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

The Moderating Role of Health Literacy and Health Promoting Behavior in the Relationship Among Health Anxiety, Emotional Regulation, and Cyberchondria

Background

People are increasingly turning to the internet to find answers to their health concerns in an era where there is a wealth of online health information, which frequently causes increased health anxiety and the phenomenon known as cyberchondria. The objectives of this study were to examine the moderating role of health literacy and health promotion behavior and the mediating role of emotional regulation between health anxiety and cyberchondria among the Pakistani population.

Methods

The study used a self-administered questionnaire to collect and examine health anxiety, emotional regulation, health literacy, health promotion behavior, and cyberchondria in 755 residents. A moderated mediation model of Hayes PROCESS was used to examine this hypothesis.

Results

The findings unveiled the average score of the participants on the study variables, as well as their categorization into low, moderate, and high categories. On scale of Health Anxiety participant scores (32% vs 53% vs 15%), Emotional Regulation (25% vs 46% vs 29%), Cyberchondria (18% vs 41% vs 41%), Health Literacy (56% vs 29% vs 15%), and Health promotion Behavior (49% vs 28% vs 23%). Moreover, result revealed that emotional regulation mediates the significant positive association between health anxiety and cyberchondria (β=0.25**p<0.001). Furthermore, health literacy moderates the negative association health anxiety and emotional regulation (β=-0.42*p<0.031), and health promotion behavior also negatively moderate the relationship between emotional regulation and cyberchondria (β=-0.27*p<0.22).

Conclusion

Based on the findings, it is recommended that health policymakers consider comprehensive national initiatives that focus on educational planning. These initiatives should boost health literacy levels and promote health-related behavior. Additionally, there is urgent need for strict measures to be put in place for monitoring online platforms and websites that spread inaccurate or false health-related information.

Is There a Relationship Between Online Health Information Seeking and Health Anxiety? A Systematic Review and Meta-Analysis

The internet has revolutionized how we live, providing unprecedented convenience and up-to-date information. Consequently, an increasing number of individuals are turning to the internet for health-related information, despite research suggesting a correlation between this behavior and health anxiety. Therefore, drawing on cognitive - behavioral theory, we explore the link between online health information seeking and health anxiety via a systematic review and meta-analysis of cross-sectional studies. Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis, we ran searches in multiple databases, including PubMed, Web of Science, Embase, Elsevier/Science Direct, Cochrane Database, China National Knowledge Infrastructure, VIP Chinese Database, and Wanfang Data. Our searches identified 16 studies eligible for review, involving 4,920 participants across seven countries. The random-effects meta-analysis revealed a significant positive correlation between online health information seeking and health anxiety (r = 0.28, 95% confidence interval [0.16, 0.41], p < .0001), despite considerable heterogeneity. Furthermore, meta-regression analysis demonstrated that the identity characteristics of the sample, female percentage, sample size, and country all contributed to the heterogeneity across studies. Overall, this meta-analysis provides support for the association between online health information seeking and health anxiety, and helps to elucidate the cognitive - behavioral theory underpinning this phenomenon.

The mediating role of rumination between stress appraisal and cyberchondria

Cyberchondria, defined as excessive concern about one's health and looking for solutions to health problems on the Internet, is becoming increasingly common. This paper examines the relations between the dimensions of stress appraisal (threat, challenge-activity, challenge-passivity, harm/loss) and cyberchondria. We also tested whether these relations were mediated by rumination. The study included a nonclinical sample of N = 615 participants aged 18 to 83 years (M = 43.86, SD = 14.57, 53 % women), who completed the short version of the Cyberchondria Severity Scale, the Rumination Scale, and the Stress Appraisal Questionnaire. We used the Computer-Assisted Web Interview (CAWI) method. The results revealed that rumination was a partial mediator between stress as a threat and cyberchondria and between stress as a harm/loss and cyberchondria. Cyberchondria was positively related to rumination, stress as a threat, and stress as a harm/loss and negatively related to the challenge-activity dimension of stress appraisal. The study indicates that stress appraisal is linked to cyberchondria and that rumination plays an important role in this relationship.

Exploring associations between eHealth literacy, cyberchondria, online health information seeking and sleep quality among university students: A cross-section study

Background

University students are increasingly inclined to use the Internet for health-related purposes, and their sleep problems are becoming increasingly prominent. Currently, the relationship between sleep quality and online health-related searches is poorly understood. The aim of this study was to exam the associations of sleep quality, Internet use, eHealth literacy, online health information seeking and cyberchondria in the sample of Chinese university students.

