Excessive fear of clusters of holes, its interaction with stressful life events and the association with anxiety and depressive symptoms: large epidemiological study of young people in Hong Kong

Abstract

Background: Excessive and persistent fear of clusters of holes, also known as trypophobia, has been suggested to reflect cortical hyperexcitability and may be associated with mental health risks. No study, however, has yet examined these associations in representative epidemiological samples.

Aims: To examine the prevalence of trypophobia in a population-representative youth sample, its association with mental health and functioning, and its interaction with external stress.

Method: A total of 2065 young people were consecutively recruited from a household-based epidemiological youth mental health study in Hong Kong. Trypophobia, symptoms of anxiety, depression and stress, and exposure to personal stressors were assessed. Logistic regression was used to assess the relationships between trypophobia and mental health. Potential additive and interaction effects of trypophobia and high stress exposure on mental health were also tested.

Results: The prevalence of trypophobia was 17.6%. Trypophobia was significantly associated with severe symptoms of anxiety (odds ratio (OR) = 1.83, 95% CI = 1.32-2.53), depression (OR = 1.78, 95% CI = 1.24-2.56) and stress (OR = 1.68, 95% CI = 1.11-2.53), even when accounting for sociodemographic factors, personal and family psychiatric history, resilience and stress exposure. Dose-response relationships were observed, and trypophobia significantly potentiated the effects of stress exposure on symptom outcomes, particularly for depressive symptoms. Those with trypophobia also showed significantly poorer functioning across domains and poorer health-related quality of life.

Conclusions: Screening for trypophobia in young people may facilitate early risk detection and intervention, particularly among those with recent stress exposure. Nevertheless, the generally small effect sizes suggest that other factors have more prominent roles in determining recent mental health outcomes in population-based samples; these should be explored in future work.

Keywords: Trypophobia; anxiety symptoms; depressive symptoms; epidemiology; stressful life event.

Fig. 1

Interaction effects of trypophobia and stressful life events on the severity of anxiety, depressive and stress symptoms. Additive and interaction effects of trypophobia and high stress exposure on the severity of (a) anxiety symptoms, (b) depressive symptoms and (c) stress symptoms in the Hong Kong epidemiological youth sample. Age, sex, personal and family psychiatric history, childhood adversity and resilience were adjusted in all models. Main effects of trypophobia and high stress exposure were significant in all three models (P = 0.001). The trypophobia × stress exposure interaction effect was significant for depressive symptoms (P = 0.001) and marginally significant for anxiety (P = 0.053) and stress (P = 0.054) symptoms. DASS-A, anxiety subscale of the 21-item Depression, Stress and Anxiety Scales (DASS-21); DASS-D, depression subscale of the DASS-21; DASS-S, stress subscale of the DASS-21; SLEs, personal stressful life events; TQ, Trypophobia Questionnaire.