Exploring Hypochondriasis: Prevalence and Influential Factors Among Women Operating Room Professionals

Background: Hypochondriasis is a subtype of somatic symptom disorder characterized by an individual's belief in having a serious medical condition despite physical health, lasting for at least 6 months, often accompanied by depression and anxiety.

Objective: Occupants of operating rooms, including surgical technologists, anesthesia technicians, and nurses, experience stress and environmental stressors due to their roles especially the women's personnel, considering their direct impact on public health, this study aimed to determine the prevalence of hypochondriasis and its contributing factors among operating room personnel in teaching hospitals affiliated with Mazandaran University of Medical Sciences.

Methods: This study, conducted using random sampling, involved 202 personnel from operating rooms of teaching hospitals. Participants responded to demographic questionnaires and the standardized Illness Attitude Scales (IAS), and the data were analyzed using SPSS software version 20. 

Results: The study revealed a hypochondriasis prevalence rate of 17.6%. Among the participants, 140 were healthy, 49 experienced mild hypochondriasis, and 9 exhibited moderate hypochondriasis. Significant relationships were found between hypochondriasis and age, gender, and marital status. However, no significant relationship was observed between education level and work experience with hypochondriasis.

Conclusion: The observed prevalence in this study was higher than that reported in previous international studies. The results indicated an increase in hypochondriasis prevalence with age, possibly attributed to elevated anxiety and depression levels. Since factors such as hypochondriasis can impact the professional and social functions of medical staff, further extensive research is necessary to explore the influencing factors.

Hypochondriasis is an initial diagnostic challenge, often manifesting with a belief in the existence of a severe illness and ensuing concern, even in the absence of any clinical signs or symptoms, for a minimum duration of six months [1]. This conviction, constituting a core element, necessitates ongoing persistence without tissue, clinical, or neurological abnormalities. Hypochondriasis has been reported to affect approximately 6% of the population, as per the fifth edition of DSM [2], exhibiting relatively high prevalence in advancing societies. For instance, its prevalence is reported as 0.2% in Canada [3]. Notably, despite women generally reporting more bodily complaints and pain, the prevalence of hypochondriasis remains consistent across genders, often within the age group of 20-30 years [4]. Given the fact that work-related stressors, when excessive, can pose threats to an individual's physical, mental, and behavioral health, hospital employees, including clinical staff, experience elevated occupational stress levels. The cumulative impact of numerous stressors specific to this occupation influences the women' healthcare personnel, presenting challenges such as high workloads, inadequate support systems, recurrent interaction with critically ill patients, and hierarchical disparities based on income, social status, and other factors, which can undermine organizational goals. Considering the high stress levels experienced by clinical staff in hospitals, it is crucial to address potential psychological disorders such as hypochondriasis and depression, as these can negatively impact professional and social functioning, contributing to various outcomes including isolation, feelings of inadequacy, depression, and notably absenteeism [5, 6] a more specialized examination of hypochondriasis reveals that somatic complaints are transmuted through psychodynamic processes. This transformation might involve the shift of bodily complaints into bodily preoccupations where physical sensations are interpreted as a warning sign. Additionally, this process might include the conversion of psychological distress, particularly anxiety, into physical symptoms. The primary aim of this process is to help manage distress by diverting it from a psychological domain to a somatic one [7].

In this context, it's noteworthy that anxiety is the most prevalent psychological disorder in women ' healthcare and hospital settings. There's a substantial overlap between anxiety and hypochondriasis, where anxiety is recognized as one of the influential factors in the development of hypochondriasis [8]. Previous studies in Iran identified the operating room as a highly stressful environment with a reported stress rate of 44.3% and a predisposition to psychological distress [9]. Therefore, investigating the prevalence of psychological disorders, especially hypochondriasis, in the operating room holds significant importance, as it directly affects the health system and could result in reduced costs associated with mitigating potential damages caused by hypochondriasis. Hence, this study aims to propose strategies for preventing and reducing the incidence of hypochondriasis among women' operating room personnel.

