The development and initial validation of the cyberchondria severity scale (CSS)

Cyberchondria in Older Adults and Its Relationship With Cognitive Fusion, Health-Related Quality of Life, and Mental Well-Being: Mediation Analysis

BACKGROUND

Cyberchondria is the compulsive searching for health information online that continues despite harmful effects. It leads to increased health anxiety and lower health-related quality of life (HRQOL). Older adults face higher risks of cyberchondria due to their limited digital literacy skills and more frequent health concerns. However, researchers have not thoroughly studied how cyberchondria affects this age group.

OBJECTIVE

This study aimed to explore cyberchondria in the older population and investigate its relationship with cognitive fusion (ie, the tendency to become entangled with thoughts and perceive them as literal truths that dictate behavior), HRQOL, and mental well-being.

METHODS

A web-based, cross-sectional survey was conducted in May 2024 with a sample of 638 participants from China aged ≥60 years recruited through the online panel of a survey company. The participants completed questionnaires assessing cyberchondria (using the Cyberchondria Severity Scale-12 [CSS-12]), cognitive fusion, HRQOL, and mental well-being. Structural equation modeling (SEM) was used to assess the hypothesized mediation model, and standardized estimates and their 95% CIs were calculated for all structural paths.

RESULTS

Participants had a mean CSS-12 score of 40 (SD 8.5), suggesting a fairly high level of cyberchondria in this sample. Participants with a higher socioeconomic status tended to report lower levels of cyberchondria. The SEM showed that cyberchondria was positively associated with cognitive fusion (β=0.505, P<.001 for both models) and negatively associated with HRQOL (β=-0.221, P<.001) and mental well-being (β=-0.212, P<.001). The mediation model showed a good fit and demonstrated that cognitive fusion fully mediated the total effect of cyberchondria on HRQOL and mental well-being.

CONCLUSIONS

Cyberchondria may be more prominent in older Chinese adults, especially those residing in rural areas and with a lower socioeconomic status. Additionally, cyberchondria can enhance cognitive fusion, contributing to poor HRQOL and mental well-being. Interventions focused on "defusing" cyberchondria-relevant thoughts may help reduce maladaptive behaviors associated with cyberchondria and improve the overall well-being of older populations.

The Relationship Between E-Health Literacy, Health Anxiety, Cyberchondria, and Death Anxiety in University Students That Study in Health Related Department

Introduction

While the Internet can be a valuable resource for learning about health issues, for those without adequate e-health literacy skills, it can have adverse effects on unwanted anxiety and cyberchondria risk. Improving e-health literacy is essential to manage health and death anxiety and help reduce the risk of cyberchondria. The aim of this study is to determine the e-health literacy, health anxiety, cyberchondria and death anxiety levels of university students, evaluate them in terms of independent variables and examine the relationship between the scales.

Methods

The study was completed with 568 students receiving education in the health department of a university. Data were obtained using the e-Health Literacy Scale, Health Anxiety Inventory, Cyberchondria Severity Scale, and Death Anxiety Scale. The chi-square, Mann-Whitney U, Kruskal-Wallis, Tamhane's T2 post hoc tests, and Spearman correlation were used to analyze the data.

Results

The mean score of e-health literacy was 28.63±4.65; health anxiety was 19.11±8.37, cyberchondria was 86.30±18.28 and death anxiety was 7.34±2.14. Cyberchondria is low in women and those who do not conduct online research on health. E-health literacy was higher in those earning above the minimum wage. Health and death anxiety was low in men and in those who did not conduct online health-related research. Health anxiety was positively correlated with cyberchondria and death anxiety and negatively correlated with e-health literacy. There was a positive relationship between cyberchondria and E-health literacy and death anxiety. This study highlights the complex relationship between eHealth literacy, health anxiety, cyberchondria and death anxiety. It shows that low e-health literacy can increase health anxiety, which in turn can worsen cyberchondria and death anxiety. By emphasising the importance of e-health literacy in health education, the findings may help students manage their anxiety, make informed health decisions, and increase their professional competence.

Examining mothers' obsessive and compulsive behaviors regarding baby care, cyberchondria level and maternal burnout in the postpartum period: Path analysis

OBJECTIVE

To examine the effects of postpartum women's obsessive and compulsive behaviors towards the care of their babies and maternal exhaustion levels on cyberchondria.

METHODS

The study, designed as a cross-sectional and correlation-seeking study, included 275 mothers. Data were collected from Turkish mothers with maternal burnout scale (MBS), scale for obsessive and compulsive behavıors of mothers ın the postpartum perıod wıth regard to baby care and cyberchondria severity scale (CSS).

RESULTS

A total of 41.8% of the mothers, whose average age was 28.49 ± 5.04, had their first birth, 62.5% of the mothers were feeding their babies with breast milk, and 65.8% had regular sleep. The total mean score of the scales was 24.76 ± 5.15 for T-MBS, 81.19 ± 22.16 for CSS, and 16.11 ± 10.28 for the obsession scale. There was a statistically significant positive relationship between the maternal burnout and postpartum obsession scales and the cyberchondria severity scale.

CONCLUSION

In the present study, mothers in the postpartum period did not show signs of burnout or obsessive-compulsive behaviors in the care of their babies, and their cyberchondria severity scores were at a moderate level.

eHealth Literacy and Cyberchondria Severity Among Undergraduate Students: Mixed Methods Study

Background

With the development of the internet, health care websites have become increasingly important by enabling easy access to health information, thereby influencing the attitudes and behaviors of individuals toward health issues. However, few studies have addressed public access to health information and self-diagnosis.

Objective

This study investigated the background factors and status of cyberchondria severity among college students by conducting a nationwide sample survey using the Cyberchondria Severity Scale. Further, we explored the perspective of eHealth literacy of those with scores higher than 1 SD from the mean by analyzing their recent experiences using web-based health information.

Methods

A nationally representative sample of college students was surveyed, and 802 valid responses were obtained (male: 435/802, 54.2%; female: 367/802, 45.8%; mean age 20.3, SD 1.4 years). The Cyberchondria Severity Scale was used, which consisted of 4 dimensions (increased anxiety, obsessive-compulsive hypochondria, perceived controllability, and web-based physician-patient interaction). Additionally, we recruited 9 volunteers who scored more than 1 SD above the mean for in-depth interviews on their web-based health information-seeking behaviors.

Results

Significant differences were found across the 4 dimensions of cyberchondria severity (F3,2403=256.26; P<.001), with perceived controllability scoring the highest (mean 2.75, SD 0.87) and obsessive-compulsive hypochondria scoring the lowest (mean 2.19, SD 0.77). Positive correlations were observed between perceived controllability, web-based physician-patient interactions, increased anxiety, and obsessive-compulsive hypochondria (r=0.46-0.75, P<.001). Regression analysis indicated that health concern significantly predicted perceived controllability (β coefficient=0.12; P<.05) and web-based physician-patient interaction (β coefficient=0.16; P<.001). Interview data revealed that students often experienced heightened anxiety (8/9, 89%) and stress (7/9, 78%) after exposure to web-based health information, highlighting the need for improved health literacy and reliable information sources.

Conclusions

The study identified both benefits and risks in college students' use of web-based health information, emphasizing the importance of critical consciousness and eHealth literacy. Future research should examine how college students move from self-awareness to actionable change and the development of critical health literacy, which are essential for effective digital health engagement.

