Open access peer-reviewed chapter
Awareness, attitudes toward health, and trait anxiety in those aged 25–44 years old.
Abstract
To analyze the association between trait anxiety and health attitude, awareness of risk factors, and prevention of cardiovascular disease in men and women aged 25–44 years. In 2013–2016, 427 men and 548 women of residents 25–44 years were studied. To assess TA (trait anxiety), a form of Spielberger’s self-report Trait Anxiety Inventory has been proposed. When interpreting the indicators, the following approximate estimates of anxiety were used: low TA (LTA), medium TA (MTA), and high TA (HTA). The framework of the budget issue Reg. No.122031700094-5. Respondents with HTA believed that they were “not quite healthy”; had complaints about their health; apparently did not take enough care of their health. People with HTA believed that it was “highly likely” that they would get a serious disease in the next 5–10 years. It turned out that only 5.1% of the population planned to consult a doctor with HTA, less than people with LTA - 12.1% (p < 0.05). It has been established that trait anxiety is associated with low self-esteem regarding one’s health status and insufficient awareness of both risk factors and prevention of CVD.
Keywords
- trait anxiety
- health attitude
- CVD risk factor awareness
- CVD prevention attitudes
- men
- women
1. Introduction
In the DSM-5 [1], anxiety is defined as the expectation of a future threat and is distinguished from fear, which is an emotional response to a real or perceived imminent threat. In addition, the term “anxiety” in DSM-5 adds an additional nuance, referring to the cognitive aspects of anxious expectation. Anxiety is a normal emotion. From an evolutionary perspective, it is adaptive because it promotes survival by encouraging people to avoid dangerous places. Since the twentieth century, anxiety has been considered a disorder in psychiatric classifications. The clinical threshold between normal adaptive anxiety in everyday life and unbearable pathological anxiety requiring treatment is the subject of clinical evaluation [2].
Mood disorders, especially melancholy, may have historical roots dating back to classical antiquity. The philosophical writings of the Latin Stoics, such as the treatises of Cicero and Seneca, are the prototype of many modern views of the clinical features and cognitive treatment of anxiety [3]. Nevertheless, the anxious affect is distinct from sadness; moreover, anxiety is defined as a somatic disease [3]. In Cicero’s time, Roman authors created new terms for philosophical and medical concepts and turned to original Greek words to define these neologisms. For the first time, Cicero makes an interesting distinction between
Anxiety in humans is a complex phenomenon and is characterized by specific cognitive, affective, and behavioral responses at the level of the holistic personality, depending on the degree of severity in the individual emotional space to objective and subjective sources of threat [5, 6].
The analysis of ideas about the functions of anxiety is fundamental to a complete study of its manifestations. If we turn to the functional approach to the study of anxiety as a subjective factor affecting the course of activity, we consider three main functions of this emotional state: signaling, search, and evaluation [7].
The signaling function of the state of anxiety is to anticipate one or another type of danger, to predict something unpleasant, threatening, and to signal it to the individual [8]. Charles Darwin considered the emotions of fear-anxiety and anger-rage to be universal characteristics of animals and humans. He believed that these emotions ensured successful adaptation to changing environmental conditions and survival in the process of natural selection [9]. S. Freud defined anxiety as a specific, unpleasant emotional state accompanied by experiential, physiological, and behavioral components. In his theory, he equated fear with objective anxiety, expressing an emotional response proportional in intensity to the real threat from the environment, and used the term “neurotic anxiety” to describe hypertrophied emotional responses not comparable to the level of objective threat. According to Freud, anxiety acts as an indicator of the presence of a situation “threat perceived presence of threat” both from external sources and from one’s own repressed thoughts and experiences, causing an unpleasant emotional state that further serves as a warning to the individual of the need for some form of adaptation. Focusing on the adaptive use of anxiety in motivational behavior, which helps an individual to avoid the threat or cope more effectively with it, the “threat signal” hypothesis by S. Freud is almost consistent with the evolutionary perspective of Ch. Darwin [10].
Proponents of the cognitive approach to analyze emotional behavior view anxiety as an emotional state that arises in response to an undefined, undifferentiated threat [11]. Although the uncertainty of the threat that is the source of the emotion of anxiety can be specified, for example, in the form of an upcoming exam or an anticipated social confrontation, the basic threat is essentially existential because it is in most cases vague and symbolic. We cannot say what will happen, when it will happen, and what will happen next in relation to what has happened, as long as the threat is not associated with a specific event [11]. Dividing human needs into two main types— that of “necessity” and that of “growth” within the framework of the need-informational theory of emotions, P. Simonov considers the low probability of satisfying any of the needs of necessity to be a source of anxiety, for example, in food, housing, means of protection from harmful influences, ensuring individual, and species existence, etc. [12]. The emergence of the emotion of anxiety is accompanied by an increase in feelings of psychological uncertainty and, to varying degrees of severity, feelings of helplessness. Anxiety is rather an emotion of anticipation of a possible confrontation or potential harm [12].
The search function of anxiety consists in inducing an active search for its sources and manifests itself in a “scanning” of the present situation in order to identify the “stressful elements” of the environment [13]. Psychosomatic and psychopathological disorders are directly related to the chronic urge to search for danger, which is driven by anxiety [14]. In turn, the activity manifested in the search for a threat object is a way of reducing anxiety. In this regard, there may be a strong urge to specify the source of anxiety and its externalization (orientation outside the self), since it is easier to cope with a differentiated, albeit often illusory, threat than with an unknown one. The urge to locate a specific source of threat can transform the emotion of anxiety into an emotion of anger, especially when it comes to protecting oneself from self-humiliation or anticipated harm [14].
One of the fundamentally important functions of anxiety is the function of evaluation of the current situation. Negatively colored emotional experiences of anxiety arise when an individual perceives a situation as dangerous and does not have ready-made, sufficiently reliable ways of dealing with it. The results of the processes of analyzing the significance of the situation and forming attitudes to it generate a cascade of various forms of adaptive activity at the informational, physiological, and behavioral levels, the purpose of which is to eliminate sources of potential threat [15].
Finally, the result of the assessment of the current situation determines not only the degree of severity of the emotion of anxiety, but also the form of the corresponding behavioral reaction or the way of coping with the threatening situation that has arisen [16]. In the simplest case, if the subject interprets the situation as safe during the analysis; the former threat signal loses it signaling function and the fear is eliminated. If danger is confirmed (or not eliminated) due to external or internal (subjective) reasons, the emotion of anxiety is accompanied by motor tendencies of active or passive avoidance (escape) [17].
