The curious case of cyberchondria: A longitudinal study on the reciprocal relationship between health anxiety and online health information seeking

Cyberchondria: conceptual relation with health anxiety, assessment, management and prevention

There is a need to synthesize available information on the emerging construct of cyberchondria to guide evidence informed practice. With this in mind, electronic search of databases including MEDLINE via PubMed, Cochrane Library, ScienceDirect and Google scholar were carried out from inception till March 2020 to identify relevant English language peer reviewed articles related to cyberchondria. Generated abstracts were grouped according to their thematic focus and summarized. A total of 49 articles were reviewed. Articles directly evaluating cyberchondria were very few and most of the treatment evidence was extrapolated from trials on health anxiety. Cyberchondria appears to be a phenomenologically overlapping entity with, yet distinguishable from, health anxiety and there may be merit in studying the two constructs separately. Four validated self-assessment measures for cyberchondria are available in literature. Cognitive behaviour therapy (CBT) delivered either physically or through the internet (iCBT) have been found to be effective for both health anxiety and cyberchondria. Pharmacologic strategies for health anxiety have mainly involved the use of Selective Serotonin Reuptake Inhibitors, with mean effective dosages higher than for depression/anxiety. Prevention of cyberchondria needs to focus on appropriate harm reduction strategies as well as supply and demand side measures. Internet based CBT therapies hold promise for management of cyberchondria. This finding must be considered preliminary due to limited evidence. Further study is required to establish the diagnostic validity of cyberchondria.

The pathways from distress tolerance to Cyberchondria: A multiple-group path model of young and middle adulthood samples

The use of the Internet for medical information elicited a recent term called “cyberchondria”. This study aimed to scrutinize the mediating effects of health anxiety (HA), anxiety symptoms (AS), and Internet addiction (IA) in the pathway from distress tolerance (DT) to cyberchondria by using a bootstrapping method. In order to examine the role of age in the proposed model, multiple-group path analysis was used to evaluate differences between young and middle adulthood groups. The final sample consisted of both young adult (n = 209) and middle adult (n = 221) Internet users located in Ankara, Turkey. The results of path analyses for both age groups showed that DT is negatively associated with AS and HA; AS and HA are positively associated with IA; IA and HA are positively associated with cyberchondria. Mediation analysis for both age groups demonstrated that AS and HA significantly mediated the relationship between DT and IA; IA significantly mediated the relationships of AS and HA with cyberchondria; HA significantly mediated the relationship between DT and cyberchondria. The results of the multiple-group path analysis showed that the relationship between IA and cyberchondria is significantly stronger in middle adulthood than young adulthood. The results of the current study are consistent with the relevant literature and provide crucial contribution especially by focusing on the role of age.

General practitioners' challenges and strategies in dealing with Internet-related health anxieties-results of a qualitative study among primary care physicians in Germany

Time and again, it is discussed that in medical practices, the number of patients who develop health anxieties due to extensive health information searches on the Internet is increasing. The objective of this study is to explore and describe general practitioners’ experiences and attitudes towards cyberchondria patients as well as strategies to stabilize affected patients. Following a qualitative approach, oral personal semi-standardized interviews with general practitioners (N = 38) in Rhineland-Palatinate, Germany, were conducted in 2019. In the course of a content analysis, one can see that most interviewees see the emergence of Internet-related health anxieties as an increasing problem in everyday care. Affected patients not only show marked levels of doubt and nervousness as well as hypersensitivity to their own state of health, but also low confidence in the physician. In addition to compliance-related difficulties, the high need for advice and the demand for further diagnostics are regarded as major problems. Various approaches were identified by which general practitioners respond to unsettled patients (more consultation time, recommendation of reputable websites, information double-checking, expanded history questionnaire, additional psychosocial training).

Prevalence and correlates of cyberchondria among professionals working in the information technology sector in Chennai, India: A cross-sectional study

Background

Cyberchondria is the excessive searching of online health information that leads to anxiety and distress. There is scarce information about its prevalence in low and middle-income country settings.

