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

The Reciprocal Relationship Between Parental eHealth Literacy Mediation and Adolescents' eHealth Literacy: Three-Wave Longitudinal Study

BACKGROUND

The online environment provides adolescents with vast amounts of health-related information; however, navigating this effectively requires high levels of eHealth literacy to avoid misinformation and harmful content. Parental guidance is often considered a crucial factor in shaping adolescents' online health behaviors; however, there is limited longitudinal research examining how parental eHealth literacy mediation influences adolescents' development of eHealth literacy over time.

OBJECTIVE

This study aims to examine the reciprocal relationship between parental eHealth literacy mediation and adolescents' eHealth literacy. It also investigates whether parental education moderates this relationship, specifically exploring whether higher levels of parental education enhance the effectiveness of eHealth literacy mediation in improving adolescents' eHealth literacy.

METHODS

A 3-wave longitudinal study was conducted, collecting data from 2500 adolescent-parent pairs. A random intercept cross-lagged panel model was applied to assess the reciprocal effects between parental eHealth literacy mediation and adolescents' eHealth literacy across the 3 waves. Parental education was included in the model as a potential moderating variable to examine whether it influences the strength of the relationship between parental eHealth literacy mediation and adolescents' eHealth literacy.

RESULTS

The findings revealed no significant within-person effects, indicating that changes in parental eHealth literacy mediation over time did not lead to corresponding changes in adolescents' eHealth literacy (T1→T2 β=-.03, P=.65; T2→T3 β=.01, P=.84), and vice versa (T1→T2 β=.02, P=.71; T2→T3 β=-.07, P=.19). Furthermore, the data did not support a moderating effect of parental education, suggesting that higher educational attainment does not enhance the impact of parental eHealth literacy mediation. However, a significant between-person association was observed: adolescents with higher levels of eHealth literacy tend to have parents who engage more frequently in eHealth literacy mediation (r=0.30, P<.001).

CONCLUSIONS

This study contributes to the understanding of parental involvement in shaping adolescents' eHealth literacy. Contrary to expectations, parental eHealth literacy mediation does not appear to have a significant longitudinal impact on the development of adolescents' eHealth literacy, nor does higher parental education strengthen this relationship. These findings suggest that additional factors beyond parental mediation and education may play a critical role in supporting adolescents' ability to navigate online health information effectively.

Internet-delivered acceptance and commitment therapy for COVID-19 related health anxiety: a pragmatic study

BACKGROUND

Health anxiety (HA) is characterized by excessive worries about having a serious illness, persisting even after medical reassurance. The COVID-19 pandemic, with widespread media coverage and lockdowns, may induce or exacerbate HA. During a pandemic, treatment options can be limited by lockdowns and social distancing, making remote, internet-delivered therapies particularly useful for individuals isolating due to health worries. This study aimed to assess the effectiveness of an internet-delivered Acceptance and Commitment Therapy (iACT) for COVID-19-related HA.

METHODS

In a Danish university hospital, an uncontrolled national implementation project was conducted. Patients self-referred were assessed via video, and those eligible (≥18 years) received 12 weeks of iACT. The primary outcome was HA symptoms measured by the Whiteley-6-R Index. Secondary outcomes included somatic symptoms, depression, anxiety, quality of life, and life satisfaction. Changes from baseline to post-treatment were analyzed using paired t-tests and Cohen's d for effect size.

RESULTS

Out of 223 screened patients, 105 were eligible for enrollment, and 67 responded to post-treatment questionnaires. Significant improvements were observed across all outcomes, particularly for HA (d = 1.40) and anxiety (d = 0.80), along with better quality of life (d = 0.65) and life satisfaction (d = 0.64).

CONCLUSIONS

Implementation of self-referral and internet-delivered treatment into routine care was feasible and seemed to be effective in treating COVID-19-related HA. However, for self-referred participants, the poor eligibility and motivation may be a limitation when implementing this online treatment during a pandemic. In addition, collecting data in routine care may be a challenge.

TRIAL REGISTRY NUMBERS

Approved by the Danish Data Protection Agency (ID no. 790861).

Social Determinants of Message Exposure and Health Anxiety Among Young Sexual Minority Men in the United States During the 2022 Mpox Outbreak

This study tested the structural influence model of communication in the context of the 2022 global outbreak of the Mpox virus among young sexual minority men. The primary objective was to understand how distinct social determinants, including education, race/ethnicity, and interpersonal discrimination, influenced exposure to Mpox messages in daily life and affected health anxiety concerning the Mpox virus in the United States. We also explored the significance of LGBTQ+ community connectedness as a crucial form of social capital during the outbreak. We collected a three-wave longitudinal dataset and examined within-person and between-person associations using a random-intercept cross-lagged panel model. Participants (N = 254) reported that internet sources and social media were their primary information sources for Mpox messages during the outbreak. Educational attainment, racial minority status, and LGBTQ+ community connectedness were significantly associated with message exposure. Young sexual minority men who faced greater interpersonal discrimination in their daily lives also reported higher rates of Mpox-related health anxiety. Longitudinal analysis indicated that (at the within-person level) Mpox anxiety was significantly associated with greater Mpox message exposure in the month following the outbreak, but that relationship waned in the subsequent month. The theoretical implications highlight the relevance of minority stress variables in the structural influence model of communication framework and suggest the importance of community connectedness as a distinct form of social capital shaping message exposure and health anxiety during the Mpox outbreak in the United States.

Sympathy towards people infected with COVID-19 mediates relations between media use and death anxiety

The COVID-19 pandemic threatened mental health. This study examined the longitudinal associations among pandemic-related media use, sympathy for people infected with COVID-19 (PIWC), and death anxiety. 132 Chinese adults completed measures three times, one week apart during the initial phase of COVID. The results showed that media use, sympathy, and death anxiety decreased significantly over the first month of the outbreak. Pandemic-related media use predicted increased future sympathy for PIWC, and sympathy predicted increased future death anxiety. The study identified the short-term effects of media use on sympathy and death anxiety, and suggests that reduced media exposure may be beneficial.

Symptom Attributions in Illness Anxiety Disorder

OBJECTIVES

A major characteristic of health anxiety is the tendency to attribute benign bodily sensations to serious illnesses. This has been supported by empirical research in non-clinical samples, and samples of individuals diagnosed with Hypochondriasis. However, no study to date has explored symptom attribution styles of individuals with the DSM-5 diagnosis of Illness Anxiety Disorder.

METHODS

Sixty-one participants, including a clinical Illness Anxiety Disorder (n = 35) and healthy control (n = 26) sample, completed self-report measures of health anxiety and an Attribution Task, whereby they were presented with eight common bodily sensations and asked to generate possible explanations for them.

RESULTS

Results showed that relative to healthy controls, participants with Illness Anxiety Disorder overall were more likely to make more serious, 'catastrophic' somatic attributions to symptoms, and less likely to generate non-threatening normalising explanations. These results also extended to their initial attributions, conceptualised as the 'jumping to conclusions' bias, and as an exploratory index of flexibility, they were also found to make less attributions overall compared to healthy controls.

CONCLUSIONS

Findings provide support for the cognitive behavioural theory of health anxiety, and highlight the importance of assessing and addressing symptom attributions with clients with illness anxiety disorder.

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.

A transdiagnostic approach to investigate of the relationships between anxiety sensitivity and health anxiety: the mediated roles of distress tolerance and emotion regulation

Background

Emotion regulation (ER) and distress tolerance (DT) are considered transdiagnostic risk factors for a range of anxiety disorders. This study investigated the relationship between anxiety sensitivity (AS) and health anxiety (HA) in the general population, focusing on the mediating roles of DT and ER.

Methods

The study was conducted as a cross-sectional survey from October to December 2023 in Tehran Province, Iran. A total of 971 individuals participated in this study (52.8% female; mean age 39.04 years, SD=10.64). Participants completed self-report questionnaires to assess HA (The Short Health Anxiety Inventory), AS (The Anxiety Sensitivity Index-3), DT (The 15-item Distress Tolerance Scale) and ER (The 10-item Emotion Regulation Questionnaire). We used structural equation modeling (SEM) to examine the hypothesis that DT and ER would mediate the relationship between AS and the HA.