Within the framework of these tendencies, three forms of behavioral reactions to a dangerous situation are usually distinguished—flight, aggression, and stupor [7], each of which modifies the orientation of the subject’s behavior in its own way. In the presence of an insurmountable danger, flight ensures the elimination of the possibility of a collision with a threatening object. If the threatening situation is an obstacle to the satisfaction of needs and is assessed as surmountable, the emotion of anxiety is transformed into the emotion of anger and aggressive behavior leads to the elimination (destruction) of the source of danger. Finally, if aggression and flight are subjectively assessed as impossible to demonstrate, an individual becomes depressed and rejects any activity [18].
Anxiety, defined as a feeling of undefined threat, a feeling of diffuse apprehension and anxious expectation, or undefined disturbance, is the most powerful mechanism of mental stress. Feeling threatened is central to anxiety and determines its biological significance as a signal of distress and danger. Anxiety can play a protective and motivational role similar to that of pain. An increase in behavioral activity, a change in the nature of the behavior, or the involvement of intrapsychic adaptive mechanisms are associated with the occurrence of anxiety [19].
Unlike pain, anxiety is a signal of danger that has not yet been realized. Predicting this is probabilistic and ultimately depends on the individual’s characteristics. At the same time, the personal factor often plays a decisive role, and in this case, the intensity of anxiety reflects the individual characteristics of the subject rather than the actual significance of the threat [20]. Anxiety, which is inappropriate in intensity and duration of the situation, prevents the formation of adaptive behavior, and leads to violation of behavioral integration and general disorganization of the human psyche. Thus, anxiety underlies all stress-induced changes in mood and behavior [21].
The anxiety series is an essential element of the process of mental adaptation. It includes (1) a feeling of internal tension that does not have a pronounced shade of threat and serves only as a signal of its approach, causing painful mental discomfort; (2) hyperesthesia, when anxiety and irritability increase and previously neutral stimuli acquire a negative color; and (3) anxiety itself, which is the central element of the series under consideration. It manifests as a sense of undefined threat. A characteristic feature is the inability to determine the nature of the threat, to predict the time of its occurrence. Often there is inadequate logical processing, as a result of which a wrong conclusion is drawn due to a lack of facts. (4) fear anxiety, focused on a certain object. Although the objects associated with anxiety may not be its cause, the subject gets the idea that anxiety can be eliminated by certain actions.
(5) A sense of the inevitability of an impending catastrophe when an increase in the intensity of anxiety disorders leads the subject to the idea that it is impossible to prevent an impending event; (6) anxiety-fearful excitement when the disorganization caused by anxiety reaches a maximum, and the possibility of purposeful activity disappears. In paroxysmal increase of anxiety, all these phenomena can be observed during one paroxysm. In other cases, the change is gradual [10].
Thus, a certain amount of anxiety is a natural and obligatory feature of an active personality. Each person has their own optimal, or desirable, level of anxiety—the so-called helpful anxiety. Individuals classified as highly anxious tend to perceive a threat to their self-esteem and vital activity in a wide range of situations and react with a very pronounced state of anxiety [22].
But the existential resonance of anxiety is much more than methodological. The first thing to grasp is that anxiety does not mean ceaselessly fretting or fitfully worrying about something or other. On the contrary, Heidegger says that anxiety is a rare and subtle mood and in one place he even compares it to a feeling of calm or peace. It is in anxiety that the free, authentic self-first comes into existence. In order to understand what Heidegger means by anxiety, we have to distinguish it from another mood he examines: fear. Heidegger gives a phenomenology of fear earlier in Being and Time. His claim is that fear is always fear of something threatening, some particular thing in the world. Fear has an object and when that object is removed, I am no longer fearful. Matters are very different from anxiety. If fear is fearful of something particular and determinate, then anxiety is anxious about nothing in particular and is indeterminate. If fear is directed toward some distinct thing in the world, spiders or whatever, then anxiety is anxious about being in the world as such. Anxiety is experienced in the face of something completely indefinite. It is, Heidegger insists, “nothing and nowhere” [23].
Anxiety is a factor that can manifest itself as an adaptive component in an acute stressful situation; with prolonged exposure to stressful factors, the anxiety reaction is considered as a pre-nosological syndrome, leading to the development of psychosomatic pathology. The syndrome of psychoemotional tension has been described, manifested by an increased level of personal and reactive anxiety, a decrease in emotional stability, the level of social adaptation and frustration tolerance, a predominance of the tone of the sympathetic system with changes in hemodynamics, increased activity of the hypothalamic-pituitary-adrenal system, an increase in lipid content and a shift in the lipoprotein spectrum toward atherogenic fractions. Similar changes have been observed in the study of emotional distress and adaptation to stress [19].
With sufficient semantic uncertainty of the term “anxiety” in psychological and psychophysiological studies, it is most often used in two main meanings that are related but refer to different concepts—as a mental state (state anxiety) and a personality trait (trait anxiety) [24]. Building on a series of pioneering factor analytic studies by Cattell that first identified relatively independent factors of situational and trait anxiety, and on Freud’s threat signal theory, Spielberger et al. developed and substantiated ideas about anxiety as a two-factor construct. It turned out that physiological changes (such as heart rate or blood pressure) that fluctuate over time contribute more to situational anxiety and significantly less to trait anxiety. Conversely, most psychometric assessment scales show high stability over time and make an overwhelming contribution to the factor of trait anxiety. Thus, although situational and trait anxiety are positively correlated, they are logically distinct constructs [17].
Currently, the term “situational anxiety” is used to describe an unpleasant emotional state that occurs in a situation of uncertain danger or threat, characterized by subjective feelings of tension, expectation of unfavorable development of events, and combined with symptoms of activation of the autonomic nervous system. Situational anxiety varies in intensity and changes over time, depending on the perceived conscious, unconscious, or psychological threat. At the same time, the term “anxiety” as a personality trait characterizes a relatively stable degree of severity of the perception of a threat to one’s self in various situations and a tendency to respond to them by increasing the state of anxiety. Trait anxiety is understood as a stable individual trait that reflects a person’s predisposition to anxiety and suggests that he or she has a tendency to perceive a fairly wide range of situations as threatening and to respond to each of them in a particular way. As a predisposition, trait anxiety is activated when certain stimuli are experienced by a person as dangerous to his or her sense of self-worth [6]. At the psychological level, its manifestations are always individualized when exposed to different stressors. A highly anxious person tends to perceive the surrounding world as potentially threatening or dangerous to a much greater extent than a low anxious person [9].