Objectives

The objective of the study was to assess the prevalence and factors influencing cyberchondria among employees working in the information technology sector in India.

Methods

An emailed questionnaire-based cross-sectional survey was conducted among 205 employees working in various information technology firms in and around Chennai. The data were analyzed using nonhierarchical k-means cluster analysis to group participants with and without cyberchondria on its four subdomains. The association of cyberchondria with general mental health as measured by the General Health Questionnaire 12 was studied using independent sample t-test. Logistic regression analysis was performed to study the association between general mental health and cyberchondria after adjusting for sociodemographic covariates.

Results

The prevalence of cyberchondria was 55.6%. The dominant pattern was excessiveness of online searching, requirement of reassurance followed by distress due to health anxiety, and compulsivity. Cyberchondria was negatively associated with general mental health (adj. OR 0.923; 95% CI 0.882-0.967) after adjusting for age, sex, education, and years of service.

Conclusions

Cyberchondria is an emerging public mental health problem in India. Since it is associated with poor mental health, measures need to be adopted to evaluate, prevent, and treat it at the population level.

Is cyberchondria a new transdiagnostic digital compulsive syndrome? A systematic review of the evidence

BACKGROUND

Cyberchondria (CYB) has been described relatively recently as a behaviour characterized by excessive online searching for medical information that is associated with increasing levels of health anxiety. Although CYB has received some attention from researchers, there is no consensus about many of its aspects.

AIMS

We describe one of the first reported cases of a treatment-seeking patient with CYB. We review the published literature on the definition of CYB, its assessment, epidemiology, cost and burden, psychological models and mechanisms associated with CYB, relationships between CYB and mental disorders and prevention and treatment strategies.

METHODS

Systematic review of all peer-reviewed papers published within the PubMed, PsycINFO, and Cochrane Library databases.

RESULTS

61 articles were selected. Nearly all the studies were descriptive and cross-sectional recruiting sample mainly from the general/university student population and collecting self-report data via online surveys. Data on epidemiology, clinical features, course, comorbidity and therapeutic interventions were scarce. CYB showed a self-reported association with health anxiety, hypochondriasis and obsessive-compulsive disorder (OCD) as well as other forms of problematic usage of the internet (PUI) The psychological mechanisms associated with CYB include low self-esteem, anxiety sensitivity, intolerance of uncertainty, pain catastrophizing and certain meta-cognitive beliefs.

CONCLUSION

A working definition of CYB includes excessive online health searches that are compulsive and may serve the purpose of seeking reassurance, whilst leading to a worsening of anxiety or distress and further negative consequences. CYB represents a clinically relevant transdiagnostic compulsive behavioural syndrome, closely related to PUI and usually presenting in association with health anxiety, hypochondriasis and/or OCD. CYB is clearly in need of further study and we identify key areas for future research.

Development of an Instrument to Assess Parents' Excessive Web-Based Searches for Information Pertaining to Their Children's Health: The "Children's Health Internet Research, Parental Inventory" (CHIRPI)

Background

People often search the internet to obtain health-related information not only for themselves but also for family members and, in particular, their children. However, for a minority of parents, such searches may become excessive and distressing. Little is known about excessive web-based searching by parents for information regarding their children’s health.

Objective

This study aimed to develop and validate an instrument designed to assess parents' web-based health information searching behavior, the Children’s Health Internet Research, Parental Inventory (CHIRPI).

Methods

A pilot survey was used to establish the instrument (21 items). CHIRPI was validated online in a second sample (372/384, 96.9% mothers; mean age 32.7 years, SD 5.8). Item analyses, an exploratory factor analysis (EFA), and correlations with parents’ perception of their children’s health-related vulnerability (Child Vulnerability Scale, CVS), parental health anxiety (modified short Health Anxiety Inventory, mSHAI), and parental cyberchondria (Cyberchondria Severity Scale, CSS-15) were calculated. A subset of participants (n=73) provided retest data after 4 weeks. CHIRPI scores (total scores and subscale scores) of parents with a chronically ill child and parents who perceived their child to be vulnerable (CVS+; CVS>10) were compared with 2×2 analyses of variances (ANOVAs) with the factors Child’s Health Status (chronically ill vs healthy) and perceived vulnerability (CVS+ vs CVS−).

