{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T06:46:23Z","timestamp":1776235583588,"version":"3.50.1"},"reference-count":54,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T00:00:00Z","timestamp":1776211200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Although both hypochondriasis and suicidality are common in psychiatric patients and related to anxiety and depression, their association in psychiatric patients remains unclear. This study investigated the direct association of hypochondriasis with suicidality and the indirect associations via anxiety and depression in psychiatric patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Clinical records of 5484 psychiatric outpatients were reviewed. Hypochondriasis, Suicidality, Anxiety, and Depression were evaluated using the hypochondriasis item of the Hamilton Depression Rating Scale, the suicidality item of the 17-item Hamilton Depression Rating Scale (HAM-D\n                      <jats:sub>17<\/jats:sub>\n                      ), the Hamilton Anxiety Rating Scale (HAM-A), and the 6-item subscale of the Hamilton Depression Rating Scale (HAM-D\n                      <jats:sub>6<\/jats:sub>\n                      ), respectively. The associations among Hypochondriasis, Suicidality, Anxiety, and Depression were examined using a parallel mediation model. The model was estimated using the lavaan package in R with 10, 000 bootstrap resamples, adjusted for age and sex. Moderation by age and sex was also investigated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Significant positive indirect associations via Anxiety (point estimate = 0.05, 95% CI [0.03, 0.06]) and Depression (point estimate = 0.17, 95% CI [0.15, 0.19]) were observed between Hypochondriasis and Suicidality. Conversely, the direct association between Hypochondriasis and Suicidality was also significant but in a negative direction (B = \u22120.16, p &amp;lt;.001). As the total indirect association was stronger than the direct association, the total association of Hypochondriasis with Suicidality was significantly positive (B\u00a0=\u00a00.05, p = 0.002). The negative direct association of Hypochondriasis with Suicidality was significantly stronger in younger patients (interaction term = 0.004, p &amp;lt;.001).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Anxiety and depression mediated the association between hypochondriasis and increased suicidality. In contrast, hypochondriasis was associated with decreased suicidality after accounting for the mediators. As the indirect association was stronger than the direct association, hypochondriasis was associated with increased suicidality overall. The direct association between hypochondriasis and decreased suicidality was stronger in younger patients.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpsyt.2026.1796129","type":"journal-article","created":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:44:49Z","timestamp":1776231889000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Direct and indirect associations of hypochondriasis with suicidality in psychiatric outpatients: mediating roles of anxiety and depression"],"prefix":"10.3389","volume":"17","author":[{"given":"Joonyoung","family":"Lim","sequence":"first","affiliation":[{"name":"Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Haein","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chaeyeon","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyeri","family":"Moon","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yunsu","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihye","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jihee","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Seog Ju","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Sungkyunkwan University College of Medicine, Samsung Medical Center","place":["Seoul, Republic of Korea"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"B1","volume-title":"Suicide worldwide in 2021: global health estimates","year":"2025"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.2139\/ssrn.3212359","article-title":"The association between mental disorders and suicide: a systematic review and meta-analysis of record linkage studies","volume":"259","author":"San Too","year":"2019","journal-title":"J Affect Disord"},{"key":"B3","doi-asserted-by":"publisher","first-page":"14","DOI":"10.2174\/1573400509666131119004444","article-title":"Epidemiology of hypochondriasis and health anxiety: comparison of different diagnostic criteria","volume":"10","author":"Weck","year":"2014","journal-title":"Curr Psychiatry Rev"},{"key":"B4","volume-title":"Diagnostic and statistical manual of mental