Exploring how health-related advertising interference contributes to the development of cyberchondria: A stressor-strain-outcome approach

Objectives

Cyberchondria is increasingly recognized as the dark side of digital health, given the pervasive use of the internet as a main source of health information in people's daily lives. While previous studies have identified many factors contributing to cyberchondria, there is a dearth of research on the impact of health-related advertisements. Therefore, this study adopts the stressor-strain-outcome (SSO) model to investigate how health-related advertising interference is directly and indirectly related to cyberchondria.

Methods

To empirically validate the proposed research model, we conducted an online survey with 437 internet users with medical information seeking experience in China. Structural equation modeling (SEM) was employed to analyze the survey data.

Results

Our findings revealed a positive, direct association between health-related advertising interference and cyberchondria. Meanwhile, advertising interference was positively related to both information overload and information irrelevance, with the former further predicting cyberchondria. Moreover, doctor-patient communication weakened the positive effect of information overload on cyberchondria.

Conclusions

The study not only theoretically contributes to the literature by theorizing the relationship between health-related advertising interference and cyberchondria but also practically underlines the pivotal role of effective doctor-patient communication in reducing the development of cyberchondria.

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.

Unpacking Inequities in ADHD Diagnosis: Examining Individual-Level Race/Ethnicity and State-Level Online Information-Seeking Patterns

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent, persistent, and costly mental health condition. The internet is an increasingly popular source for information related to ADHD. With a nationally representative sample (2018 NSCH), we aimed to separate individual- and state-level effects to examine inequities in ADHD diagnoses. We extracted state-level relative search volumes using "ADHD," "ADHD treatment," "ADHD medication," and "ADHD therapy" from Google Trends, and sociodemographic and clinical variables from the 2018 National Survey of Children's Health (N = 26,835). We examined state variation in ADHD-related information-seeking and applied multilevel modeling to examine associations among individual-level race/ethnicity, state-level information-seeking patterns, and ADHD diagnoses. Online information seeking related to ADHD varies by state and search term. Individual-level racial/ethnic background and state-level information-seeking patterns were associated with ADHD diagnoses; however, their cross-level interaction was not significant. This study adds to the strong body of evidence documenting geographical variation and diagnostic disparity in mental health and the growing literature on the impact of the digital divide on population health, indicating an urgent need for addressing inequities in mental health care. Increasing public interest in and access to empirically supported online information may increase access to care, especially among people of color.

Online health information seeking and the association with anxiety among older adults

Introduction

The Internet supplies users with endless access to a wealth of information and is generally the first source searched by U.S. adults (18 years and older) when seeking health information. Age and anxiety are associated with online health information seeking (OHIS). Older adults (65 years and older) are increasing their OHIS. Importantly, OHIS can potentially lead to improved health outcomes for older adults. The relationship between OHIS and anxiety is less clear. Studies report those with more symptoms of anxiety are more likely to be OHIS, while other studies find the reverse pattern or no association. Generalized anxiety disorder affects up to 11% of older adults and is oftentimes unrecognized and untreated.

Methods

To address the mixed findings in the literature, we analyzed six waves (2015-2020) of data from the National Health and Aging Trends Study to assess the causal relationship between anxiety and OHIS using a Random Intercept Cross-lagged Panel Model framework.

Results

We found that while anxiety symptoms lead to OHIS in the next wave, OHIS was not associated with anxiety symptoms in the next wave.

Discussion

This suggests that for this sample of older adults, OHIS does not reduce or exacerbate older adults' symptoms of anxiety.

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.