Results

CHIRPI’s internal consistency was standardized alpha=.89. The EFA identified three subscales: Symptom Focus (standardized alpha=.87), Implementing Advice (standardized alpha=.74) and Distress (standardized alpha=.89). The retest reliability of CHIRPI was measured as r_tt=0.78. CHIRPI correlated strongly with CSS-15 (r=0.66) and mSHAI (r=0.39). The ANOVAs comparing the CHIRPI total score and the subscale scores for parents having a chronically ill child and parents perceiving their child as vulnerable revealed the main effects for perceiving one’s child as vulnerable but not for having a chronically ill child. No interactions were found. This pattern was observed for the CHIRPI total score (η²=0.053) and each subscale (Symptom Focus η²=0.012; Distress η²=0.113; and Implementing Advice η²=0.018).

Conclusions

The psychometric properties of CHIRPI are excellent. Correlations with mSHAI and CSS-15 indicate its validity. CHIRPI appears to be differentially sensitive to excessive searches owing to parents perceiving their child’s health to be vulnerable rather than to higher informational needs of parents with chronically ill children. Therefore, it may help to identify parents who search excessively for web-based health information. CHIRPI (and, in particular, the Distress subscale) seems to capture a pattern of factors related to anxious health-related cognitions, emotions, and behaviors of parents, which is also applied to their children.

Three decades of increase in health anxiety: Systematic review and meta-analysis of birth cohort changes in university student samples from 1985 to 2017

Health anxiety can be defined as a multifaceted trait that is primarily characterised by a fear of, or preoccupation with, serious illness. Whereas low levels of health anxiety can be helpful, clinically significant levels are associated with personal suffering and substantial societal costs. As general anxiety is probably on the rise, and the Internet has increased access to health-related information, it is commonly speculated that health anxiety has increased over the past decades. We tested this hypothesis based on a systematic review and meta-analysis of birth cohort mean health anxiety in Western university student samples from 1985 to 2017. Sixty-eight studies with 22 413 student participants were included. The primary analysis indicated that the mean score on the Illness Attitudes Scales had increased by 4.61 points (95 % CI: 1.02, 8.20) from 1985 to 2017. The percentage of general population Internet users in the study year of data collection was not predictive of student mean health anxiety. In conclusion, this study corroborates the hypothesis of an increase in health anxiety, at least in the student population, over the past decades. However, this increase could not be linked to the introduction of the Internet.

Longitudinal association between alcohol use and physical activity in US college students: Evidence for directionality

Objective: To investigate directionality of the association between alcohol use and physical activity in a college student sample, longitudinally across three time points. Participants: A total of 396 undergraduate students from a large university in the United States (62% females) participated in this study. Methods: Self-report data of alcohol use and physical activity were collected at three timepoints with 3-month lags between waves. Random-intercept cross-lagged panel modeling was used to disentangle within- and between-person effects. Results: Despite no significant between-person effects, there were significant cross-lagged paths from alcohol use to vigorous physical activity at the within-person level. Specifically, when individuals consumed more alcohol than normal at earlier timepoints, they reported more subsequent vigorous physical activity at 3-month follow-ups. Conclusion: We provide evidence that alcohol use may positively predict later physical activity in college students over the course of a school year. These findings advance theoretical understanding of how these two health behaviors are linked using sophisticated methods.

Both trusting and understanding medical advice: Assessing patient alliance and confusion after medical consultations

OBJECTIVE

The current objective is to validate the Medical Consultation Experience Questionnaire (MCEQ) and to examine distinctions between constructs of patient perceived alliance and experienced confusion in relation to key health outcomes.

METHODS

A total of 857 participants were recruited online across two samples (adults with various medical conditions and with diabetes and/or hypertension specifically).