This cross-sectional analytical study employed a random sampling method and involved 202 women surgical technologists, anesthesia technicians, and nurses with operative room experience, working in teaching hospitals affiliated with Mazandaran University of Medical Sciences in the year 2023.The inclusion criteria encompassed obtaining informed consent, possessing a diploma, associate degree, or bachelor's degree in surgical technology, anesthesia, or nursing, along with successful completion of the respective training program. The exclusion criteria involved factors such as the use of anxiety and depression medications, addiction, or emotional challenges like the loss of immediate family members, divorce, separation, pregnancy, and hormonal disorders within the past year.

The data collection instruments consisted of the Evans Illness Attitude Scales-36, a standardized self-report questionnaire for assessing hypochondriasis, and a demographic questionnaire. The Evans Illness Attitude Scales-36 contains 36 questions, assigning individuals into healthy (0-20), borderline (21-30), mild (31-40), moderate (41-60), and severe (above 60) categories based on their scores. The demographic questionnaire gathered information on age, marital status, educational level, work history, organizational position, and the use of antidepressant or anti-anxiety medications [10]. After obtaining the necessary permissions from the Vice-Chancellor of Research and Technology at Mazandaran University of Medical Sciences, and in coordination with the management of affiliated teaching hospitals, the questionnaires were distributed among the participants. Detailed explanations regarding data confidentiality, non-disclosure of personal information, and the requirement to answer only the provided questionnaire items were provided. After obtaining complete participant consent and with their full cooperation, the filled questionnaires were collected. The collected data were then analyzed using the SPSS software version 20 to investigate correlations between hypochondriasis and relevant factors.

Out of the 202 operating room personnel in teaching hospitals affiliated with Mazandaran University of Medical Sciences, 198 individuals participated in the study. The participants' average age was 36 years, ranging from the youngest at 24 to the eldest at 55. The majority of participants (65.6%) fell within the age range of 30-40 years, with a total of 130 participants. Among the participants, 64% were married. Furthermore, 87% of the participants held a bachelor's degree.

Table 1: Cross-tabulation of Age and Self-Care Disorder.

Furthermore, data analysis demonstrated that the prevalence of self-care disorder among the medical staff employed in the operating room department of educational and medical centers affiliated with Mazandaran University of Medical Sciences is 6.17%. Accordingly, out of 140 individuals, those with normal scores were 140, while 49 individuals fell into the borderline category. Among the 9 individuals who were identified with this disorder according to questionnaire scores, all were experiencing the mild form of self-care disorder. Additionally, based on demographic findings and their analysis, a significant relationship was observed between self-care disorder and variables such as age, gender, and marital status (P less than 0.05). However, no significant relationship was found between occupational category, educational level, work experience, and self-care disorder respectively (P=0.485, P=0.084).

In this study, the prevalence of self-care disorder among women individuals working in the operating room department of educational and medical centers affiliated with Mazandaran University of Medical Sciences, Sari (north of Iran) was investigated. A total of 198 employees were examined for the presence of self-care disorder symptoms, and the overall prevalence of this disorder was determined to be 6.17%. Of the individuals working in the operating room department, 3.29% exhibited self-care disorder tendencies, while 7.70% were considered to have a normal status. In a similar study conducted in the operating rooms of educational and medical centers affiliated with the University of Medical Sciences in Gilan(north of Iran), the prevalence of this disorder was found to be 19.18% among the mentioned population. This contrasts with a prevalence of 1 to 2% reported for this disorder in the general population of Canada [11]. This difference between the Iranian population and the global prevalence could stem from variations in cultures and the participants' working, living, and well-being conditions in the two studies. Additionally, another study conducted among medical students at Azad University in Lahijan found that approximately 37% of the participants exhibited a moderate form of self-care disorder [12]. The age range of the participants in the present study was 22 to 55 years, and a significant relationship was established between gender, age, marital status, and self-care disorder. Similar findings were observed in a similar study conducted by Pourghaneh and colleagues in Gilan [10], as well as in a study conducted by Nowgabi in Gonabad(west of Iran) [13].

