Prevalence and predictors of clinically significant health anxiety among Saudi medical students: A multi-university cross-sectional study

BACKGROUND: Health anxiety is a common yet underrecognized concern among medical students, who are routinely exposed to illness-related content and academic pressure. This study aimed to estimate the prevalence of clinically significant health anxiety among Saudi medical students and identify its predictors. Secondary objectives were to examine its association with quality of life and explore disease-related fears. METHODS: A descriptive, cross-sectional study was conducted across multiple Saudi universities between November 2024 and April 2025. Participants were recruited via convenience sampling, and data were collected using a structured online questionnaire. The instrument included sociodemographic items, the Short Health Anxiety Inventory (SHAI), a self-perception of illness question, and the SF-12 to assess quality of life. Descriptive statistics, Chi-square tests, Mann-Whitney U tests, Pearson correlation, and logistic regression analysis were used to analyze the data. RESULTS: A total of 650 students completed the survey. Clinically significant health anxiety was reported in 30% of participants. Health anxiety prevalence was higher among females compared to males (36.3% vs. 25.8%), as well as among students in their second academic year, rural residents, private university students, and those with personal or family psychiatric history. Logistic regression identified several significant predictors: female students demonstrated 2.3-fold higher odds of health anxiety compared to males (AOR = 2.33, 95% CI: 1.51-3.62), rural residence, private university enrollment (AOR = 6.14, 95% CI: 3.66-10.5), and psychiatric history. A significant negative correlation was found between health anxiety and quality of life (r = -0.25, p < 0.001). Students with health anxiety reported notably lower quality of life scores. Additionally, a network analysis of disease-related fears revealed cancer as the most frequently reported concern, followed by cardiovascular and endocrine conditions. These fears clustered into somatic, chronic, and neuropsychiatric domains. CONCLUSION: Clinically significant health anxiety affects nearly one-third of Saudi medical students and is associated with key sociodemographic and academic risk factors, as well as poorer quality of life. These findings underscore the need for mental health support systems and preventive strategies within medical education environments to address and manage health-related anxieties early.