Metacognitions About Health in Relation to Coronavirus Anxiety: The Mediating Role of Cognitive Attentional Syndrome and Distress Tolerance

The current study aimed to investigate the mediating role of cognitive attentional syndrome (CAS) and distress tolerance in the relationship between health-related metacognitions and coronavirus anxiety. The sample of this study consisted of 462 participants (381 female). Participants voluntarily completed self-report questionnaires on each of the variables mentioned above. The results of the structural modeling analysis showed that health-related metacognitions have a significant effect on the mediator variable of distress tolerance and CAS. Also, health-related metacognitions had a direct effect on coronavirus anxiety. Also, based on the results of the bootstrap test, it can be argued that health-related metacognitive beliefs, apart from their direct effect, play an important role in coronavirus anxiety, with CAS acting as a mediator. This study provides insights into the relationships among metacognitive beliefs, coronavirus anxiety, CAS, and distress tolerance. In particular, dysfunctional metacognitive beliefs, including an individual's beliefs about the uncontrollability of disease-related thoughts, are risk factors that could negatively affect mental health, leading to coronavirus anxiety. In addition, the association of dysfunctional beliefs with maladaptive behaviors resulting from the cognitive attentional syndrome is also involved in predicting and causing coronavirus anxiety. Given the insignificant role of emotional distress tolerance in the psychopathology of COVID-19 anxiety, the findings emphasize the importance of cognitive factors in this context.

Using the ABC theory of emotion to examine the relationship between health anxiety and health information-seeking behavior among the rural population

Objective

The aim of the current study was to explore the relationship between online and offline health information-seeking behaviors, as antecedents and consequences, and health anxiety and related belief factors in rural residents.

Methods

Based on the ABC theory of emotions (ABC model), this study developed two theoretical models of the association between health anxiety and health information-seeking behavior: Placing health information-seeking behavior (both online and offline) as an outcome and antecedent, respectively, and setting three belief factors of the perceived health threat, intolerance of uncertainty, and catastrophic misinterpretations. We collected 730 self-reported data points from 20 June to 5 July 2022 for rural residents in China and empirically tested the research model and hypotheses using partial least squares-based structural equation modeling.

Results

The perceived health threat and intolerance of uncertainty are significant motivators of health anxiety, and health anxiety has a direct beneficial effect on both online and offline health information-seeking behaviors. Health anxiety is influenced either directly or indirectly by catastrophic misinterpretations resulting from online health information-seeking, while offline health information-seeking behavior does not contribute as strongly to health anxiety directly but mainly reinforces it through the mediating influence of catastrophic misinterpretations.

Conclusions

Rural residents' health anxiety promotes their online and offline health information behaviors. And both their online and offline health information-seeking behaviors may promote health anxiety directly and through catastrophic misinterpretations. Comparing the two, online health information-seeking behaviors primarily exacerbate health anxiety through direct effects, whereas offline health information-seeking behaviors primarily affect health anxiety through catastrophic misinterpretations. We provide suggested guidelines for alleviating health anxiety and regulating health information behaviors among rural residents.

Health-related social media use and COVID-19 anxiety in adolescence: health anxiety as covariate and moderator

Background

Adolescents can benefit from engagement with health-related content on social media (e.g., viewing, commenting, or sharing content related to diseases, prevention, or healthy lifestyle). Nevertheless, such content may be distressing or exaggerated and present a challenge to mental well-being, especially during the COVID-19 pandemic. Rumination about such content may lead to COVID-19 anxiety. Yet, the individual factors that would explain the association between health-related social media use (SMU) and COVID-19 anxiety are understudied.

Objective

In the current study, we aimed to fill the gap by investigating the association between health-related social media use (SMU) and COVID-19 anxiety in light of several individual factors: health anxiety, eHealth literacy, and mild and severe experience with COVID-19 infection. We (1) studied the relationship between individual factors and health-related SMU, (2) tested health anxiety as a moderator in the association between health-related SMU and COVID-19 anxiety, and (3) explored a direct effect of experience with COVID-19 on COVID-19 anxiety.

Methods

Using structural equation modeling, we analyzed cross-sectional data from a representative sample of 2,500 Czech adolescents aged 11-16, 50% girls. Sociodemographic measures, health-related SMU, COVIDCOVID-19 anxiety, health anxiety, eHealth literacy, and mild and severe experience with COVID-19 infection were assessed with an anonymous online survey. The data were collected in June 2021.