Global Research on Cyberchondria: Scientometric and Visual Analysis From 2003 to 2022

This study aims to summarise the research themes, hotspots, and boundaries in the field of cyberchondria using scientometrics and visual analysis methods. Until 31 December 2022, 181 publications (165 articles, 16 reviews) were identified under the topic of 'cyberchondria' in the Web of Science Core Collection database. VOSviewer was used for analysis. It was observed that publications related to cyberchondria have rapidly developed into a research area in the last 4 years, constituting 79.0% (n = 143) of the total publications. The most common co-occurring keywords are 'cyberchondria', 'health anxiety', and 'COVID-19'. Clusters representing three different themes were obtained by conducting co-occurring keyword analysis. The first and largest cluster comprises 'COVID-19', 'anxiety', and 'internet addiction', the second cluster includes 'cyberchondria' and 'health anxiety', and the third cluster centres around 'health information' and 'health education' keywords. This study has mapped out the information landscape of cyberchondria research over the past 20 years using scientometric and visual analysis methods. The significant increase in recent years indicates a diversification and continued growth in studies conducted in this field. By presenting the general state of the field, this study provides valuable insights for future research endeavours.

Illness anxiety, infertility stress, resilience and thyroid-stimulating hormone among infertile people undergoing ART treatment in China

OBJECTIVE

Infertile people undergoing assisted reproductive technology (ART) treatment in China may experience severe infertility-related stress and illness anxiety (IA). However, little relevant research has been conducted until now.

DESIGN

This study investigated the IA of 340 infertile people undergoing ART treatment, including 43 males, 292 females and 5 who preferred not to answer, in 2 tertiary general public hospitals in Wen Zhou, China.

MAIN OUTCOME MEASURES

Blood samples for thyroid-stimulating hormone (TSH) levels were obtained from 107 women to explore the relationship between IA and TSH. The questionnaire contained the Mandarin version of the Fertility Problem Inventory, the Resilient Trait Scale for Chinese Adults and the Whiteley Index, measuring infertility stress, resilience and IA, respectively.

RESULTS

An incidence rate of 44.1% of IA among infertile people undergoing ART treatment in China was determined, and 30.2% of men and 46.6% of women had severe IA (χ2 = 4.05, p < 0.05). The risk of severe IA in women was around twice that in men (OR = 2.01, 95% CI: 1.01-4.01). Women's IA level was significantly associated with their TSH level (β = 0.27, p < 0.01). Resilience played a moderating role in the relationship between parenthood importance and illness anxiety.

CONCLUSION

This study highlighted the importance and urgency of providing holistic care for illness anxiety of infertile people undergoing ART treatment in China, especially women. The findings of this study indicated that mind-body therapies and resilience empowerment workshops could be conducive to infertile people's holistic health.

The Relationship between Parents' Use of the Pediatric Emergency Department and Cyberchondria

The study aimed to investigate the correlation between children's attendance at the emergency department and the cyberchondria of parents. The population for this cross-sectional study comprised parents of children aged 0 to 18 attending the emergency department. Research data were collected using an Information Form, the Cyberchondria Severity Scale (CSS). The participants had mean CSS scores of 41.45 ± 19.22. There were significant differences observed between the reason for choosing the emergency department with mean scores for the total CSS (F = 2.289, P = .021), distress (F = 2.466, P = .013), and compulsion (F = 2.822, P = .005) subscales. A weak positive correlation was identified between the number of attendances at the emergency department in the last year and the excessiveness (r = .204) subscale. Participants had moderate levels of CSS. According to the research findings, most parents attended the emergency department for non-urgent reasons. In addition, as the cyberchondria severity level of parents increased, their attendance at health institutions and emergency departments was determined to increase.

Cyberchondria Levels in Adolescent Patients With Polycystic Ovary Syndrome in the Digital Age

STUDY OBJECTIVE

Cyberchondria is defined as a form of anxiety characterized by excessive health searches on the Internet. Our aim in this study is to investigate the extent of cyberchondria in adolescents with polycystic ovary syndrome (PCOS) and to compare them with adolescents of the same age.

METHODS

A total of 426 adolescents who presented to clinic between April 2023 and September 2023 and agreed to participate in the study were included in the study. Patients were divided into two groups: PCOS group (135 patients) and control group (291 patients). The Cyberchondria Severity Scale (CSS) was administered to participants face-to-face. The CSS and subscale scores of both patient groups were analyzed and compared.

RESULTS

Total CSS scores were significantly different between groups (P = .007) with a mean value of 72 (59-83) in the control group and 77 (63-91) in the PCOS group. When cyberchondria subscales were analyzed, statistical difference was found between the groups in the subcategories of compulsion (P: .015), distress (P: .039), excessiveness (P: .028), and mistrust of medical professional (P: .005).

CONCLUSION

Adolescents with PCOS demonstrated higher levels of cyberchondria which could aggravate associated symptoms of anxiety and depression. Health providers should be mindful to evaluate internet use in this patient population and provide anticipatory guidance.

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.

Developing a cyberchondria severity scale to promote self-care among university students during COVID-19

Cyberchondria is a hybrid term signifying a state in which individuals compulsively search for health-related information online because of health distress or anxiety, further aggravating their worries. This study develops a Cyberchondria Severity Scale (CSS) to assess the current situation of university students. Exploratory factor analysis (EFA) was conducted using 145 valid questionnaires. Subsequently, a nationwide survey was conducted at various universities in Taiwan, and 802 questionnaires were used for confirmatory factor analysis (CFA). The EFA led to the development of a CSS for college students with four constructs: increased anxiety (α = 0.91), obsessive-compulsive hypochondria (α = 0.87), perceived controllability (α = 0.88), and online physician-patient interaction (α = 0.86), with a Cronbach's alpha of 0.92 and variance of 66.81%. The CFA indicated that item reliability ranged from 0.50 to 0.86, factor loadings ranged from 0.71 to 0.93, and the composite reliability for latent variables ranged from 0.83 to 0.90 (p < .001). The extracted average variance ranged from 0.46 to 0.60. There were significant differences in various dimensions: perceived controllability had the highest score and obsessive-compulsive hypochondria had the lowest (F3,2403=256.26, p < .001). Therefore, CSS has emerged as a reliable and valid measure. Future studies should explore the factors that influence cyberchondria, promote online health information searches, and enhance reading comprehension skills.

[Health anxiety: Another epidemic to prepare for]

Health anxiety (HA) is a frequent problem (up to 20% of consultants in the context of secondary care) responsible for decreased well-being, disability, somatic and psychiatric complications, which contributes to high healthcare expenditures at the population level. It is likely, if not definitely established, that the prevalence of ACS is increasing, and this can partly be explained by the growing medicalization of society in general, the appetite of Media for health issues, and the uncontrolled use of the Internet (which can lead certain vulnerable subjects to cyberchondria). The pandemic of COVID-19 could have contributed to it, at least by the significant increase in the overall level of psychological distress in the population it has caused, although this has not formally been demonstrated to date. The diagnosis of ACS is easy, as soon as its assessment is considered as a mandatory part of any medical consultation. Certain intuitive attitudes of doctors, such as reassurance, prove to be iatrogenic for the patient with HA. The management of HA can be facilitated by an acculturation of physicians to cognitive conceptions of anxiety in general and HA in particular. HA is effectively treatable by certain psychotherapy and in the first place cognitive and behavioral therapies (CBT), but the availability of trained therapists and accessible at a lower cost is sorely lacking, particularly in France.