RESULTS

A confirmatory factor analysis demonstrated good fit and high item loadings for the theoretical bifactor model. Item response theory analyses showed very high individual item discrimination and good test information across a wide range of values. Confusion was uniquely and significantly more strongly related to psychological distress than was alliance; the same was true for alliance with positive affect. Both alliance and confusion significantly contributed to treatment motivation. Only confusion explained unique variance in control of HbA1C levels and blood pressure after controlling for alliance and other variables.

CONCLUSIONS

The MCEQ is a valid instrument for assessing distinct constructs of alliance and confusion. Future research should focus on the unique role of confusion for patient outcomes.

PRACTICE IMPLICATIONS

By using the MCEQ to assess patient alliance and confusion, it may be possible to detect and prioritize individual patient needs and improve patient outcomes.

The impact of internet-delivered cognitive behavioural therapy for health anxiety on cyberchondria

Cyberchondria refers to an emotional-behavioural pattern whereby excessive online searches lead to increased anxiety about one's own health status. It has been shown to be associated with health anxiety, however it is unknown whether existing cognitive behavioural therapy (CBT) interventions targeting health anxiety also improve cyberchondria. This study aimed to determine whether internet-delivered cognitive behavioural therapy (iCBT) for severe health anxiety led to improvements in self-reported cyberchondria and whether improvements in cyberchondria were associated with improvements in health anxiety observed during treatment. Methods: We analysed secondary data from a randomised controlled trial (RCT) comparing an iCBT group (n = 41) to an active control group who underwent psychoeducation, monitoring and clinical support (n = 41) in health anxious patients with a DSM-5 diagnosis of Illness Anxiety Disorder and/or Somatic Symptom Disorder. The iCBT group showed a significantly greater reduction in cyberchondria compared to the control group, with large differences at post-treatment on the Cyberchondria Severity Scale Total scale (CSS; Hedges g = 1.09), and the Compulsion, Distress, Excessiveness subscales of the CSS (g's: 0.8-1.13). Mediation analyses showed improvements in health anxiety in the iCBT group were mediated by improvements in all of the CSS subscales, except for the Mistrust subscale. Conclusions: Internet CBT for health anxiety improves cyberchondria.

Recent Insights Into Cyberchondria

PURPOSE OF REVIEW

The construct of cyberchondria was introduced relatively recently. This article aims to review the conceptualization, theoretical basis and correlates of cyberchondria, as well as its prevention and management.

RECENT FINDINGS

Although there is no consensus, most definitions of cyberchondria emphasize online health research associated with heightened distress or anxiety. The two theoretical models of cyberchondria involve reassurance seeking and specific metacognitive beliefs. Cyberchondria has relationships with health anxiety, problematic Internet use and symptoms of obsessive-compulsive disorder, with public health implications pertaining to functional impairment and altered healthcare utilization. Suggestions about prevention and management of cyberchondria have been put forward, but not tested yet. Research interest in cyberchondria has steadily increased. It is uncertain whether cyberchondria can be considered a distinct entity. Future research should aim to clarify the conceptual status of cyberchondria, quantify its impact and develop evidence-based approaches for a better control of cyberchondria.

Evaluating the Cyberchondria Construct Among Computer Engineering Students in Pune (India) Using Cyberchondria Severity Scale (CSS-15)

Background:

The Internet has become an important tool in day-to-day life. Reading medical data from Internet sources can have a negative impact on the common man. Anxiety due to excess searching for medical information online is known as cyberchondria.

Aim:

To evaluate the cyberchondria construct among the computer engineering students in Pune (India) using Cyberchondria Severity Scale (CSS-15).

Settings and Design:

A cross-sectional study was conducted among third- and fourth-year computer engineering students.

Methods:

The study recruited 180 students. A self-administered, English-translated CSS-15 questionnaire was used to collect the data. The responses were based on the Likert scale. Four constructs were scored from 0 to 4 while the mistrust of medical professional construct was scored in reverse order.

Statistical Analysis:

Descriptive statistics in the form of numbers and percentages were calculated.

Results:

The survey was completed by 171 (95%) participants, 77 females and 94 males with the mean age of 19.77 ± 1.07 years. All (100%) participants were affected by excessiveness and reassurance construct, 92% by distress, and 75% by compulsion. Only 19% were found to be affected by mistrust of a medical professional. Among all the domains, reassurance was severely affected among 52.04% of the participants.

