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. 2025 Apr 17;15(4):e090123.
doi: 10.1136/bmjopen-2024-090123.

Association between health anxiety and self-triage decisions: evidence from a cross-sectional study with Australian emergency department non-urgent patients

Thilini Nisansala Egoda Kapuralalage  1 , Ho Fai Chan  2   3 , James Hughes  4   5 , Benno Torgler  2   3   6 , Stephen Whyte  2   3
Affiliations

Association between health anxiety and self-triage decisions: evidence from a cross-sectional study with Australian emergency department non-urgent patients

Thilini Nisansala Egoda Kapuralalage et al. BMJ Open. .

Abstract

Objective: The aim of this exploratory study was to investigate the association between health anxiety and self-triage decisions among emergency department non-urgent patients.

Design: Cross-sectional single-centre study SETTING: Emergency department in the Princess Alexandra Hospital in Brisbane, Australia PARTICIPANTS: Between 13 December 2022 and 30 August 2023, an exhaustive recruitment strategy was deployed to recruit 400 patients. Eligible participants were patients aged 18 years or above who belonged to the Australasian Triage Scale category four or five (non-urgent), were physically and mentally capable of participating in the study and presented to the emergency department between 6:00 a.m. and 23:00 p.m. during the study period.

Main outcome measures: The primary outcome was accurately self-triaged decisions, while the secondary outcome was inaccurately self-triaged decisions, including both overtriaged and undertriaged decisions. Self-triage decisions were assessed using six hypothetical medical scenarios.

Results: Regression results revealed that health anxiety was not associated with accurately self-triaged decisions. However, compared with non-urgent patients exhibiting no health anxiety, those in the third and fourth quartiles (the upper two quartiles) of the Whiteley Index-6 were expected to make 0·29 (95% CI 0·09 to 0·50) and 0·25 (95% CI 0·07 to 0·44) more overtriaged decisions (mean=0·42; SD=0·71), respectively. In contrast, negative associations between health anxiety and undertriaged decisions were observed. Subgroup analyses by age showed statistically significant associations between health anxiety and inaccurately self-triaged decisions among the older adult patient group (aged 35-79 years). Moreover, analyses stratified by sex revealed that female and male patients in the fourth quartile of the Whiteley Index-6 were expected to make 0·26 (95% CI 0·02 to 0·49) and 0·27 (95% CI 0·05 to 0·48) more overtriaged decisions, respectively, compared with those with no health anxiety.

Conclusions: Our results suggest no significant association between health anxiety and accurately self-triaged decisions. In contrast, health anxiety was associated with inaccurately self-triaged decisions. This implies that patients with health anxiety overestimate the need for healthcare and therefore could substantially impact the misuse of health services, particularly emergency departments.

Keywords: Economics; Health Services; Health policy.

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Conflict of interest statement

Competing interests: Thilini Nisansala Egoda Kapuralalage had financial support from the PA Research Foundation for the submitted work. All other authors (HFC, JH, BT, SW) have no competing interest to declare.

Figures

Figure 1
Figure 1. Self-triaged decisions made by non-urgent patients for six medical scenarios.
Figure 2
Figure 2. The relationship between health anxiety and self-triaged decisions.
See this image and copyright information in PMC

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