For the analysis of neuropsychological and psychophysiological mechanisms of anxiety as an emotion and as a personal determinant, the most commonly used representations of J. Gray on three neuropsychological systems that play an important role in the control of emotional behavior: Approach System, Fight/Flight System, and Behavioral Inhibition System [25, 26]. The Approach System is associated with conditional reinforcement (or non-punishment) and is aimed at increasing the likelihood of repetition of the action in the future. The Fight/Flight System is associated with unconditional punishment. The Behavioral Inhibition System—with conditional punishment or lack of reinforcement. The balance between the levels of reactivity of these three systems determines the typological characteristics of the individual. High-trait anxiety is more likely to correspond to increased activity in the Behavioral Inhibition System than to a deficit in the Achievement System. In other words, anxiety is more characterized by an increased sense of threat rather than a weakening of the sense of satisfaction. Since individual differences in the reactivity of the Behavioral Inhibition System can determine the level of trait anxiety, it is necessary to dwell in more detail on the functions of this system.
The Behavioral Inhibition System organizes responses to conditioned aversive stimuli based on their association with punishment or positive non-reinforcement. All three types of responses or “outputs” of the Behavioral Inhibition System (behavioral inhibition, increased attention, and an increase in the level of nonspecific activation), regardless of the “input” (novelty; stimuli associated with punishment; stimuli associated with positive non-reinforcement), are blocked by antianxiety agents.
Presumably, the Behavioral Inhibition System plays an important “tracking” role so that the behavior is carried out “according to plan.” When real events coincide with the predicted ones, the system continues to work only in “tracking” mode, and the behavior remains under the control of other brain mechanisms. However, in the case of an unpredicted event, the absence of a predicted event, or if the next predicted event is aversive (associated with punishment or positive non-reinforcement), the system switches to the “control” mode of behavior, causing one of its characteristic responses: inhibition of the current behavior, increased attention, or an increase in the level of nonspecific activation. These behavioral inhibition functions correlate with key features of high-trait anxiety and its clinical manifestations [24]. High-trait anxiety in healthy individuals is characterized by increased sensitivity to stimuli associated with punishment or lack of positive reinforcement (inputs to the behavioral inhibition system). In the case of clinical manifestations of anxiety, phobic behavior is mainly associated with the output of the behavioral inhibition system in the “control” mode, and obsessive-compulsive symptoms are associated with excessive tracking of the system in the “tracking” mode. Finally, in subjects with panic attacks, the parameter corresponding to the sum of the activity of the behavioral inhibition and fight/flight systems should prevail. At the same time, panic attacks are characteristic of patients with chronic activity in both Fight/Flight and Behavioral Inhibition systems [24]. Using Aizenkov’s three-dimensional personality space with factors of extraversion, neuroticism, and psychoticism, J. Gray suggested that the selected parameters may reflect, albeit indirectly, the activity of the three neuropsychological emotional systems discussed above, and that high-trait anxiety, reflecting the reactivity of the Behavioral Inhibition System, is at the same pole as high neuroticism, high introversion, and low psychopathy.
While J. Gray’s model has an important theoretical significance, the experimental analysis of psychometric assessments of anxiety as a trait and as a state, as subjective manifestations of the tonic and phasic forms of the passive defense reflex, in reciprocal relationships with the forms of which the tonic and phasic orientation reflexes as respectively [25, 26], is of great interest. It is common knowledge that in humans, the tonic defensive reflex resulting from the action of a threatening stimulus is expressed by an increase in heart rate, in contrast to the phasic orientation response, which is characterized by a decrease in heart rate [27]. When comparing high and low anxiety subjects according to the characteristics of heart rate and R-R interval variability, it was found that the state of high anxiety subjects at rest is close to the state of low anxiety subjects during information load [27]. The researchers interpret such a physiological characteristic of highly anxious subjects as a manifestation of the strengthening of the tonic form of the passive-defensive reflex, which is constantly observed both at rest and during information load. Besides, the tonic defensive reflex is represented subjectively by high-trait anxiety and objectively by high heart rate, high value of stress index, and decrease in variability of R-R intervals. At the same time, the group of people with low trait anxiety is characterized by a greater contribution of the orientation reflex, which corresponds to a lower heart rate and a greater variability of R-R intervals both in the background and with information load [28].
Over the past decade, there has been increased research interest in anxiety disorders, largely due to increased recognition of the burden and consequences associated with untreated illness [29]. Untreated anxiety is associated with significant personal and societal costs, including frequent primary and emergency care visits, reduced work productivity, unemployment, and impaired social relationships [29].
Self-rated health is “a summary statement about how numerous aspects of health, both subjective and objective, are combined in the perception of an individual respondent” and is a powerful indicator of people’s health status. Self-rated health is related to age, gender, education level, marital status, socioeconomic status, social environment, support, and behaviors that affect physical and mental health. In addition, a relationship has been found between self-rated health and objective health, which is a reliable predictor of people’s health status because it combines objective knowledge about possible medical conditions with the interpretation of a person’s physical and mental indicators [30].
Self-rated health is a reliable indicator of objective health [31], as it combines objective knowledge of potential medical conditions with the interpretation of physical and mental indicators of a person [32]. This allows for a general assessment of the respondent’s overall health but has also been associated with the prediction of mortality [33, 34, 35]. The reliability of this type of self-report has been defined as good or even better than indicators related to chronic disease, functional ability, and psychological well-being [36], and is also prognostic for aspects such as the incidence of chronic disease [33, 37] and functional decline in the work of organs and systems [37, 38].
Studies show that a more comprehensive understanding of health [39] includes not only the absence of health problems but also other possible determinants related to physical fitness and general well-being [40]. This is consistent with the WHO definition of health, which refers not only to the absence of disease or disability, but also to a state of complete physical, mental, and social well-being [41]. Studies have shown that the absence of limitations in daily activities is an important determinant of functional health status [42, 43] and the number of chronic diseases and pain [44]. In addition, not only has psychological well-being been associated with health perceptions [37], particularly self-esteem, distress, and depression [44], but also with cognitive functioning [45].
The problem of public participation in preventive programs aimed at changing behavioral habits is still relevant, since the absence of an elementary “health culture,” together with stress and an unfavorable environmental situation repeatedly increases the risks of morbidity and mortality [22].
However, the success of preventive programs depends not only on the efforts of medical professionals but also on the conscious desire of the individual to change his or her behavioral stereotypes. A kind of indicator of such aspirations is health attitude, which is considered one of the main sociopsychological factors influencing the activity of the population in population projects for the primary prevention of CND [46].
It is possible to characterize health attitude as the result of a set of relations that characterize a given society at a certain stage of its development. A related issue is the identification of factors that have an impact on health attitudes. There are general factors, which are determined by the economic situation, sociopolitical system of a society, peculiarities of its culture and ideology, and specific factors, which include the state of health, lifestyle characteristics, health awareness, influence of family, school, health system, etc. These factors are refracted in the structure of the personality of the individual—the bearer of a certain attitude to health, or this refraction is carried out in the structure of mass consciousness, forming certain norms of behavior in the field of health [47]. The most traditional is the study of the conditionality of health attitude by such sociodemographic characteristics of an individual as gender, age, level of education, skill level, marital status, etc. This is due to the fact that in lifestyle change issues, the best results are achieved when information is targeted to clearly defined groups of the population according to their social status [48]. Effective disease prevention is facilitated by factors such as medical and health literacy, positive attitudes toward preventive measures, and the ability to change habits. On the other hand, the social environment and sustainable models of public culture are factors that can counteract prevention and contribute to maintaining the status quo at the public level [48]. Therefore, it is necessary to develop and implement modern preventive programs created within the framework of the biopsychosocial model of health and health care [22].
