Use of Web-Based Health Services in Individuals With and Without Symptoms of Hypochondria: Survey Study

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 Relation of Health Anxiety to Treatment Utilization Among Patients with Substance Use Disorders: The Moderating Role of Racial/Ethnic Background

Background: Although health anxiety is broadly related to the overutilization of healthcare, limited research has examined this relation among individuals with substance use disorders (SUDs), or the extent to which racial/ethnic differences influence this relationship. Objectives: The purpose of the current study is to examine the moderating role of racial/ethnic minoritized background in the relationship between health anxiety and treatment utilization among individuals with SUDs. In the present study, patients with SUDs receiving residential treatment in Mississippi (N=118; 62% racial/ethnic minoritized status, 35.6% White) completed a measure of health anxiety and answered questions about past mental health, physical health, and substance use treatment. Regression models examined whether racial/ethnic minoritized status (White vs. racial/ethnic minoritized status) moderated the relation of health anxiety to treatment utilization among patients with SUDs. Treatment utilization was examined by asking whether participants had seen a doctor or mental health provider, engaged in substance use treatment, or alcohol treatment prior to their current treatment (dichotomous), as well as the number of times they had engaged in each treatment (physical health, mental health, substance use, and alcohol treatment) in the past year (continuous). Results: Results revealed that the facets of health anxiety involving concerns about pain and disease phobia were positively associated with treatment utilization, but only among racial/ethnic minoritized participants, with concerns about pain positively associated with self-reported physical health treatment utilization (OR=0.70, 95% CI=0.50; 0.97) and disease phobia positively associated with past mental health (B = 0.36, p = 0.023) and alcohol use treatment (B=-0.23, p=.009). Conversely, disease phobia was related to less prior alcohol use treatment among White participants (B=-0.23, p=.009). Conclusions: Overall, among patients in residential treatment for SUDs, racial/ethnic minoritized participants with SUDs reported more health anxiety compared to white participants, and certain facets of health anxiety (i.e., concerns about pain and worry about severe illness) were linked to heightened treatment utilization among racial/ethnic minoritized individuals.

The predation relationship between online medical search and online medical consultation-empirical research based on Baidu platform data

Introduction

This study investigates the mutual influence between online medical search and online medical consultation. It focuses on understanding the health information needs that drive these health information-seeking behaviors by utilizing insights from behavioral big data.

Methods

We used actual behavioral data from Chinese internet users on Baidu platform's "Epidemic Index" from November 26, 2022, to January 25, 2023. Data modeling was conducted to ensure the reliability of the model. Drawing on the logistic model, we constructed a foundational model to quantify the evolutionary patterns of online medical search and online medical consultation. An impact function was defined to measure their mutual influence. Additionally, a pattern detection experiment was conducted to determine the structure of the impact function with maximum commonality through data fitting.

Results

The analysis allowed us to build a mathematical model that quantifies the nonlinear correlation between online medical search and online medical consultation. Numerical analysis revealed a predation mechanism between online medical consultation and online medical search, highlighting the role of health information needs in this dynamic.

Discussion

This study offers a novel practical approach to better meet the public's health information needs by understanding the interplay between online medical search and consultation. Additionally, the modeling method used here is broadly applicable, providing a framework for quantifying nonlinear correlations among different behaviors when appropriate data is available.

Somatoform Disorders in Primary Care-An Exploratory Mixed-Methods Study on Experiences, Challenges and Coping Strategies of General Practitioners in the Federal Republic of Germany

Somatoform symptoms are widely spread in outpatient care. For treating physicians, it can be challenging to establish a relationship that is conducive to compliance and to take stabilising action when dealing with affected patients. As primary care providers, GPs are usually the first point of contact for patients with somatoform disorders; they set the course for stabilisation and further care. To date, there is a lack of studies that focus on how GPs respond to such patients. In particular, strategies for establishing a stable doctor-patient relationship have hardly been explored. Consequently, this study investigated how GPs recognise the symptoms of somatoform disorders, what significance they attach to them and how they handle patients. The primary focus is on experienced patient properties, assumed causes of somatoform disorders, obstacles and complexities in consultation, care and stabilisation strategies, as well as diagnostic forms of support. A total of 2797 GPs in the German federal states of Hesse, Rhineland-Palatinate and Baden-Württemberg were surveyed anonymously by means of a written questionnaire between January and August 2023. A t-test was performed with independent samples to determine significant differences between two groups. In addition, 64 GPs were interviewed between March and April by means of qualitative semi-standardised interviews. The respondents make use of a wide range of communication and stabilisation strategies when treating somatoform physical complaints. The GPs combine the establishment of a tangential doctor-patient relationship with measures to consistently exclude physical causes and to enable the best possible assessment of patients, as well as to gently introduce them to the clinical picture of somatoform disorders. Most physicians are not familiar with current clinical guidelines. Cooperation with specialists and therapists is widely described as complicated. GPs have access to a wide range of communication and stabilisation strategies for the management of somatoform physical complaints. Yet, they experience interaction with this patient group as difficult in daily practice. GPs articulate a clear need for more external support. Apart from increasing therapeutic care capacities and interdisciplinary structures, it seems advisable to extend low-threshold therapy and support services.

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.