Cyberchondria, Health Literacy, and Perception of Risk in Croatian Patients with Risk of Sexually Transmitted Infections and HIV-A Cross-Sectional Study

Background: The perception of the risk of sexually transmitted infections (STIs) is a well-researched phenomenon, but not in relation to cyberchondria and health literacy. Therefore, our aim was to examine the association between the assessment of the risk of sexually transmitted diseases and HIV, cyberchondria, and health literacy. Materials and methods: This study was conducted in 2020-2021 in Croatia. The experimental group consisted of patients from the Centre for Voluntary Counselling and Testing for HIV (N = 134). The control group consisted of other patients recruited from daily epidemiological practices (N = 171). The instruments that were used were questionnaires that measure the perception of risk of sexually transmitted infections and HIV, health literacy, and cyberchondria. Results: Out of 305 respondents, 134 (43.9%) were in the STI counselling group, and 171 (56.1%) were in the control group. Generally, the participants in the former perceived the risk of sexually transmitted infections and HIV to be higher (but still low) than those in the latter. There was no difference in health literacy between the STI and control group; the health literacy score was average in both groups. There were differences in almost all the cyberchondria factors, except for Mistrust. Health literacy, belonging to the STI counselling group, and risk behaviours were positively associated with CH in the logistic regression analysis. Conclusions: People with a risk for STIs tend to minimize this risk, have higher cyberchondria levels, and have average health literacy. Cyberchondria is positively associated with health literacy, and more education about excessive health-related internet research is needed.

Anxiety sensitivity moderates the relationship between internet addiction and cyberchondria among nurses

Internet addiction and cyberchondria have a bidirectional relationship. However, no known studies have evaluated the moderating role of anxiety sensitivity in that relationship. The study aimed to determine whether anxiety sensitivity moderates the relationship between internet addiction and cyberchondria among Jordanian nurses. Data were collected from 303 nurses using a web-based survey and convenience snowballing sampling methods using a cross-sectional research design. The Internet Addiction Test and the short version of the Cyberchondria Severity Scale were used to assess internet addiction and cyberchondria. Nurses reported mild internet addiction, low anxiety sensitivity, and moderate cyberchondria. Also, these findings suggested that sensitivity to anxious feelings moderates the relationship between internet addiction and cyberchondria. These findings would help nurses use psychosocial interventions for people with internet addiction and cyberchondria by understanding how their anxiety sensitivity promotes their internet addiction and cyberchondria.

Cyberchondria and smartphone addiction: A correlation survey among undergraduate medical students in Egypt

BACKGROUND

There is an increase in smartphone usage globally. Cyberchondria (CYB) is characterized by excessive Internet searches for health information. Smartphone addiction is constantly rising among medical students together with CYB as a collateral emerging risk, yet there is limited research available on the topic.

METHODS

This cross-sectional study explores the rising phenomenon of smartphone addiction and its potential role in CYB among medical students in seven Egyptian universities. A total of 1435 medical students participated in completing online questionnaires that assessed smartphone addiction and CYB using the Smartphone Addiction Scale-Short Version (SAS-SV) and Cyberchondria Severity Scale (CSS-12). Multivariable regression analysis was applied to assess predictors of smartphone addiction and CYB.

RESULTS

Based on the used scales, 57.6% of students were suffering from smartphone addiction, and 85.8% exhibited a moderate degree of CYB. There was a significant positive correlation between smartphone addiction scores and CYB (p < 0.05). The multivariable regression models revealed that four factors including using Facebook, using WhatsApp, increasing time spent on the Internet per day, and a higher CYB score increase the probability of smartphone addiction. The factors that increase the probability of CYB are using Facebook, an increase in the frequency of Internet searches, a higher degree of worry about one's health or a family member's health, and being a smartphone addict.

CONCLUSION

Smartphone addiction among undergraduate medical students is prevalent. Social media use, time spent online, and smartphone addiction were linked with the risk of CYB. Regular physical activity decreases the probability of smartphone addiction. Awareness programs and increased mental and physical activities are required to help reduce smartphone addiction among youth.

The impact of online health information source preference on intolerance to uncertainty and cyberchondria in a youthful generation

Background

The increasing utilization of the Internet to access health-related information is believed to heighten anxiety and trigger cyberchondria due to the presence of conflicting and sometimes overly detailed information.

Aim

To investigate the levels of cyberchondria and intolerance of uncertainty among university students and their relationship with different online health information sources.

Methods

Between June and July 2022, 420 university students (mean age = 21.5 ± 2 years, 54% female) participated in this cross-sectional study. The socio-demographic form, Uncertainty Intolerance Scale (IUS), and Cyberchondria Severity Scale (CSS) were used in data collection. Pearson correlation test and binary logistic regression analysis were used to identify factors associated with cyberchondria.

Results

Forums and private hospital/clinic websites were the most frequently utilized online health information sources, while governmental websites were the least. The mean scores for CSS and IUS were 81.5 and 41.0, respectively. There was no significant gender-based difference in CSS and IUS scores. Students who used newspapers/magazines and social media for health information had significantly higher scores on both scales. Cyberchondria had a negative association with age [odds ratio (OR) = 0.90], a positive significant relationship with newspaper/magazine website use (OR = 7.24), and IUS score (OR = 1.09). There was a positive and moderate correlation between CSS and IUS scores (r = 0.39, P < 0.001).

Conclusions

Our results underline the susceptibility to cyberchondria and intolerance of uncertainty among young adults who used less reliable online health information sources and highlight promoting online health literacy to reduce vulnerabilities and the need for further research on socio-demographic determinants in both mental problems.

Does Health Literacy Protect Against Cyberchondria: A Cross-Sectional Study?

Introduction: The use of online health resources and self-diagnosis intensified during the COVID-19 pandemic, often resulting in symptoms of cyberchondria. However, little is still known about this phenomenon's real scale and determinants. The aim of the study was to examine the prevalence of cyberchondria among adult internet users in Poland. Furthermore, the study was focused on analyzing the determinants of cyberchondria, with special regard to health literacy (HL) and e-health literacy (eHL). Methods: The analysis was based on data from a computer-assisted web-based interviewing survey performed with a sample of 1,613 internet users. Uni- and multivariable linear regression models were developed for potential determinants of cyberchondria. Results: Younger respondents were more likely to have higher cyberchondria scores than older respondents. Men were more likely to have lower cyberchondria scores than women. Higher health anxiety was significantly associated with cyberchondria severity. In the multivariable regression model, the severity of cyberchondria was significantly higher among respondents with inadequate rather than sufficient HL (B = 6.24, p < 0.001). In turn, greater eHL was significantly correlated with more severe cyberchondria (B = 0.92, p < 0.001). Conclusions: Our study confirmed that HL may be perceived as a protecting factor against cyberchondria. Unexpectedly, higher eHL predicts more severe cyberchondria.

Cyberchondria severity and utilization of health services in Polish society: a cross-sectional study

BACKGROUND

It has been suggested that cyberchondria leads to increased utilization of healthcare services. Unfortunately, not many studies have analyzed this effect comprehensively. The aim of this study was to analyze the relationship between cyberchondria severity and the utilization of healthcare services among adult Internet users after adjusting for sociodemographic characteristics and the health status of respondents.

