Suicidal Ideation, Coping Styles and Cortisol Levels in Patients with Illness Anxiety Disorder: A Cross-sectional Study

Introduction: Illness Anxiety Disorder (IAD) is characterised by a persistent preoccupation with having a serious illness despite adequate medical reassurance. This preoccupation is driven by cognitive distortions and maladaptive coping mechanisms that amplify distress. Emerging evidence links IAD to heightened suicide risk; however, data on suicidal ideation and coping profiles-particularly from Indian clinical settings-remain scarce. Aim: The present study aimed to determine levels of suicidal ideation, coping mechanisms, and serum cortisol levels among patients with IAD, in comparison with the general population. Materials and Methods: The present single-centre, hospitalbased cross-sectional study was conducted in the psychiatry Outpatient Department of a tertiary hospital in Southern India from July 2024 to June 2025 (N=66; IAD=33; controls=33). Suicidal ideation was assessed using the Beck Scale for Suicide Ideation (BSS), coping strategies were evaluated with the Brief Coping Orientation to Problems Experienced (COPE) subscales, illness-anxiety severity was measured using the Short Health Anxiety Inventory (SHAI), and morning serum cortisol levels were estimated using Chemiluminescent Microparticle Immunoassay (CMIA). Data analysis was performed in IBM Statistical Package for the Social Sciences (SPSS) Statistics version 27.0 using t-tests or Mann–Whitney U tests for continuous variables, Chisquare or Fisher’s exact tests for categorical variables, and Pearson or Spearman correlations; a two-sided α=0.05 was considered statistically significant. Results: The IAD and control groups were comparable in terms of sociodemographic characteristics (age 39.0±7.2 vs 38.2±10.9 years). Suicidal ideation was higher in the IAD group (BSS 0.4±1.0 vs 0.0±0.0; p=0.034). Total coping scores were similar (52.4±4.8 vs 53.7±7.9; p=0.412); however, participants with IAD used less positive reframing (p<0.001), humor (p=0.001), and acceptance (p<0.001), and relied more on denial (p=0.024), venting (p=0.004), and instrumental support (p=0.027). SHAI scores did not correlate with suicidal ideation but were inversely associated with total coping (r=-0.354; p=0.043) and avoidant coping (r=-0.542; p=0.001). Within the IAD group, maladaptive coping was associated with higher BMI (29.8±3.3 vs 25.8±3.4; p=0.023) and joint-family residence (p=0.002). Conclusion: Patients with IAD exhibited higher suicidal ideation and greater reliance on maladaptive coping strategies compared to the general population. The above findings underscore the importance of integrating psychological interventions focused on adaptive coping in the management of illness anxiety.