Validation of the Cyberchondria Severity Scale (CSS): replication and extension with bifactor modeling

Dimensionality in confirmatory factor analysis is not in the eye of the beholder: Ancillary bifactor statistical indices illuminate dimensionality and reliability

This tutorial delves into dimensionality assessment within the context of psychological measurement instruments, particularly focusing on bifactor models. It underscores the imperative to move beyond traditional fit indices when evaluating factor structures while highlighting the significance of ancillary bifactor indices such as explained common variance, OmegaH and percentage of uncontaminated correlations in gaining a more comprehensive understanding of the interplay between general and specific group factors. The tutorial offers a step-by-step guide to leveraging the power of R software for confirmatory factor analysis and the acquisition of ancillary bifactor indices. Through practical case studies, it elucidates the potential pitfalls of exclusively relying on fit indices and advocates for a balanced, multifaceted approach to dimensionality assessment. By integrating fit measures and ancillary indices, researchers can draw more informed and nuanced conclusions about measurement instrument dimensionality, ultimately enhancing the precision of psychological assessment.

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.

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.

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 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.

Cyberchondria levels in women with human papilloma virus

AIM

To investigate the level of cyberchondria in patients with high-risk human papilloma virus (HPV) positivity.

METHODS

One hundred and forty women who applied to our clinic between July 2020 and September 2020 and were diagnosed with high-risk HPV positivity or abnormal uterine bleeding (AUB) were included in the study. The Cyberchondria Severity Scale (CSS) was administered face-to-face to the participants. CSS and subscales scores of both groups of patients were evaluated and compared.

RESULTS

The mean score of the patients on the CSS was 78.54 ± 22.09 and the patients with AUB and HPV(+) was 67.43 ± 19.87 and 84.16 ± 21.08, respectively. The mean subscale scores were as follows, compulsion 13.89 ± 6.49, distress 20.07 ± 7.54, excessiveness 22.40 ± 8.18, reassurance 15.07 ± 6.56, and mistrust of medical professionals 7.26 ± 3.62. The mean scores of the CSS and subscales except for the mistrust of medical professional subscale were higher in patients who were HPV-positive than in other patients.

CONCLUSIONS

Women with HPV have higher levels of cyberchondria. Medical professionals can reduce this anxiety by giving information to patients.

The Spanish version of the short form of the Cyberchondria Severity Scale (CSS-12): Testing the factor structure and measurement invariance across genders

Cyberchondria refers to excessive and repeated online health-related searching, which is associated with increased distress and anxiety. The Cyberchondria Severity Scale (CSS) is the most widely used measure for assessment of cyberchondria, and its shortened version (CSS-12) has recently been developed. The aim of the present study was to develop the Spanish version of the CSS-12 and test its psychometric properties. A community sample of 432 Spanish-speaking adults (67.6% women; mean age = 36.00 ± 15.22 years) completed the Spanish translation of CSS-12 along with measures of health anxiety, obsessive-compulsive, anxiety and depressive symptoms. The Spanish version of the CSS-12 comprises a general cyberchondria factor and four specific factors (‘excessiveness’, ‘compulsion’, ‘distress’, and ‘reassurance’). Multi-group confirmatory factor analysis indicated measurement invariance across gender groups. Internal consistency values for the total score and subscales were good to excellent. The CSS-12 showed strong correlations with health anxiety, and moderate to low correlations with anxiety, obsessive-compulsive and depressive symptoms, supporting the convergent and divergent validity of the CSS-12, respectively. In conclusion, these results show that the CSS-12 is a valid and reliable tool for measuring cyberchondria in both genders in the general Spanish population.

Relationship between Health-Anxiety and Cyberchondria: Role of Metacognitive Beliefs