Taking into account the above facts, it is of interest to study the associative relationship between trait anxiety and health attitude, prevention of CVD, and awareness of CVD risk factors among people aged 25–44 in Novosibirsk.
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2. Materials and methods
A screening study of a representative sample of the population aged 25–44 years was conducted in one of the districts of Novosibirsk (budget issue No. Reg. no. 122031700094-5) in 2013–2016. A total of 975 subjects were examined, males n = 427, mean age 34 ± 0.4 years, response - 71%; females n = 548, mean age 35 ± 0.4 years, response - 72%.
The general examination was performed according to the standard methods of the WHO program “MONICA-psychosocial (MOPSY)” [49]. Self-assessment of health status, attitudes toward preventive methods, and health-related behaviors were assessed using the knowledge and attitudes toward one’s health questionnaire. To assess TA (trait anxiety), a form of Spielberger’s self-report scale has been proposed [16], consisting of 20 statements. For each statement, four levels of intensity are provided: 1 – “hardly ever,” 2 – “sometimes,” 3 – “often,” and 4 – “almost always.” When analyzing the results of the self-report, it was assumed that the final total score could range from 20 to 80 points. Also, the higher the final indicator, the higher the TA level. When interpreting the indicators, the following approximate estimates of anxiety were used: up to 30 points - low TA (LTA), 31–44 points - medium TA (MTA), 45 or more - high TA (HTA).
Individuals who completed the questionnaire incorrectly were excluded from analysis. The SPSS version 20 software package was used for statistical analysis [50]. Pearson’s chi-squared criterion χ 2 was used to test the statistical significance of the differences between the groups [51]. A significance level of p < 0.05 was assumed.
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3. Results
The relationship between personal anxiety and health attitudes, health screening, medical care and disease prevention, and awareness of CVD risk factors was examined.
To the question: “How do you rate your health?,” the answer “Not quite healthy” was more frequent among people with HTA than with LTA, both in the population (62.8 and 32%) and among men (57.1 and 26.7%) and women (64.9 and 37.1%). On the contrary, the number of those who considered themselves “healthy” was higher among those with LTA than among those with HTA, both in the population (36.8 and 21.8%), as well as among men (43.8 and 33.3%) and women (29.9 and 17.5%) (χ2 = 52,965 df = 8 p < 0.0001 -population, χ2 = 17.629 df = 8 p < 0.05 -male χ 2 = 34.993 df = 8 p < 0.001 female) (Table 1).
| Question: | Both genders | Male | Female | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LTA | MTA | HTA | LTA | MTA | HTA | LTA | MTA | HTA | ||||||||||
| n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | |
| 1. How do you rate your health? | ||||||||||||||||||
| Perfectly healthy | 18 | 4.1 | 5 | 1.2 | 0 | 0 | 11 | 5.1 | 3 | 1.8 | 0 | 0 | 7 | 3.2 | 2 | 0.8 | 0 | 0 |
| In good health | 115 | 26.3 | 72 | 17.3 | 10 | 12.8 | 50 | 23.0 | 33 | 20 | 2 | 9.5 | 65 | 29.4 | 39 | 15.5 | 8 | 14 |
| Healthy | 161 | 36.8 | 130 | 31.2 | 17 | 21.8 | 95 | 43.8 | 58 | 35.2 | 7 | 33.3 | 66 | 29.9 | 72 | 28.6 | 10 | 17.5 |
| Not quite healthy | 140 | 32.0 | 196 | 47.0 | 49 | 62.8 | 58 | 26.7 | 66 | 40 | 12 | 57.1 | 82 | 37.1 | 130 | 51.6 | 37 | 64.9 |
| Ill | 4 | 0.9 | 14 | 3.4 | 2 | 2.6 | 3 | 1.4 | 5 | 3.0 | 0 | 0 | 1 | 0.5 | 9 | 3.6 | 2 | 3.5 |
| Total | 438 | 100 | 417 | 100 | 78 | 100 | 217 | 100 | 165 | 100 | 21 | 100 | 221 | 100 | 252 | 100 | 57 | 100 |
| χ2 = 52.965 df = 8 p < 0.0001 | χ2 = 17.629 df = 8 p < 0.05 | χ2 = 34.993 df = 8 p < 0.001 | ||||||||||||||||
| 2. Do you have any health complaints? | ||||||||||||||||||
| Yes | 230 | 52.9 | 307 | 73.4 | 58 | 74.4 | 115 | 53.5 | 111 | 67.3 | 16 | 76.2 | 115 | 52.3 | 196 | 77.5 | 42 | 73.7 |
| No | 205 | 47.1 | 111 | 26.6 | 20 | 25.6 | 100 | 46.5 | 54 | 32.7 | 5 | 23.8 | 105 | 47.7 | 57 | 22.5 | 15 | 26.3 |
| Total | 435 | 100 | 418 | 100 | 78 | 100 | 215 | 100 | 165 | 100 | 21 | 100 | 220 | 100 | 253 | 100 | 57 | 100 |
| χ2 = 43.140 df = 2 p < 0.001 | χ2 = 9.737 df = 2 p < 0.01 | χ2 = 35, 029 df = 2 p < 0.001 | ||||||||||||||||
| 3. Do you think you take enough care of your health? | ||||||||||||||||||
| Yes | 79 | 18.1 | 48 | 11.5 | 6 | 7.7 | 29 | 13.5 | 13 | 7.9 | 3 | 14.3 | 50 | 22.6 | 35 | 13.8 | 3 | 5.3 |
| I could take more care | 297 | 68.1 | 254 | 60.8 | 49 | 62.8 | 153 | 71.2 | 103 | 62.4 | 12 | 57.1 | 144 | 65.2 | 151 | 59.7 | 37 | 64.9 |
| Apparently not enough | 60 | 13.8 | 116 | 27.8 | 23 | 29.5 | 33 | 15.3 | 49 | 29.7 | 6 | 28.6 | 27 | 12.2 | 67 | 26.5 | 17 | 29.8 |
| Total | 436 | 100 | 418 | 100 | 78 | 100 | 215 | 100 | 165 | 100 | 21 | 100 | 221 | 100 | 253 | 100 | 57 | 100 |
| χ2 = 33.191 df = 4 p < 0.001 | χ2 = 13.382 df = 4 p < 0.010 | χ2 = 24.966 df = 4 p < 0.001 | ||||||||||||||||
Table 1.