METHODS

The analysis detailed in this paper examined data from a computer-based, web-based interviewing survey performed among a representative sample of 1613 Polish Internet users. Cyberchondria severity was assessed with the Cyberchondria Severity Scale (CSS). The variables reflecting the use of healthcare services were based on the frequency of visits to family physicians and specialists, diagnostic procedures, hospital admissions, and emergency services, and finally being vaccinated against COVID-19. The effect of cyberchondria severity on the utilization of healthcare services and alternative medicine was adjusted for key sociodemographic variables, the presence of chronic diseases, disability, and unspecific symptoms. For variables reflecting the use of services, ordinal logistic regression and multivariable logistic regression models were developed.

RESULTS

Cyberchondria severity was a significant predictor of the utilization of all but one of the analyzed healthcare services and alternative medicine. The odds of being in a higher category of the utilization of visits to family physicians and specialists, hospital admissions, emergency services and alternative medicine services increased by a factor of 1.01-1.02 for every unit increase of the cyberchondria score. The cyberchondria score was a negative predictor of COVID-19 vaccine uptake. The effect of cyberchondria on outcome variables was independent of the level of health anxiety, sociodemographic variables, and variables reflecting the health status of respondents.

CONCLUSIONS

Cyberchondria leads to more intensive use of nearly all healthcare services, but in the case of vaccination against COVID-19, cyberchondria severity was a negative predictor. Cyberchondria's effect extends beyond health anxiety.

Is cyberchondria specific to hypochondriasis?

Cyberchondria (i.e., excessive health-related Internet search linked to psychological distress) is usually associated with health anxiety, but relationships with other psychopathological symptoms were also found. However, studies are lacking in patients with hypochondriasis, and it remains unclear whether cyberchondria and its subfacets are specific to hypochondriasis (i.e., higher levels in hypochondriasis compared to other mental disorders). Patients with hypochondriasis (N = 50), a clinical (N = 70), and a healthy comparison group (N = 51) completed two questionnaires on cyberchondria whose combined 17 subscales were reduced to three relevant cyberchondria subfacets by second-order factor analysis. The cyberchondria subfacet emotional distress/negative consequences linked to health-related Internet searches showed significantly higher scores in patients with hypochondriasis than in the two comparison groups (d ≥ 1.7) and was the only predictor of dimensional health anxiety (β = .58, p ≤ .001). The two subfacets type/extent of health-related Internet searches and characteristics of the Internet (e.g., attitude toward unreliability, vast amounts of information) were less specifically associated with hypochondriasis. The results are consistent with models of cyberchondria and hypochondriasis, particularly on the anxiety-reinforcing vicious circle and maintaining factors. Based on the findings, practical implications are discussed.

The digital health dilemma: Exploring cyberchondria, well-being, and smartphone addiction in medical and non-medical undergraduates

BACKGROUND

The Internet is a popular source of health information, but too much research can cause anxiety (cyberchondria). Medical and non-medical personnel interpret information differently, leading to varying rates of cyberchondria. Smartphone addiction may also contribute to cyberchondria and impact mental health.

METHODS

The study was an epidemiological survey-based investigation with a cross-sectional design involving undergraduate students (aged 18 years or older) from Indian universities or colleges. The study utilized the Cyberchondria Severity Scale-Short Form (CSS-12), WHO-5 well-being index, and Smartphone Addiction Scale-Short Version (SAS-SV).

RESULTS

A total of 1033 participants (53.1% females and 46.4% males) were recruited in the survey. Of the participants, 58.5% were pursuing medical or paramedical courses, while the remaining 41.5% belonged to the non-medical group. High-severity cyberchondria was present in about 4.4% of the students. The medical cohort demonstrated a significantly lower cumulative CSS in comparison to the non-medical cohort (t = - 3.90; P < 0.01). Smartphone addiction was observed in 57.2% of individuals in the medical group and 55.9% of individuals in the non-medical group (P = 0.68). Medical students had a significantly lower mean well-being score compared to non-medical students (58.4 vs. 59.6; P < 0.01). There was a positive correlation between cyberchondria severity and smartphone addiction, which was consistent across both groups.

CONCLUSION

Medical students have less cyberchondria than non-medical students. Cyberchondria severity is linked to smartphone addiction. Non-medical students with cyberchondria have higher subjective well-being.

The relationship between orthorexia nervosa and cyberchondria levels in nurses: A cross-sectional study

PURPOSE

The study was conducted with the aim of investigating the relationship between orthorexia nervosa and cyberchondria levels among nurses.

METHODS

This cross-sectional study was conducted with 399 nurses through face-to-face interviews. The data were collected using a participant information form, the Cyberchondria Severity Scale, and the Orthorexia Nervosa-11 scale (ORTO-11).

RESULTS

The mean score of the nurses' cyberchondria severity scale was 73.95 ± 18.53, while the mean score of the Orthorexia Nervosa-11 scale was 28.23 ± 4.76. In the study, a low negative correlation was found between the cyberchondria and orthorexia nervosa levels (p < 0.05).

CONCLUSIONS

The increase in the level of cyberchondria among nurses increases the risk of orthorexia nervosa. Therefore, it is recommended that nurses receive proper nutritional education and psychosocial support to reduce their tendency towards orthorexia nervosa and cyberchondria.

Research and Evaluation of a Cyberchondria Severity Scale in a Chinese Context

Purpose

Cyberchondria is a problematic or unhelpful behavior pattern that describes excessive or repetitive online health-related information searching related to an enhanced level of health anxiety. Such internet-derived medical anxiety can manifest itself in different ways across cultures. This study explores the unique nature of cyberchondria in the context of Chinese culture, identifying the risk factors for the condition and the possible negative outcomes.

Methods

An exploratory factor analysis (EFA) was used to explore whether the structure of the Chinese version of the Cyberchondria Severity Scale (C-CSS) is different from that in western context. Subsequently, a confirmatory factor analysis (CFA) was used to verify the model fit of the C-CSS. Finally, a series of regression analysis were used to test the relationship between cyberchondria and its antecedent variables and consequence variables in Chinese context.

Results

Retained 18 items and revised to 3 dimensions (Negative Effects, Excessiveness and Reassurance Seeking), the Chinese version of the Cyberchondria Severity Scale (C-CSS) was developed. In the context of China, the three antecedents were also effective predictors of cyberchondria, and C-CSS is also related to theoretically relevant outcomes.

Conclusion

This study initially demonstrated the validity, reliability and applicability of C-CSS to assess the severity of cyberchondria among Chinese undergraduates.

The short-form of the Cyberchondria Severity Scale (CSS-12): Adaptation and validation of the Spanish version in young Peruvian students

BACKGROUND

Cyberchondria is defined as the increase in health-related anxiety or anguish associated with excessive or repeated online searches for health-related information. Our objective was to cross-culturally adapt and validate the CSS-12 scale for Peruvian Spanish speakers, to determine whether the Bifactor model works as well in our population as in previous studies' and to explore whether the Bifactor-ESEM is a more suitable model.

METHODS

We performed a cultural adaptation using the Delphi method and a validation study on medical students between 2018 and 2019. Reliability was evaluated by using Cronbach's alpha (α) and McDonald's omega (Ω) for internal consistency, and Pearson's r and intraclass correlation coefficient (ICC), for test-retest reliability. We evaluated construct validity by contrasting four measurement models for the CSS-12 and the convergent validity against health anxiety.