Purpose: The current study was designed to examine the relationship between health anxiety, cyberchondria (its constructs), and metacognitive beliefs. In addition, it also evaluated the moderating role of metacognitive beliefs in this relationship. Design and Method: The present study used the purposive sampling technique to acquire a sample of (N = 500) adults, among them (N = 256) women and (N = 244) men, and the age of the sample ranged from 20 to 50 years. Short Health Anxiety Inventory, Cyberchondria Severity Scale, and Metacognitions Questionnaire–Health Anxiety were used to operationalize the present study variables. Findings: The descriptive statistics revealed that all instruments have good psychometric properties, as Cronbach’s alpha coefficients for all scales are ≥0.70. In addition to this, the Pearson correlation showed that all variables of the present study have a significant positive correlation with each other. Furthermore, the regression analysis described that health anxiety and metacognitive beliefs (biased thinking and beliefs about uncontrollable thoughts) were the significant positive predictors of cyberchondria. Moreover, moderation analysis showed that metacognitive beliefs significantly strengthened the association between health anxiety and cyberchondria and its constructs. Practical Implications: The present study will help medical practitioners to understand how metacognitive beliefs and health anxiety can cause an increase in cyberchondria. This will help them to design better treatment plans for people with cyberchondria.

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.

Does cyberchondria predict Internet addiction among students during the COVID-19 pandemic? A web-based survey study

BACKGROUND

Previous literature has investigated the association of this phenomenon and Internet addiction. Nevertheless, little research has been conducted to elucidate the predictive associations among these concepts among students.

OBJECTIVE

This study reported students' cyberchondria and Internet addiction, and it examined whether cyberchondria predicts Internet addiction.

MATERIAL AND METHODS

During the COVID-19 pandemic, cross-sectional data were collected using a web survey from a convenience snowball sample of 143 students enrolled in e-learning courses at a governmental university.

RESULTS

A moderate level of cyberchondria and a mild level of Internet addiction was evident among students. A moderate level of cyberchondria and a mild level of Internet addiction was evident among students. Moderate to high significant correlations were reported among the studied concepts and with the sample's characteristics. Cyberchondria and unavailability of the Internet at school were predictors of Internet addiction.

IMPLICATIONS

Healthcare providers, including nurses, should provide information that preserves students' mental health during stressful periods such as the COVID-19 pandemic and should offer clear instructions on stress and anxiety management during such times. A longer scale, especially for cyberchondria, is warranted in future research with a random and larger sample.

CONCLUSIONS

Findings suggest that cyberchondria serves as a predictor of Internet addiction, contrary to findings of previous studies. Various psychosocial interventions should always be initiated to help students prevent or address cyberchondria and Internet addiction.

The Status and Influencing Factors of Cyberchondria During the COVID-19 Epidemic. A Cross-Sectional Study in Nanyang City of China

Cyberchondria is considered “the anxiety-amplifying effects of online health-related searches.” During the COVID-19 pandemic, people are likely to search health-related information online for reassurance because of fear and related physical symptoms, while cyberchondria may be triggered due to the escalation of health anxiety, different online seeking behavior preference, information overload, and insufficient e-health literacy. This study aimed to investigate the status and influencing factors of cyberchondria in residents in China during the epidemic period of COVID-19. The participants were 674 community residents of Nanyang city surveyed from February 1 to 15, 2020. We administered online measures, including the Chinese Short Form of the Cyberchondria Severity Scale (C-CSS-12), Short Health Anxiety Inventory (SHAI), eHealth Literacy Scale (eHEALS), Patient Health Questionnaire-15 (PHQ-15), and COVID-19-related online information seeking behavior questionnaire. In our study, the average C-CSS-12 total score of residents was 30.65 ± 11.53 during the virus epidemic; 25% of participants scored 22 or below, 50% scored 23 to 38, and 21.9% scored 39 to 60. The SHAI total score (β = 0.598 > 0, P < 0.001), the use of general search engines (β = 1.867 > 0, P = 0.039), and searching for information on how to diagnose COVID-19 (β = 2.280 > 0, P = 0.020) were independent risk factors for cyberchondria, while searching lasting less than 10 min each (β = −2.992 < 0, P = 0.048), the use of traditional media digital platforms (β = −1.650 < 0, P = 0.024) and professional medical communication platforms (β = −4.189 < 0, P = 0.007) were independent protective factors. Our findings showed that nearly a quarter of the participants scored 39 or higher on the C-CSS-12 in Nanyang city during the pandemic, which should be taken seriously. Health anxiety and COVID-19-related online information seeking behavior including online duration, topics and choice on different information channels were important influencing factors of cyberchondria. These findings have implications for further research and clinical practice on cyberchondria in China.