Among people with HTA, both the population (74.4%) and men (76.2%) answered the question: “Do you have any health complaints?,” they answered in the affirmative more often than those with LTA (52.9 and 52.3%, respectively) in contrast to women. It was found among them that in women with MTA (77.5%) and HTA (73.7%) the affirmative response was more frequent than in women with LTA (52.3%) (χ2 = 43.140 df = 2 p < 0.001-population, χ2 = 9.737 df = 2 p < 0.01-male, χ 2 = 35.029 df = 2 p < 0.001-female) (Table 1).
To the question: “Do you think you take enough care of your health?,” the majority of people with HTA, both in the population (29.5%) and among women (29.8%), were more likely to say “apparently not enough” compared with people with LTA (13.8 and 12.2%). Among men in the population with both HTA (28.6%) and MTA (29.7%), the answer “apparently not enough” was more prevalent than among those with LTA (15.3%) (χ2 = 33.191 df = 4 p < 0.001-population, χ2 = 13.382 df = 4 p < 0.010-male, χ2 = 24.966 df = 4 p < 0.001-female) (Table 1). 1. (Awareness, attitudes toward health, and trait anxiety in aged 25–44 years old)
Analyzing the question: “Do you think that a healthy person of your age can get a serious disease in the next 5–10 years?,” it turned out that in the population with HTA, the largest proportion of respondents - 41% said “highly likely,” compared with LTA - 27.8% and MTA - 37.1%. Among women in the population, the proportion of people who answered “highly likely” was high both among women with MTA (41.9%) and with HTA (38.6%), compared with LTA (28.5%). No obvious differences were found among men (χ2 = 15.460 df = 4 p < 0.01 population, χ2 = 4.288 df = 4 p 0.05 - male, χ2 = 14.853 df = 4 p < 0.01 - female) (Table 2).
| Question: | Both genders | Male | Female | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LTA | MTA | HTA | LTA | MTA | HTA | LTA | MTA | HTA | ||||||||||
| n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | |
| 4. Do you think that a healthy person of your age can get a serious disease in the next 5–10 years? | ||||||||||||||||||
| Highly likely | 121 | 27.8 | 155 | 37.1 | 32 | 41 | 58 | 27.0 | 49 | 29.7 | 10 | 47.6 | 63 | 28.5 | 106 | 41.9 | 22 | 38.6 |
| Likely | 299 | 68.6 | 250 | 59.8 | 40 | 51.3 | 149 | 69.3 | 109 | 66.1 | 10 | 47.6 | 150 | 67.9 | 141 | 55.7 | 30 | 52.6 |
| Unlikely | 16 | 3.7 | 13 | 3.1 | 6 | 7.7 | 8 | 3.7 | 7 | 4.2 | 1 | 4.8 | 8 | 3.6 | 6 | 2.4 | 5 | 8.8 |
| Total | 436 | 100 | 418 | 100 | 78 | 100 | 215 | 100 | 165 | 100 | 21 | 100 | 221 | 100 | 253 | 100 | 57 | 100 |
| χ2 = 15.460 df = 4 p < 0.01 | χ2 = 4.288 df = 4 p < 0.05 | χ2 = 14.853 df = 4 p < 0.01 | ||||||||||||||||
| 5. Do you think that a healthy person of your age can avoid some serious diseases by taking preventive measures in advance? | ||||||||||||||||||
| Yes, absolutely | 299 | 68.7 | 296 | 70.8 | 52 | 66.7 | 149 | 69.6 | 118 | 71.5 | 14 | 66.7 | 150 | 67.9 | 178 | 70.4 | 38 | 66.7 |
| Maybe yes | 134 | 30.8 | 117 | 28.0 | 24 | 30.8 | 63 | 29.4 | 44 | 26.7 | 7 | 33.3 | 71 | 32.1 | 73 | 28.9 | 17 | 29.8 |
| Unlikely | 2 | 0.5 | 5 | 1.2 | 2 | 2.6 | 2 | 0.9 | 3 | 1.8 | 0 | 0 | 0 | 0 | 2 | 0.8 | 2 | 3.5 |
| Total | 435 | 100 | 418 | 100 | 78 | 100 | 214 | 100 | 165 | 100 | 21 | 100 | 221 | 100 | 253 | 100 | 57 | 100 |
| χ2 = 4.289 df = 4 p > 0.05 | χ2 = 1.380 df = 4 p > 0.05 | χ2 = 7.989 df = 4 p > 0.05 | ||||||||||||||||
| 6. Do you believe that modern medicine can prevent heart disease? | ||||||||||||||||||
| Yes, all types of heart disease | 65 | 14.9 | 52 | 12.4 | 17 | 21.8 | 37 | 17.2 | 22 | 13.3 | 4 | 19 | 28 | 12.7 | 30 | 11.9 | 13 | 22.8 |
| Yes, most types of heart disease | 194 | 44.5 | 179 | 42.8 | 22 | 28.2 | 101 | 47 | 75 | 45.5 | 8 | 38.1 | 93 | 42.1 | 104 | 41.1 | 14 | 24.6 |
| Depending on the disease | 147 | 33.7 | 149 | 35.6 | 31 | 39.7 | 59 | 27.4 | 55 | 33.3 | 6 | 28.6 | 88 | 39.8 | 94 | 37.2 | 25 | 43.9 |
| No, only some disease | 28 | 6.4 | 36 | 8.6 | 7 | 9.0 | 17 | 7.9 | 13 | 7.9 | 3 | 14.3 | 11 | 5.0 | 23 | 9.1 | 4 | 7.0 |
| No, not a single type of disease | 2 | 0.5 | 2 | 0.5 | 1 | 1.3 | 1 | 0.5 | 0 | 0 | 0 | 0 | 1 | 0.5 | 2 | 0.8 | 1 | 1.8 |
| Total | 436 | 100 | 418 | 100 | 78 | 100 | 215 | 100 | 165 | 100 | 21 | 100 | 221 | 100 | 253 | 100 | 57 | 100 |
| χ2 = 11.525 df = 8 p > 0.05 | χ2 = 4.339 df = 8 p > 0.05 | χ2 = 12.463 df = 8 p > 0.05 | ||||||||||||||||
| 7. Do you think that it is currently possible to successfully treat all heart diseases? | ||||||||||||||||||
| Yes, all of them | 37 | 8.5 | 47 | 11.2 | 11 | 14.3 | 26 | 12 | 21 | 12.7 | 3 | 14.3 | 11 | 5 | 26 | 10.3 | 8 | 14.3 |
| Yes, most types of heart disease | 257 | 58.8 | 218 | 52.2 | 33 | 42.9 | 121 | 56 | 90 | 54.5 | 9 | 42.9 | 136 | 61.5 | 128 | 50.6 | 24 | 42.9 |
| Depending on the disease | 137 | 31.4 | 143 | 34.2 | 31 | 40.3 | 67 | 31 | 49 | 29.7 | 8 | 38.1 | 70 | 31.7 | 94 | 37.2 | 23 | 41.1 |
| No, just some disease | 6 | 1.4 | 9 | 2.2 | 2 | 2.6 | 2 | 0.9 | 5 | 3 | 1 | 4.8 | 4 | 1.8 | 4 | 1.6 | 1 | 1.8 |
| No, not a single type of disease | 0 | 0 | 1 | 0.2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0.4 | 0 | 0 |
| Total | 437 | 100 | 418 | 100 | 77 | 100 | 216 | 100 | 165 | 100 | 21 | 100 | 221 | 100 | 253 | 100 | 56 | 100 |
| χ2 = 10,758 df = 8 p < 0.05 | χ2 = 4072 df = 6 p < 0.05 | χ2 = 13,231 df = 8 p < 0.05 | ||||||||||||||||
Table 2.