Results

We conducted a path analysis to test the main relationships and an additional simple-slopes analysis to explore the moderating effect of health anxiety. Higher health anxiety and eHealth literacy were associated with increased health-related SMU. The effect of experience with COVID-19 infection on both COVID-19 anxiety and health-related SMU was negligible. Health-related SMU and COVID-19 anxiety were positively associated, however, only for adolescents high in health anxiety. For other adolescents, the two variables were unrelated.

Conclusion

Our findings show that adolescents with higher health anxiety and eHealth literacy engage in health-related SMU more intensively. Furthermore, for adolescents high in health anxiety, the frequency of health-related SMU is associated with the risk of COVID-19 anxiety. This is likely due to differences in media use. Adolescents with high health anxiety may use social media for content that is more likely to lead to COVID-19 anxiety compared to other adolescents. We recommend focusing on the identification of such content, which may lead to more precise recommendations regarding health-related SMU compared to cut-back on the frequency of overall SMU.

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

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

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.

Relations of Adolescent Knowledge of COVID-19, Social Media Engagement, and Experiences During Quarantine/Lockdown with Well-Being

This study investigated the relations of adolescent COVID-19 knowledge, quarantine/lockdown experiences, and social media use with indices of their psychosocial adjustment. The sample consisted of 215 adolescents from throughout the United States, with adolescents ranging from ages 14 to 17. Better knowledge of COVID-19 was related to lower loneliness, stress, anxiety, depression, and fear of missing out (FoMO). Higher parent-reported restrictions during quarantine were associated with these difficulties as well. Further, the lowest anxiety was reported for adolescents with good COVID-19 knowledge who also checked social media relatively less frequently. The findings point to the importance of accurate information about COVID-19 for adolescents and the impact of quarantine/lockdown experiences on their perceived emotional and social adjustment.

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

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

Linking the Pathway from Exposure to Online Vaccine Information to Cyberchondria During the COVID-19 Pandemic: A Moderated Mediation Model

Cyberchondria describes excessive health information seeking on the Internet is associated with escalating concerns and anxiety. Drawing upon the stimulus-organism-response model, this study proposes a moderated mediation model to explore how people develop cyberchondria when they search for COVID-19 vaccine-related information on the Internet. To test the proposed model, an online survey was conducted in China. Results showed that there was a direct and positive relationship between exposure to online vaccine information and cyberchondria. This relationship was also partially mediated by perceived information overload. Moreover, e-health literacy negatively moderated the indirect relationship between exposure to online vaccine information and cyberchondria through perceived information overload. The results from this study can advance our knowledge on the development of cyberchondria during public health crises, and inform health professionals and social media operators on developing evidence-based interventions to manage this issue.

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

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

Coronavirus anxiety and cyberchondria among teachers during the COVID-19 pandemic: an online survey: Coronavirus anxiety and cyberchondria

This study aimed to determine anxiety and cyberchondria and to investigate the links between anxiety and cyberchondria among teachers. This cross-sectional and descriptive study was conducted with 250 teachers. Data were collected using demographic information form, Cyberchondria Severity Scale and Coronavirus Anxiety Scale Short Form. The mean age of the teachers was 40.40 ± 8.83 years. The anxiety mean score was 7.70 ± 3.67, cyberchondria severity mean score was 73.47 ± 20.59. There were significant positive correlations between anxiety about COVID-19 and cyberchondria(r = 0.423, p < 0.001). Researchers must determine whether there is a benefit in further solving these relationships and reducing and preventing intervention in cyberchondria and anxiety; they must focus on results which increase anxiety, and investigate the correlation between cyberchondria, anxiety and behavior.

Investigating the Obsessive and Compulsive Features of Cyberchondria: A Holistic Review

Background

Cyberchondria has been brought into sharp focus during the COVID-19 health emergency; it refers to individuals who obsessively and compulsively search for health information online, resulting in excessive health concerns. Recent scholarship focuses on its obsessive and compulsive aspect, following a biopsychosocial approach as opposed to a pathology of health anxiety. It lacks interpretation of the socio-psychological dynamics between the dimensions.

Objective

This review aims to propose a holistic view toward understanding cyberchondria as an obsessive–compulsive syndrome and considers possible interventions. It specifically seeks to explain cyberchondria from diversified mediator variables and to pinpoint connections between each perspective.