disorders","year":"2013"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.155.1.125","article-title":"Hypochondriasis","volume":"28","author":"Warwick","year":"1990","journal-title":"Behav Res Ther"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2020.110290","article-title":"Suicide and suicidality in somatic symptom and related disorders: a systematic review","volume":"140","author":"Torres","year":"2021","journal-title":"J Psychosomatic Res"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1964.tb05741.x","article-title":"Relationship of alcoholism, hypochondria, and attempted suicide","volume":"40","author":"Stenb\u00e4ck","year":"1964","journal-title":"Acta Psychiatrica Scandinavica"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.4103\/0019-5545.43059","article-title":"Suicidal ideation and attempts in patients with major depression: sociodemographic and clinical variables","volume":"47","author":"Srivastava","year":"2005","journal-title":"Indian J Psychiatry"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2016.08.019","article-title":"Cross-national differences in hypochondriasis symptoms between Korean and American outpatients with major depressive disorder","volume":"245","author":"Chang","year":"2016","journal-title":"Psychiatry Res"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1001\/jamapsychiatry.2023.4744","article-title":"All-cause and cause-specific mortality among individuals with hypochondriasis","volume":"81","author":"Mataix-Cols","year":"2024","journal-title":"JAMA Psychiatry"},{"key":"B11","doi-asserted-by":"publisher","first-page":"391","DOI":"10.1016\/s0022-3999(03)00622-6","article-title":"A systematic review of the epidemiology of somatisation disorder and hypochondriasis","volume":"56","author":"Creed","year":"2004","journal-title":"J Psychosomatic Res"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1023\/a:1026595011371","article-title":"Equivalence of the mediation, confounding and suppression effect","volume":"1","author":"MacKinnon","year":"2000","journal-title":"Prev Sci"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.23.1.56","article-title":"A rating scale for depression","volume":"23","author":"Hamilton","year":"1960","journal-title":"J Neurology Neurosurgery Psychiatry"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1111\/j.2044-8341.1959.tb00467.x","article-title":"The assessment of anxiety states by rating","volume":"32","author":"Hamilton","year":"1959","journal-title":"Br J Med Psychol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1097\/00004850-200503000-00004","article-title":"The relationship between early changes in the HAMD-17 anxiety\/somatization factor items and treatment outcome among depressed outpatients","volume":"20","author":"Farabaugh","year":"2005","journal-title":"Int Clin Psychopharmacol"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.1097\/yic.0b013e328343ba08","article-title":"Do early changes in the HAM-D-17 anxiety\/somatization factor items affect the treatment outcome among depressed outpatients? Comparison of two controlled trials of St John's wort (Hypericum perforatum) versus a SSRI","volume":"26","author":"Bitran","year":"2011","journal-title":"Int Clin Psychopharmacol"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0259861","article-title":"Usefulness of Hamilton rating scale for depression subset scales and full versions for electroconvulsive therapy","volume":"16","author":"Fenton","year":"2021","journal-title":"PloS One"},{"key":"B18","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1016\/j.jad.2011.11.013","article-title":"Is it valid to measure suicidal ideation by depression rating scales","volume":"136","author":"Desseilles","year":"2012","journal-title":"J Affect Disord"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1017\/S1461145708009139","article-title":"The controversial link between antidepressants and suicidality risks in adults: data from a naturalistic study on a large sample of in-patients with a major depressive episode","volume":"12","author":"Seem\u00fcller","year":"2009","journal-title":"Int J Neuropsychopharmacol"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1002\/da.20758","article-title":"Treatment\u2010emergent suicidal ideation during 4 months of acute management of unipolar major depression with SSRI pharmacotherapy or interpersonal psychotherapy in a randomized clinical trial","volume":"28","author":"Rucci","year":"2011","journal-title":"Depression Anxiety"},{"key":"B21","doi-asserted-by":"publisher","first-page":"68","DOI":"10.1016\/j.jpsychires.2015.06.003","article-title":"Assessing measures of suicidal ideation in clinical trials with a rapid-acting