Conceptualizations of Cyberchondria and Relations to the Anxiety Spectrum: Systematic Review and Meta-analysis

BACKGROUND

Cyberchondria describes the detrimental effects of health-related internet use. Current conceptualizations agree that cyberchondria is associated with anxiety-related pathologies and may best be conceptualized as a safety behavior; however, little is known about its exact underlying mechanisms.

OBJECTIVE

This systematic review and meta-analysis aims to give an overview of the conceptualizations of cyberchondria and its relation to anxiety-related pathologies, quantify the strength of association to health anxiety by using meta-analyses, highlight gaps in the literature, and outline a hypothetical integrative cognitive-behavioral model of cyberchondria based on the available empirical evidence.

METHODS

A systematic literature search was conducted using PubMed, Web of Science, and PsycINFO electronic databases. A total of 25 studies were included for qualitative synthesis and 7 studies, comprising 3069 individuals, were included for quantitative synthesis. The meta-analysis revealed a strong association of cyberchondria (r=0.63) and its subfacets (r=0.24-0.66) with health anxiety.

RESULTS

The results indicate that cyberchondria is a distinct construct related to health anxiety, obsessive-compulsive symptoms, intolerance of uncertainty, and anxiety sensitivity. Further studies should distinguish between state and trait markers of anxiety-related pathologies and use experimental and naturalistic longitudinal designs to differentiate among risk factors, triggers, and consequences related to cyberchondria.

CONCLUSIONS

Health-related internet use in the context of health anxiety is best conceptualized as health-related safety behavior maintained through intermittent reinforcement. Here, we present a corresponding integrative cognitive-behavioral model.

Unveiling the relationships between cyberchondria and psychopathological symptoms

Cyberchondria is a clinical entity of excessive and repetitive online health-related searches, associated with health anxiety, obsessive-compulsive symptoms and intolerance of uncertainty. Its relationships with depressive and somatic symptoms have not yet received much attention. The purpose of this study was to examine the individual and comparative effects of several psychopathology constructs on the severity of cyberchondria. Through an online platform, participants (N = 749) completed specific self-report measures assessing the severity of cyberchondria, anxiety, intolerance of uncertainty, depressive, somatic, and obsessive-compulsive symptoms. Standard and hierarchical multiple regression analyses were used to assess how well the independent variables influenced the levels of cyberchondria, before and after controlling for age, education, and sex. When measures of all constructs were included in the analysis, all were significant predictors of cyberchondria levels, except for anxiety. Health anxiety made the strongest contribution. When age, education and sex were controlled for, all measures except for anxiety were also significant predictors of cyberchondria severity. Our study confirms that health anxiety, obsessive-compulsive symptoms and intolerance of uncertainty are all associated with cyberchondria severity, with health anxiety making the strongest unique contribution. Depression and somatic symptoms also predicted cyberchondria severity. These findings have important implications for research and clinical practice.

The relative contribution of health cognitions and metacognitions about health anxiety to cyberchondria: A prospective study

OBJECTIVES

Cyberchondria involves the excessive and compulsive use of the Internet to search for health information. The present study investigated the relative contribution of health cognitions and metacognitions about health anxiety to prospective cyberchondria scores, controlling for health anxiety and hours spent online per day.

METHODS

A convenience sample of 221 participants was recruited for the purpose of this study with a final sample totaling 125 participants (58.4% females, M_age  = 34.51 years) who completed the full survey at baseline (T₀ ) and a measure of cyberchondria after 30 days (T₁ ).

RESULTS

The results of the study showed that metacognition about health anxiety relating to beliefs about the uncontrollability of thoughts was the only significant predictor of prospective cyberchondria scores when controlling for health anxiety.

CONCLUSIONS

These results offer further support to the role of beliefs about the uncontrollability of thoughts in cyberchondria. The implications of the findings are discussed.

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

Background

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety?