Methodology

Comprehensive searches of databases such as PubMed and Springer were conducted to identify English articles relating to cyberchondria from 2001 to 2022. Based on a systematic filtering process, 27 articles were finally reviewed.

Findings

The authors compare and confirm three forecasts to predict cyberchondria, associating it with individual metacognition, uncertainty of unverified information, and algorithm-driven, biased information environments.

Value

Theoretically, a holistic framework is proposed to explain the obsessive and compulsive features of cyberchondria. Clinically, the research calls for more professional psychoeducation and chain screening of cyberchondria and other psychological disorders. Socially, it promotes support for risk-sensitive, information-deficient groups during pandemics like COVID-19. It also stresses more careful use of algorithm-driven search engine technology for platforms delivering medical information. Future research may explore areas such as the association between cyberchondria and other social-related disorders, as well as correlations among cyberchondria, obsessive and compulsive disorders, medical trust, and algorithm-driven search results.

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.

Online Health Information Seeking for Self and Child: An Experimental Study of Parental Symptom Search

BACKGROUND

Parents often search the web for health-related information for themselves or on behalf of their children, which may impact their health-related decision-making and behaviors. In particular, searching for somatic symptoms such as headaches, fever, or fatigue is common. However, little is known about how psychological and relational factors relate to the characteristics of successful symptom-related internet searches. To date, few studies have used experimental designs that connect participant subjective search evaluation with objective search behavior metrics.

OBJECTIVE

This study aimed to examine the features of web-based health-related search behaviors based on video-coded observational data, to investigate which psychological and relational factors are related to successful symptom search appraisal, and to examine the differences in search-related outcomes among self-seekers and by-proxy seekers.

METHODS

In a laboratory setting, parents living in Austria (N=46) with a child aged between 0 and 6 years were randomized to search their own (n=23, 50%) or their child's (n=23, 50%) most recent somatic symptom on the web. Web-based activity was recorded and transcribed. Health anxiety, eHealth literacy, attitude toward web-based health information, relational variables, state of stress, participants' search appraisals, and quantitative properties of the search session were assessed. Differences in search appraisals and search characteristics among parents who searched for themselves or their children were examined.

RESULTS

Across both groups, searches were carried out for 17 different symptom clusters. Almost all parents started with Google (44/46, 96%), and a majority used initial elaborated key phrases with >1 search keyword (38/45, 84%) and performed on average 2.95 (SD 1.83) search queries per session. Search success was negatively associated with health anxiety (r_s=-0.39, P=.01), stress after the search (r_s=-0.33, P=.02), and the number of search queries (r_s=-0.29, P=.04) but was not significantly associated with eHealth literacy (r_s=0.22, P=.13). Of note, eHealth literacy was strongly and positively correlated with satisfaction during the search (r_s=0.50, P<.001) but did not significantly correlate with search characteristics as measured by search duration (r_s=0.08, P=.56), number of performed search queries (r_s=0.20, P=.17), or total clicks (r_s=0.14, P=.32). No differences were found between parents searching for their own symptoms and parents searching for their child's symptoms.

CONCLUSIONS

This study provides exploratory findings regarding relevant dimensions of appraisals for symptom-based information seeking on the web. Consistent with previous literature, health anxiety was found to be associated with poorer search evaluation. Contrary to expectations, eHealth literacy was related neither to search success nor to search characteristics. Interestingly, we did not find significant differences between self-seekers and by-proxy seekers, suggesting similar search and evaluation patterns in our sample. Further research with larger samples is needed to identify and evaluate guidelines for enhanced web-based health information seeking among parents and the general public.

Searched and found? The association between use of health information sources and success in getting the desired information

BACKGROUND

Although many health information seeking studies are concerned with longer range outcomes (e.g. patient-provider communication) the immediate outcomes for the searchers are whether they found the desired information, for whom and how successfully.

OBJECTIVES

To examine the association between health information seeking via various sources and the reported extent of success in getting the desired information the information needs perspective.

