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Theory and Decision

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20-06-2017

The Impact of Health-Related Emotions on Belief Formation and Behavior

Authors: Elyès Jouini, Clotilde Napp

Published in: Theory and Decision | Issue 3/2018

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Abstract

We present a theoretical model of health beliefs and behaviors that explicitly takes into account the emotional impact of possible bad news (i.e., illness), ex-ante in the form of anxiety and ex-post in the form of disappointment. Our model makes it possible to explain (simultaneously) a number of anomalies such as ’low’ testing rates, heterogeneous perceptions of risk levels, underestimation of health risk, ostriches and hypochondriacs, over-use and under-use of health services, patient preference for information when relatively certain of not being ill, yet avoiding information when relatively certain of being ill, etc. Our model matches observed patterns both in health beliefs and health behaviors and irrational health beliefs and behaviors can be characterized as the optimal response under a given structure of emotions and preferences.

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For breast cancer risk, the analyses of Katapodi et al. (2004, 2009a, b) show that “women do not have accurate perceptions of their risk”, some women having a “pessimistic bias” and others having an “optimistic bias”; more precisely, 40% are optimists, underestimating their breast cancer risk, \(10\%\) are pessimists, overestimating their breast cancer risk, \(12\%\) are “ostriches” or extremely optimistic, believing that they “definitely will not get breast cancer”, and \(4\%\) are hypochondriacs or extremely pessimistic believing that they “will get cancer”.

Woody Allen provides a good illustration of such an hypochondriac: “at the appearance of the mildest symptom, let’s say chapped lips, I instantly leap to the conclusion that the chapped lips indicate a brain tumor. Or maybe lung cancer.[...] The point is, I am always certain I have come down with something life threatening. It matters little that few people are ever found dead of chapped lips”. W. Allen (Hypochondria: an Inside Look. NYTimes, 01.12.2013).

Lerman et al. (1996b) find that 40% of high-risk patients who are offered a test for genetic susceptibility to breast and ovarian cancer declined the test. In a similar study on a type of colon cancer, 57% of high-risk individuals declined communication of the test results (Lerman et al. 1999). See Köszegi (2003) for a review.

“Every minor ache or pain sends me to a doctor’s office in need of reassurance that my latest allergy will not require a heart transplant.[...] I get all available vaccines and inoculations, making me immune to everything from Whipple’s disease to the Andromeda strain.[...] It is also true that when I leave the house for a stroll in Central Park or to Starbucks for a latte, I might just pick up a quick cardiogram or CT prophylactically.” W. Allen (Hypochondria: an Inside Look. NY Times, 01.12.2013).

Delayed diagnosis of melanoma directly impacts patient survival; however, Richard et al. (2000) find that the median melanoma patient delays seeing a doctor for two months after realizing that she has a suspicious lesion and Betti et al. (2003) observe a mean delay of more than 6 months.

As the director of a genetic counseling program told the New York Times: “There are basically two types of people. There are “want to knowers” and there are “avoiders”. There are some people who, even in the absence of being able to alter outcomes, find information beneficial. The more they know, the more their level of anxiety goes down. But there are others who cope by avoiding, who would rather stay hopeful and optimistic and not have the unanswered questions answered.” New York Times Magazine, Sept 17., 1995, quoted in Grant et al. (1996).

Note that y also represents the subjectively anticipated health level.

“Worry [...] is concerned with future events, the future being thought about is a negative one, and this is accompanied by feelings of anxiety”, McLeod et al. (1991), quoted in Caplin and Leahy (2001).

See Bell (1985), Loomes and Sugden (1986), Gul (1991) for models of disappointment, and Köszegi and Rabin (2006) for reference-dependent models.

More precisely, we show that an increase in risk is associated with an increase in anxiety at date 0 in the case of immediate resolution of uncertainty, given by \(v\left( 1\right) -v\left( 0\right) \) and an increase in disappointment at date 1 in the case of delayed resolution of uncertainty, given by \(-D\left( 0,y^{*}\right) \) and we show that for an individual for whom the value of information is zero, the first quantity is larger than the second quantity.

Unlike Köszegi (2003), we assume that treatment is possible only when an individual tests positive.

Note that these specifications are consistent with Bell (1985) or Loomes and Sugden (1986) models of disappointment, but also with Köszegi and Rabin (2006) model, in which disappointment derives from comparing the realized outcome to all possible outcomes.

The main result of Köszegi (2003, Theorem 1) shows that avoidance cannot take any form, and more precisely that for a non serious disease, the individual chooses immediate resolution of uncertainty; this result is obtained under the assumption that the set of treatments available is independent of whether the individual learns his true health state or not.

Even though testing rates for HIV are much higher than testing rates for Huntington’s disease, the prediction on testing rates cannot be empirically verified since the benefits from treatment interfere.

We have not considered doctor-patient interaction, and the strategic problems that arise (Caplin and Leahy 2004) but have instead focused on individuals’ decision making.

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Title: The Impact of Health-Related Emotions on Belief Formation and Behavior
Authors: Elyès Jouini
Clotilde Napp
Publication date: 20-06-2017
Publisher: Springer US
Published in: Theory and Decision / Issue 3/2018
Print ISSN: 0040-5833
Electronic ISSN: 1573-7187
DOI: https://doi.org/10.1007/s11238-017-9610-3

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