors are related to coronavirus anxiety? J Anxiety Disord. 2020;73:102239. doi: 10.1016/j.janxdis.2020.102239. 
19. Maarefvand M, Hosseinzadeh S, Farmani O, Safarabadi Farahani A, Khubchandani J. Coronavirus outbreak and stress in Iranians. Int J Environ Res Public Health. 2020;17(12):4441. doi: 10.3390/ijerph17124441. 
20. Zandifar A, Badrfam R. Iranian mental health during the COVID-19 epidemic. Asian J Psychiatr. 2020;51:101990. doi: 10.1016/j.ajp.2020.101990. 
21. Salari N, Hosseinian-Far A, Jalali R, Vaisi-Raygani A, Rasoulpoor S, Mohammadi M, et al. Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and meta-analysis. Global Health. 2020;16(1):57. doi: 10.1186/s12992-020- 00589-w. 
22. Qian M, Wu Q, Wu P, Hou Z, Liang Y, Cowling BJ, et al. Psychological responses, behavioral changes and public perceptions during the early phase of the COVID-19 outbreak in China: a population based cross-sectional survey. medRxiv. 2020. doi: 10.1101/2020.02.18.20024448. 
23. Liu D, Ren Y, Yan F, Li Y, Xu X, Yu X, et al. Psychological impact and predisposing factors of the coronavirus disease 2019 (COVID-19) pandemic on general public in China. SSRN Electronic Journal. 2020. doi: 10.2139/ssrn.3551415. 
24. Banerjee D. The COVID-19 outbreak: crucial role the psychiatrists can play. Asian J Psychiatr. 2020;50:102014. doi: 10.1016/j.ajp.2020.102014. 
25. Raeisi A, Hajebi A, Rasoulian M, Abbasinejad M. The effects of COVID-19 on mental health of the society: a dynamic approach in Iran. Med J Islam Repub Iran. 2020;34(1):712-4. doi: 10.34171/mjiri.34.102.