Results

AS was modestly related to all measures (r from -0.40 to 0.55). According to the SEM analysis, AS (β = 0.45, 95%CI [0.34, 0.56]) had a significant direct effect on HA. However, the analysis of the indirect effects revealed that both DT (β = 0.10, 95% CI [0.06, 0.16]) and emotion regulation strategies-cognitive reappraisal (β = 0.06, 95% CI [0.01, 0.11]) and expressive suppression (β = 0.11, 95% CI [0.06, 0.18])-act as partial mediators in the relationship between AS and HA.

Conclusions

AS plays a crucial role in predisposing individuals to HA. The mediating roles of DT and ER provide insight into the link between AS and HA. Nevertheless, the study's cross-sectional design and reliance on a non-clinical sample limit the applicability of the results. Further research involving different samples and intervention studies is needed to validate and expand upon these findings.

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.

Investigation of the effect of internet addiction on cyberchondria

This research was conducted to examine the effect of internet addiction on cyberchondria. The research is important to understand how today's digital technologies contribute to health-related concerns and affect individuals' perceptions of health. Quantitative research design was used in this research conducted in Konya, a metropolitan city in Turkey. The study was conducted using the convenience sampling method on 403 participants. In the research, 'Personal Information Form', 'Internet Addiction Scale' and 'Cyberchondria Scale' were used. The data were analyzed with the SPSS program. As an analysis method, upon determining that the data were normally distributed, t-test, ANOVA, Pearson correlation and simple linear regression analyzes were applied in independent groups. The majority of participants (69%) were female, 52.9% were between the ages of 18-27 and 53.8% were married. In terms of education level, 44.9% had a bachelor's degree or higher, and 59.6% earned minimum wage or less. Among the occupational groups, the largest proportion was students (31.5%), and their daily internet use was mostly 2-3 hours (44.4%). Internet is most frequently used for social media (47.4%) and news/agenda follow-up (25.1%). Within the scope of the research, internet addiction varies significantly according to the participants' age groups, education levels, professions, average daily internet usage time, and internet usage purposes; it was found that the cyberchondria levels of the participants showed significant differences according to the variables of income level, profession, daily internet usage time and internet use purpose. The research revealed a positive and significant relationship between the level of internet addiction and the level of cyberchondria. It has also been observed that internet addiction has a positive and significant effect on cyberchondria. These results show that cyberchondria tendencies become stronger with the increase in internet use among individuals.

How Health Anxiety is Associated with Perceived Risk of Reinfection Among COVID-19 Infected People After the Epidemic Control Measures Lifted in China: A Multiple Mediating and Multi-Group Analysis

Background

After the lifting of epidemic control measures in China at the end of 2022, the number of COVID-19 infections has increased dramatically. Such an upsurge may intensify people's health anxiety and raise concerns about the risk of reinfection. While numerous studies have shown the correlation between them during the COVID-19, research on their underlying mechanism remains limited.

Purpose

This study aims to test the relationship and mechanism between health anxiety and perceived risk of reinfection among COVID-19 infected people from different occupational backgrounds.

Methods

A cross-sectional study was conducted from December 24th to 28th, 2022, after the epidemic control measures were lifted. A total of 1122 Chinese individuals were infected with COVID-19 (67.91% females, M age = 28.13) completed measures of health anxiety, perceived risk of reinfection, fear of COVID-19, online health information seeking (OHIS), and COVID-19 information fear of missing out (FOMO). Data were analyzed using multiple-mediation model and multi-group analysis.

Results

Health anxiety, perceived risk of reinfection, fear of COVID-19, OHIS and COVID-19 information FOMO were positively and significantly related to each other (r ranged from 0.25 to 0.77, all p < 0.001). Fear of COVID-19 (β = 0.27, p < 0.01), OHIS (β = 0.10, p < 0.001), and COVID-19 information FOMO (β = -0.05, p < 0.01) fully mediated the relationship between health anxiety and perceived risk of reinfection, the path of chaining mediation is also significant. Discrepancies in mediation models surfaced across the three types of work groups.

Conclusion

Findings suggest fear of COVID-19, OHIS and COVID-19 information FOMO may play significant mediating roles in explaining the relationship between health anxiety and perceived risk of reinfection. Interventions to reduce the perceived risk of reinfection should aim to improve the quality of online health information and individuals' online health literacy and reduce fear of COVID-19 during and after the pandemic.

Unraveling the relationships among pandemic fear, cyberchondria, and alexithymia after China's exit from the zero-COVID policy: insights from a multi-center network analysis

Objective

China's abrupt exit from the zero-COVID policy in late 2022 led to a rapid surge in infections, overwhelming healthcare systems and exposing healthcare providers to intensified psychological pressures. This sudden shift exacerbated pandemic-related psychological issues, including fear, health anxiety, and emotional processing difficulties. This study aimed to unravel the relationships among pandemic fear, cyberchondria, and alexithymia following China's exit from the zero-COVID policy.

Methods

A multi-center cross-sectional survey was conducted among 4088 nurses from 43 public hospitals in China. The web-based survey comprised the Fear of COVID-19 Scale, Cyberchondria Severity Scale, and Toronto Alexithymia Scale. Network analysis was employed to explore the interconnections and identify central components within these psychological and behavioral constructs.

Results

The analysis revealed a dense network with predominantly positive connections. Specific aspects of cyberchondria and pandemic fear exhibited the highest strength centrality, indicating their critical influence. The externally oriented thinking dimension of alexithymia emerged as a crucial bridge node, linking pandemic fear and cyberchondria. The network structure demonstrated consistency across diverse educational backgrounds and career stages.

Conclusion

These findings highlight the need for targeted interventions focusing on key network components, particularly externally oriented thinking, to disrupt the detrimental cycle of pandemic fear and cyberchondria. Healthcare organizations should promote balanced objective fact-focused and problem-solving approaches while also fostering skills in emotional awareness and expression, thereby mitigating the risk of maladaptive pandemic fear responses and dysfunctional online health information-seeking behaviors.

Nurses' use of 'wellness' supplements during the COVID-19 pandemic in the United States

AIM

Quantify disparities and identify correlates and predictors of 'wellness' supplement use among nurses during the first year of the pandemic.

DESIGN

Longitudinal secondary analysis of Nurses' Health Studies 2 and 3 and Growing Up Today Study data.

METHODS

Sample included 36,518 total participants, 12,044 of which were nurses, who completed surveys during the first year of the COVID-19 pandemic (April 2020 to April 2021). Analyses were conducted in March 2023. Modified Poisson models were used to estimate disparities in 'wellness' supplement use between nurses and non-healthcare workers and, among nurses only, to quantify associations with workplace-related predictors (occupational discrimination, PPE access, workplace setting) and psychosocial predictors (depression/anxiety, county-level COVID-19 mortality). Models included race/ethnicity, gender identity, age and cohort as covariates.

RESULTS

Nurses were significantly more likely to use all types of supplements than non-healthcare workers. Lacking personal protective equipment and experiencing occupational discrimination were significantly associated with new immune supplement use. Depression increased the risk of using weight loss, energy and immune supplements.

CONCLUSION

Nurses' disproportionate use of 'wellness' supplements during the COVID-19 pandemic may be related to workplace and psychosocial stressors. Given well-documented risks of harm from the use of 'wellness' supplements, the use of these products by nurses is of concern.

IMPACT

'Wellness' supplements promoting weight loss, increased energy, boosted immunity and cleansing of organs are omnipresent in today's health-focused culture, though their use has been associated with harm. This is of added concern among nurses given their risk of COVID-19 infection at work. Our study highlighted the risk factors associated with use of these products (lacking PPE and experiencing occupational discrimination). Findings support prior research suggesting a need for greater public health policy and education around the use of 'wellness' supplements.

REPORTING METHOD

STROBE guidelines were followed throughout manuscript.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution was involved.