Conclusion:

All the computer engineering students were affected by some or the other constructs of cyberchondria. This indicates that the Internet can affect an individual's mental, physical, and social activity by giving a vast amount of information and cause anxiety or distress related to their search.

What are the Implications of Excessive Internet Searches for Medical Information by Orthopaedic Patients?

BACKGROUND

Cyberchondria may be defined as heightened distress evoked through excessive searches of the internet for medical information. In healthy people, cyberchondria is associated with a greater intolerance of uncertainty and greater health anxiety. These relationships are likely bidirectional. People who have a greater intolerance of uncertainty may be more likely to search the internet for medical information and have greater health anxiety. This greater health anxiety may lead to an increased likelihood of engaging in further internet searches and greater intolerance of uncertainty. These three constructs are important for patients because they impact patient function and health care costs. We were specifically interested in understanding the role of cyberchondria in the association between intolerance of uncertainty and health anxiety among orthopaedic patients because it has not been explored before and because knowledge about these interactions could inform treatment recommendations.

QUESTIONS/PURPOSES

Does cyberchondria mediate (that is, explain) the association between intolerance of uncertainty and health anxiety in orthopaedic patients searching for medical information on the internet, after controlling for potentially confounding variables?

METHODS

This was a cross-sectional study of 104 patients who had searched the internet for any medical information about their current condition. A research assistant approached 155 patients attending two orthopaedic outpatient clinics, one hand and upper extremity service and one sports medicine clinic, during a 3-month period. Ten patients declined to participate and 41 patients were excluded, predominantly because they had never searched for medical information online. The patients completed the Cyberchondria Severity Scale, Intolerance of Uncertainty Scale-short version, Short Health Anxiety Inventory, and a numerical rating scale for pain intensity at baseline, as well as demographic and clinical questionnaires. We performed a series of linear regression analyses to determine whether a greater intolerance of uncertainty predicts greater cyberchondria (mediator) and whether cyberchondria predicts greater health anxiety. Although it is more appropriate to use the language of association (such as "whether cyberchondria is associated with health anxiety") in many observational studies, here, we opted to use the language of causation because this is the conventional language for studies testing statistical mediation.

RESULTS

After controlling for potentially confounding variables including pain intensity, multiple pain conditions, and education, cyberchondria explained 33% of the variance of the effect of intolerance of uncertainty on health anxiety (95% CI, 6.98 to 114.72%; p < 0.001).

CONCLUSIONS

Among orthopaedic patients who search the internet for medical information, a greater intolerance of uncertainty is associated with greater cyberchondria, which is associated with greater anxiety about health. Identifying patients with an intolerance of uncertainty and educating them about the negative role of compulsive searches for medical information may improve the success of orthopaedic treatment. Orthopaedic surgeons should also consider making referrals for cognitive behavioral therapy in these instances to increase the patient's tolerance of uncertainty, decrease internet searching habits, and reduce anxiety about health.

LEVEL OF EVIDENCE

Level III, prognostic study.

Patients' Online Information-Seeking Behavior Throughout Treatment: The Impact on Medication Beliefs and Medication Adherence

Research on the longitudinal impact of using the internet as an information source on patients' beliefs and medication adherence is scarce. Chronic patients (N = 107) from six hospitals were surveyed to longitudinally explore their online information seeking behavior throughout treatment (i.e., before the consultation about their newly prescribed medication in the initiation phase and after six months in the implementation phase) and how this affects their medication beliefs (concerns and necessity) and medication adherence after three weeks (T1) and six months (T2). Most patients (79%) used the internet. Patients who used the internet before the consultation reported to have more concerns about their medication at T1 and T2 compared to those who did not. Moreover, patients who used the internet throughout treatment valued their concerns higher than the necessity after six months (T2). Patients who used the internet after the consultation reported to be more non-adherent after three weeks (T1) compared to those who did not. Because of the longitudinal nature of this study, we were able to pinpoint in which treatment phase patients' online information seeking behavior is particular relevant in affecting patients' beliefs and medication adherence.