RESULTS

The Spanish CSS-12 showed excellent reliability (α = .93; Ω = .93; ICC = .93; r = .96). The Bifactor ESEM model showed the best fit, supporting a unidimensional measure of the general cyberchondria. This measure was positively associated with health anxiety (r = .51).

CONCLUSIONS

The Spanish CSS-12 provides a valid and reliable unidimensional measure of cyberchondria, which is distinguishable from the more general health anxiety. This can be applied to similar populations and future research. The Bifactor-ESEM model appears to offer a more accurate and realistic representation of the multifaceted nature of cyberchondria. We provide a free-to-use form of the Spanish CSS-12 as supplemental material.

Investigation of the relationship between depression, cyberchondria levels and the quality of life of female students during the COVID-19 pandemic

This study aimed to explore the correlation between cyberchondria levels, depression risk, and the quality of life among female students amidst the COVID-19 pandemic. The research was conducted with 534 female students enrolled in a public university. Participants were asked to complete a Personal Information Form, Cyberchondria Severity Scale (CSS), Beck Depression Inventory (BDI), and "Short Form-36 (SF-36)" questionnaire. The findings from the multiple linear regression analysis revealed that the level of cyberchondria increased the depression risk by 0.06 times among students. Additionally, nonsmokers were found to have a depression risk that was 4.06 times lower than smokers. A negative and weak correlation was observed between the total score of the CSS and the SF-36 survey. Based on the study's results, it can be concluded that the participants exhibited a moderate level of cyberchondria. Moreover, the study revealed a decreased quality of life and an increased risk of depression in participants as their level of cyberchondria increased. In order to mitigate the adverse impact of current and future health crises, it is imperative to prioritize organizing educational programs aimed at enhancing the e-health literacy level among female students, along with interventions to manage cyberchondria behaviors.

Validation of the Arabic version of the cyberchondria severity scale 12 items (CSS-12-Ar) among a sample of Lebanese adults

BACKGROUND

To the best of our knowledge, the Cyberchondria Severity Scale-12 (CSS-12) has not been translated into Arabic; therefore, our objective was to assess the psychometric properties of the Arabic version of the CSS (CSS-12-Ar) among a sample of Lebanese adults.

METHODS

Participants were enrolled in January 2021. A confirmatory factor analysis (CFA) was carried out using the MPlus software v.7.2, reporting several goodness-of-fit indicators: Relative Chi-square (χ2/df), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI) and Tucker Lewis Index (TLI). To evaluate measurement invariance across gender, we conducted higher-order multiple group confirmatory analysis using lavaan software.

RESULTS

449 participants enrolled in this study (mean age: 24.34 ± 8.22 years, 70.6% females). Since the correlations between the four-factor model were very high (r > 0.8), we ran the higher-order CFA in which all first-order latent variables were loading a general factor. The analyzed model was well-fitted to the data χ2(50) = 173.34; p < 0.001; CFI = 0.926; RMSEA = 0.074 [0.062, 0.086]. The Cronbach's alpha values were good for the total score (0.92), as well as for excessiveness (0.80), distress (0.77), reassurance (0.81) and compulsion (0.76). The results provided evidence of full scalar invariance across gender. The comparison of latent mean scores revealed no significant differences across gender, in either the cyberchondria total score or its facets. The CSS-12 score was positively associated with anxiety (r = 0.10; p = 0.003) (convergent validity), OCD (r = 0.11; p = 0.016) and stress (r = 0.35; p < 0.001) (concurrent validity).

CONCLUSION

The CSS-12-Ar was deemed a suitable scale to measure the severity of cyberchondria among Lebanese university students. We hope that researchers and clinicians can benefit now from this scale.

COVID-19 era-related e-learning: a cross-sectional web-scale study of cyberchondria, internet addiction and anxiety-related symptomatology among university nursing students

OBJECTIVE

The study assessed COVID-19 era-related e-learning cyberchondria, internet addiction and anxiety-related symptomatology among nursing students. The relationships, predictors and differences between the studied concepts were measured.

DESIGN

In 2021, a quantitative cross-sectional research design using a web survey with a sample size of 333 nursing students yielded a response rate of 70%.

RESULTS

Nursing students had a moderate level of cyberchondria, low to moderate internet addiction, a moderate to severe level of anxiety and depression, and a normal stress level. Demographic characteristics, cyberchondria, internet addiction and anxiety-related symptomatology were significantly correlated. Grade point average, age, type of organisation where the students were trained and level of education were significant predictors of the studied variables. Significant differences in the studied concepts were found based on the sample's characteristics such as gender, type of organisations or universities where the students were trained or studied, and age.

CONCLUSION

Cyberchondria, internet addiction, depression, anxiety and stress symptomatology are troublesome. Higher education organisations might benefit from examining the variables of interest and investigating the relations between internet addiction and depression and anxiety symptomatology among nursing students. Such research will aid in tailoring treatments to assist vulnerable students by targeting counselling and educational efforts toward building a future generation of nurses with reduced cyberchondria, internet addiction and anxiety-related symptomatology.

Effects of the Fear of COVID-19 and Efficacy of Coping Behavior for Infectious Diseases after the End of COVID-19: Moderating Effects of Cyberchondria and eHealth Literacy

As the coronavirus disease (COVID-19) pandemic ends, it is worth considering whether the ability to cope with such a pandemic has improved. The initial response to COVID-19 was hampered by the fear of new infectious diseases and spread of misinformation on the Internet. This highlights the need to enhance our ability to critically evaluate information rather than indiscriminately search for and trust information on the Internet. Therefore, this study examined how cyberchondria and eHealth literacy moderate the effect of fear of COVID-19 on the efficacy of coping behaviors for future epidemics and pandemics. The participants were 1000 adults in South Korea who were selected based on population proportionality. The results showed that fear of COVID-19 was significantly positively related to cyberchondria, and eHealth literacy was significantly positively related to the efficacy of coping behaviors. Further, the fear of COVID-19 had a significantly negative effect on the efficacy of coping behaviors, and the moderating effect of cyberchondria varied according to the level of eHealth literacy. These results emphasize the importance of eHealth literacy in enabling critical decision-making regarding misinformation.

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.

Cyberchondria and Chinese Adolescent Mental Health in the Age of COVID-19 Pandemic

One of the far-reaching impacts of the COVID-19 pandemic is that it has become the fertile soil of cyberchondria. Adolescents' mental health was severely hit by this by-product of the COVID-19 pandemic both due to the direct effects and its indirect effects on security. This study investigated whether and how cyberchondria was associated with Chinese adolescents' mental health (i.e., well-being and depressive symptoms). Based on a large Internet sample (N = 1,108, 67.5 percent female, M_age = 16.78 years), cyberchondria, psychological insecurity, mental health, and a series of covariates were assessed. Preliminary analyses were conducted in SPSS Statistics software and main analyses were conducted in Mplus. Path analyses indicated that (a) cyberchondria was negatively associated with well-being (b = -0.12, p = 0.001) and positively associated with depressive symptoms (b = 0.17, p < 0.001); (b) psychological insecurity could fully mediate the association between cyberchondria and mental health (indirect effect _well-being = -0.15, 95% confidence interval [CI -0.19 to -0.12] and indirect effect _{depressive symptoms} = 0.15, 95% CI [0.12 to 0.19]); (c) the two dimensions (social insecurity and uncertainty) of psychological insecurity could play the mediating role in the associations between cyberchondria and mental health, uniquely and parallelly; and (d) these results did not vary by gender. This study suggests that cyberchondria may arouse individuals' psychological insecurity about interpersonal interaction and the development of events, which ultimately decreases their well-being and increases the risk of depressive symptoms. These findings facilitate the establishment and implementation of relevant prevention and intervention programs.