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

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

The Relationship between Cyberchondria and Health Anxiety and the Moderating Role of Health Literacy among the Pakistani Public

Following the COVID-19 pandemic, the current study examines the association between cyberchondria and health anxiety in the Pakistani population, with health literacy as a moderator. This study utilized a cross-sectional research approach, with data gathered through simple random sampling. The study enlisted 1295 participants from Pakistan aged between 18 and 70, 63% of whom were male and 36% of whom were female. The researchers found a statistically significant positive link between cyberchondria and health anxiety (β = 0.215; t = 1.052; p 0.000). The moderating influence of health literacy suggests that health anxiety has a significantly negative effect on the relationship between cyberchondria and health anxiety (β = -0.769; t = 2.097; p 0.037). Moreover, females had higher cyberchondria scores than males. Health-related anxiety did not differ between the sexes, and males had greater health literacy than females. These results emphasize the critical role of health literacy in the moderating effects of cyberchondria on health anxiety. Furthermore, they reveal significant gender differences in both cyberchondria and health literacy.

The space between us: The effect of perceived threat on discomfort distance and perceived pleasantness of interpersonal vicarious touch

The space we keep between ourselves and others allows us either to engage in close shared experiences or to distance ourselves for safety. Focusing primarily on the latter, previous studies have identified a link between interpersonal boundaries and perceived threat, perceptual discrimination including pain perception as well as how we move and behave as a result. Although interpersonal distancing has been studied in a range of contexts, a mechanistic way of how such spatial behaviour might alter how we perceive affective touch has yet to be investigated. Here we probe the effect of perceived threat of COVID-19 on interpersonal boundary preferences and perceived pleasantness of vicarious affective touch. Our results demonstrate that increased perceived threat from COVID-19 is associated with larger boundaries of discomfort distance. Moreover, we show a positive association between perceived threat and pleasantness of vicarious touch coming from a member of the household, but no association with outsider touch. Importantly, rather than focusing on the purely "positive" and prosocial functions of affective touch, these results bolster a novel perspective that socially-relevant cues guide both approach and avoidance behaviours.

Mechanistic studies in pathological health anxiety: A systematic review and emerging conceptual framework

BACKGROUND

Pathological health anxiety (PHA) (e.g., hypochondriasis and illness anxiety disorder) is common in medical settings and associated with increased healthcare costs. However, the psychological and neurobiological mechanisms contributing to the development and maintenance of PHA are incompletely understood.

METHODS

We performed a systematic review to characterize the mechanistic understanding of PHA. PubMed, PsycINFO, and Embase databases were searched to find articles published between 1/1/1990 and 12/31/2022 employing a behavioral task and/or physiological measures in individuals with hypochondriasis, illness anxiety disorder, and PHA more broadly.

RESULTS

Out of 9141 records identified, fifty-seven met inclusion criteria. Article quality varied substantially across studies, and was overall inadequate. Cognitive, behavioral, and affective findings implicated in PHA included health-related attentional and memory recall biases, a narrow health concept, threat confirming thought patterns, use of safety-seeking behaviors, and biased explicit and implicit affective processing of health-related information among other observations. There is initial evidence supporting a potential overestimation of interoceptive stimuli in those with PHA. Neuroendocrine, electrophysiology, and brain imaging research in PHA are particularly in their early stages.

LIMITATIONS

Included articles evaluated PHA categorically, suggesting that sub-threshold and dimensional health anxiety considerations are not contextualized.

CONCLUSIONS

Within an integrated cognitive-behavioral-affective and predictive processing formulation, we theorize that sub-optimal illness and health concepts, altered interoceptive modeling, biased illness-based predictions and attention, and aberrant prediction error learning are mechanisms relevant to PHA requiring more research. Comprehensively investigating the pathophysiology of PHA offers the potential to identify adjunctive diagnostic biomarkers and catalyze new biologically-informed treatments.

A national survey of pandemic fear and cyberchondria after ending zero-COVID policy: The chain mediating role of alexithymia and psychological distress

BACKGROUND

More than half the domestic population in China were infected with COVID-19 in two months after ending "zero-infection policy", which severely overwhelmed frontline healthcare providers with stress and fear. However, there is no study to date investigating the associations between nurses' fear of pandemic and cyberchondria. This study aimed to 1) investigate the correlations between fear pandemic and cyberchondria among frontline nurses, and 2) discover its potential mechanism.

METHODS

A cross-sectional sample of frontline nurses (N = 8161) was recruited from 98 hospitals across China in February 2023. Participants were invited to complete an online, self-rated standardized questionnaire focused on pandemic fear, alexithymia, psychological distress, and cyberchondria. Environmental, clinical and socioeconomic information were collected for adjustment while conducting chain mediation analysis.

RESULTS

When other covariates were controlled, it was found that fear of the pandemic significantly contributed to cyberchondria (b = 0.58, 95%CI [0.56, 0.60], p < .001). The chain mediation model suggested that both alexithymia and psychological distress were mediating factors between pandemic fear and cyberchondria.

CONCLUSIONS

The higher the perceived fear, the greater the cyberchondria, which suggests that reducing fear about the pandemic and providing adequate support could reduce the incidence of cyberchondria. As alexithymia and psychological distress may be transdiagnostic mechanisms between fear and cyberchondria, targeted interventions focused on expression dysregulation and emotional identification could be useful.

Older people's experiences of vulnerability in a trust-based welfare society affected by the COVID-19 pandemic

The early coronavirus disease 2019 (COVID-19) outbreak inflicted vulnerability on individuals and societies on a completely different scale than we have seen previously. The pandemic developed rapidly from 1 day to the next, and both society and individuals were put to the test. Older people's experiences of the early outbreak were no exception. Using an abductive analytical approach, the study explores the individual experiences of vulnerability as described by older people hospitalised with COVID-19 in the early outbreak. In these older people, we found that the societal context and the individual experiences of vulnerability were inextricable linked. The study demonstrates that despite significant individual stress, informants displayed an interesting ability to also view their situation to reorient their perspective. The experience of vulnerability is both conditional and individual, which imposes a degree of unpredictability that neither they nor others were able to negotiate. The article discusses the phenomenon of unpredictability in light of a modern society with regard to how individuals and society may encounter unexpected events in the future where the potential to reorient will be vital.

More Adult Women than Men at High Cardiometabolic Risk Reported Worse Lifestyles and Self-Reported Health Status in the COVID-19 Lockdown

BACKGROUND

The COVID-19 lockdown represented an immense impact on human health, which was characterized by lifestyle and dietary changes, social distancing and isolation at home. Some evidence suggests that these consequences mainly affected women and altered relevant ongoing clinical trials. The aim of this study was to evaluate the status and changes in diet, physical activity (PA), sleep and self-reported health status (SRH) as perceived by older adult men and women with metabolic syndrome during the COVID-19 lockdown.

METHODS

We analyzed data from 4681 Spanish adults with metabolic syndrome. We carried out a telephone survey during May and June 2020 to collect information on demographics, dietary habits, PA, sleep, SRH and anthropometric data.

RESULTS

The mean age of participants was 64.9 years at recruitment, and 52% of participants were men. Most participants (64.1%) perceived a decrease in their PA during confinement. Regarding gender-specific differences, a higher proportion of women than men perceived a decrease in their PA (67.5% vs. 61.1%), Mediterranean diet adherence (20.9% vs. 16.8%), sleep hours (30.3% vs. 19.1%), sleep quality (31.6% vs. 18.2%) and SRH (25.9% vs. 11.9%) (all p < 0.001).

CONCLUSIONS

The COVID-19 lockdown affected women more negatively, particularly their self-reported diet, PA, sleep and health status.

Influence of Healthcare Delivery Type on Patients' Mental Health: Is Hospitalization Always a Stressful Factor? Can Allostatic Load Help Assess a Patient's Psychological Disorders?

BACKGROUND

Psychological distress is a predictor of future health and disease data, with consequent implications for both the patient and the healthcare system. Taking advantage of the unprecedented situation caused by the COVID-19 pandemic we aimed to assess whether the type of medical care received by patients during the initial months of the pandemic influenced their evolution, particularly at the psychological level. Additionally, we investigated whether allostatic load was associated not only with physical but also psychological alterations.