Furthermore, the results obtained in the study by Ghasemnejad in 1990 and Shahroki et al. in 1989 were similar to the reported findings. A significant relationship between age and the occurrence of self-care disorder was evident. Considering the statistical evidence from previous studies on the correlation between increased age and depression, as observed in the study by Alizadeh et al. and Roshandel et al. [14], it can be anticipated that aging, due to an increased likelihood of experiencing depression, may also increase the probability of developing self-care disorder. This assumption is supported by a study conducted by Bravo et al. in 2001, which reported a significant influence of depression on the emergence of self-care disorder [15]. This phenomenon can be explained by the repeated encounters healthcare professionals have with patients who present elusive symptoms and complex diagnostic pathways [16]. As these patients traverse through a journey of uncertainty [17], possibly visiting multiple specialists and undergoing various tests before reaching a conclusive diagnosis, it can potentially foster a subconscious skepticism towards the genuineness of certain symptoms. Certain cases even require surgical intervention for healing [18]. 

The healthcare providers might inadvertently begin to associate certain individuals' cases with a protracted and challenging diagnostic process, possibly leading to an internalization of the notion that a portion of patients might be amplifying or misinterpreting their symptoms. This, in turn, could contribute to a heightened awareness of somatic symptom disorder among the medical staff, creating an environment in which medical professionals' approach certain cases with a predisposition to doubt the accuracy or severity of reported symptoms.

Regarding gender, among the participants in this study, all individuals were female.so we cannot assess the gender relation to selfcare however. the findings of the study by Talaii et al. [19] and Ghasemnejad et al. [12] by contrasts with the study by Nowgabi et al [19]. and the study by Fink in 2005, where no significant correlation between gender and self-care disorder was found. Moreover, in the present study, a significant relationship was found between marital status and self-care disorder, which is consistent with Nowgabi's study and suggests that being unmarried might be a contributing factor to the susceptibility of self-care disorder [19]. However, further extensive studies are needed to clarify this matter.  The educational backgrounds of the participants in this study included vocational degrees, operating room and anesthesia bachelor's degrees, nursing bachelor's degrees, and master's degrees in nursing. The study's results indicated no significant relationship between educational level and self-care disorder, while the study by Talaii et al. found a notably higher prevalence of self-care disorder at the vocational degree level [17]. The results of this study suggest that as individuals' age increases, the prevalence of self-care disorder also rises. The statistical correlation between increased age and self-care disorder could stem from the rise in depression, as mentioned earlier. Additionally, elevated anxiety levels and the fear of illness and death might contribute to this relationship, one of the prevalent phenomena in recent years, especially after the vaccination against COVID-19, which was administered to prevent the contraction of the virus and substantially reduce the incidence of the disease [20], is the concept of somatic symptom disorder. Many individuals associate various illnesses with these vaccines. These vaccines exhibited numerous short-term [21, 22] and long-term such as disruption in the menstrual cycle side effects [23], with a majority of these reported side effects originating in females [24]. Some even believed that if short-term side effects did not occur, safety was not guaranteed. However, during a study conducted iran on a cohort of 1408 healthcare personnel, contrary to this belief, different conclusions were reached [25]. Nevertheless, comprehensive studies on somatic symptom disorder following COVID-19 are lacking, highlighting the deficiency in such research.

In comparison to research conducted worldwide, a high prevalence of self-harm disorder was observed in this study. The results of this study indicate that as the age of the participants increases, the frequency of self-harm disorder also rises. The statistically significant correlation of this relationship might stem from escalated levels of anxiety and depression, warranting a broader investigation in this domain. Additionally, due to limited access to all hospital personnel, the study focused on individuals employed in the operating room, a section known for inducing stress. Considering the societal health significance, it is recommended that further research be carried out within a larger statistical population in the field of medical sciences of the country.

Acknowledgment

The researchers express their sincere gratitude to the Ethics and Research Committee of Mazandaran University of Medical Sciences, the affiliated colleges and medical centers and hospitals affiliated with Mazandaran University of Medical Sciences.

Authorship

all authors meet the ICMJE authorship criteria 

Conflicts of interest 

No potential conflict of interest relevant to this article was reported.

Funding

The authors received no financial support for this article's research, authorship, and publication.

Ethical approval 

This study was approved by Mazandaran University of Medical Sciences (IR.MAZUMS.REC.1400.8603). The analysis was performed by the principles of the Declaration of Helsinki.