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.

The Relationship between Orthorexia Nervosa and Obsessive Compulsive Disorder

Orthorexia nervosa (ON) is characterized by an intense avoidance of foods considered unhealthy, obsession with healthy eating behaviors, and pathological fixation on healthy foods. Although there are still debates in the literature about the psychological factors and symptoms of ON, it should be noted that many of the symptoms share common features with obsessive compulsive disorder (OCD). The aim of the present study was to investigate the relationship between ON and OCD with its subtypes. In this framework, the cross-sectional study was conducted with an opportunistic sample of 587 participants (86% women and 14% men), with an average age of 29.32 (s.d. = 11.29; age range = 15-74). Our work showed that almost all OCD subtypes were largely correlated with ON. The lowest correlation was for "Checking" and the highest for "Obsession". Overall, the OCD subtypes (i.e., Indecisiveness, Just Right, Obsession, and Hoarding) were more strongly associated with ON measures, while subtypes Checking and Contamination, although positively associated, had lower correlation coefficients.

Predictors of Cyberchondria during the COVID-19 pandemic: A cross-sectional study using supervised machine learning

BACKGROUND

Cyberchondria is characterized by repeated and compulsive online searches for health information, resulting in increased health anxiety and distress. It has been conceptualized as a multi-dimensional construct fueled by both anxiety and compulsivity-related factors and described as a "transdiagnostic compulsive behavioral syndrome" which is associated with health anxiety, problematic internet use and obsessive-compulsive symptoms. Cyberchondria is not included in the ICD-11 or the DSM-5, and its defining features, etiological mechanisms and assessment continue to be debated.

OBJECTIVE

This study aimed to investigate changes in the severity of cyberchondria during the pandemic and identify predictors of cyberchondria at this time.

METHODS

Data collection started on May 4, 2020 and ended on June 10, 2020, which corresponds to the first wave of the COVID-19 pandemic in Europe. At the time the present study took place, French-speaking countries in Europe (France, Switzerland, Belgium and Luxembourg) all implemented lockdown or semi-lockdown measures. The survey consisted of a questionnaire collecting demographic information (sex, age, education level and country of residence) and information on socioeconomic circumstances during the first lockdown (e.g., economic situation, housing and employment status), and was followed by several instruments assessing various psychological and health-related constructs. Inclusion criteria for the study were being at least 18 years of age and having a good understanding of French. Self-report data were collected from 725 participants aged 18 to 77 years (mean 33.29, SD 12.88 years), with females constituting the majority (416/725, 57.4%).

RESULTS

The results show that the COVID-19 pandemic affected various facets of cyberchondria: cyberchondria-related distress and interference with functioning increased (distress z=-3.651, P<.001; compulsion z=-5.697, P<.001), whereas the reassurance facet of cyberchondria decreased (z=-6.680, P<.001). Also, COVID-19-related fears and health anxiety emerged as the strongest predictors of cyberchondria-related distress and interference with functioning during the pandemic.

CONCLUSIONS

These findings provide evidence about the impact of the COVID-19 pandemic on cyberchondria and identify factors that should be considered in efforts to prevent and manage cyberchondria at times of public health crises. Also, they are consistent with the theoretical model of cyberchondria during the COVID-19 pandemic proposed by Starcevic and his colleagues in 2020. In addition, the findings have implications for the conceptualization and future assessment of cyberchondria.

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.

The relation between digital literacy, cyberchondria, and parents' attitudes to childhood vaccines

PURPOSE

This study aimed to examine the relationship between digital literacy, cyberchondria and parents' hesitancy about childhood vaccines.

DESIGN AND METHODS

The study was cross-sectional, and parents with children aged 3-5 years who had access to the questionnaire were sent online and volunteered to participate.

RESULTS

The total mean score of the Parents' Attitude to Childhood Vaccines Scale was 44.89 ± 14.99, 31.3% of the parents were hesitant about childhood vaccines. Parental hesitancy about childhood vaccinations was 3.26 times (95% CI, 1.56-6.81) for single participants and 2.77 times (95% CI, 1.33-5.74) for the participants with a high school diploma than primary school graduates, 4.69 times for the participants who did not have a healthcare professional in their family (95% CI, 2.08-10.59), 16.02 times (95% CI, 6.61-10.80) for the participants who did not have a full round of vaccines, 1.81 times higher (95% CI, 1.13-2.88) than the participants who did not have enough information about vaccines. Hesitancy increased as the cyberchondria severity score increased (95% CI, 1.02-1.09), and digital literacy decreased (95% CI, 0.34-0.87).

CONCLUSIONS

One-third of the parents had hesitations about childhood vaccines. Vaccine hesitancy is affected negatively by digital literacy and positively by cyberchondria.

PRACTICE IMPLICATION

Meeting parents' accurate and reliable vaccine information will positively affect their attitudes and behaviours. Therefore, the level of cyberchondria among parents should be reduced, and their digital literacy should be increased.

Health-Related Cognitions and Metacognitions Indirectly Contribute to the Relationships Between Impulsivity, Fear of COVID-19, and Cyberchondria

The aim of the study was to converge a structural equation model to unfold the compositive relationships between trait impulsivity, health cognitions, metacognitions about health, fear of COVID-19 and cyberchondria, after controlling for gender, age, marital status, having a chronic illness and chronic illness among first-degree relatives. Six hundred fifty-one participants (423 females, 65%; 228 males, 35%) participated in the study. The Short UPPS-P Impulsive Behavior Scale (S-UPPS-P), Health Cognitions Questionnaire (HCQ), The Meta-Cognitions about Health Questionnaire (MCQ-HA), Cyberchondria Severity Scale -Short Form (CSS-12), and Fear of COVID-19 Scale (FCV-19 S) were completed by volunteered participants. The structural model showed that the S-UPPS-P directly and indirectly contributed to the HCQ, MCQ-HA, CSS-12, and FCV-19 S. The multi-group structural analysis by gender showed that the structural model had a partial measurement and factorial invariance. We concluded that the significant associations between impulsivity, fear of COVID-19 and cyberchondria were indirectly contributed by health-related cognitions and metacognitions.

Cyberchondria and COVID-19 anxiety and internet addiction among nursing students

This study was conducted to determine the relationship between cyberchondria and COVID-19 anxiety and internet addiction in nursing students. This cross-sectional study was conducted with 843 students studying in the nursing department of Adnan Menderes University. The mean age of the students was 20.8 ± 1.72 years and 61.2% were female. The Cyberchondria Severity Scale-Short Form, Coronavirus Anxiety Scale, and the Young Internet Addiction Test-Short Form were used to collect data. The study found a positive association between internet addiction, cyberchondria severity, and anxiety about COVID-19. It was found that the anxiety of COVID-19 had a mediating role in the association between internet addiction and cyberchondria severity. It was found that the use of the internet as a source of information on health problems and trusting the health information found had a significant effect on high cyberchondria levels (p < 0.05). Taken together, the findings of previous studies and this study on the role of the association between internet addiction and cyberchondria exacerbating anxiety due to the pandemic provide further evidence for healthcare professionals that greater focus is needed on the problems of the new era related to people-internet interaction. To reduce the negative effects of the current health crisis and future health crises, interventions for nursing students to control their internet use and cyberchondria behaviors should be prioritized.

