Healthy patients who perceive poor health: Why are they worried sick?

Objective: To explore characteristics of patients who are physically health y but who perceive poor health by investigating the hypothesis that mental health problems, financial strain, and deficiencies in social support under lie why these patients are "worried sick." Methods: Three hundred forty-eig ht continuity patients in 2 rural primary care practices were administered the PRIME-MD, the MOS SF-36, a health-related worry (1-item, 5-point) scale , the MOS social support survey, and perceived economic strain instruments. The patient's physician rated physical health on a 10-point scale. Health care utilization was defined as the number of office visits and total offic e and laboratory charges for 6 months before and after the interview date. Results: Two hundred thirty-seven patients (group A) scored in the upper an d middle terciles on the MOS health perceptions scale. One hundred eleven p atients scored in the lower tercile on health perceptions: 59 (group B) wer e rated as having good physical health (physical health rating > 6) and 52 (group C) as having poor health (rating less than or equal to 6). The "worr ied sick" patients (group B) resembled Group A with regard to physical heal th, but resembled the sick (group C) with regard to all MOS functional scal es, prevalence of mental health diagnoses, and worry. Social support was si milar across groups. Only 1 of 3 measures of economic strain was less in gr oup A than 3 and C. Conclusions: Our measures of mental health problems, fi nancial strain, and deficiencies in social support accounted only in part f or the differences among the three groups. Other explanations of why some a re "worried sick" require study, such as other life stressors and personali ty traits.