Attitudes toward CVD and TA prevention in aged 25–44 years old.
As for the answers to the question: “Do you think that a healthy person of your age can avoid some serious diseases by taking preventive measures in advance?,” no significant differences were found between groups differing in the level of TA, both in men and women and in the general population (χ2 = 4.289 df = 4 p<0.05-population, χ2 = 1.380 df = 4 p <0.05-men, χ2 = 7.989 df = 4 p< 0.05-female) (Table 2).
When it comes to the questions: “Do you believe that modern medicine can prevent heart disease?” (χ2 = 11.525 df = 8 p<0.05-population., χ2 = 4.339 df = 8 p< 0.05-male, χ2 = 12.463 df = 8 p< 0.05-female) and “Do you think that it is currently possible to successfully treat all heart diseases?” (χ2 = 10,758 df = 8 p< 0.05-population, χ2 = 4072 df = 6 p< 0.05-male, χ2 = 13,231 df = 8 p< 0.05-female). We found no differences in the responses of people with different TA levels (Table 2). 2. (Attitudes toward CVD and TA prevention in aged 25–44 years old).
According to the data obtained, from the questionnaire question: “One of middle-aged people’s health problems is heart disease. There are different opinions on this. Which opinion is the most acceptable for you?” Among the population, the majority of respondents would only consult a doctor if they had severe pain in the area of the heart—people with LTA (51.8%), MTA (62.2%), and HTA (60.3%). At the same time, 5.1% of respondents with HTA did not expect to see a doctor for any painful condition, even with significant heart pain, compared to 3% of people with LTA. Regardless of pain in the heart area, 6.4% of people with HTA were always willing to see a doctor, which was lower than in people with LTA - 9.4% (χ2 = 14.144 df = 6 p < 0.05) (Table 3).
| Question: | Both genders | Male | Female | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LTA | MTA | HTA | LTA | MTA | HTA | LTA | MTA | HTA | ||||||||||
| n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | |
| 8. One of middle-aged people’s health problems is heart disease. There are different opinions on this. Which opinion is the most acceptable for you? | ||||||||||||||||||
| Regardless of whether or not I have pain or discomfort in the heart area, I have regular check-ups with a doctor. | 41 | 9.4 | 28 | 6.7 | 5 | 6.4 | 22 | 10.2 | 6 | 3.6 | 2 | 9.5 | 19 | 8.6 | 22 | 8.7 | 3 | 5.3 |
| I see the doctor whenever I have heart pain or discomfort. | 156 | 35.8 | 111 | 26.6 | 22 | 28.2 | 71 | 32.9 | 42 | 25.5 | 6 | 28.6 | 85 | 38.6 | 69 | 27.3 | 16 | 28.1 |
| I would go to a doctor if I had severe pain or an unpleasant sensation in the heart area, but I would not go if the pain or unpleasant sensation was only mild. | 226 | 51.8 | 260 | 62.2 | 47 | 60.3 | 115 | 53.2 | 108 | 65.5 | 12 | 57.1 | 111 | 50.5 | 152 | 60.1 | 35 | 61.4 |
| Even if I had severe pain or an unpleasant sensation in the heart area, I would not go to a doctor. | 13 | 3 | 19 | 4.5 | 4 | 5.1 | 8 | 3.7 | 9 | 5.5 | 1 | 4.8 | 5 | 2.3 | 10 | 4 | 3 | 5.3 |
| Total | 436 | 100 | 418 | 100 | 78 | 100 | 216 | 100 | 165 | 100 | 21 | 100 | 220 | 100 | 253 | 100 | 57 | 100 |
| χ2 = 14.144 df = 6 p < 0.05 | χ2 = 10.286 df = 6 p > 0.05 | χ2 = 9.644 df = 6 p > 0.05 | ||||||||||||||||
| 9. People have different opinions about modern methods of diagnosing heart disease. Which opinion do you agree with? | ||||||||||||||||||
| I trust the way I feel. If I feel good, it means I’m not ill. | 105 | 24 | 106 | 25.4 | 15 | 19.2 | 62 | 28.7 | 49 | 29.9 | 3 | 14.3 | 43 | 19.5 | 57 | 22.5 | 12 | 21.1 |
| A doctor knows better. If he/she does a checkup on me and tells me that I am healthy or sick, I trust him/her. | 141 | 32.3 | 125 | 30 | 25 | 32.1 | 71 | 32.9 | 51 | 31.1 | 5 | 23.8 | 70 | 31.7 | 74 | 29.2 | 20 | 35.1 |
| Until thorough research is done by specialists, I will not necessarily agree with the doctor’s opinion after a general examination. | 191 | 43.7 | 186 | 44.6 | 37 | 47.4 | 83 | 38.4 | 64 | 39 | 12 | 57.1 | 108 | 48.9 | 122 | 48.2 | 25 | 43.9 |
| Total | 437 | 100 | 417 | 100 | 78 | 100 | 216 | 100 | 164 | 100 | 21 | 100 | 221 | 100 | 253 | 100 | 57 | 100 |
| χ2 = 12.593 df = 6 p < 0.05 | χ2 = 21.943 df = 6 p < 0.001 | χ2 = 1.359 df = 4 p > 0.05 | ||||||||||||||||
| 10. Have you had any pleasant experiences with medical care? | ||||||||||||||||||
| Never | 127 | 29.5 | 92 | 22.2 | 10 | 12.8 | 73 | 34.6 | 43 | 26.4 | 2 | 9.5 | 54 | 24.7 | 49 | 19.5 | 8 | 14 |
| Once or twice | 101 | 23.5 | 101 | 24.4 | 26 | 33.3 | 55 | 26.1 | 45 | 27.6 | 11 | 52.4 | 46 | 21 | 56 | 22.3 | 15 | 26.3 |
| Several times | 160 | 37.2 | 175 | 42.3 | 31 | 39.7 | 68 | 32.2 | 61 | 37.4 | 3 | 14.3 | 92 | 42 | 114 | 45.4 | 28 | 49.1 |
| Often | 41 | 9.5 | 40 | 9.7 | 10 | 12.8 | 15 | 7.1 | 12 | 7.4 | 4 | 19 | 26 | 11.9 | 28 | 11.2 | 6 | 10.5 |
| Very often | 1 | 0.2 | 6 | 1.4 | 1 | 1.3 | 0 | 0 | 2 | 1.2 | 1 | 4.8 | 1 | 0.5 | 4 | 1.6 | 0 | 0 |
| Total | 430 | 100 | 414 | 100 | 78 | 100 | 211 | 100 | 163 | 100 | 21 | 100 | 219 | 100 | 251 | 100 | 57 | 100 |
| χ2 = 18,000 df = 8 p < 0.05 | χ2 = 23,109 df = 8 p < 0.01 | χ2 = 6461 df = 8 p > 0.05 | ||||||||||||||||
Table 3.