According to cognitive-behavioral models, traits, triggering events, cognitions, and adverse behaviors play a pivotal role in the development and maintenance of health anxiety. During virus outbreaks, anxiety is widespread. However, the role of trait health anxiety, cyberchondria, and coping in the context of virus anxiety during the current COVID-19 pandemic has not yet been studied. An online survey was conducted in the German general population (N = 1615, 79.8 % female, Mage = 33.36 years, SD = 13.18) in mid-March 2020, which included questionnaires on anxiety associated with SARS-CoV-2, trait health anxiety, cyberchondriaPandemic (i.e. excessive online information search), and emotion regulation. The participants reported a significantly increasing virus anxiety in recent months (previous months recorded retrospectively), especially among individuals with heightened trait health anxiety. CyberchondriaPandemic showed positive correlations with current virus anxiety (r = .09-.48), and this relationship was additionally moderated by trait health anxiety. A negative correlation was found between the perception of being informed about the pandemic and the current virus anxiety (r=-.18), with adaptive emotion regulation being a significant moderator for this relationship. The findings suggest that trait health anxiety and cyberchondria serve as risk factors, whereas information about the pandemic and adaptive emotion regulation might represent buffering factors for anxiety during a virus pandemic.

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

Testing the Italian version of the Cyberchondria Severity Scale and a metacognitive model of cyberchondria

Cyberchondria refers to the tendency to excessively and compulsively search for online medical information despite the distress experienced, with consequent impairment of daily-life activities. The current two studies sought to explore (i) the factor structure of the Italian version of the Cyberchondria Severity Scale (CSS) and (ii) a metacognitive model of cyberchondria. Participants were Italian community adults who reported using the Internet to search for health-related information (Study 1: N = 374, Study 2: N = 717). Results from Study 1 supported the Italian version of the CSS exhibiting a five-factor structure, with the resulting scales demonstrating good internal consistency, 5-week test-retest reliability, and generally strong correlations with indices of health anxiety. In Study 2, results of a path analysis showed that the negative metacognitive belief domain ("thoughts are uncontrollable") shared the strongest direct association with each of the five dimensions of cyberchondria, followed by beliefs about rituals. Consistently, the strongest indirect associations were found between "thoughts are uncontrollable" and all the five cyberchondria dimensions via beliefs about rituals. These results provide support for an Italian version of the CSS and the metacognitive conceptualization of cyberchondria.

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

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

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

BACKGROUND

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

QUESTIONS/PURPOSES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

LEVEL OF EVIDENCE

Level III, prognostic study.

Maternal anxiety and internet-based food elimination in suspected food allergy

BACKGROUND

Food allergy is associated with stress, anxiety, and impairment in quality of life in both children and families. This study aimed to assess the anxiety of mothers in the case of suspected food allergy in their children and the influence of Internet usage on their levels of anxiety and food elimination.

METHODS

Ninety-two patients aged 0-2 years presented at a pediatric allergy department following either a physicians' presumptive diagnosis or family's suspicion of food allergy (Group 1) and 99 healthy controls (Group 2) were evaluated. The clinical diagnosis of food allergy was confirmed or excluded by oral food challenge (OFC). The validated Turkish version of Spielberger State-Trait Anxiety Inventory (STAI) was applied to the mothers of both groups on admission and to Group 1 3 months after OFC.

RESULTS

The state and trait anxiety (STAI-S and STAI-T) scores were significantly higher in Group 1 than Group 2 (P < 0.001, z = 5.410, and P = 0.021, z = 2.304, respectively). Seventy-nine mothers (85.9%) had been eliminating foods on admission. Thirty-seven (40.2%) mothers had eliminated foods on their own. The performance of food allergy-related Web searches was significantly higher among mothers who eliminated foods by themselves than those who did not (P = 0.004, χ²  = 8.391, df = 1). The second STAI-S score was significantly lower among mothers whose children's food allergy diagnosis was excluded than confirmed (effect size = 1.06 (95% CI: 0.56-1.57), P = 0.001, z = 3.442).

CONCLUSION

It is important to make a correct food allergy diagnosis with a detailed allergy work-up, including OFC, to avoid anxiety and not cause unnecessary food elimination.

Cyberchondria and its Relationships with Related Constructs: a Network Analysis

Cyberchondria denotes repeated online searches for health information that are associated with increasing levels of health anxiety. The aims of this study were to apply network analysis to investigate the extent to which cyberchondria is a distinct construct, ascertain which of the related constructs have the strongest relationships with cyberchondria and investigate whether some of the symptoms of cyberchondria are more central to the construct of cyberchondria. Questionnaires assessing the severity of cyberchondria, health anxiety, obsessive-compulsive disorder symptoms, intolerance of uncertainty, problematic Internet use, anxiety, depression and somatic symptoms were administered to 751 participants who searched for health information online during a previous 3-month period and were recruited from an online crowdsourcing platform. Network analyses were used to compute the networks, perform community detection tests and calculate centrality indices. Results suggest that cyberchondria is a relatively specific syndrome-like construct, distinct from all related constructs and consisting of interrelated symptoms. It has the strongest relationships with problematic Internet use and health anxiety. No symptom of cyberchondria emerged clearly as more central to the construct of cyberchondria. Future research should aim to deepen our understanding of cyberchondria and its links with psychopathology, especially its close relationship with problematic Internet use.