Primary Health Care Nurses' Experiences of Consultations With Internet-Informed Patients: Qualitative Study

Background

Most people in modern societies now use the Internet to obtain health-related information. By giving patients knowledge, digital health information is considered to increase patient involvement and patient-centered interactions in health care. However, concerns are raised about the varying quality of health-related websites and low health literacy in the population. There is a gap in the current knowledge of nurses’ experiences with Internet-informed patients.

Objective

The objective of this study was to explore primary health care nurses’ experiences of consultations with patients who present health-related information from the Internet.

Methods

This is a qualitative study based on interviews with 9 primary health care nurses. Data were analyzed using qualitative content analysis. Results are reported according to the consolidated criteria for reporting qualitative research guidelines.

Results

The phenomenon of Internet-informed patients was considered to change the usual rules in health care, affecting attributes and actions of patients, patterns of interactions in consultations, and roles of nurses and patients. Three categories were identified: (1) Facing the downsides of Googling, (2) Patients as main actors, and (3) Nurse role challenged. Although the benefits of health-related Internet information were described, its negative consequences were emphasized overall. The problems were mainly ascribed to inaccurate Internet information and patients’ inability to effectively manage the information.

Conclusions

Our study suggests ambivalent attitudes among nurses toward health-related Internet information. In order to promote equitable care in the digital era, increased awareness in health care about useful strategies for overcoming the difficulties and embracing the benefits of conferring with Internet-informed patients seems to be a legitimate goal.

Unravelling the Prospective Associations Between Mixed Anxiety-Depression and Insomnia During the Course of Cognitive Behavioral Therapy

OBJECTIVE

Previous studies have suggested that there is a reciprocal relationship between anxiety/depression and insomnia. However, little is known about the prospective relationships between these constructs across the course of cognitive behavioral therapy (CBT). The aim of the study was to examine these relationships in clients who received short-term CBT in a primary care setting.

METHODS

A total of 653 clients (mean [SD] age = 37.8 [12.9], 26.4% men) with mild to moderate levels of anxiety and depression and a treatment duration of at least 7 weeks were included for analyses. The clients completed questionnaires measuring mixed anxiety-depression (MAD - Patient Health Questionnaire Anxiety and Depression Scale) and insomnia (3 items derived from the Karolinska Sleep Questionnaire representing core DSM-V criteria) on a session-to-session basis. The data were analyzed using latent growth curve models and random intercept cross-lagged panel models.

RESULTS

The results of the latent growth curve models showed that there was a significant decrease in both MAD (cubic slope; B = .002, p < .001, quadratic slope; B = .036, p < .001, linear slope; B = -.205, p < .001) and insomnia (linear slope; B = -.080, p < .001) across treatment. A strong correlation (r = .838, p < .001) between the linear slopes indicated co-occurring change processes. The cross-lagged panel model showed that insomnia significantly predicted MAD at the subsequent measurements (B = .190, p < .001), but not vice versa (B = .252, p = .343).

CONCLUSIONS

Changes in MAD and insomnia are co-occurring processes during the course of CBT. Changes in insomnia predicted prospectively changes in MAD, but not vice versa. Targeting insomnia in the context of brief CBT in clients with mild to moderate anxiety and depression may therefore further reduce not only symptoms of insomnia but also symptoms of anxiety and depression.

Self-esteem and cyberchondria: The mediation effects of health anxiety and obsessive–compulsive symptoms in a community sample