METHODS

All the patients diagnosed with COVID-19 infection at HM Madrid Hospital during the month of March 2020 were studied, both those hospitalized (110) and those treated on an outpatient basis (46). They were psychologically evaluated using the Profile of Mood States (POMS) test. We calculated the allostatic load using different laboratory parameters.

RESULTS

Outpatient patients had significantly higher scores than hospitalized ones in Tension-Anxiety (52 ± 19.3 vs. 38 ± 4.3; p < 0.001). So, 36.9% of the outpatient patients exhibited anxiety. Allostatic load has not been correlated with patients' psychological alterations.

CONCLUSIONS

Psychological distress of outpatient patients should be taken into account in their management to improve mental health planning. This knowledge could provide comprehensive care to patients including their mental health, in the face of subsequent epidemics/pandemics.

Have the effects of Covid-19 been overcome? Levels of Covid-19 fear, Covid-19 anxiety and hopelessness in young adolescents: A structural equation modeling

OBJECTIVE

This research aimed to determine the level of fear, anxiety, and hopelessness of Covid-19 in young adolescents' post Covid-19 period.

DESIGN AND SAMPLES

Young adolescents in the 17-24 age group were included in this study, which was conducted in a descriptive-cross-sectional design.

MEASUREMENTS

Sociodemographic characteristics questionnaire form and Coronavirus (Covid-19) Fear Scale, Coronavirus Anxiety Scale, and Beck Hopelessness Scale were used to collect data.

RESULTS

90.8% of the participants had been vaccinated, 26.9% had previously caught in Covid-19, and 10.3% of those who had been caught in the disease had a severe course. 10.7% of young adolescents had to take medicines, 56.4% had a family history of Covid-19, and 18.7% had lost a relative as a result of Covid-19, was found. The level of fear, anxiety and hopelessness was higher among women, first-grade students, those who did not receive the Covid-19 vaccine, those who have caught in Covid-19 before, and those who have lost a family due to Covid-19.

CONCLUSION

It is thought that the increase in the awareness level of young adolescents about Covid-19 improves preventive health behaviors and enables the development of positive behaviors related to the disease.

Impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during the COVID-19 pandemic

BACKGROUND

Infertility continued to be a major stressor among women with infertility during COVID-19pandemic. This study aimed to evaluate the impact of primary care posttraumatic stress disorder (PC-PTSD) on fertility problem of Iranian women with infertility during COVID-19 pandemic.

METHOD

In this cross-sectional study, 386 women with infertility completed the questionnaires of PC-PTSD-5 and Fertility Problem Inventory (FPI) at an infertility center between 2020 and 2022.

RESULTS

The mean of fertility problems was 145.20 (± 32.31). In terms of FPI subscales, the means were as follows: Sexual concern 21.80 (± 7.58), social concern 26.53 (± 8.94), relationship concern 26.02 (± 9.18), need for parenthood concern 40.88 (± 8.98), and rejection of childfree lifestyle 29.96 (± 7.69). The highest mean of FPI subscales was related to the need for parenthood concern in women with infertility. The strongest correlation was found between the subscales of sexual concern and social concern followed by sexual concern and relationship concern. The variables of PC-PTSD were a predictor of fertility problems (β = 0.203, P < .0001). Additionally, the variables of PC-PTSDwere a predictor of sexual concern (β = 0.248, P < .0001), social concern (β = 0.237, P < .0001), relationship concern (β = 0.143, P < .020), and need for parenthood concern (β = 0.101, P < .010). After adjusting for demographic characteristics, there was a significant relationship between FPI with job (β=-0.118, P < .031), education (β=-0.130, P < .023), living place (β = 0.115, P < .035), smoking (β = 0.113, P < .036), relationship with husband (β = 0.118, P < .027), and PC-PTSD symptom (β = 0.158, P < .0001). In addition, the multivariate linear regression showed a significant association between sexual concern and education (β=-0.152, P < .008), smoking (β = 0.129, P < .018), PC-PTSD symptom (β = 0.207, P < .0001); social concern and job (β=-0.119, P < .033), PC-PTSD symptom (β = 0.205, P < .0001); relationship concern and education (β=-0.121, P < .033), living place (β = 0.183, P < .001), relationship with husband (β = 0.219, P < .0001); and rejection of childfree lifestyle and job (β=-0.154, P < .007).

CONCLUSION

Systematic PTSD screening during COVID-19 pandemic by healthcare providers can be uniquely used to identify, evaluate, and treat trauma-related health conditions in infertility settings, which can link women with infertility to mental health services. This can be novel and useful for future policymakers and practitioners in the infertility field.

The anxiety response of patients with severe psychiatric disorders to the recent public health crisis

BACKGROUND

The devastating health, economic, and social consequences of COVID-19 may harm the already vulnerable groups, particularly people with severe psychiatric disorders (SPDs). The present study was conducted to investigate the anxiety response of patients with SPDs during the COVID-19 pandemic.

METHODS

A total of 351 patients with SPDs [Schizophrenia Spectrum (SSD), Bipolar (BD), Major Depressive (MDD), and Obsessive-Compulsive (OCD) Disorders] and healthy controls in Guilan province, Iran, throughout 2021-2022 were included in this cross-sectional analytical study. The anxiety response consisted of four concepts: COVID-19-related anxiety, general health anxiety, anxiety sensitivity, and safety behaviors. We conducted an unstructured interview and provided sociodemographic and clinical information. Also, the participants were asked to complete four self-report measures of the Corona Disease Anxiety Scale, the Anxiety Sensitivity Index-Revised, the Short Health Anxiety Inventory, and the Checklist of Safety Behaviors.

RESULTS

Analysis of variance showed a significant difference between the groups of patients with SPDs and the control group in COVID-19-related anxiety (F = 6.92, p = 0.0001), health anxiety (F = 6.21, p = 0.0001), and safety behaviors (F = 2.52, p = 0.41). No significant difference was observed between them in anxiety sensitivity (F = 1.77, p = 0.134). The Games-Howell test showed that the control group obtained a higher mean than the groups of people with BD (p < 0.0001), SSD (p = 0.033), and OCD (p = 0.003) disorders in COVID-19-related anxiety. The patients with MDD (p = 0.014) and OCD (p = 0.01) had a higher mean score than the control group in health anxiety. Tukey's test showed that the mean of safety behaviors of the control group was significantly higher than the OCD group (p = 0.21). No significant difference was found between the groups of patients with MDD, BD, SSD, and OCD in terms of COVID-19-related anxiety, health anxiety, and safety behaviors.

CONCLUSION

Anxiety response to health crisis is different in groups with SPDs and control group. The findings of this study suggest that although health anxiety is present in many of these patients during the pandemic, their anxiety response to the health crisis may be less than expected. There can be various explanations, such as pre-existing symptoms, low health literacy, and possible co-occurring cognitive impairment. The results of this study have many practical and policy implications in meeting the treatment needs of this group of patients during public health crises and indicate that their needs may not be compatible with the expectations and estimates that health professionals and policymakers already have.

Moderating Effect of Coping Strategies on the Association Between the Infodemic-Driven Overuse of Health Care Services and Cyberchondria and Anxiety: Partial Least Squares Structural Equation Modeling Study

BACKGROUND

The COVID-19 pandemic has led to a substantial increase in health information, which has, in turn, caused a significant rise in cyberchondria and anxiety among individuals who search for web-based medical information. To cope with this information overload and safeguard their mental well-being, individuals may adopt various strategies. However, the effectiveness of these strategies in mitigating the negative effects of information overload and promoting overall well-being remains uncertain.

OBJECTIVE

This study aimed to investigate the moderating effect of coping strategies on the relationship between the infodemic-driven misuse of health care and depression and cyberchondria. The findings could add a new dimension to our understanding of the psychological impacts of the infodemic, especially in the context of a global health crisis, and the moderating effect of different coping strategies on the relationship between the overuse of health care and cyberchondria and anxiety.