Methods

A total of 2744 students completed self-reported questionnaires online containing the Pittsburgh Sleep Quality Index (PSQI), eHealth Literacy Scale, Online Health Information Seeking, Cyberchondria Severity Scale (CSS) and questions regarding sleep duration, Internet use, health status, and demographic information.

Results

The prevalence of poor sleep quality (PSQI >7) among the university students was 19.9% and 15.6% students slept less than 7 h per day. As time spent on online daily and playing phone before bed increased, the prevalence of sleep disturbance gained. Sleep disturbance was significantly associated with cyberchondria (OR = 1.545, p = 0.001), health status [good (OR = 0.625, p = 0.039), poor (OR = 3.128, p = 0.010), and fair (OR = 1.932, p = 0.001)]. Sleep quality, online health information seeking and eHealth literacy positively influenced with cyberchondria. Compared to 7-8 h sleep duration, online health information seeking (OR = 0.750, p = 0.012) was significantly associated with ≥8 h sleep duration.

Conclusion

Our findings highlighted poor health status, too much time spent on online daily and high cyberchondria level might decrease sleep quality in the sample of Chinese university students, further suggesting the need for developing interventions based on online health-related searches for improving sleep quality among university students.

Cyberchondria: a Growing Concern During the COVID-19 Pandemic and a Possible Addictive Disorder?

Purpose of Review

The main purpose of this narrative review is to provide a brief overview of the current empirical evidence regarding the conceptualization, assessment, and treatment of cyberchondria, with a focus on the potential classification of cyberchondria as a behavioral addiction. Although cyberchondria has been widely associated with anxiety, it has also been suggested that it may be linked to obsessive-compulsive features. A less explored proposal is the categorization of cyberchondria as a behavioral addiction. The present review explores the existing literature with respect to the possible classification of cyberchondria as a behavioral addiction by considering cyberchondria with respect to components of the interaction of person, affect, cognition and execution model.

Recent Findings

There is a lack of consensus regarding the definition and conceptualization of cyberchondria. The empirical evidence available to date suggests that cyberchondria is a multifactorial construct that operates transdiagnostically, particularly with respect to obsessive-compulsive-related disorders and health-related anxiety. The extent to which the condition may reflect a behavioral addiction as a form of problematic use of the internet also warrants consideration. Cyberchondria may have become more prevalent during the COVID-19 pandemic, with particular populations prone to health-related anxiety likely having greater vulnerability. Existing data in part support the potential classification of cyberchondria as a behavioral addiction, although many gaps in understanding currently exist.

Summary

Cyberchondria appears to be a growing concern. However, there is not yet enough empirical evidence to determine whether this clinical condition has enough similarities with behavioral addictions to be considered as one. Likewise, psychometric instruments that exist to date have not been designed from the theoretical framework of behavioral addictions, so most of the factors that they evaluate may be preferentially related to anxiety. Finally, there is still no consensus on whether cyberchondria should be addressed in the context of health anxiety interventions, OCRD, or behavioral addictions; thus, more empirical evidence is needed.

Social Support Mediates the Association between Health Anxiety and Quality of Life: Findings from a Cross-Sectional Study

This study aimed to test if perceived social support and cyberchondria mediate the association between health anxiety and quality of life (QoL) in a nonclinical sample. Cross-sectional research involved adult internet users (n = 538) between 16 May 2020 and 29 December 2020 in Poland who completed self-report questionnaires, including the cyberchondria severity scale (CSS-PL), the short health anxiety inventory (SHAI), the multidimensional scale of perceived social support (MSPSS) and the quality of life scale (QOLS). A mediation analysis was performed to examine the direct effects of health anxiety on cyberchondria, perceived social support and quality of life. Likewise, the effects of cyberchondria and perceived social support on QoL were analyzed. Hence, indirect effects of health anxiety on QoL through cyberchondria and perceived social support were explored. Health anxiety significantly impaired QoL both directly and indirectly through low-perceived social support. Perceived social support partly mediated the association between health anxiety and QoL. Cyberchondria did not have a significant direct effect on the latter. Thus, cyberchondria did not mediate the relationship between health anxiety and QoL. Boosting-perceived social support may mitigate the detrimental effect of health anxiety on QoL. Cyberchondria was not found to have a significant effect on QoL in contrast to health anxiety alone.