Cyberchondria refers to the excessive and repeated searching for medical information on the Internet and may be considered as health-related problematic Internet use. Previous findings indicated that cyberchondria is positively associated with health anxiety and obsessive–compulsive symptoms. Also, research suggests that excessive or problematic Internet use as well as health worries and compulsive behaviors are present among individuals with low self-esteem. This study sought to examine: (1) the association between self-esteem and cyberchondria, and (2) the mediating role of health anxiety and obsessive–compulsive symptoms in the relationship between self-esteem and cyberchondria. Participants (N = 207) from a community sample completed self-report measures assessing global self-esteem, health anxiety, obsessive–compulsive symptoms, and cyberchondria. We found that self-esteem directly predicted cyberchondria and that health anxiety and obsessive–compulsive symptoms parallelly mediated the relationship between self-esteem and cyberchondria. These findings suggest that low self-esteem, health anxiety and obsessive–compulsive symptoms can be considered vulnerability factors for cyberchondria. In addition, the reverse mediation model indicated that cyberchondria potentially predicts self-esteem both directly and through health anxiety and obsessive–compulsive symptoms. The bidirectional relationship among the analyzed variables are discussed in the context of potential psychological predictors and consequences of cyberchondria and possible mechanisms explaining cyberchondria. The current study provides further insight into the conceptualization of cyberchondria and the feasibility of specific treatment directions.

Moving toward a metacognitive conceptualization of cyberchondria: Examining the contribution of metacognitive beliefs, beliefs about rituals, and stop signals

Cyberchondria refers to the repeated use of the Internet to search for health information that leads to negative consequences. The present set of studies examined the tenability of a proposed metacognitive conceptualization of cyberchondria that includes metacognitive beliefs about health-related thoughts, beliefs about rituals, and stop signals. The contribution of those variables to cyberchondria was examined among 330 undergraduate students from a U.S. university in Study 1 and 331 U.S. community respondents in Study 2. All participants reported using the Internet to search for health information. Across both studies, metacognitive beliefs, beliefs about rituals, and stop signals shared positive bivariate associations with cyberchondria and accounted for unique variance in cyberchondria scores in multivariate analyses. Beliefs about rituals and stop signals emerged as relatively specific to cyberchondria versus health anxiety in multivariate analyses. Results provide preliminary support for a metacognitive conceptualization of cyberchondria, with extensions of the present findings discussed.

Information-Seeking about Anxiety and Perceptions about Technology to Teach Coping Skills in Older Veterans

OBJECTIVE

We sought to learn where older veterans seek information about anxiety and coping. Due to increasing use of technology in health care, we also explored benefits and barriers of using technology to teach coping skills.

METHODS

Twenty veterans (mean age = 69.5 years, SD = 7.3) participated in semi-structured interviews in which we inquired about where they seek information about anxiety. We explored quantitative and qualitative differences for veterans with high versus low anxiety. In follow-up focus groups, we examined opinions about learning coping skills using technology.

RESULTS

Though veterans primarily named health care professionals as sources of information about anxiety, online searches and reading books were frequently mentioned. Reported benefits of using technology were convenience and standardized instruction of coping skills. Barriers included lack of interaction and frustration with technology usability.

CONCLUSION

Older veterans use multiple sources, heavily rely on interpersonal sources (e.g., professionals, friends), and employ varied search strategies regarding how to cope with anxiety. Using technology to teach coping skills was generally acceptable to older veterans.

CLINICAL IMPLICATIONS

Health care professionals could guide patients towards credible online and book sources. Providing instruction about using technology may help older adults use technology to learn coping skills.

The Health and Retirement Study: Analysis of Associations Between Use of the Internet for Health Information and Use of Health Services at Multiple Time Points

BACKGROUND

The use of the internet for health information among older people is receiving increasing attention, but how it is associated with chronic health conditions and health service use at concurrent and subsequent time points using nationally representative data is less known.

OBJECTIVE

This study aimed to determine whether the use of the internet for health information is associated with health service utilization and whether the association is affected by specific health conditions.

METHODS

The study used data collected in a technology module from a nationally representative sample of community-dwelling older Americans aged 52 years and above from the 2012 Health and Retirement Study (HRS; N=991). Negative binomial regressions were used to examine the association between use of Web-based health information and the reported health service uses in 2012 and 2014. Analyses included additional covariates adjusting for predisposing, enabling, and need factors. Interactions between the use of the internet for health information and chronic health conditions were also tested.