METHODS

The data used in this study were obtained from a cross-sectional web-based survey. A professional survey company was contracted to collect the data using its web-based panel. The survey was completed by Chinese individuals aged 18 years or older without cognitive problems. Model parameters of the relationships between infodemic-driven overuse of health care, cyberchondria, and anxiety were analyzed using bootstrapped partial least squares structural equation modeling. Additionally, the moderating effects of coping strategies on the aforementioned relationships were also examined.

RESULTS

A total of 986 respondents completed the web-based survey. The mean scores of the Generalized Anxiety Disorder-7 and Cyberchondria Severity Scale-12 were 8.4 (SD 3.8) and 39.7 (SD 7.5), respectively. The mean score of problem-focused coping was higher than those of emotion- and avoidant-focused coping. There was a significantly positive relationship between a high level of infodemic and increased overuse of health care (bootstrapped mean 0.21, SD 0.03; 95% CI 0.1581-0.271). The overuse of health care resulted in more severe cyberchondria (bootstrapped mean 0.107, SD 0.032) and higher anxiety levels (bootstrapped mean 0.282, SD 0.032) in all the models. Emotion (bootstrapped mean 0.02, SD 0.008 and 0.037, SD 0.015)- and avoidant (bootstrapped mean 0.026, SD 0.009 and 0.049, SD 0.016)-focused coping strategies significantly moderated the relationship between the overuse of health care and cyberchondria and that between the overuse of health care and anxiety, respectively. Regarding the problem-based model, the moderating effect was significant for the relationship between the overuse of health care and anxiety (bootstrapped mean 0.007, SD 0.011; 95% CI 0.005-0.027).

CONCLUSIONS

This study provides empirical evidence about the impact of coping strategies on the relationship between infodemic-related overuse of health care services and cyberchondria and anxiety. Future research can build on the findings of this study to further explore these relationships and develop and test interventions aimed at mitigating the negative impact of the infodemic on mental health.

COVID-19 anxiety and its relation to anxiety-related disorder symptoms and mechanisms

The COVID-19 pandemic had a significant impact on the mental health of individuals, particularly in the area of anxiety-related disorders. Anxiety regarding COVID-19 has been associated with health anxiety, panic disorder, and obsessive-compulsive disorder symptoms. Additionally, COVID-19 anxiety has been associated with anxiety sensitivity, disgust, maladaptive metacognitions, and intolerance of uncertainty. While researchers have established that anxiety disorders and anxiety-related mechanisms were associated with COVID-19 anxiety, which specific anxiety-related symptoms and mechanisms are primarily associated with COVID-19 anxiety needs to be more extensively explored. The current study sought to further this area by examining which particular anxiety-related disorder symptoms and mechanisms were uniquely associated with COVID-19 anxiety. A non-clinical sample of 593 Canadian undergraduate participants (Mage = 21.13 years; 67.7 % female) completed this cross-sectional study between September 2020 and February 2021. Participants completed online questionaries assessing anxiety-related disorder symptoms and mechanisms in addition to multiple scales of COVID-19 anxiety. When examining symptoms, health anxiety (prs = 0.17-0.29) and obsessive-compulsive disorder (prs = 0.16-0.35) symptoms had the strongest unique associations with COVID-19 anxiety. Among the anxiety-related mechanisms, disgust sensitivity (prs = 0.14-0.16) and health anxiety-specific intolerance of uncertainty (prs = 0.12-0.30) had the strongest unique associations with COVID-19 anxiety. Individuals experiencing these disorders and anxiety-related mechanisms may be at a heightened vulnerability to experiencing heightened anxiety during future pandemics. Mental health professionals should discuss COVID-19 anxiety with individuals experiencing health anxiety or obsessive-compulsive disorder symptoms. Lastly, the study highlights the significance of considering a variety of specific anxiety-related disorder symptoms and mechanisms when working to understand pandemic anxiety.

A Conditional Process Analysis of Emerging Adults' Motivated Information Management with Parents, Family Conversation Orientation, and Intentions to Vaccinate for COVID-19

Using the theory of motivated information management (TMIM), this study tested the effect of emerging adults' uncertainty discrepancy about COVID-19 vaccines on their intentions to vaccinate. In March and April of 2021, 424 emerging adult children reported on the likelihood of seeking or avoiding information from a parent about COVID-19 vaccines in response to their uncertainty discrepancy and negative emotions related to the vaccines. Results supported the direct and indirect effects specified by the TMIM. Moreover, the indirect effects of uncertainty discrepancy on intentions to vaccinate via the TMIM's explanatory mechanisms were conditioned by family conversation orientation. Consequently, the family communication environment may alter motivated information management in parent-child relationships.

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.

Anticipatory worry and returning to campus during the COVID-19 pandemic

BACKGROUND

Assessing the psychological needs of students and employees as they return to campus is crucial to resuming University life in a safe and secure way. The current research aimed to explore how safety concerns, anticipatory worry, and mitigation efforts affected the well-being of individuals within a campus community.

METHODS

A five-part survey was distributed via student & employee listservs in the Fall 2020 at a midsize private university in the Mid-Atlantic Mid-Atlantic United States. Participants were surveyed about sources of worry regarding Covid-19, levels of anticipatory worry, amenability to various mitigation strategies and whether intended implementation of safety mitigation measures impacted worry levels.

RESULTS

Data collected from 559 students and employees indicated a relationship between source of worry and level of distress, with the greatest source of worry being fear of getting sick. Anticipatory worry after thinking about safety mechanisms was significantly lower than anticipated worry before thinking about safety mechanisms. No differences were found between students and employee experiences of worry, and there was no moderating effect of role on the difference between anticipated worry after, as compared to before, thinking about the mechanisms.

CONCLUSION

Findings highlight how different sources of concern related to Covid-19 are associated with varying levels of distress, the significant impact that the presence of mitigation strategies can have on reducing overall levels of anticipatory worry, and the universality of distress associated with Covid-19.

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.

Coronavirus Anxiety, COVID Anxiety Syndrome and Mental Health: A Test Among Six Countries During March 2021

The negative impact of the COVID-19 pandemic on mental health outcomes is widely documented. Specifically, individuals experiencing greater degrees of severity in coronavirus anxiety have demonstrated higher levels of generalized anxiety, depression and psychological distress. Yet the pathways in which coronavirus anxiety confers vulnerability are not well known. The present investigation sought to address this gap in the scientific literature by testing the indirect effect of the COVID-19 anxiety syndrome, which centres on the function of detecting and managing the environmental threat of virus exposure and its sequalae. Data were collected during the height of the pandemic (March 2021) and included 5297 adults across six countries. Structural equation modelling techniques revealed that the COVID-19 anxiety syndrome evidenced a statistically significant indirect effect between coronavirus anxiety and generalized anxiety, depression and work/social adjustment. Overall, results suggest there could be public health merit to targeting anxiety related to virus exposure to improve behavioural health for those who are struggling with excessive fear and worry.

Understanding the Design of Fear Appeals by Applying the Extended Parallel Process Model: A Qualitative Analysis of COVID-19 Public Service Announcements

PURPOSE

Identify how early COVID-19 public health messages incorporated in the tenets of the extended parallel process model (EPPM).

SETTING

YouTube videos developed by governmental departments, medical institutions, news organizations, and non-profit organizations in the United States were aggregated.

METHOD

This qualitative study conducted a keyword search to identify public service announcements (PSAs). The sample was further refined after searching PSAs that contained fear appeals. A thematic analysis was performed by using the constant comparative method.

SAMPLE

A total of forty-three videos was included in the final analysis.

RESULT

Two themes emerged regarding messages aimed at arousing the perceived severity of threat. These themes include emphasizing the consequences of being infected and utilizing personal narratives. Perceived susceptibility of threat was aroused by emphasizing that some groups have higher risks than others. Two themes emerged around arousing perceived response efficacy: (1) the authority of professionals; and (2) altruism and personal responsibility. One way was identified to arouse perceived self-efficacy, which is informing the protective measures.

CONCLUSION

Multiple strategies were used in PSAs about COVID-19 to arouse fear during the early stages of the pandemic. The utilization of self-efficacy was oversimplified, by not providing details about the rationale for the recommended behavior.

Student mental health during the COVID-19 pandemic: Are international students more affected?

