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Psychological predictors of health anxiety and pain in ambulatory presentations in a hospital emergency department

Published online by Cambridge University Press:  26 August 2022

Hannah Parker
Department of Psychology, The University of Bath, Bath, UK
Edward Carlton
Emergency Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK University of Bristol Medical School, Bristol, UK
Sophie Harris
Department of Psychology, The University of Bath, Bath, UK
Jo Daniels*
Department of Psychology, The University of Bath, Bath, UK Emergency Department, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
*Corresponding author. Email:



Health anxiety in attendees of out-patient medical clinics is well established; however, there has been a lack of research into health anxiety within emergency settings.


This study explored the prevalence of health anxiety in ambulatory presentations in a tertiary emergency department (ED) as well as the factors associated with pain and health anxiety in this setting.


A cross-sectional questionnaire design was used to gather data from adult ED ambulatory attendees across a 4-day sampling period to assess psychological and physical health variables. Number of attendances to ED over the previous 12 months was accessed through healthcare records.


Of the final sample (n = 106), 77% were white British, 54% were male, and 14% presented with severe health anxiety as measured by the Short Health Anxiety Inventory (≥18). Participants with pre-existing health conditions had significantly higher levels of health anxiety (M = 12.36, SE = 1.59) compared with those without (M = 7.79, SE = 0.66). Stepwise multiple regression analyses identified anxiety sensitivity and pain catastrophizing as significant independent predictors of health anxiety, explaining 51% of the variance in health anxiety. Pain catastrophizing was also a significant independent predictor of pain level, accounting for 20% of the variance.


This study provides insight into the prevalence of health anxiety in ED ambulatory presentations and key psychological predictors of health anxiety and pain. This has implications for treatment in an ED setting whereby patients may benefit from referral to medical psychology or mental health services.

© The Author(s), 2022. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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