METHODS

Data were obtained from the 2017 Israel Social Survey and analysed using multinomial regression models. The sample included individuals who reported engaging in seeking health information prior to the survey and mentioned the extent of success in obtaining the desired health information (fully, partially, or not-at-all) (N = 2197). Multinominal regression technique served for the multivariable analysis.

DISCUSSION

Engagement in health information seeking via friends, family and using various websites (excluding those by Ministry of Health and Health Funds) was associated with the increased likelihood of partial success in getting the desired information. Education level and population group, affected level of success.

CONCLUSIONS

The (partial) success in meeting health consumers' information needs is associated with the turn to particular sources. Public health professionals and health provider institutions should improve provision and delivery of health information to meet consumer health information needs.

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.

Safety Learning in Anxiety, Pavlovian Conditioned Inhibition and COVID Concerns

Experimental studies of fear conditioning have identified the effectiveness of safety signals in inhibiting fear and maintaining fear-motivated behaviors. In fear conditioning procedures, the presence of safety signals means that the otherwise expected feared outcome will not now occur. Differences in the inhibitory learning processes needed to learn safety are being identified in various psychological and psychiatric conditions. However, despite early theoretical interest, the role of conditioned inhibitors as safety signals in anxiety has been under-investigated to date, in part because of the stringent test procedures required to confirm the demonstration of conditioned inhibition as such. Nonetheless, the theoretical implications of an inhibitory learning perspective continue to influence clinical practice. Moreover, our understanding of safety signals is of additional importance in the context of the increased health anxiety and safety behaviors generated by the COVID-19 pandemic.

Does Internet Use Aggravate Public Distrust of Doctors? Evidence from China

The internet has exacerbated the spillover of medical information, and changes in the quantity, quality, and scope of information supply also affect public trust in doctors, which is of great significance to the construction of a harmonious physician–patient relationship. The objective of this study is to explore the relationship between internet use and residents’ trust in doctors using data from the China Family Panel Studies for 2018. The empirical investigation utilizes an endogenous switching regression model (ESR) to overcome the endogeneity bias. Our results indicate that internet use is negatively associated with residents’ trust in doctors (β = 0.07, p < 0.05). Specifically, the patient trust of internet users is nearly 7 percent less than that of non-internet users. Nevertheless, residents with higher dependence on traditional media such as television, newspapers, magazines and radio as an information channel show stronger patient trust. Finally, the results of the subsample analysis indicate a need to focus on older and less-educated residents, who are more vulnerable and more likely to be affected.

The structural model of cyberchondria based on personality traits, health-related metacognition, cognitive bias, and emotion dysregulation

INTRODUCTION

Cyberchondria is excessive seeking for online health-related information related to increasing health anxiety and distress levels. The current study investigated the mediating role of health-related metacognition, cognitive bias, and emotion dysregulation in the relationship between personality traits and cyberchondria.

METHODS

Participants were 703 individuals 18+ years old who had access to the internet (males = 43.8%, mean age = 33.82 ± 10.09 years and females = 56.2%, mean age = 34.37 ± 11.16 years). They voluntarily completed a questionnaire package that included the Cyberchondria Severity Scale (CSS), the revised NEO Personality Inventory (NEO-PI-R), the Difficulties in Emotion Regulation Scale (DERS), the Meta-Cognitions about Health Questionnaire (MCQ-HA), and the Health Cognitions Questionnaire (HCQ).

RESULTS

The initial evaluation of the model demonstrated that the personality traits of openness to experience, agreeableness, and conscientiousness had no significant relationship with other variables in the structural model, and the effects of neuroticism and extroversion were the only significant results. Rerunning the model with the removal of non-significant variables revealed a full mediation of health-related metacognition, cognitive bias, and emotion dysregulation in the relation between personality traits (neuroticism and extraversion) and cyberchondria. Fit indices demonstrated the acceptable fit of the model with the collected data (χ² = 979.24, p <.001; NFI = 0.92, CFI = 0.93, GFI = 0.90, IFI = 0.93, RMSEA = 0.071, and SRMR = 0.063). The results indicated that the present model could explain R ² = 54% of cyberchondria variance.