Background: The psychological well-being of students may be especially affected by the COVID-19 pandemic; international students can lack local support systems and represent a higher risk subgroup. Methods: Self-reported depressive symptoms, suicidal ideation, anxiety, post-traumatic stress disorder (PTSD), insomnia, alcohol use, academic stress, and loneliness were examined in two cohorts of university students (March 2020 n = 207, March 2021 n = 142). We investigated differences i) between 2020 and 2021, ii) between domestic and international students, and ii) whether differences between the two cohorts were moderated by student status. Results: More depressive symptoms, academic stress, and loneliness were reported in 2021. International students reported more depressive symptoms, suicidal ideation, anxiety, PTSD, academic stress, and loneliness. The main effect of cohort was not moderated by student status. Conclusions: International students had worse mental health outcomes overall, but were not affected more by the COVID-19 pandemic than domestic students.

The Effect of Psychological Inflexibility on Social-Distancing Phobia Mediated by Preoccupation With Sleep and Intolerance of Uncertainty in the Elderly Population During the COVID-19 Pandemic

OBJECTIVE

The aim of this study was to explore whether psychological inflexibility in the elderly population is related to social-distancing phobia, and examine whether their viral anxiety, preoccupation with sleep, or intolerance of uncertainty may mediate the relationship.

METHODS

Among the elderly population aged ≥65 in Korea, we conducted an anonymous online survey during January and February 2023. We collected the responses of 300 participants, collected demographic information, and symptoms using rating scales such as the Social-Distancing Phobia scale, Stress and Anxiety to Viral Epidemics-6 items (SAVE-6), Intolerance of Uncertainty Scale-12 (IUS-12), Acceptance and Action Questionnaire-II (AAQ-II), and Glasgow Sleep Effort Scale (GSES).

RESULTS

Social-distancing phobia was expected by the SAVE-6 (β=0.34, p<0.001), IUS-12 (β=0.18, p=0.003), and GSES (β=0.18, p= 0.001) in the linear regression analysis. In the mediation analysis, psychological inflexibility did not directly influence social-distancing phobia. However, viral anxiety, intolerance of uncertainty, or preoccupation with sleep completely mediated the influence of psychological inflexibility on social-distancing phobia among elderly population.

CONCLUSION

The management of psychological inflexibility, intolerance of uncertainty, or preoccupation with sleep needs to be considered when designing interventions to address social-distancing phobia in elderly populations in future pandemics.

Severe COVID anxiety among adults in the United Kingdom: cohort study and nested feasibility trial

BACKGROUND

People with severe COVID anxiety have poor mental health and impaired functioning, but the course of severe COVID anxiety is unknown and the quality of evidence on the acceptability and impact of psychological interventions is low.

METHODS

A quantitative cohort study with a nested feasibility trial. Potential participants aged 18 and over, living in the UK with severe COVID anxiety, were recruited online and from primary care services. We examined levels of COVID anxiety in the six months after recruitment, and factors that influenced this, using linear regression. Those scoring above 20 on the short Health Anxiety Inventory were invited to participate in a feasibility trial of remotely delivered Cognitive Behavioural Therapy for Health Anxiety (CBT-HA). Exclusion criteria were recent COVID-19, current self-isolation, or current receipt of psychological treatment. Key outcomes for the feasibility trial were the level of uptake of CBT-HA and the rate of follow-up.

RESULTS

204 (70.2%) of 285 people who took part in the cohort study completed the six month follow-up, for whom levels of COVID anxiety fell from 12.4 at baseline to 6.8 at six months (difference = -5.5, 95% CI = -6.0 to -4.9). Reductions in COVID anxiety were lower among older people, those living with a vulnerable person, those with lower baseline COVID anxiety, and those with higher levels of generalised anxiety and health anxiety at baseline. 36 (90%) of 40 participants enrolled in the nested feasibility trial were followed up at six months. 17 (80.9%) of 21 people in the active arm of the trial received four or more sessions of CBT-HA. We found improved mental health and social functioning among those in the active, but not the control arm of the trial (Mean difference in total score on the Work and Social Adjustment Scale between baseline and follow up, was 9.7 (95% CI = 5.8-13.6) among those in the active, and 1.0 (95% C.I. = -4.6 to 6.6) among those in the control arm of the trial.

CONCLUSIONS

While the mental health of people with severe COVID anxiety appears to improve over time, many continue to experience high levels of anxiety and poor social functioning. Health anxiety is highly prevalent among people with severe COVID anxiety and may provide a target for psychological treatment.

TRIAL REGISTRATION

Retrospectively registered at ISRCTN14973494 on 09/09/2021.

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

Background

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

Methods

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

Results

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

Conclusion

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

Perceived value threats are related to fear of health impairments

Health impairments are problems in the body and mental functioning, which can be a result of a disease or side effects of treatment. Fear of health impairments plays an important role in decision-making and behavior. People might fear health impairments because of their beliefs about their dangerousness, but also because these impairments threaten important values. However, while the role of cognitive appraisal in the fear of health impairments is investigated, the role of motivation is less clear. To fill this gap, this study analyzed the role of values as motivational constructs in the fear of cognitive, motor, and sensory impairments, as well as impairments of reproductive functions and disfiguring impairments. Participants evaluated these health impairments as frightening or not. They also evaluated how these health impairments may threaten values and reported their value priorities. Health impairments are believed to threaten personally focused values (openness to change and self-enhancement) more than socially focused values (conservation and self-transcendence). Threats to personally focused values are related to higher fear of health impairments.

Health Anxiety, Fear of COVID-19, Nosophobia, and Health-protective Behaviors Among Healthcare Professionals

Objective

This study examined fear of COVID-19, nosophobia, health anxiety, and health-protective behaviors among healthcare professionals during the COVID-19 pandemic.

Methods

A cross-sectional, correlational research design was used in this study. The data of healthcare professionals (N=300) from three disciplines of medicine (Bachelor of Medicine and Bachelor of Surgery [MBBS], Bachelor of Dental Surgery [BDS], Doctor of Physiotherapy [DPT]) were collected using a purposive sampling technique. The Fear of COVID-19 Scale (FCV-19S), Medical Student Disease Perception and Distress Scale (MSD), Short Health Anxiety Inventory (SHAI), and Health Protective Behavior Scale (HBPS) were used as assessment measures. Statistical Package of Social Sciences (SPSS) version 22 was used to analyze the data obtained.

Results

Of the 300 participants, 132 (44%) were male and 168 (56%) were female. A total of 199 participants (63.3%) had a MBBS degree, 59 (19.7%) had a BDS degree, and 41 (14%) had a DPT degree. The findings revealed a significant positive correlation between nosophobia, health anxiety, and fear of COVID-19, whereas health-protective behavior showed a negative association with health anxiety. Sex, health anxiety, and nosophobia were significant predictors of health-protective behaviors among medical professionals.

Conclusion

The fear related to COVID-19 is associated with nosophobia and health anxiety among medical professionals, which has a substantial impact on health, work performance, and vulnerability to developing psychological distress if left unmonitored.

Measurement properties of the Health Anxiety by Proxy Scale (HAPYS): A new questionnaire to assess parents' worries about their child's health

OBJECTIVE

Health anxiety by proxy refers to parents' excessive worries about their child's health. The Health Anxiety by Proxy scale (HAPYS) is a new self-report questionnaire to assess parents' worries and behaviors regarding their child's health. This study aimed to investigate the measurement properties of the HAPYS.

METHODS

Questionnaires were completed by 204 parents, and a HAPYS score was obtained for 200 parents: 39 parents diagnosed with health anxiety, 33 parents with different anxiety disorders, 33 parents with a Functional Somatic Disorder, and 95 healthy parents. We evaluated the following measurement properties: structural validity, reliability, convergent validity ((pain catastrophizing, parents' reports of child's emotional and physical symptoms), discriminant validity (parental reports of child's well-being), and known-groups validity (see compared groups above).