Attitudes of 25–44 years old toward their health, medical care, and TA.
In addition, the results of the survey revealed the opinion of the population and men regarding trust in the doctor and diagnosis of CVD in respondents with HTA, LTA, and MTA. About half of the respondents among the population − 47.4% with HTA, trusted specialized research more than just a doctor’s examination, compared with men in the population, 57.1% of whom with HTA gave a similar answer. About a third of the respondents among the population with LTA - 32.3% and HTA −32.1% trusted the doctor’s examination without additional research, the lowest indicator in this answer option was among men with HTA - 23.8%. At the same time, there was a decrease in trust in their health rate among the respondents. Only 19.2% of respondents with HTA among the population trusted their health rate, compared to 25.4% of those with MTA and 24% of those with LTA. A similar trend was observed among men: those with LTA - 28.7%, MTA - 29.9%, and HTA - 14.3% (χ2 = 12.593 df = 6 p < 0.05-population χ2 = 21.943 df = 6 p < 0.001 -male) (Table 3).
As the answers to the question: “Have you had any pleasant experiences with medical care?” revealed, fewer (12.8%) in the population with HTA have never experienced positive emotions, compared to LTA - 29.5% and MTA - 22.2%. At the same time, among men with HTA only 9.5% replied this way, which is less than those with LTA - 34.6% (χ2 = 18.000 df = 8 p < 0.05-population, χ2 = 23.109 df = 8 p < 0.01 -male) (Table 3). 3. (Attitudes of 25–44 years old toward their health, medical care, and TA).
To the question: “If you feel unwell at work, what do you do? (Retired and unemployed answer as if they were working),” it turned out that among the population and among men with LTA and HTA, the frequency of the answer “I continue to work” did not differ significantly from the answer “I go to the doctor.” So, among the population, only 5.1% of those with HTA planned to go to the doctor, which is less than among those with LTA - 12.1% (χ2 = 11.330 df = 4 p < 0.05-general population, χ2 = 10.256 df = 4 p < 0.05-male) (Table 4). Further to the question: “If you have the flu or a fever, what do you do?,” the most frequent answer in the population was “I stay at home and do everything to get back to work as soon as possible” with MTA - 53.5%, in contrast to those with HTA - 34.6%. When replying “I work as usual,” 44.9% of respondents with a high level of TA answered in the affirmative, which is less among those with LTA - 26.6% (χ2 = 15.740 df = 4 p < 0.01) (Table 4).
| Question: | Both genders | Male | Female | |||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| LTA | MTA | HTA | LTA | MTA | HTA | LTA | MTA | HTA | ||||||||||
| n | % | N | % | n | % | n | % | n | % | n | % | n | % | n | % | n | % | |
| 11. If you feel unwell at work, what do you do? (Retired and unemployed answer as if they were working) | ||||||||||||||||||
| I continue to work | 165 | 37.8 | 181 | 43.3 | 39 | 50 | 80 | 37 | 64 | 38.8 | 9 | 42.9 | 85 | 38.5 | 117 | 46.2 | 30 | 52.6 |
| I stop working and rest | 219 | 50.1 | 208 | 49.8 | 35 | 44.9 | 111 | 51.4 | 95 | 57.6 | 12 | 57.1 | 108 | 48.9 | 113 | 44.7 | 23 | 40.4 |
| I go to the doctor | 53 | 12.1 | 29 | 6.9 | 4 | 5.1 | 25 | 11.6 | 6 | 3.6 | 0 | 0 | 28 | 12.7 | 23 | 9.1 | 4 | 7 |
| Total | 437 | 100 | 418 | 100 | 78 | 100 | 216 | 100 | 165 | 100 | 21 | 100 | 221 | 100 | 253 | 100 | 57 | 100 |
| χ2 = 11.330 df = 4 p < 0.05 | χ2 = 10.256 df = 4 p < 0.05 | χ2 = 5.840 df = 4 p > 0.05 | ||||||||||||||||
| 12. If you have the flu or a fever, what do you do? | ||||||||||||||||||
| I work as usual | 116 | 26.6 | 117 | 28.1 | 35 | 44.9 | 64 | 29.8 | 48 | 29.1 | 10 | 47.6 | 52 | 23.5 | 69 | 27.4 | 25 | 43.9 |
| I stay at home and do my best to get back to work as soon as possible | 215 | 49.3 | 223 | 53.5 | 27 | 34.6 | 99 | 46 | 92 | 55.8 | 8 | 38.1 | 116 | 52.5 | 131 | 52 | 19 | 33.3 |
| I stay at home until I feel better | 105 | 24.1 | 77 | 18.5 | 16 | 20.5 | 52 | 24.2 | 25 | 15.2 | 3 | 14.3 | 53 | 24 | 52 | 20.6 | 13 | 22.8 |
| Total | 436 | 100 | 417 | 100 | 78 | 100 | 215 | 100 | 165 | 100 | 21 | 100 | 221 | 100 | 252 | 100 | 57 | 100 |
| χ2 = 15.740 df = 4 p < 0.01 | χ2 = 8.711 df = 4 p > 0.05 | χ2 = 11.026 df = 4 p > 0.05 | ||||||||||||||||
| 13. Do you think it makes sense to get screened? | ||||||||||||||||||
| Yes, it is useful | 386 | 88.1 | 351 | 84 | 64 | 82.1 | 185 | 85.3 | 138 | 83.6 | 18 | 85.7 | 201 | 91 | 213 | 84.2 | 46 | 80.7 |
| Probably, yes | 47 | 10.7 | 62 | 14.8 | 13 | 16.7 | 29 | 13.4 | 24 | 14.5 | 3 | 14.3 | 18 | 8.1 | 38 | 15 | 10 | 17.5 |
| Probably not | 4 | 0.9 | 5 | 1.2 | 1 | 1.3 | 3 | 1.4 | 3 | 1.8 | 0 | 0 | 1 | 0.5 | 2 | 0.8 | 1 | 1.8 |
| It is not useful | 1 | 0.2 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | 0.5 | 0 | 0 | 0 | 0 |
| Total | 438 | 100 | 418 | 100 | 78 | 100 | 217 | 100 | 165 | 100 | 21 | 100 | 221 | 100 | 253 | 100 | 57 | 100 |
| χ2 = 5497 df = 6 p > 0.05 | χ2 = 0,578 df = 4 p > 0.05 | χ2 = 9142 df = 6 p > 0.05 | ||||||||||||||||
Table 4.
