Accuracy of self-referral in health anxiety: comparison of patients self-referring to internet-delivered treatment versus patients clinician-referred to face-to-face treatment
Open accessAbstract
Background: Severe health anxiety is a chronic and costly disorder if untreated. Patient self-referral may lower barriers to treatment and decrease diagnostic delay. Aims: This study evaluated the accuracy of self-referral for severe health anxiety and compared characteristics of patients self-referred to internet-delivered treatment with patients referred by a clinician to face-to-face treatment. Method: Two trials in the same clinic employed different referral methods for health anxiety, namely self-referral and clinician-referral (trial registration: clinicaltrials.gov: NCT01158430 and NCT02735434). The trials were conducted at different time points but with largely comparable eligibility criteria. The accuracy of the recruitment methods was compared by looking at the number of eligible patients in the two trials. Patients completed a baseline questionnaire and subsequently underwent a diagnostic interview by experienced clinicians. Mean differences in self-report and clinical data explored between-group demographic and clinical characteristics. Results: In total, 101/151 (67%) self-referred patients were eligible compared with 126/254 (50%) clinician-referred patients (P = 0.001). Self-referred patients were 3.4 years older (P = 0.008) and had a somewhat higher educational level (P = 0.030). Patients who self-referred reported significantly higher levels of health anxiety, emotional distress and somatic symptoms compared with clinician-referred patients. Yet, they had less clinician-assessed comorbid anxiety disorders (P<0.001) and better physical health-related quality of life (P<0.001) suggesting a more distinct symptom profile. Conclusions: Self-referral was found to be an accurate method to recruit highly relevant patients with treatment-demanding health anxiety. Thus, both self-referral and clinician-referral seem feasible and valid referral methods, but they may recruit patients with slightly different characteristics. Declaration of interest: None.
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The authors' previous cohort showed poor mental functioning but average physical functioning at baseline.
“our cohort showed poor mental functioning but average physical functioning at baseline [49].”
From Cost Effectiveness of Internet-Delivered Acceptance and Commitment Therapy for Patients with Severe Health Anxiety: A Randomised Controlled Trial (2022) · cites this paper as [49]
The Results (Clinical characteristics; page unavailable) report lower mental health-related quality of life in self-referred patients than in clinician-referred patients, and Table 3 gives the self-referred group a physical-component score of 52.9. The paper does not characterize that physical functioning as average or establish a population benchmark for the claim. (LLM, conf=0.78)
Experimental — accuracy not yet measuredPatients who self-refer to treatment equally well meet inclusion criteria or even better than patients referred by clinicians (Hoffmann et al., 2019; van Scheppingen et al., 2014).
“Here, it has been found that patients who self-refer to treatment equally well meet inclusion criteria or even better than patients referred by clinicians (Hoffmann et al., 2019; van Scheppingen et al., 2014).”
From Internet-delivered Mindfulness-Based Cognitive Therapy for anxiety and depression in cancer survivors: Predictors of treatment response (2021) · cites this paper as Hoffmann et al., 2019
Self-referral has been employed in several previous studies of internet-delivered interventions (Hoffmann et al., 2019).
“An alternative to recruiting patients through systematic screening of psychological distress is self-referral, which has been employed in several previous studies of internet-delivered interventions (Hoffmann et al., 2019).”
From Internet-delivered Mindfulness-Based Cognitive Therapy for anxiety and depression in cancer survivors: Predictors of treatment response (2021) · cites this paper as Hoffmann et al., 2019
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“An alternative to recruiting patients through systematic screening of psychological distress is self-referral, which has been employed in several previous studies of internet-delivered interventions (Hoffmann et al., 2019).”
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“, less travel time for patients and absence from work, and reduced rent for outpatient offices in hospitals) but also to offer a treatment option that is accessible and may appeal to a broader patient population [49], thus minimizing the treatment gap.”
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“Participants are assessed using a short standardized diagnostic interview based on schedules for clinical assessment in neuropsychiatry (SCAN) [32,33] and supplemented with an assessment of HA by proxy using the HAPYS.”
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- Authors
- Hoffmann, D., Rask, C. U., Hedman-Lagerlöf, E., Eilenberg, T., & Frostholm, L.
- Affiliations
- Aarhus University Hospital (DK)
- Venue
- BJPsych Open
- Publisher
- Royal College of Psychiatrists
- Published
- 2019-09
- Volume
- 5
- Issue
- 5
- Pages
- e80-e80
- ISSN
- 2056-4724 (ISSN-L)
- PMC
- PMC6737511
- OpenAlex
- W2973185997
- Cited by
- 11
- References
- 44
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 1
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BJPsych Open (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- Aarhus Universitet
- Aarhus Universitetshospital
- TrygFonden
- Danish Foundation TrygFonden
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Keywords
- health anxiety, self-referral, clinician referral, internet-delivered treatment, face-to-face treatment, patient recruitment, treatment eligibility, delayed diagnosis, somatic symptoms, emotional distress, physical health-related quality of life, comorbid anxiety disorders
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