RESULTS

HAPYS demonstrated a one factor dimensionality, and excellent internal reliability (α = 0.95; CI: 0.93-0.97) and test-retest reliability after two weeks (ICC = 0.91; CI: 0.87-0.94). Convergent validity with the construct of parental catastrophizing about child pain was good (r = 0.72; CI: 0.64-0.78)). Good known-groups validity was demonstrated by the largest total HAPYS score observed in parents with health anxiety (median = 35; IQR: 9-53) and the lowest score in healthy parents (median = 9; IQR: 5-15) (p < 0.001).

CONCLUSION

The findings support that HAPYS is a useful measure of health anxiety by proxy. Future research should examine the measurement properties in larger samples and different languages with further statistical analyses of structural validity.

Catastrophizing Maladaptive Coping Affects the Association Between Viral Anxiety and Fear of Progression in Cancer Patients During COVID-19 Pandemic

OBJECTIVE

The aim of the present study was to explore whether or not cancer patients' viral anxiety and depression during the coronavirus-2019 (COVID-19) pandemic were associated with a fear of cancer progression. We also assessed whether coping strategies affected the relationship.

METHODS

The present cross-sectional survey included cancer patients who visited Ulsan University Hospital in Ulsan, Korea. The participants' demographic information and responses to the following symptoms rating scales were collected: Stress and Anxiety to Viral Epidemic-6; Patient Health Questionnaire-9; Cognitive Emotion Regulation Questionnaire-short version; or Fear of Progression Questionnaire-short version.

RESULTS

Of the 558 cancer patients surveyed, 25 (4.5%) reported that their treatment schedule was delayed during the COVID-19 pandemic. The patients' fear of progression was found to be related to age (β=-0.08; p=0.011), viral anxiety (β=0.40; p<0.001), depression (β=0.26; p<0.001), and catastrophizing coping strategies (β=0.15; p=0.004), for an overall adjusted R2 of 0.46 (F=66.8; p<0.001). Mediation analysis showed that viral anxiety and depression were directly associated with fear of progression, while catastrophizing mediated this relationship.

CONCLUSION

Fear of progression in cancer patients was associated with viral anxiety, depression, and maladaptive coping techniques, such as catastrophizing, during the COVID-19 pandemic.

Illness anxiety predicts higher mental strain and vaccine willingness-A nine-wave longitudinal study during the first 1.5 years of the COVID-19 pandemic in Germany

Illness anxiety may amplify vulnerability to psychopathological symptoms during the COVID-19-pandemic-perhaps especially at the beginning of the pandemic and during high infection waves, but empirical evidence on this is lacking. In addition, considering a potentially functional facet of it, illness anxiety might be associated with higher vaccine willingness. We analyzed data of a nine-wave longitudinal online-survey (March 2020-October 2021) with 8148 non-probability sampled adults of the general population in Germany (clinicaltrials.gov: NCT04331106). Using multilevel analysis, we investigated longitudinal associations of dimensionally assessed illness anxiety (worry about illness, bodily preoccupation) with mental strain and vaccine willingness and considered the dynamic of the pandemic (i.e., duration and infection rates). Higher worry about illness and bodily preoccupation were associated with higher COVID-19-related fears, unspecific anxiety, depressive symptoms, and vaccine willingness. Vaccine willingness increased over time and in parallel to higher infection rates. Symptoms of mental strain decreased with continuing duration of the pandemic but increased when infection rates inclined. This decrease and increase, respectively, was steeper in individuals with higher illness anxiety. Our findings suggest that individuals with higher illness anxiety are more vulnerable to experience psychopathological symptoms during the ongoing pandemic, particularly at its beginning and during times of high infection rates. Thus, illness anxiety and associated symptoms should be targeted by adaptive measures. The fluctuation of symptoms parallel to the pandemic situation implies that support should be particularly issued at the beginning of extraordinary situations as well as during phases of high infection rates.

Positive Mental Health of Migrants in the UK during COVID-19: A Review

COVID-19 impacted the mental health of many people in the UK. The negative impact was especially substantial among vulnerable population groups, including migrants. While research has focused on the negative aspects of mental health during the pandemic, the positive mental health of migrants in the UK during COVID-19 remained to be evaluated. This review aimed to identify literature that focused on positive mental health, and thematically synthesise the findings to understand what positive mental health approaches were employed to support specific outcomes during the pandemic for them to survive in this difficult time. Medline, Embase, and PsycINFO were searched using terms including "mental health", "migrants", and "COVID-19". The Critical Appraisal Skills Programme checklist was used to assess the quality of the included studies. There were only two studies examining the positive mental health of UK migrants during this period. They describe approaches such as religious beliefs, passion for and acknowledgement of their job, learning new things, being physically active, social media, and social activities, producing outcomes such as inner peace, confidence, well-being, and a sense of belonging. The quality of the included studies was high. More research about positive mental health in migrants in the UK during the pandemic is needed.

Mindfulness Interventions and Surveys as Tools for Positive Emotional Regulation During COVID-19: A Scoping Review

Objectives

The COVID-19 pandemic has caused high mortality rates worldwide, as well as consequent psychological and physical stress. The present study aimed to review the main existing scientific research studies conducted since the onset of the COVID-19 that have used mindfulness-based interventions (MBIs) as tools for emotional regulation, aiming to improve individuals’ ability to cope with general stress caused by pandemic periods and their consequences (e.g., contagion, confinement, loss of loved ones or job stability) especially related with anxiety, stress, depression, or emotional dysregulation.

Method

To this aim, six databases (i.e., PubMed, Medline, Embase, Scopus, Web of Science, and Science Direct) were consulted and analyzed following PRISMA-Sc guidelines.

Results

Of the 16 studies selected, 7 are clinical trials that used MBIs, and 9 are online surveys in which mindfulness and emotional regulation variables were assessed to explore their interrelations. Generally, the analysis suggested that the cultivation of MBI strategies for treating anxiety and depression during COVID-19 confinement periods resulted in improved psychological well-being.

Conclusions

MBI techniques can be considered useful intervention tools in current and future worldwide changing situations, in which personal development and resilience should be considered an urgent issue for both educational and preventive health practices. Conversely, there are also some limitations that arose from the field of MBI research that hopefully might be addressed in future research (such as the diversity of intervention techniques used across studies).

Pre registration

This study is not preregistered.

Contextual influence of the COVID-19 pandemic on pregnant women's emotional regulation abilities

INTRODUCTION

Emotional regulation is a key factor that could determine the quality of becoming a parent. Since pregnancy is accompanied by changes in the emotional system, fluctuations in emotional regulation may also occur during this period. In 2020, the COVID-19 pandemic had major psychological repercussions on the general population which could have also affected emotional regulation capacities.

OBJECTIVE

The objective of this study was to determine whether emotional regulation has characteristics during pregnancy and to evaluate the influence of the COVID-19 pandemic on the emotional regulation of pregnant women.

METHOD

One hundred fifty-one women aged between 19 and 42 years old participated in this study. Their emotional regulation abilities were assessed using the Difficulties Emotion Regulation Scale before and during the pandemic. A two-factor multivariate analysis of covariance, "parental status" (pregnant vs. childless) and "time of data collection" (before vs. during COVID-19), was conducted to compare the emotional regulation abilities of pregnant women with those of childless women before and during the pandemic.

RESULTS

(1) Prior to the pandemic, pregnant women exhibited better emotional regulation skills than childless women, characterized by greater acceptance and understanding of their emotions. (2) During the pandemic: (a) pregnant women's emotional regulation scores were comparable to those of women without children. (b) They also had more difficulty than pre-pandemic pregnant women in identifying their emotions.

CONCLUSION

The lack of improvement in emotional regulation skills in pregnant women during the COVID-19 pandemic is a specific impact of COVID on this population. This could affect their mental health, as well as the emotional adjustment of the mother towards her baby.

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.

