Health Anxiety Predicts Postponing or Cancelling Routine Medical Health Care Appointments among Women in Perinatal Stage during the Covid-19 Lockdown

Abstract

To avoid spreading the Corona Virus Disease 2019 (COVID-19), health authorities have forced people to reorganize their working and private lives and to avoid open and public spaces as much as possible. This has also been the case for women both during pregnancy and after delivery. Here, we investigated the associations between subjective beliefs in risk of infections and health anxiety, depression, stress, and other perinatal dimensions. To this end, we assessed 103 women (mean age: 28.57 years) during pregnancy and after delivery. They completed a series of questionnaires covering sociodemographic information, perinatal information, health anxiety, post-partum depression, and stress. Sixty-six participants (64.1%) were in the pre-partum stage, and 37 (35.9%) were post-partum. Health anxiety was unrelated to depression or stress. Knowing and being close to infected people was associated with higher health anxiety. Strict following of the safety recommendations was associated with greater health anxiety, depression, and stress. Postponing or cancelling routine medical check appointments was observed among participants with high health anxiety scores. Higher illness severity, overall health anxiety scores, and lower stress scores predicted those participants who postponed or cancelled their routine medical check appointments. Post-partum stage and a larger number of children were associated with higher stress scores, but not with depression or stress. The results are of practical and clinical importance; it appears that health anxiety, which is to say fear of getting infected with COVID-19 during pregnancy or at the post-partum stage, was associated with postponing or cancelling routine medical check appointments, but not with stress or depression.

Sources of Health Anxiety for Hospital Staff Working during the Covid-19 Pandemic

“…Our first hypothesis was that those who were close to others infected with COVID-19 also reported higher anxiety about their health, and this was confirmed. It follows that the current results are in accord with previous findings [ 17 , 18 , 27 ]. However, we expanded upon previous research in showing that personal circumstances were completely independent of the work-related context in their impact on health anxiety among hospital staff during the COVID-19 pandemic.…”

“…As already employed elsewhere [ 27 ], participants completed the Persian version [ 33 ] of the Health Anxiety Inventory [ 19 ]. The questionnaire consists of 18 questions focusing on anxiety about one own’s health, ranging from no fear concerning health at all to hypochondriasis (DSM-IV; [ 34 ]) or somatic symptom disorder and illness anxiety disorder (DSM-5; [ 35 ]).…”

“…The following two hypotheses and one research question were formulated. First, previous studies showed that being close to people infected with COVID-19 would increase psychological distress, higher anxiety, and avoidance behavior [ 17 , 18 , 27 ]; accordingly, we expected that being close to people infected with COVID-19 would be associated with higher health anxiety. Second, others have shown that hospital staff members working on the frontline reported higher symptoms of distress and anxiety [ 12 , 13 ]; given this, we anticipated that working on the frontline would be associated with higher scores for health anxiety and trait and state anxiety.…”

“…Third, health belief models share a common basis with the cognitive–emotional stress model of Lazarus and Folkman [ 23 ] and research on placebo effects [ 24 , 25 , 26 ]. It is not the COVID-19 virus per se [ 27 ], or stress per se [ 23 ], or a placebo per se [ 25 , 26 , 28 ] that produces an emotional, cognitive, and behavioral effect, but the subjective and cognitive–emotional meaning projected onto the virus, to a work environment, or to a placebo. Fourth, given this background, the present study differs from previous studies in focusing on the subjective and cognitive–emotional and behavioral responses of healthcare workers during the pandemic, and not on objective realities.…”

“…Fifth, from the above, it follows that purely individual cognitive–emotional processes impact on perceptions of danger, which here is the subjective risk of getting infected by the virus. In a previous study of women during the peripartal stage, health anxiety and being close to people infected with COVID-19 were the main drivers of postponement or avoidance of routine medical appointments [ 27 ]. Thus, one might expect health anxiety to be related to subjective but not objective exposure to danger in general and to COVID-19 specifically.…”