DISCUSSION

These findings suggest that health-related metacognition, cognitive bias, and emotion dysregulation could demonstrate a full mediating role in the correlation between personality traits and cyberchondria.

Undergraduate Students' Online Health Information-Seeking Behavior during the COVID-19 Pandemic

As the COVID-19 pandemic has swept across the world, the amount of health-related information available has skyrocketed. Individuals can easily access health information through the internet, which may influence their thoughts or behavior, causing potential technological risks that may affect their lives. This study examined the online health information-seeking behavior of undergraduate students. Taking health issues as a guiding framework, content analysis was adopted to assess participants' online health information-seeking behavior using a computer screen recording software, and coding analysis was conducted. The study was conducted during the COVID-19 pandemic with a formal sample of 101 participants. In terms of online health information-seeking behavior, 59% of the study participants used nouns as keywords, only 27% used Boolean logic retrieval techniques, 81% paid attention to the date of the data, and 85% did not consider the author's professionalism. The results indicate that health information-seeking behavior and outcome judgments may be a missing piece of the puzzle in higher education. Consequently, the development of online health information-seeking skills through programs for undergraduate students is suggested to ensure that online readers have access to appropriate health information.

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.

Associations between Depression, Anxiety, Fatigue, and Learning Motivating Factors in e-Learning-Based Computer Programming Education

Quarantines imposed due to COVID-19 have forced the rapid implementation of e-learning, but also increased the rates of anxiety, depression, and fatigue, which relate to dramatically diminished e-learning motivation. Thus, it was deemed significant to identify e-learning motivating factors related to mental health. Furthermore, because computer programming skills are among the core competencies that professionals are expected to possess in the era of rapid technology development, it was also considered important to identify the factors relating to computer programming learning. Thus, this study applied the Learning Motivating Factors Questionnaire, the Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder Scale-7 (GAD-7), and the Multidimensional Fatigue Inventory-20 (MFI-20) instruments. The sample consisted of 444 e-learners, including 189 computer programming e-learners. The results revealed that higher scores of individual attitude and expectation, challenging goals, clear direction, social pressure, and competition significantly varied across depression categories. The scores of challenging goals, and social pressure and competition, significantly varied across anxiety categories. The scores of individual attitude and expectation, challenging goals, and social pressure and competition significantly varied across general fatigue categories. In the group of computer programming e-learners: challenging goals predicted decreased anxiety; clear direction and challenging goals predicted decreased depression; individual attitude and expectation predicted diminished general fatigue; and challenging goals and punishment predicted diminished mental fatigue. Challenging goals statistically significantly predicted lower mental fatigue, and mental fatigue statistically significantly predicted depression and anxiety in both sample groups.

Locking down behavioural compliance: The role of emotion and emotion regulation in breaches of COVID-19 mitigation measures in Aotearoa New Zealand

Although anxiety and worry can motivate engagement with COVID-19 preventative behaviours, people may cognitively reframe these unpleasant emotions, restoring wellbeing at the cost of public health behaviours. New Zealand young adults (n = 278) experiencing nationwide COVID-19 lockdown reported their worry, anxiety, reappraisal and lockdown compliance. Despite high knowledge of lockdown policies, 92.5% of participants reported one or more policy breaches (M = 2.74, SD = 1.86). Counter to predictions, no relationships were found between anxiety or worry with reappraisal or lockdown breaches. Findings highlight the importance of targeting young adults in promoting lockdown compliance and offer further insight into the role of emotion during a pandemic.