Internet Derived Information Obstruction Treatment (IDIOT) Syndrome: A Breviloquent Review

The rapid increase in internet use in the current digital era has caused a potential increase in anxiety, and a person either self-medicates or abruptly stops the drug for his medical illness, thereby the rise in the Internet Derived information Obstructing Treatment (IDIOT) syndrome. The Internet Derived Information Obstructing Treatment (IDIOT) syndrome occurs when patients abruptly quit their treatment because they have blindly trusted internet medical information. WHO calls this an " Infodemic," which has created a complex situation in healthcare, as it has caused too much information in digital and physical environments during an outbreak of the disease and caused mistrust in health authorities. Patients get important health information online and anticipate additional assistance, Dr. C. N. Manjunath, Director, Jayadeva Hospital, says “Doctors are becoming sick because of stress, and they need to take care of their health. There is an added demand to ac­q­u­ire communication skills rather than merely technical and professional qualities.” Patients must not merely believe healthcare-related information available from online health resources and must seek the help of licensed healthcare professionals for their health concerns. There must be an increase in the awareness programs among the public to as not to fall as victims and blindly follow or abruptly stop their medical prescriptions for their medical illness from available online health resources.

The effect of cyberchondria on anxiety, depression and quality of life during COVID-19: the mediational role of obsessive-compulsive symptoms and Internet addiction

Since the global pandemic of the coronavirus disease 2019 (COVID-19), online health information-seeking behaviors have notably increased. Cyberchondria can be a vulnerability factor for the worsening of anxiety-depressive symptoms and quality of life. The current study aims to understand the predictive effect of cyberchondria on health anxiety, anxiety, depression and quality of life considering the mediating effect of obsessive-compulsive symptoms and Internet addiction and the moderating effect of COVID anxiety. 572 Italian participants (66% female; Mean age = 34; SD = 15) took part in a cross-sectional online survey involving CSS-12, MOCQ-R, IAT, SHAI, HADS, WHOQoL-BREF and CAS. Mediation and moderation analyses were conducted. Obsessive-compulsive symptoms and Internet addiction were found to partially mediate the cyberchondria-health anxiety and the cyberchondria-anxiety links and to totally mediate the cyberchondria-depression and the cyberchondria-quality of life links. COVID anxiety was found to moderate the relationship between cyberchondria and anxiety. The findings suggest that compulsivity may have a key role in the explanation of the underlying mechanisms of cyberchondria. Healthcare practitioners should provide additional support for individuals with cyberchondria. As such, cyberchondria is a contributing factor to the exacerbation of anxiety-depressive disorders and may impact on the quality of life.

Cyberchondria and Associated Factors Among Brazilian and Portuguese Dentists

Cyberchondria is a psychopathological behavior that affects people who compulsively consult the internet, by searching the symptoms of different pathologies from which they believe they are suffering, and when influenced by what they read, are sure they have some of these diseases. The aim of this study was to assess the cyberchondria level and associated factors among Brazilian and Portuguese dentists. A total 597 Brazilian and Portuguese dentists participated in this cross-sectional study. They were contacted via WhatsApp and asked to complete an online questionnaire on the Google Forms platform, from January 17 to 31, 2021, during the COVID-19 pandemic. Sociodemographic information was collected and cyberchondria was measured using the Portuguese language version of the Cyberchondria Severity Scale. Binary logistic regression models were used to estimate the unadjusted and adjusted Odds Ratio (OR) and corresponding 95% confidence interval (CI) for theassociationofcyberchondria and covariates. Each covariate was individually included in the regression model, and the unadjusted OR (95% CI) was estimated. Most participants were Brazilian (62.8%), women (75.5%), married (60.5%) and with children (55.6%). Average age was 42.1 years (+ 12.5). In the final model, it was found that with each increase of one year in age, the chance of a high level of cyberchondria decreased (OR=0.97; 95% CI 0.95-0.98). Brazilian dentists were 1.85 times more likely (95% CI 1.25-2.75) to have a high level of cyberchondria than Portuguese dentists. Women were 1.62 times more likely (95% CI 1.07-2.44) to have a high level of cyberchondria than men. It was concluded that young age, Brazilian nationality, and female gender favored the high level of cyberchondria among the participants in this sample during COVID-19 pandemic.