RESULTS

A total of 48.0% (476/991) of Americans aged 52 years and above reported using Web-based health information. The use of Web-based health information was positively associated with the concurrent reports of doctor visits, but not over 2 years. However, an interaction of using Web-based health information with diabetes showed that users had significantly fewer doctor visits compared with nonusers with diabetes at both times.

CONCLUSIONS

The use of the internet for health information was associated with higher health service use at the concurrent time, but not at the subsequent time. The interaction between the use of the internet for health information and diabetes was significant at both time points, which suggests that health-related internet use may be associated with fewer doctor visits for certain chronic health conditions. Results provide some insight into how Web-based health information may provide an alternative health care resource for managing chronic conditions.

Cyberchondria: Overlap with health anxiety and unique relations with impairment, quality of life, and service utilization

Cyberchondria refers to a clinical phenomenon in which repeated Internet searches regarding medical information result in excessive concerns about physical health. Cyberchondria is positively associated with symptoms of health anxiety, though it remains unclear as to whether cyberchondria poses a unique public burden. The current study replicated previous findings regarding the relationship between cyberchondria and health anxiety, and extended those findings to examine the extent to which health anxiety and cyberchondria may be differentially associated with public health outcomes, including impairment, quality of life, and service utilization. Community participants (N = 462) recruited via online crowdsourcing completed a battery of self-report questionnaires assessing cyberchondria, health anxiety, and measures of public health outcomes, including the WHOQOL and SDS. Bifactor latent variable modeling indicated that cyberchondria was closely related to, yet importantly distinct from, health anxiety. Moreover, when accounting for overlap with health anxiety, cyberchondria was associated with increased functional impairment and healthcare utilization. Results provide further support for the identification of cyberchondria as a distinct set of clinical symptoms that may pose a significant public health burden. Future research should determine ways in which to treat and/or prevent symptoms.

Cyberchondria: Examining relations with problematic Internet use and metacognitive beliefs

Cyberchondria refers to the repeated use of the Internet to search for health-related information, which leads to negative consequences. This two-part study provides the first known examination of how cyberchondria relates to (a) problematic Internet use and (b) metacognitive beliefs. Participants were U.S. community adults who reported using the Internet to search for health-related information (Study 1: N = 337, Study 2: N = 260). In Study 1, cyberchondria shared a strong association with problematic Internet use, and that association was unaccounted for by age, gender, current reported medical status, negative affect, or health anxiety. In Study 2, cyberchondria was found to share moderate to strong associations with metacognitive beliefs. The association between cyberchondria and metacognitive beliefs about the uncontrollability of thoughts remained intact after accounting for the Study 1 covariates, as well as anxiety sensitivity and intolerance of uncertainty. Neither anxiety sensitivity nor intolerance of uncertainty shared unique associations with cyberchondria. These results provide a preliminary indication that a metacognitive conceptualization of problematic Internet use may be applicable to cyberchondria.

Codevelopment Between Key Personality Traits and Alcohol Use Disorder From Adolescence Through Young Adulthood

OBJECTIVE

Personality traits related to negative emotionality and low constraint are strong correlates of alcohol use disorder (AUD), but few studies have evaluated the prospective interplay between these traits and AUD symptoms from adolescence to young adulthood.

METHOD

The Minnesota Twin Family Study (N = 2,769) was used to examine the developmental interplay between AUD symptoms and three personality measures of constraint, negative emotionality, and aggressive undercontrol from ages 17 to 29.

RESULTS

Results from random-intercept, cross-lagged panel models showed that low constraint and aggressive undercontrol predicted subsequent rank-order increases in AUD symptoms from ages 17 to 24. AUD symptoms did not predict rank-order change in these traits from ages 17 to 24. There was support for both cross-effects from ages 24 to 29. Biometric analysis of the twin data showed genetic influences accounted for most of the phenotypic correlations over time.

CONCLUSION

Results are consistent with the notion that personality traits related to low constraint and aggressive undercontrol are important vulnerability/predisposition factors for the development of early adult AUD. In later young adulthood, there is more evidence for the simultaneous codevelopment of personality and AUD. Implications are addressed with attention to personality-based risk assessments and targeted AUD prevention approaches.