Health Anxiety and Its Correlations with Self-Perceived Risk and Attitude on COVID-19 among Malaysian Healthcare Workers during the Pandemic

Healthcare workers (HCW) are exposed to health-related anxiety in times of pandemic as they are considered to have a high risk of being infected whilst being the vital workforce to manage the outbreak. This study determined the factors that influence health anxiety and its extent in correlations with perceived risk, knowledge, attitude, and practice of HCW. A cross-sectional online survey was conducted on a total of 709 HCW from both public and private healthcare facilities who completed a set of questionnaires on sociodemographic data, knowledge, attitude, and practice of HCW on COVID-19, and health anxiety traits assessed using the short version Health Anxiety Inventory (HAI). Multiple linear regression (adjusted R² = 0.06) revealed respondents with higher perceived risk for COVID-19 significantly predicted higher HAI scores (beta 1.281, p < 0.001, 95%, CI: 0.64, 1.92), and those with a higher cautious attitude towards COVID-19 significantly predicted higher HAI scores (beta 0.686, p < 0.001, 95%CI: 0.35, 1.02). Healthcare workers’ perceived risk and cautious attitude towards COVID-19 might be potentially influenced by management of the sources and approaches to the dissemination of information of the pandemic. The implementation of certain measures that minimize the infection risk and its related anxiety is important to preserve both their physical and psychological wellbeing.

Health Anxiety Predicts the Perceived Dangerousness of COVID-19 over and above Intrusive Illness-Related Thoughts, Contamination Symptoms, and State and Trait Negative Affect

This study sought to evaluate the specificity of health anxiety, relative to other forms of psychopathology, in perceptions of COVID-19 as dangerous. Measures of health anxiety, COVID-19 perceived dangerousness, negative affect, anxiety, depression, stress, contamination-related obsessions and compulsions, and intrusive illness-related thoughts were administered online to 742 community individuals during the Italian national lockdown. Results showed that, after controlling for demographic variables and other internalizing problems, health anxiety was the single most important factor associated with the perceived dangerousness of COVID-19. Moreover, a comparison between the current sample's scores on various symptom measures and scores from prepandemic Italian samples revealed that, whereas other internalizing symptoms increased by a large or very large magnitude during the pandemic, levels of health anxiety and negative affect increased by a medium amount. This result may indicate that health anxiety is relatively trait-like, increasing the likelihood that our correlational data support the model of health anxiety as a vulnerability rather than an outcome. Together, these results indicate that health anxiety may be a specific risk factor for COVID-related maladjustment and support the distinction of health anxiety from other psychological problems.

The mediating effect of the cyberchondria and anxiety sensitivity in the association between problematic internet use, metacognition beliefs, and fear of COVID-19 among Iranian online population

With the rapid growth of the novel coronavirus disease 2019 (COVID-19), individuals may try to find related medical information using the internet to overcome their fears. Under such circumstances, individuals with the features of cyberchondria, anxiety sensitivity, and metacognitive beliefs in negative thoughts may suffer more fears than those without these features. Therefore, the present study proposed a model to understand the associations between problematic internet use (PIU), cyberchondria, anxiety sensitivity, metacognition beliefs, and fear of COVID-19. Utilizing a cross-sectional online survey, 651 Iranians completed the following psychometric scales: Metacognition Questionnaire-30 (MCQ-30), Anxiety Sensitivity Questionnaire (ASI), Cyberchondria Severity Scale-Short Form (CSS-12), Fear of COVID-19 Scale (FCV-19S), and Generalized Problematic Internet Use Scale (GPIUS). Structural equation modeling (SEM) was used to assess the proposed model via several fit indices. The indices include Tucker-Lewis index (TLI), comparative fit index (CFI), standardized root mean square residual (SRMR), and root mean square error of approximation (RMSEA). The fit indices (CFI = 0.948, TLI = 0.938, RMSEA = 0.053, and SRMR = 0.001) indicated the good fit between the data and the proposed model. Moreover, fear of COVID-19 was significantly and directly predicted by cyberchondria (β = 0.479, p < .001) and anxiety sensitivity (β = 0.286, p < .001). The relationship between PIU and cyberchondria with fear of COVID-19 was mediated significantly by anxiety sensitivity and metacognitive beliefs. Because fear of COVID-19 was found to be significantly associated with cyberchondria and anxiety sensitivity, healthcare providers may want to provide additional support for those with cyberchondria and anxiety sensitivity tendencies.

Recent Insights Into Cyberchondria

PURPOSE OF REVIEW

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

RECENT FINDINGS

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