A multi-site German validation of the Interoceptive Accuracy Scale and its relation to psychopathological symptom burden

Altered interoception is thought to be implicated in the development of psychopathology. Recent proposals highlight the need to differentiate between dimensions of interoception to better understand its relation to mental health. Here, we validated a German version of the Interoceptive Accuracy Scale (IAS) and investigated the relationship between IAS scores and clinical outcomes, across seven samples from four research centers (N = 3462). The German IAS version was best explained by a one-factor structure that showed acceptable psychometric properties. We replicated previous findings showing a negative association between IAS scores and measures of alexithymia. IAS scores were negatively related to measures of clinical symptomatology (e.g., anxiety, depressive, and somatoform symptoms) and neurotic traits. These findings suggest that the German IAS is a reliable and valid instrument for subjective interoceptive accuracy. Results emphasize the importance of distinguishing between dimensions of interoception to understand its potential modulatory and protective role in psychopathology.

COVID-19 Vaccine Acceptance, Trust in Vaccine, Anxiety Levels, and Related Factors in Turkish Society

BACKGROUND

Vaccine acceptance and trust in vaccines pose a complex process affected by many factors. The present study was conducted to determine coronavirus disease 2019 (COVID-19) vaccine acceptance, trust in vaccines, anxiety levels, and related factors in Turkish society.

METHODS

The data of this cross-sectional and descriptive-correlational study were collected with the snowball method by using an online questionnaire throughout Turkey. The study was conducted between March 15 and April 3, 2021, with 3148 participants from 7 regions and 81 cities in Turkey.

RESULTS

It was found that the participants accepted the vaccine at 72.8%, and the trust rate in the vaccine was 66.0%. It was also found that women, single participants, those who had immune system diseases, and with COVID-19 had higher Coronavirus Anxiety Scale scores at significant levels. According to Logistic Regression Analysis, gender, age, trust in the vaccine, perception of risk levels regarding COVID-19, and coronavirus anxiety levels are factors affecting the intentions of participants to accept/reject the vaccine. It was determined that male participants were more likely to accept the coronavirus vaccine (P = 0.028). It was found that health-care employees had higher trust in the coronavirus vaccine (P = 0.006) and acceptance rates (P = 0.010) at significant levels compared with the general population.

CONCLUSION

The COVID-19 vaccine acceptance rate in Turkish society was found to be high, and the level of trust in vaccines and anxiety levels were above the moderate level.

The influence of emotion regulation strategies and sleep quality on depression and anxiety

Chronic stress is a major risk factor for a number of mental health disorders, including depression and pathological anxiety. Adaptive cognitive emotion regulation (CER) strategies (i.e. positively-focused thought processes) can help to prevent psychiatric disturbance when enduring unpleasant and stressful experiences, but little is known about the inter-individual factors that govern their success. Sleep plays an important role in mental health, and may moderate the effectiveness of adaptive CER strategies by maintaining the executive functions on which they rely. In this study, we carried out a secondary analysis of self-reported mental health and sleep data acquired during a protracted and naturally-occurring stressor - the COVID-19 pandemic - to firstly test the hypothesis that adaptive CER strategy use is associated with positive mental health outcomes and secondly, that the benefits of adaptive CER strategy use for mental health are contingent on high-quality sleep. Using established self-report tools, participants estimated their depression (N = 551) and anxiety (N = 590)2 levels, sleep quality and tendency to engage in adaptive and maladaptive CER strategies during the Spring and Autumn of 2020. Using a linear mixed modelling approach, we found that greater use of adaptive CER strategies and higher sleep quality were independently associated with lower self-reported depression and anxiety. However, adaptive CER strategy use was not a significant predictor of self-reported anxiety when accounting for sleep quality in our final model. The positive influence of adaptive CER strategy use on depression was observed at different levels of sleep quality. These findings highlight the importance of adaptive CER strategy use and good sleep quality in promoting resilience to depression and anxiety when experiencing chronic stress.

Health anxiety, death anxiety and coronaphobia: Predictors of postpartum depression symptomatology during the COVID-19 pandemic

OBJECTIVE

To determine levels of postpartum depression symptoms and possible relevant predictors, such as death anxiety, health anxiety, and coronavirus-related anxiety.

DESIGN

Cross-sectional web-based survey using quantitative methods.

SETTING

Exclusively online recruiting via social media and unpaid cross-posting conducted during the third wave of the COVID-19 pandemic in Romania.

PARTICIPANTS

Women were eligible to take part in the study if they were mothers over the age of 18 and had a baby aged between 4 weeks - 12 months of age; 1024 women were included in the final sample.

MEASUREMENTS AND FINDINGS

Health anxiety, death anxiety, coronavirus-related anxiety, and postpartum depression symptoms were measured using validated instruments. Current depression symptomatology was 67.6%, 26.7% scored above the cut-off for high health anxiety, 1% for coronavirus-related anxiety, and 62.7% for death anxiety. Significant predictors for depressive symptomatology were breastfeeding, history of depression, family income, number of children, health anxiety, death anxiety, and coronavirus anxiety. Further, hierarchical multiple regression analysis indicated that death anxiety, health anxiety, and coronavirus anxiety predicted postpartum depression symptoms over and above socio-demographic factors.

KEY CONCLUSIONS

Supported by previous studies, our results suggest that postpartum depression symptomatology levels during the COVID-19 pandemic are high and that they are predicted by health and death anxiety, which are also increased during the pandemic.

IMPLICATION FOR PRACTICE

The findings provide information to identify the risk for depression symptoms in postpartum mothers during acute public health situations.

Self-reported interoception, worries and protective behaviors during the COVID-19 pandemic: a longitudinal study

BACKGROUND

Protective behaviors were essential for minimizing the spread of the virus during the coronavirus disease 2019 (COVID-19) pandemic. It is often assumed that awareness of bodily sensations (interoception) can improve decision-making and facilitate adaptive behavior.

OBJECTIVE

This paper investigates cross-sectional and longitudinal relationships between different aspects of self-reported interoception, trait anxiety, COVID-related worry, and health protective behaviors.

METHODS

The study was conducted on a community sample of 265 adults. The two data collection phases took place online, before (baseline) and during the second wave of the COVID-19 pandemic in Hungary.

RESULTS

Contrary to our expectations, neither cross-sectional nor longitudinal associations were found between protective behaviors and indicators of self-reported interoception. However, worry at baseline predicted protective behaviors during the second wave, even after controlling for socio-economical characteristics and protective behaviors at baseline.

CONCLUSION

Our results highlight the adaptivity of health-related worry when behavioral steps to avoid threats are known and available. Also, higher level of perceived interoception did not appear to be health protective under these circumstances.

Comparing COVID-19 Response Behaviors between a Cancer Patient Sample and a Population-Based Cancer-Free Sample in a Rural Midwestern State

INTRODUCTION

The COVID-19 pandemic caused an increase in fear, anxiety, and depressive symptoms globally. For populations at increased risk for adverse outcomes due to illness, such as cancer patients, these worries may have been exacerbated. Understanding how the pandemic impacted cancer patients will inform better preparation for future events that cause disturbances to cancer care delivery.

METHODS

This study analyzed data from two surveys to determine whether cancer patients' responses differed from a cancer-free population-based sample in terms of concerns, preventive behaviors, and thoughts on their healthcare provider's communication regarding COVID-19 in a US Midwestern state. In August 2020, a survey was sent to 10,009 Iowans aged 18 and older, randomly selected from the 2018 Iowa voter registration file. In September 2020, a survey was emailed to 2,954 cancer patients aged 18 and older who opted into the University of Iowa Holden Comprehensive Cancer Center's Patients Enhancing Research Collaborations at Holden program. Previously validated and pretested Likert-type and multiple-choice items assessed concern regarding COVID-19, social distancing perception and behaviors, and demographic characteristics of respondents. We used χ2 tests and logistic regression to examine differences between the cancer patient and general population survey responses.

RESULTS

We included 3,622 responses from the general population survey and 780 responses from the cancer patient survey in this analysis. Cancer patient survey respondents were more frequently older, lived in urban areas, had Medicare insurance coverage, had a college degree or higher, and were married. Cancer patients were more likely to report engaging in social distancing behaviors and greater concern regarding the pandemic.

CONCLUSION

This study suggests differences in the impact of the COVID-19 pandemic on cancer patients compared to cancer-free members of the general population. These results indicate the need for consideration of cancer patients' physical and mental health during large-scale disruptions to cancer care.