antidepressant","volume":"68","author":"Ballard","year":"2015","journal-title":"J Psychiatr Res"},{"key":"B22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.jad.2018.12.017","article-title":"Prevalence, clinical correlates and IQ of suicidal ideation in drug naive Chinese Han patients with major depressive disorder","volume":"248","author":"Li","year":"2019","journal-title":"J Affect Disord"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ajp.2017.17040472","article-title":"The effect of a single dose of intravenous ketamine on suicidal ideation: a systematic review and individual participant data meta-analysis","volume":"175","author":"Wilkinson","year":"2018","journal-title":"Am J Psychiatry"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0447.1975.tb00002.x","article-title":"Quantitative rating of depressive states: correlation between clinical assessment, Beck's self\u2010rating scale and Hamilton's objective rating scale","volume":"51","author":"Bech","year":"1975","journal-title":"Acta Psychiatrica Scandinavica"},{"key":"B25","doi-asserted-by":"publisher","DOI":"10.1159\/000457131","article-title":"A systematic review of the clinimetric properties of the 6-item version of the Hamilton Depression Rating Scale (HAM-D6)","volume":"86","author":"Timmerby","year":"2017","journal-title":"Psychother Psychosomatics"},{"key":"B26","doi-asserted-by":"publisher","first-page":"354","DOI":"10.1037\/a0029315","article-title":"When can categorical variables be treated as continuous? A comparison of robust continuous and categorical SEM estimation methods under suboptimal conditions","volume":"17","author":"Rhemtulla","year":"2012","journal-title":"psychol Methods"},{"key":"B27","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1207\/s15327906mbr3901_4","article-title":"Confidence limits for the indirect effect: distribution of the product and resampling methods","volume":"39","author":"MacKinnon","year":"2004","journal-title":"Multivar Behav Res"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3758\/brm.40.3.879","article-title":"Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models","volume":"40","author":"Preacher","year":"2008","journal-title":"Behav Res Methods"},{"key":"B29","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18637\/jss.v048.i02","article-title":"lavaan: an R package for structural equation modeling","volume":"48","author":"Rosseel","year":"2012","journal-title":"J Stat Software"},{"key":"B30","doi-asserted-by":"publisher","DOI":"10.32614\/CRAN.package.psych","article-title":"Package \u2018psych\u2019","volume":"337","author":"Revelle","year":"2015","journal-title":"Compr R Arch Network"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.21105\/joss.01686","article-title":"Welcome to the tidyverse","volume":"4","author":"Wickham","year":"2019","journal-title":"J Open Source Software"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: a critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"J Appl Psychol"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2015.10.006","article-title":"The relationship of hypochondriasis to anxiety, depressive, and somatoform disorders","volume":"57","author":"Scarella","year":"2016","journal-title":"Psychosomatics"},{"key":"B34","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1016\/j.cpr.2015.11.008","article-title":"Anxiety and its disorders as risk factors for suicidal thoughts and behaviors: a meta-analytic review","volume":"43","author":"Bentley","year":"2016","journal-title":"Clin Psychol Rev"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1016\/j.brat.2012.05.001","article-title":"Health anxiety disorders: a cognitive construal","volume":"50","author":"Rachman","year":"2012","journal-title":"Behav Res Ther"},{"key":"B36","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.brat.2014.05.002","article-title":"Cognitive-behavioral therapy for hypochondriasis\/health anxiety: a meta-analysis of treatment outcome and moderators","volume":"58","author":"Olatunji","year":"2014","journal-title":"Behav Res Ther"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.1038\/s44159-023-00156-1","article-title":"Understanding clinical fear and anxiety through the lens of human fear conditioning","volume":"2","author":"Beckers","year":"2023","journal-title":"Nat Rev Psychol"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.1016\/j.janxdis.2013.12.006","article-title":"The impact of hypervigilance: evidence for a forward feedback loop","volume":"28","author":"Kimble","year":"2014","journal-title":"J Anxiety Disord"},{"key":"B39","doi-asserted-by":"publisher","first-page":"4314","DOI":"10.1038\/s41598-019-39931-7","article-title":"Anxiety sensitivity, its stability