Our study found that 9.3% of participating medical students had clinically significant health anxiety (using the SHAI). We also found that a significantly higher rate of subjects with health anxiety had a history of medical or mental health problems contributing to their choice of college compared to those without health anxiety, although none of the students’ demographic and background characteristics significantly predicted the occurrence of clinically significant health anxiety. Rates of health anxiety in medical students have generally been high, although these have varied across studies. Early studies from the 1960s indicated prevalence rates of 70% and 78.8% in medical students [17, 18]. A later study by Kellner et al.  showed that these early rates were probably an exaggeration when they demonstrated a rate of 8.3%, which is comparable to our finding of 9.3%. Since then, findings from other countries have also been comparable to our study: 11.0% in Iran , 11.9% in Pakistan , and 16.1–17.4% in Saudi Arabia [22, 23]. The study in Norway by Ellingsen and Wilhelmsen  showed a rate of 1.25% that was lower than our finding. The variation in rates probably demonstrates methodological differences in measuring health anxiety across medical students in terms of the tools used and the sample sizes of different studies. Yet most of these rates in medical students seem to be comparable to rates of health anxiety in the general population, which has been reported to be between 2.1 and 13.1% .
However, the verdict on whether health anxiety is more common in medical students compared to non-medical students is less conclusive [6, 10,11,12]. Howes and Salkovskis  reported that rates of health anxiety seem to be no higher in medical students compared to other (non-medical) students and non-students. Similarly, Kellner et al.  reported no difference in rates of health anxiety in medical students compared to law students, as did Waterman and Weinman  who reported no difference in rates of health anxiety or the number of doctors’ visits made for new health issues since starting university between medical students, nonmedical science students, and law students. However, Moss-Morris and Petrie  found that both first- and third-year medical students scored higher than third-year law students on cognitive aspects of health anxiety, but that these differences did not translate into differences in the number of health visits in the previous year. Contrary to this, Ellingsen and Wilhelmsen  found that medical students had significantly lower health anxiety than law students and suggested that people without medical knowledge are more likely to interpret symptoms as something potentially serious and become anxious, while people with medical knowledge can probably better appraise the situation over time. They found no difference in the frequency of doctors’ visits.
Our study found that there was no significant difference between those with and those without health anxiety in terms of age, gender, year of study, whether they are originally from Al-Ain (where the university is based), previous higher education, any years retaken at university, or any years taken out of university. This seems to suggest that these are not significant factors in our sample as to whether medical students develop health anxiety or not. This is similar to Zahid et al.  who found that age, gender, year of medical school, and visits to the doctor in the previous 6 months were not associated with an increased risk of developing significant health anxiety. Ellingsen and Wilhelmsen  also found no gender difference in rates of health anxiety in medical students, as did Al-Turki et al. , who in addition to finding no gender differences also found no differences between early-year students compared to clinical students in rates of health anxiety. However, Moss-Morris and Petrie  found that first-year medical students scored higher on emotional distress and hypochondriacal concerns than third-year medical students, although they were comparable on the cognitive aspects of health anxiety. They suggested that health anxiety in medical students can be separated into a perceptual (cognitive) component and an emotional distress component, and that differentiating between these components may help explain the variations between different levels of medical students . This may suggest that more senior medical students are better at appraising and managing distress associated with the idea they may have a health issue. Yet, Azuri et al.  noticed that among first- to sixth-year medical students, there was a significant rise in health anxiety and emotional distress on entering clinical years which decreased later on, but that the perceptual-cognitive aspects increased gradually over the 6 years without decline. Interference with life scores remained low all through the 6 years, suggesting that health anxiety depended on the year of study, but that it most probably did not interfere with students’ ability to function. Similarly, Eslami et al.  reported that rates of health anxiety were significantly higher in interns (15.3%) compared to clerkship students (8.1%), supporting the notion of rising health anxiety with progressing years. Contrary to this, Althagafi et al.  reported that preclinical students had significantly higher rates of health anxiety (21.1%) than clinical year students (14%), but rates in medical students did not significantly differ from non-medical students.
The fact that there was no significant difference in the number of students repeating years or taking years out from university seems to suggest that even in those who develop health anxiety, the impact on academic performance was not to a degree that delayed the progress of students from one year to another. However, this does not rule out the possibility that the academic performance of students with health anxiety was not affected compared to those without health anxiety. Although medical students with health anxiety in our sample may appear to be progressing similar to their peers, they may have still experienced a decline in their performance, but not to the degree that they repeated the year or take time out of university, suggesting that if academic performance is affected, then it is probably only to a mild or moderate degree.
Our study found no difference between those with and without health anxiety in terms of frequency of anyone close having suffered from a serious health problem, again suggesting that this was not a significant factor in our sample. On the contrary, Ellingsen and Wilhelmsen  reported that students who had experienced illness in close family tended to have lower health anxiety.
A significantly higher percentage of students in our sample with health anxiety had a history of medical or mental health problems contributing to the choice of college than those without health anxiety. Also in our sample, a near significantly (p = 0.05) higher percentage of students with health anxiety had a past history of mental health problems than those without health anxiety. Ellingsen and Wilhelmsen  found that students who reported a history of depression had significantly higher (p < 0.01) health anxiety scores compared to those without health anxiety. This suggests that perhaps the negative and pessimistic thinking that is commonly associated with depression could predispose individuals to negatively interpret physical symptoms and make them more prone to health anxiety. The near significant difference (p = 0.05) in those with and without health anxiety in terms of past history of mental health problems could possibly explain the significant difference between the two groups that a past history of medical or mental health conditions in the student influenced their choice of college. Individual experiences of medical and mental illness may play a role in the development of health anxiety and in the choice of studying medicine.
Although our study is the first to investigate health anxiety in the UAE, it was conducted before the onset of the covid-19 pandemic. So, our study provided a baseline regarding levels of health anxiety before the era of covid-19 where worldwide there have been increased concerns and worries in the public perception towards health issues. Since then, there have been a number of studies from the UAE looking at anxiety in university students, although none specifically measured health anxiety during this period. Saddik et al.  investigated a sample of 719 medical students across 4 emirates within the UAE in the first month of the lockdown in the UAE (March 2020) and found that 24.3% reported mild to severe anxiety on the GAD-7. Medical students reported lower anxiety levels compared to dental students and higher levels of anxiety during their clinical rotations which decreased with the introduction of online learning . This represented a slight increase from the previous finding in medical students in the UAEU from before the covid-19 pandemic, which showed rates of anxiety (also using the GAD-7) of 20.7% , and from the previous finding by Awadalla et al.  that reported rates of anxiety of 22.3% (also on the GAD-7) in 404 undergraduate students at Zayed University, Dubai, before the covid-19 pandemic, although their sample did not include any medical students.
The study by Drissi et al.  also in the first month of the lockdown in the UAE found rates of anxiety and depression of 42.9% using the GHQ-12 in a sample of 154 students in the UAEU, although only 10 participants (6.5%) were medical students. Saravanan et al.  in the third month of the lockdown in the UAE (May 2020) reported rates of anxiety specifically related to covid-19 of 15.9% in a sample of 433 university students in Sharjah using the Coronavirus Anxiety Scale, of whom only 10.2% (N = 44) were medical students.