Health anxiety pushed more Australian emergency department patients toward overtriage
Patients with higher health anxiety were more likely to escalate their own symptoms into emergency-level concerns, even when their judgments were tested against hypothetical scenarios designed to separate accurate triage from error. In a single-centre cross-sectional study at the Princess Alexandra Hospital in Brisbane, investigators examined 400 emergency department patients classified as Australasian Triage Scale category 4 or 5, meaning non-urgent presentations. The question was not whether anxious patients felt unwell; it was whether that anxiety changed how they decided where they belonged in the healthcare system.
It did, but not in every direction.
Health anxiety was not associated with accurately self-triaged decisions. The clearest signal appeared in overtriage, where patients with the third and fourth quartiles of the Whiteley Index-6 were expected to make 0.29 and 0.25 more overtriaged decisions, respectively, compared with patients who had no health anxiety. The study also found negative associations between health anxiety and undertriaged decisions, suggesting that anxious patients were less likely to downplay symptoms when judging their own care needs.
That pattern fits a straightforward behavioral mechanism. Health anxiety heightens threat perception, amplifies bodily vigilance, and can turn ordinary physical sensations into perceived warning signs. In the emergency department, where patients must decide whether a symptom signals a benign issue or a time-sensitive problem, a stronger bias toward danger is likely to push decisions toward urgent care even when the clinical picture does not warrant it.
Hypothetical scenarios exposed a systematic tilt toward emergency care
Self-triage decisions were assessed using six hypothetical medical scenarios, an approach that allowed the study to probe decision-making without waiting for a real-world crisis. The primary outcome was accurately self-triaged decisions, while the secondary outcome captured inaccurate self-triage, including both overtriage and undertriage. The design matters because it distinguishes skill from inclination: a person may be able to identify the correct urgency in some circumstances, yet still consistently lean toward excess caution when anxiety is high.
Among the full cohort, regression results showed no association between health anxiety and accurate self-triage. The signal emerged only when inaccurate decisions were separated by direction. Patients in the upper two Whiteley Index-6 quartiles were more likely to overestimate the need for healthcare, and the effect was visible in both female and male patients in the highest quartile. Female patients in that group were expected to make 0.26 more overtriaged decisions, while male patients were expected to make 0.27 more overtriaged decisions, each compared with participants who had no health anxiety.
Age also shaped the association. Subgroup analyses showed statistically significant links between health anxiety and inaccurately self-triaged decisions among older adults, defined in the study as patients aged 35 to 79 years. In practice, that means the relationship was not confined to a narrow demographic slice or to one sex alone. The tendency to overcall urgency appeared broad enough to matter for emergency department flow and for broader patterns of service use.
One sentence captures the operational problem: anxious patients tend to move toward emergency care, not away from it.
Why the result matters for emergency department demand and patient behavior
The findings point to a familiar but often undermeasured force in acute care utilization. People do not choose emergency departments only because of symptom severity; they also act on their interpretation of uncertainty. Health anxiety can make uncertainty feel intolerable, and emergency care offers immediate diagnostics, reassurance, and a sense of safety. That combination is clinically understandable, but it can also drive use of services that are poorly matched to the actual acuity of illness.
The study’s authors framed the issue as a potential contributor to misuse of health services, particularly emergency departments. The data support that concern without overstating it. This was an exploratory cross-sectional study at a single site, so it cannot establish causation or predict exactly how many visits anxiety might generate across a health system. Even so, the direction of the associations is clinically coherent: anxiety did not improve accuracy, but it did make patients more likely to see danger where urgent care may not have been needed.
That distinction has consequences for triage design, patient education, and communication at the front line. If health anxiety preferentially increases overtriage, then interventions that simply tell patients to “use emergency care appropriately” may miss the real driver. A better response may require reassurance strategies, better symptom interpretation tools, and clearer guidance on what differentiates urgent from non-urgent symptoms. Such approaches could reduce unnecessary emergency presentations without discouraging people who truly need rapid assessment.
What the Brisbane cohort can and cannot tell clinicians
The study recruited patients between 13 December 2022 and 30 August 2023 using an exhaustive strategy at a single emergency department in Brisbane. Eligible participants were adults aged 18 years or older, physically and mentally capable of taking part, and triaged as category 4 or 5 under the Australasian system. Those boundaries matter because the sample focused on non-urgent users of emergency care rather than on severely ill patients already identified by staff as needing immediate treatment.
The Whiteley Index-6 provided the measure of health anxiety, and the associations were tested with regression analyses. The upper quartiles of anxiety consistently tracked with more overtriage, while accurate self-triage remained unchanged. In practical terms, the study suggests that health anxiety does not necessarily distort all triage judgments equally; it appears to skew people toward caution, especially when they are asked to judge whether symptoms belong in emergency care.
For emergency clinicians, that may help explain why some low-acuity presentations are not simply misunderstandings of symptoms but are shaped by a stable psychological tendency to assume the worst. For health services, the implication is equally concrete: reducing avoidable emergency department use may require addressing anxiety itself, not only access barriers or patient knowledge gaps.
The unanswered question is how durable this association is outside one hospital and whether a targeted intervention can change triage behavior without creating unsafe underuse of emergency care. This cross-sectional design cannot answer that, and neither can it separate anxiety from other drivers of fear, distress, or prior healthcare experience. Even so, the pattern is clear enough to merit attention: when health anxiety rises, overtriage rises with it.