How cyberchondria and decision self-efficacy shapes the acceptability of COVID-19 vaccine: A gender-based comparison

Objective

Alarmingly, the individuals' reach and coverage to get vaccinated in developing regions during the pandemic is a massive challenge for concerned authorities. This study aimed to demonstrate how cyberchondria play a significant role in a classical health belief model. Cyberchondria may influence cognitive factors (e.g. self-efficacy), which may contribute to an increase in attitude-behavior gap. Especially in the context of a health-centric scenario, it may discourage individuals to take protective measures.

Method

By using the cross-sectional research design, the authors conducted a quantitative survey in Pakistan and collected 563 responses from 303 male respondents (rural = 91; urban = 212) with (Urban M:35.5, standard deviation (SD):13.4) and rural M:37.5, SD:8.4).

Result

The findings indicate that decision self-efficacy among males is stronger than that in females. It dominates other determinants, which can dampen the individuals' intentions to get vaccinated. For instance, the effect of conspiracies and perceived seriousness was noted nonsignificant and weak. In females, perceived seriousness was stronger determinant than in males. In addition, the negative effect of decision self-efficacy was noted in the case of females, and conspiracy and cyberchondria had a negative role.

Conclusion

This study highlights valuable implications for future research in infodemic, health communication and health literacy, and practical implications for regulatory bodies and public administration.

The association between fear of Covid-19 and smartphone addiction among individuals: the mediating and moderating role of cyberchondria severity

The coronavirus disease-2019 (COVID-19) has quickly spread all over the world and has contributed to psychological consequences including fear of the virus. Depending upon the severity of their problems, individuals often search the internet via their mobile devices to understand whether the symptoms they perceive are symptoms of the disease. This condition has been termed 'cyberchondria'. In this context, the aim of this study is examine the mediating and moderating role of cyberchondria severity in the association between smartphone addiction and the fear of COVID-19. The sample comprised 520 participants (335 females [64.4%], 185 males [35.6%] aged 17 to 65 years [Mean = 28.61 years, SD = 10.60]). A survey included the Cyberchondria Severity Scale Short-Form, The Smartphone Addiction Scale-Short Version, and The Fear of COVID-19 Scale. Structural equation modeling and SPSS Process Macro moderator variable analysis were used to test the research model. The study found a positive association between smartphone addiction, fear of COVID-19, and cyberchondria severity. Cyberchondria severity had both moderating and mediating role in the association between smartphone addiction and the fear of COVID-19. In conclusion, it has been determined that during the COVID-19 pandemic, cyberchondria severity has negative effects on individuals' fear of COVID-19.

Digitalization and Urological Diseases: Severity of Cyberchondria and Level of Health Anxiety in Patients Visiting Outpatient Urology Clinics

This study aimed to evaluate the cyberchondria levels of patients who applied to the urology outpatient clinic. The second goal of this study was to evaluate the relationship between cyberchondria severity and health anxiety in these patients. The present prospective observational study was conducted at the urology outpatient clinic of two tertiary centers in our city between September and December 2021. Eligible patients were the adult patients (>18 and ≤60 years) who used the Internet for health purposes and had no self-reported psychological or mental disease. The patients were divided into following groups according to their complaints: general urology, uro-oncology, andrology, functional urology, and endourology (stone disease). The level of cyberchondria and health anxiety was evaluated for these patients by using the Short Health Anxiety Inventory (SHAI) and a short-form version of the Cyberchondria Severity Scale (CSS-12). This study enrolled 578 patients (190 female, 388 male). The mean age of patients was 43.4 ± 13.3 years (18-60 years). The mean CSS-12 was 28.1 ± 12.1, and the mean value of SHAI was 18.9 ± 13.6. The patients had andrological symptoms, is uniquely related to higher CSS and health anxiety, and followed by uro-oncological diseases. However, the least relationship was observed in patients with functional urological diseases (analysis of variance [ANOVA], p < 0.001 for CSS-12; p < 0.001 for SHAI). In addition, a positive correlation was observed between the CSS and SHAI (Pearson's correlation = 0.782). The increased level of cyberchondria causes increased health anxiety and an increased disease burden in these patients. Therefore, physicians should consider this increased treatment burden during the treatment of patients.

Identifying the Effect of Digital Healthcare Products in Metaverse on Mental Health: Studying The Interaction of Cyberchondria and Technophobia

Objectives: Metaverse has emerged as an innovative social media platform and Internet applications which integrates several cutting-edge technologies. It possesses connectedness, hyper spatio-temporality, and several technology attributes. The metaverse also can potentially reinvent health's digital and practical prospects, much as the Internet drastically changed that industry. Major ramifications will follow for both our well-being and the provision of healthcare. In China, after the emergence of the pandemic, there is a substantial need for digital healthcare services since the interaction between hospitals and people requiring consultation is minimal. The current study will examine the impact of digital healthcare products in the metaverse on mental health while considering the moderating effect of cyberchondria and technophobia. The need for more resources and increased demand for healthcare services creates difficulty in promptly delivering services to the needy. Metaverse and its technology can improve the performance of the current healthcare system. Methods: The research utilized a quantitative survey- based method in the healthcare sector among staff members. Of 330 questionnaires distributed, 307 were collected and analyzed through SPSS and AMOS. Results: The analysis signified a strong and significant association between digital healthcare products and mental health in the metaverse, along with the considerable moderation of technophobia. Conclusion: The paper can improve healthcare sector staff members' provision practices and mental health. It can provide cost-effective solutions to the sector.

The role of emotional functioning in the relationship between health anxiety and cyberchondria

Access to health information can have positive effects in the form of increased health awareness. However, self-diagnosis based on information available on websites can be dangerous, causing distress as an increasing amount of time is spent on searching. The main aim of the study was to determine the role of emotional functioning in the relationship between health anxiety and cyberchondria. The study included N = 615 participants aged 18 to 83 years (M = 43.86, SD = 14.57). The authors used the Cyberchondria Severity Scale, the Short Health Anxiety Inventory, the Life Orientation Test, the Difficulties in Emotion Regulation Scale, and the Kessler 6 Psychological Distress Scale. The results demonstrate that health anxiety is significantly related to cyberchondria and that pessimism and difficulties in emotion regulation act as mediators in this relationship.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-04126-3.

Cyberchondria, Anxiety Sensitivity, Hypochondria, and Internet Addiction: Implications for Mental Health Professionals

Repetitive online searches for health information increase anxieties and result in Internet addiction. Internet addiction, cyberchondria, anxiety sensitivity, and hypochondria have been studied separately, but how these concepts are reciprocally linked has not been investigated. This study aimed to determine the levels, correlations, and predictors of Internet addiction, cyberchondria, anxiety sensitivity, and hypochondria among students based on the sample's characteristics. A sample of 143 university students participated in this cross-sectional online survey. A self-reported questionnaire was employed to collect data from students. The studied concepts had moderate to high correlations with each other and with the students' characteristics. Not getting infected with the coronavirus was among the demographic factors inserted into the regression model that only predicted cyberchondria. The model of cyberchondria was significant and explained 11.5% of the variance in the score of concepts. The results of the standard regression analysis indicated that the model predicting Internet addiction accounted for 41.2% of the variability. Our unique findings indicate that cyberchondria can contribute to developing Internet addiction compared to earlier studies. The findings suggest the importance of empowering students to overcome their anxieties by managing cyberchondria and Internet addiction. Mental health professionals, namely psychiatric nurses, are at the forefront of taking preventive mental health measures on campus, such as screening and referring students who exhibit these problems to psychological support and counseling to cope with their anxieties.