and longitudinal association with severity of anxiety symptoms","volume":"9","author":"Hovenkamp-Hermelink","year":"2019","journal-title":"Sci Rep"},{"key":"B40","doi-asserted-by":"publisher","first-page":"946","DOI":"10.1037\/ccp0000342","article-title":"Anxiety sensitivity and suicidal ideation\/suicide risk: a meta-analysis","volume":"86","author":"Stanley","year":"2018","journal-title":"J Consulting Clin Psychol"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.1192\/bjp.2018.27","article-title":"Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies","volume":"212","author":"Ribeiro","year":"2018","journal-title":"Br J Psychiatry"},{"key":"B42","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1177\/2167702616628523","article-title":"A unified model of depression: integrating clinical, cognitive, biological, and evolutionary perspectives","volume":"4","author":"Beck","year":"2016","journal-title":"Clin psychol Sci"},{"key":"B43","doi-asserted-by":"publisher","DOI":"10.1177\/1088868309352321","article-title":"Two decades of terror management theory: a meta-analysis of mortality salience research","volume":"14","author":"Burke","year":"2010","journal-title":"Pers Soc Psychol Rev"},{"key":"B44","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41562-025-02115-7","article-title":"A meta-analysis of the association of death anxiety with psychological distress and psychopathology","volume":"9","author":"Dumitru","year":"2025","journal-title":"Nat Hum Behav"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.1097\/00005053-200208000-00002","article-title":"Hypochondriasis and fear of death","volume":"190","author":"Noyes","year":"2002","journal-title":"J Nervous Ment Dis"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.1891\/0889-8391.22.2.167","article-title":"Death anxiety: A cognitive-behavioral approach","volume":"22","author":"Furer","year":"2008","journal-title":"J Cogn Psychother"},{"key":"B47","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1016\/j.jpsychores.2018.10.002","article-title":"Death anxiety and its association with hypochondriasis and medically unexplained symptoms: a systematic review","volume":"115","author":"Birgit","year":"2018","journal-title":"J Psychosomatic Res"},{"key":"B48","doi-asserted-by":"publisher","first-page":"16","DOI":"10.1080\/07481187.2023.2179686","article-title":"A systematic review of the relationship between death anxiety, capability for suicide, and suicidality","volume":"48","author":"Sims","year":"2024","journal-title":"Death Stud"},{"key":"B49","doi-asserted-by":"publisher","DOI":"10.1080\/07481180701356936","article-title":"Death anxiety across the adult years: an examination of age and gender effects","volume":"31","author":"Russac","year":"2007","journal-title":"Death Stud"},{"key":"B50","doi-asserted-by":"publisher","first-page":"69","DOI":"10.1080\/07481187.2016.1206997","article-title":"Death across the lifespan: age differences in death-related thoughts and anxiety","volume":"41","author":"Chopik","year":"2017","journal-title":"Death Stud"},{"key":"B51","doi-asserted-by":"publisher","DOI":"10.65030\/idr.11003","article-title":"Potential mediators of the relationship between gender and death anxiety","volume":"11","author":"Eshbaugh","year":"2013","journal-title":"Individ Dif Res"},{"key":"B52","doi-asserted-by":"publisher","DOI":"10.17795\/ijpbs-2024","article-title":"Race and gender differences in correlates of death anxiety among elderly in the United States","volume":"10","author":"Assari","year":"2016","journal-title":"Iranian J Psychiatry Behav Sci"},{"key":"B53","doi-asserted-by":"publisher","DOI":"10.1080\/07481188908252334","article-title":"Gender and sex-role stereotypes in scales of death concern","volume":"13","author":"Robbins","year":"1989","journal-title":"Death Stud"},{"key":"B54","doi-asserted-by":"publisher","DOI":"10.1177\/00302228221085177","article-title":"Delay of gratification, gender role attitudes, and death reflections predict death anxiety","volume":"89","author":"Zampella","year":"2024","journal-title":"OMEGA-Journal Death Dying"}],"container-title":["Frontiers in Psychiatry"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1796129\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T05:44:50Z","timestamp":1776231890000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2026.1796129\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,15]]},"references-count":54,"alternative-id":["10.3389\/fpsyt.2026.1796129"],"URL":"https:\/\/doi.org\/10.3389\/fpsyt.2026.1796129","relation":{},"ISSN":["1664-0640"],"issn-type":[{"value":"1664-0640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,15]]},"article-number":"1796129"}}