The CSS-12: Development and Validation of a Short-Form Version of the Cyberchondria Severity Scale

Cyberchondria is defined as an increase in anxiety about one's health status as a result of excessive online searches. McElroy and Shevlin (2014) developed the first multidimensional, self-report measure of this construct-the Cyberchondria Severity Scale (CSS). The CSS consists of 33 items which can be summed to form a total score, and/or 5 subscale scores. The aim of the present study was to develop a short-form version of the CSS, removing the "Mistrust" subscale. Participants were undergraduate students from two UK universities (N = 661, 73% female, M_age = 22.19 years, SD = 5.88). Students completed the CSS, Short Health Anxiety Inventory (SHAI) and Generalized Anxiety Disorder Assessment (GAD-7). Twelve items were chosen for retention in the short form based on an exploratory factor analysis. These items corresponded to the four factors previously identified in the 33-item scale (minus the "Mistrust" subscale). Confirmatory factor analysis was used to validate the structure of the CSS-12. Confirmatory bifactor modeling indicated that the majority of item covariance was accounted for by a general cyberchondria factor. Construct validity was assessed by examining associations with the SHAI and GAD-7, with stronger correlations observed between the CSS-12 and the SHAI (compared with the GAD-7). The CSS-12 is a brief, reliable, and valid measure of worry/anxiety attributable to excessive online health research.

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

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

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

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

Mapping of Crowdsourcing in Health: Systematic Review

Background

Crowdsourcing involves obtaining ideas, needed services, or content by soliciting Web-based contributions from a crowd. The 4 types of crowdsourced tasks (problem solving, data processing, surveillance or monitoring, and surveying) can be applied in the 3 categories of health (promotion, research, and care).

Objective

This study aimed to map the different applications of crowdsourcing in health to assess the fields of health that are using crowdsourcing and the crowdsourced tasks used. We also describe the logistics of crowdsourcing and the characteristics of crowd workers.

Methods

MEDLINE, EMBASE, and ClinicalTrials.gov were searched for available reports from inception to March 30, 2016, with no restriction on language or publication status.

Results

We identified 202 relevant studies that used crowdsourcing, including 9 randomized controlled trials, of which only one had posted results at ClinicalTrials.gov. Crowdsourcing was used in health promotion (91/202, 45.0%), research (73/202, 36.1%), and care (38/202, 18.8%). The 4 most frequent areas of application were public health (67/202, 33.2%), psychiatry (32/202, 15.8%), surgery (22/202, 10.9%), and oncology (14/202, 6.9%). Half of the reports (99/202, 49.0%) referred to data processing, 34.6% (70/202) referred to surveying, 10.4% (21/202) referred to surveillance or monitoring, and 5.9% (12/202) referred to problem-solving. Labor market platforms (eg, Amazon Mechanical Turk) were used in most studies (190/202, 94%). The crowd workers’ characteristics were poorly reported, and crowdsourcing logistics were missing from two-thirds of the reports. When reported, the median size of the crowd was 424 (first and third quartiles: 167-802); crowd workers’ median age was 34 years (32-36). Crowd workers were mainly recruited nationally, particularly in the United States. For many studies (58.9%, 119/202), previous experience in crowdsourcing was required, and passing a qualification test or training was seldom needed (11.9% of studies; 24/202). For half of the studies, monetary incentives were mentioned, with mainly less than US $1 to perform the task. The time needed to perform the task was mostly less than 10 min (58.9% of studies; 119/202). Data quality validation was used in 54/202 studies (26.7%), mainly by attention check questions or by replicating the task with several crowd workers.

Conclusions

The use of crowdsourcing, which allows access to a large pool of participants as well as saving time in data collection, lowering costs, and speeding up innovations, is increasing in health promotion, research, and care. However, the description of crowdsourcing logistics and crowd workers’ characteristics is frequently missing in study reports and needs to be precisely reported to better interpret the study findings and replicate them.