Attitudes to work, health screening, and TA in aged 25–44 years.
The respondents were asked the question: “Do you think it makes sense to get screened?” We did not find significant differences between groups differing in the level of TA, since the overwhelming majority of individuals in the population held the opinion about the benefits of preventive health checks (χ2 = 5.497 df = 6 p> 0.05-population χ2 = 0.578 df = 4 p< 0.05 - male, χ2 = 9.142 df = 6 p< 0.05 - female) (Table 4). 4. (Attitudes to work, health screening, and TA in aged 25–44 years).
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4. Discussion
The study of psychological and behavioral processes related to health and illness has flourished in recent decades, leading to a number of advances in disease prevention, symptom management, and promotion of healthy behaviors. Anxiety has been found to be particularly important for physical health, with several studies indicating a strong association between anxiety disorders and physical health [52], as well as between the constructs underlying many anxiety disorders, such as anxiety sensitivity (i.e., fear of anxiety-related sensations) and chronic disease [53]. In addition, anxiety-related traits, symptoms, and disorders have been associated with lower engagement in healthy behaviors [54] and higher engagement in unhealthy behaviors [55].
More broadly, anxiety is becoming a phenomenon of increasing importance in health psychology [56]. Among mental disorders, anxiety and depression are considered the leading disorders [57] with a high likelihood of increased emerging health anxiety [58]. Health anxiety is defined as anxiety and fear due to a perceived threat to one’s health. It is conceptualized as a multidimensional construct on a continuum ranging from lack of health awareness to disordered health anxiety, such as illness anxiety disorder [59, 60, 61]. Trait anxiety may influence perceptions of the disease and, consequently, the need for medical care and attitudes toward prevention programs [62].
Therefore, studying the influence of trait anxiety on how objective and subjective health indicators change in the young population is very relevant and reflects the needs of this population in the prevention of CVD [63]. For example, a significant proportion of respondents in our population, both men (62.8%) and women (64.9%) with high levels of anxiety, believed that they were not completely healthy or had complaints about their health: 76.2% of men and 73.7% of women. Of course, caring for your own health serves an important adaptive function—it helps you survive. Timely elimination of the symptoms of the disease is useful, but some people become overly concerned about their health and have anxiety that varies from mild to extreme [64].
People with high levels of anxiety in our population were more likely to believe that they were not taking enough care of their health, both men (28.6%) and women (29.8%); they believed that there was a high probability that they could get a serious illness in the next 5 or 10 years. That is, high levels of anxiety increase the need for medical care [65], increase the risk of prolonged sickness absence [66], and are a persistent condition if left untreated [67].
One of the types of health-related behavior that has received considerable attention in the context of anxiety is seeking medical help or contact with a medical professional or institution [68]. It is believed that people with anxiety disorders experience a greater number or severity of physical health problems, are more likely to mistake somatic or anxiety-related sensations for medical symptoms, or are more likely to respond to health-related concerns. However, there are no studies found that were aimed at understanding the extent to which anxiety disorders may also be associated with avoidance, delayed treatment, or inconsistent medical treatment, although some data seem to indicate that they are related in some cases [69]. This gap in the literature is surprising given the central role of avoidance, including both behavioral avoidance of anxiety-provoking stimuli and avoidance of internal alarm signals, in the development and maintenance of anxiety disorders [70]. Theoretically, many anxious individuals who tend to fear the somatic sensations associated with anxiety, or who have specific health-related fears, may prefer to avoid potentially threatening information from a clinician related to these feelings and problems; rather than reducing anxiety by seeking support from a doctor, they may prefer to postpone a visit or avoid seeing a doctor altogether [71]. This fully explains the fact that the opinion of our population that they would go to the doctor only in case of severe heart pain, and that this answer does not correlate with the level of anxiety, was found to be similar in the Tyumen sample [71]. More than half of Tyumen women, regardless of age, would go to a doctor only if they had severe pain in the heart area, and only a third—if they had any pain or unpleasant sensation in the heart area [71].
Among people with a high level of trait anxiety, about half of the population (47.4%) and more than half of the men (57.1%) in the population trusted specialized research more than just a doctor’s examination; they experienced negative emotions about medical care less often, both among the population (12.8%) and among men (9.5%). Both overuse and underuse of health care services have important individual and public health consequences: the search for trust and avoidance contribute to the persistence of anxiety and deterioration over time [72, 73], and both can place a burden on the health care system [74], as untimely care can lead to the development of more serious and/or long-term health problems [75].
In conclusion, trait anxiety contributes to low self-rated health, insufficient engagement in preventive health care, and ignorance of CVD risk factors. In other words, high levels of trait anxiety may be associated with delayed, irregular, or inconsistent medical care [43].
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5. Conclusions
It was found that people with HTA believed that they were “not quite healthy” among the population (62.8%), among men (57.1%), and women (64.9%); had complaints about their health, among population (74.4%), among men in the population (76.2%); believed that they “apparently not enough” care about their health: among the population (29.5%), among men (28.6%), and women (29.8%) in the population.
It was found that respondents with HTA believed it was “highly likely” that they could get a serious disease in the next 5–10 years, among the population (41%), among women (38.6%).
It was found that people with HTA (60.3%) would go to the doctor only with severe pain in the heart area; regardless of the pain in the heart area, 6.4% of the population were always ready to go to the doctor; they trusted specialized studies more than a doctor’s examination among men (57.1%) and among the population (47.4%).
It was found that people with HTA were less likely to go to the doctor when they felt unwell at work (5.1%) than those with LTA (12.1%). If they had a high temperature, the most common response among the population with MTA (53.5%) was “I stay at home and do everything I can to get back to work as soon as possible,” and “I work as usual” among those with HTA (44.9%).
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