Cyberchondria During the COVID-19 Pandemic

Many factors govern the behavior pertaining to anxiety regarding health – it may be stressors, triggers, adverse situations faced by people. Since the outbreak of the COVID-19 virus, health-related anxiety has been widespread. December 2019 saw the occurrence of a form of pneumonia, not known at that time, from the Wuhan region of China to rapidly proceed into a worldwide pandemic and lockdown. This disrupted normal life across the globe and affected social and economic functioning. Cyberchondria has been one of the coping strategies seen during this time, pertaining to online health-related searches which offer answers and relief as seen at the surface but also bringing a plethora of mental health challenges. The authors in this chapter try to simplify what exactly cyberchondria is and how has it affected the lives of the worldwide population during the COVID-19 crisis, the biggest pandemic of recent times. The origin, development, and prevalence of the concept, along with coping, treatment, and prevention of the condition are discussed.

Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study

BACKGROUND

Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19.

OBJECTIVE

This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria.

METHODS

Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling.

RESULTS

A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t_1,692=-2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t_1,692=-3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t_1,692=-3.69, P<.001, Cohen d=0.29).

CONCLUSIONS

The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises.

Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study

Background

Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19.

Objective

This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria.

Methods

Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling.

Results

A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t1,692=–2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t1,692=–3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t1,692=–3.69, P<.001, Cohen d=0.29).

Conclusions

The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises.

Cyberchondria Amidst COVID-19 Pandemic: Challenges and Management Strategies

The corona-virus disease 2019 (COVID-19), first found in Wuhan, China in December 2019, has posed an inexplicable threat to the global community. After its inception, the virus proliferated rapidly, which led to the cause of millions of deaths, and having a detrimental effect on physical health, social lives, economic uncertainty, and mental health of people. The World Health Organization has reported that there are 111 million confirmed cases of COVID-19 and 2.45 million deaths due to COVID-19 worldwide. Indisputably, the present pandemic has contributed to the extensive psychological and environmental distress together with clinical depression, anxiety and post-traumatic stress disorder (PTSD), domestic violence, and unemployment. Due to the ambiguous nature of the pandemic, educational organizations, and outdoor activities are closed, thus burdening the mental health of younger populations. Children as well as youths are more glued to the Internet for their studies, online gaming, shopping, watching movies, and searching health-related information. Despite the advantages of using the Internet, it has some severe consequences too. Some people are repeatedly searching for physical and mental well-being related information without verifying credible sources, which, in turn, causes distress and anxiety. In such situations, individuals may end up contributing to an illness known as cyberchondria. In this paper, we have tried to highlight the problematic use of Internet for health-related searches and have outlined the management of such illness. We suggest two strategies: firstly, to reduce repeated online searches of health information and, secondly, to manage anxiety-augmenting thoughts that are triggered due to the maladaptive thoughts caused by the abstruse information.

An Observational Study in Manipur State, India on Preventive Behavior Influenced by Social Media During the COVID-19 Pandemic Mediated by Cyberchondria and Information Overload

OBJECTIVES

The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency posing unprecedented challenges for health authorities. Social media may serve as an effective platform to disseminate health-related information. This study aimed to assess the extent of social media use, its impact on preventive behavior, and negative health effects such as cyberchondria and information overload.

METHODS

A cross-sectional observational study was conducted between June 10, 2020 and August 9, 2020 among people visiting the outpatient department of the authors' institution, and participants were also recruited during field visits for an awareness drive. Questions were developed on preventive behavior, and the Short Cyberchondria Scale and instruments dealing with information overload and perceived vulnerability were used.

RESULTS

The study recruited 767 participants with a mean age of about 45 years. Most of the participants (>90%) engaged in preventive behaviors, which were influenced by the extent of information received through social media platforms (β=3.297; p<0.001) and awareness of infection when a family member tested positive (β=29.082; p<0.001) or a neighbor tested positive (β=27.964; p<0.001). The majority (63.0%) of individuals often searched for COVID-19 related news on social media platforms. The mean±standard deviation scores for cyberchondria and information overload were 9.09±4.05 and 8.69±2.56, respectively. Significant and moderately strong correlations were found between cyberchondria, information overload, and perceived vulnerability to COVID-19.

CONCLUSIONS

This study provides evidence that the use of social media as an information- seeking platform altered preventive behavior. However, excessive and misleading information resulted in cyberchondria and information overload.