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

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

The Cyberchondria Severity Scale (CSS): German Validation and Development of a Short Form

PURPOSE

'Cyberchondria' describes a pattern of researching health information online motivated by distress or anxiety about health, which becomes excessive and in turn increases distress. The Cyberchondria Severity Scale (CSS) assesses this construct. The aims of the present study were to validate a German version of the CSS and to propose a short form.

METHOD

The CSS was translated and posted online. Inclusion criteria were fulfilled by n = 500 participants (age 29.1 ± 10.4 years, 73.6 % women). Item analyses, an exploratory factor analysis and correlations with health anxiety, somatic symptoms, health-care utilization and depression were calculated. A brief version with 15 items was developed (CSS-15) and validated in a second sample (n = 292; age 24.2 ± 4.1 years, 76.4 % women).

RESULTS

The internal consistency of the CSS was α = .93 and its split-half reliability α = .95. The mean item-total correlation was r itc = .51, the mean inter-item correlation r = .29 and the mean item difficulty p i = .36. The principal component analysis extracted five factors. The CSS score correlated highly with health anxiety and moderately with somatic symptoms and health-care utilization. The CSS-15 still had an internal consistency of α = .82 and the confirmatory factor analysis confirmed the five factors. The correlation coefficients with health-related measures were unaffected.

CONCLUSION

The German version of the CSS possesses very good psychometric characteristics, which were preserved in a short version. The factorial structure was replicated. The correlations with health anxiety and depression for both scales underscore their validity and clinical relevance.

Cyberchondria: Examining relations with problematic Internet use and metacognitive beliefs

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

Cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese

Abstract Introduction: The internet has proven to be a valuable resource for self-care, allowing access to information and promoting interaction between professionals, caregivers, users of health care services and people interested in health information. However, recurring searches are often related to excessive health anxiety and a phenomenon known as cyberchondria can have impacts on physical and mental health. Within this background, a Cyberchondria Severity Scale has been developed to differentiate healthy and unhealthy behavior in internet searches for health information, based on the following criteria: compulsion, distress, excesses, and trust and distrust of health professionals. Objective: To conduct cross-cultural adaptation of the Cyberchondria Severity Scale for Brazilian Portuguese, because of the lack of an appropriate instrument for Brazil. Methods: This study was authorized by the original author of the scale. The process was divided into the following four steps: 1) initial translation, 2) back-translation, 3) development of a synthesized version, and 4) experimental application. Results: Translation into Brazilian Portuguese required some idiomatic expressions to be adapted. In some cases, words were not literally translated from English into Portuguese. Only items 7, 8, 12, 23 and 27 were altered, as a means of both conforming to proper grammar conventions and achieving easy comprehension. The items were rewritten without loss of the original content. Conclusion: This paper presents a translated version of the Cyberchondria Severity Scale that has been semantically adapted for the Brazilian population, providing a basis for future studies in this area, which should in turn contribute to improved understanding of the cyberchondria phenomenon in this population.

The Whiteley Index-6: An Examination of Measurement Invariance Among Self-Identifying Black, Latino, and White Respondents in Primary Care

Brief measures that are comparable across disparate groups are particularly likely to be useful in primary care settings. Prior research has supported a six-item short form of the Whiteley Index (WI), a commonly used measure of health anxiety, among English-speaking respondents. This study examined the measurement invariance of the WI-6 among Black ( n = 183), Latino ( n = 173), and White ( n = 177) respondents seeking treatment at a U.S. community health center. Results supported a bifactor model of the WI-6 among the composite sample ( N = 533), suggesting the presence of a general factor and two domain-specific factors. Results supported the incremental validity of one of the domain-specific factors in accounting for unique variance in somatic symptom severity scores beyond the general factor. Multiple-groups confirmatory factor analysis supported the configural, metric, ands scalar invariance of the bifactor WI-6 model across the three groups of respondents. Results provide support for the measurement invariance of the WI-6 among Black, Latino, and White respondents. The potential use of the WI-6 in primary care, and broader, settings is discussed.