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.

Advances in problematic usage of the internet research - A narrative review by experts from the European network for problematic usage of the internet

Global concern about problematic usage of the internet (PUI), and its public health and societal costs, continues to grow, sharpened in focus under the privations of the COVID-19 pandemic. This narrative review reports the expert opinions of members of the largest international network of researchers on PUI in the framework of the European Cooperation in Science and Technology (COST) Action (CA 16207), on the scientific progress made and the critical knowledge gaps remaining to be filled as the term of the Action reaches its conclusion. A key advance has been achieving consensus on the clinical definition of various forms of PUI. Based on the overarching public health principles of protecting individuals and the public from harm and promoting the highest attainable standard of health, the World Health Organisation has introduced several new structured diagnoses into the ICD-11, including gambling disorder, gaming disorder, compulsive sexual behaviour disorder, and other unspecified or specified disorders due to addictive behaviours, alongside naming online activity as a diagnostic specifier. These definitions provide for the first time a sound platform for developing systematic networked research into various forms of PUI at global scale. Progress has also been made in areas such as refining and simplifying some of the available assessment instruments, clarifying the underpinning brain-based and social determinants, and building more empirically based etiological models, as a basis for therapeutic intervention, alongside public engagement initiatives. However, important gaps in our knowledge remain to be tackled. Principal among these include a better understanding of the course and evolution of the PUI-related problems, across different age groups, genders and other specific vulnerable groups, reliable methods for early identification of individuals at risk (before PUI becomes disordered), efficacious preventative and therapeutic interventions and ethical health and social policy changes that adequately safeguard human digital rights. The paper concludes with recommendations for achievable research goals, based on longitudinal analysis of a large multinational cohort co-designed with public stakeholders.

The role of base-rate neglect in cyberchondria and health anxiety

Cyberchondria is characterized by excessive health-related online search behavior associated with an unfounded escalation of concerns about common symptomatology. It often co-occurs with health anxiety. We investigated whether base-rate neglect-the cognitive bias to ignore a priori probabilities (e.g., of serious diseases)-plays a significant role in cyberchondria and health anxiety. 368 participants were randomly assigned to eight experimental conditions, manipulating the base-rate (30 % vs. 70 %), the judgment domain (health-neutral versus health-related), and the salience of base-rate information (low vs. high) in a 2×2×2 between-subjects design when asking them for probability judgments with versus without disease relevance. We found that high salience decreased base-rate neglect in participants with low, but not in those with elevated levels of either cyberchondria or health anxiety. Under low salience conditions, however, both cyberchondria and health anxiety severity were uncorrelated with base-rate neglect. These effects were independent of whether health-related or health-neutral problems were evaluated. Our findings suggest a domain-general probabilistic reasoning style that may play a causal role in the pathogenesis of cyberchondria and health anxiety.

Prevalence of Cyberchondria among Outpatients with Metabolic Syndrome in a Tertiary Care Hospital in Southern India

Background. In today’s world, Internet-based medical information plays a significant role in patient education. There are several accessible health-related websites. It has become common to search Internet before going for a medical consultation. The main objective of this study was to determine the prevalence of cyberchondriasis and its association with demographic variables. Methods. A cross-sectional study was carried out among metabolic syndrome patients attending the cardiology, endocrinology, and neurology outpatient departments of a tertiary care hospital in South India. The prevalence of cyberchondriasis and its constructs were measured using the cyberchondria severity scale (CSS). Inferential statistics revealed no statistically significant difference in the average CSS scores across sociodemographic variables. Spearman correlation was conducted to determine the relationship between the constructs. Results. A total of 379 participants with metabolic syndrome were included in the study. 42.5% of them were severely affected, and 28.0% were moderately affected by cyberchondriasis. Among the constructs studied, compulsion (85.7%), distress (91.8%), excessiveness (96.6%), and reassurance (76.1%) constructs had an impact on a greater number of study participants, compared to mistrust of medical professional construct (33.0%). Cyberchondriasis had a significant relationship with the history of myocardial infarction (p value = 0.03). There was a statistically significant positive linear relationship between mistrust and reassurance (rs = 0.169, p value<0.001). Reassurance had a significant negative linear relationship with distress (rs = −0.147, p value = 0.004). Conclusion. In India, cyberchondriasis is a growing public mental health issue. Awareness among the general population is necessary to minimize the possible outcomes of cyberchondriasis like anxiety and depression. Screening individuals for possible risk factors is recommended.

The Doctor Is In(ternet): The Mediating Role of Health Anxiety in the Relationship between Somatic Symptoms and Cyberchondria

Cyberchondria is a dysfunctional behavioral pattern characterized by an excessive and anxiety-amplifying engagement in searching for reassuring health information on the Internet. Research demonstrated that somatic symptoms and health anxiety might foster maladaptive health-related behaviors, such as cyberchondria. However, the relationships between somatic symptoms, health anxiety, and cyberchondria have been scarcely examined. Accordingly, this study aimed to test the mediating effect of health anxiety on the association between somatic symptoms and cyberchondria. Four hundred and thirty-one adults from the community (158 males, 36.66%), aged between 18 and 74, were recruited via an online survey. Participants completed self-report measures of somatic symptoms, health anxiety, and cyberchondria. A mediation analysis demonstrated that the severity of somatic symptoms predicted increased levels of cyberchondria and that health anxiety partially mediated this association. Therefore, interventions aimed at decreasing health anxiety may also play a role in decreasing the risk of developing cyberchondria.

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.

Family Dysfunction and Cyberchondria among Chinese Adolescents: A Moderated Mediation Model

Cyberchondria has become a severe health problem and a significant public concern. In addition to the impacts that cyberchondria involves, individual psychological and behavioral factors have been identified. However, the role of family function and the mediating and moderating mechanisms underlying these relations are not understood well, especially among adolescents. Based on family functioning and cognitive-behavioral theory, this study sought to examine whether family dysfunction was associated with cyberchondria, and a moderated mediation model was prepared as a means of exploring whether health anxiety was a mediator of relationships between family dysfunction and cyberchondria, as well as whether optimism moderated these mediating processes. A total of 2074 Chinese adolescents (mean = 15.08 years, SD = 1.79) reported their demographic information, family dysfunction, health anxiety, optimism, and cyberchondria. The findings showed that family dysfunction was positively related to cyberchondria. Moreover, health anxiety partially mediated the relationship between family dysfunction and cyberchondria. Finally, optimism moderated the interplay among health anxiety and cyberchondria. Consistent with the expectancy-value models, this positive relationship was weaker for adolescents with a higher level of optimism. These results suggest that it is vital to simultaneously consider individual and family factors as a means of understanding adolescent cyberchondria when performing cyberchondria intervention programs.