Does cyberchondria overlap with health anxiety and obsessive-compulsive symptoms? An examination of latent structure and scale interrelations

Searching for medical information online is a widespread activity that increases distress for many individuals. Researchers have speculated that this phenomenon, referred to as cyberchondria, overlaps substantially with both health anxiety and obsessive-compulsive symptoms. This study sought to examine: (1) the distinguishability of cyberchondria from health anxiety and obsessive-compulsive symptoms and (2) the components of health anxiety and obsessive-compulsive symptoms that cluster most strongly with cyberchondria. The sample consisted of community adults in the United States with no current reported medical problems (N=375). Results from confirmatory factor analyses (CFAs) support the idea that cyberchondria is distinct from, yet related to, health anxiety and obsessive-compulsive symptoms. Results from zero-order correlations and regression analyses suggest that cyberchondria clusters with the affective (health worry) component of health anxiety. Regression results diverged from prior findings, as obsessive-compulsive symptoms did not share associations with cyberchondria after accounting for negative affect and health anxiety. The present results indicate that cyberchondria is possibly discernible from both health anxiety and obsessive-compulsive symptoms, while also providing insight into areas of potential overlap.

Conducting Clinical Research Using Crowdsourced Convenience Samples

Crowdsourcing has had a dramatic impact on the speed and scale at which scientific research can be conducted. Clinical scientists have particularly benefited from readily available research study participants and streamlined recruiting and payment systems afforded by Amazon Mechanical Turk (MTurk), a popular labor market for crowdsourcing workers. MTurk has been used in this capacity for more than five years. The popularity and novelty of the platform have spurred numerous methodological investigations, making it the most studied nonprobability sample available to researchers. This article summarizes what is known about MTurk sample composition and data quality with an emphasis on findings relevant to clinical psychological research. It then addresses methodological issues with using MTurk--many of which are common to other nonprobability samples but unfamiliar to clinical science researchers--and suggests concrete steps to avoid these issues or minimize their impact.

Relationships between cyberchondria and obsessive-compulsive symptom dimensions

Researchers have recently begun to investigate a vicious cycle of escalating physical health concerns and online medical information seeking coined "cyberchondria". Research has shown that cyberchondria is strongly associated with health anxiety (HA), but there is a dearth of work investigating the potential relationships between cyberchondria and other anxiety-related pathologies. One such condition is obsessive-compulsive disorder (OCD), which could theoretically be related to cyberchondria given the physical health relevant focus of certain types of OC symptoms. The current study sought to investigate the potential relationship between cyberchondria OCD across OC symptom dimensions. Community participants (N=468) were recruited via online crowdsourcing to complete a battery of self-report questionnaires including cyberchondria and OC measures. Structural equation modeling revealed significant unique associations between both contamination/washing and responsibility for harm/checking symptoms, and cyberchondria, such that greater cyberchondria was associated with greater OC symptoms after controlling for HA and trait negative affect. These results suggest that similar to proposed models of cyberchondria and HA, cyberchondria could potentially play a role in the development/maintenance of two dimensions of OC symptoms, or vice versa. Future work will need to determine the causal nature of these relationships or whether they are simply co-occurring phenomena.

Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria: A replication and extension examining dimensions of each construct

BACKGROUND

Preliminary findings suggest that anxiety sensitivity (AS) and intolerance of uncertainty (IU) may confer vulnerability for cyberchondria, defined as repeated internet searches for medical information that exacerbates health anxiety. Prior studies are limited because it remains unclear whether specific AS or IU dimensions differentially relate to certain cyberchondria dimensions.

METHODS

The present study examined associations among AS, IU, and cyberchondria dimensions using a sample of community adults (N = 578) located in the United States.

RESULTS

As predicted, physical AS and inhibitory IU were the only AS or IU dimensions to share unique associations with the distress cyberchondria dimension after controlling for the overlap among the AS dimensions, IU dimensions, and health anxiety. Cognitive AS and social AS unexpectedly evidenced unique associations with cyberchondria dimensions.

LIMITATIONS

The results are limited by the cross-sectional study design and use of a community, rather than clinical, sample.

CONCLUSIONS

This study provides evidence that specific AS and IU dimensions may confer vulnerability to certain cyberchondria dimensions. Further clarifying associations among AS, IU, and cyberchondria may lead to improvements in our conceptualization and, ultimately, treatment of cyberchondria.