Brave New Healthcare: A Narrative Review of Digital Healthcare in American Medicine

The digital revolution has had a profound effect on American and global healthcare, which was accelerated by the pandemic and telehealth applications. Digital health also includes popular and more esoteric forms of wearable monitoring systems and interscatter and other wireless technologies that facilitate their telemetry. The rise in artificial intelligence (AI) and machine learning (ML) may serve to improve interpretation from imaging technologies to electrocardiography or electroencephalographic tracings, and new ML techniques may allow these systems to scan data to discern and contextualize patterns that may have evaded human physicians. The necessity of virtual care during the pandemic has morphed into new treatment paradigms, which have gained patient acceptance but still raise issues with respect to privacy laws and credentialing. Augmented and virtual reality tools can facilitate surgical planning and "hands-on" clinical training activities. Patients are working with new frontiers in digital health in the form of "Dr. Google" and patient support websites to learn or share medical information. Patient-facing digital health information is both a blessing and curse, in that it can be a boon to health-literate patients who seek to be more active in their own care. On the other hand, digital health information can lead to false conclusions, catastrophizing, misunderstandings, and "cyberchondria." The role of blockchain, familiar from cryptocurrency, may play a role in future healthcare information and would serve as a disruptive, decentralizing, and potentially beneficial change. These important changes are both exciting and perplexing as clinicians and their patients learn to navigate this new system and how we address the questions it raises, such as medical privacy in a digital age. The goal of this review is to explore the vast range of digital health and how it may impact the healthcare system.

Online enquiries and health concerns - a survey of German general practitioners regarding experiences and strategies in patient care

Aim

Increasingly at GP practices, patients appear who are extremely worried as a result of health information researched online and consequently affected by doubts and concerns. The study highlights GP attitudes and experiences with regard to this patient group. Moreover, it identifies strategies adopted by GPs to respond appropriately to worried or scared patients.

Subject and methods

In the German federal states of Baden-Württemberg, Rhineland-Palatinate and Saarland, 2532 GPs were surveyed between June and August 2022. Owing to the explorative nature of the study, a descriptive analysis was conducted.

Results

Of the total respondents, 77% deemed the current problem of internet-related health concerns to be a major challenge in everyday practice. The implications affect patients' mental stability and expectations towards the doctor (esp. demand for further instrumental diagnosis, 83%). One doctor in five (20%) has experienced the termination of patient contact because the relationship with the patient was no longer possible due to the patient's uncontrolled online information behaviour. To respond to worried or scared patients, the respondents generally ask certain patient groups about online research (39%) and take this into account in the doctor-patient discussion (23%). Furthermore, the respondents use a detailed explanation of the diagnosis and/or treatment (65%) and recommend websites that they consider reputable (66%). Some of the doctors prefer a joint examination of the information researched by the patient (55%) as well as to explain the benefits and risks of online research (43%).

Conclusion

Many GPs demonstrate a high level of awareness and sensitivity with regard to extensive online research and potentially worried patients. It seems advisable to actively address the online search for information in the patient consultation to prevent possible negative effects on the doctor-patient relationship and to actively involve the patient. In this respect, it would also be worth considering expanding the medical history to include the dimension of online searching.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10389-023-01909-1.

How does information overload about COVID-19 vaccines influence individuals' vaccination intentions? The roles of cyberchondria, perceived risk, and vaccine skepticism

This research proposes and tests an integrated model to explain how information overload influence vaccine skepticism and vaccination intention. In addition, this research investigates the effectiveness of using a celebrity endorsement strategy in promoting vaccination and compares its effectiveness with other endorsement types. A survey study (Study 1) was conducted to examine the mechanism underlying the impact of the COVID-19 vaccine information overload on vaccine skepticism that, subsequently, affects vaccination intention. It also examined the moderating role of celebrity endorsement trustworthiness. The results indicate that information overload positively influenced vaccine skepticism through cyberchondria and perceived risk of the vaccine, which subsequently reduces vaccination intention. The negative effect of vaccine skepticism on vaccination intention was weakened by the celebrity endorsement that was considered trustworthy. A follow-up experimental study (Study 2) was performed to compare the effectiveness of celebrity endorsement with other endorsement types (i.e., government official and medical expert endorsements). The results showed that the celebrity endorsement was more effective in mitigating the negative effect of vaccine skepticism on vaccination intention compared to government official and medical expert. The findings provide practical insights into how governments can minimize people's vaccine skeptical views and increase their vaccination intentions.

The Portrait of Cyberchondria-A Cross-Sectional Online Study on Factors Related to Health Anxiety and Cyberchondria in Polish Population during SARS-CoV-2 Pandemic

The SARS-CoV-2 pandemic has served as a magnifying glass for cyberchondria, while the internet emerged as one of the main sources of medical information and support. The core ambition of this study was to estimate the level of cyberchondria and describe the socio-demographic, clinical and pandemic-related factors affecting its severity amid the SARS-CoV-2 pandemic. A cross-sectional study was performed between 16 May 2020 and 29 December 2020 in Poland within a sample of 538 adult internet users. The online survey tool included a Polish adaptation of the Cyberchondria Severity Scale (CSS-PL) and the Short Health Anxiety Inventory (SHAI), complemented with a set of questions covering sociodemographic, clinical and pandemic-related factors. Participants were clustered according to severity of health anxiety and cyberchondria symptoms. The performed binary logistic regression indicated professional inactivity, having a chronic mental disorder and subjectively limited access to healthcare due to COVID-19 to be key determinants of severe health anxiety and cyberchondria. Cyberchondria might be a remarkable public health issue as large proportion of respondents from the analyzed sample population of internet users met the criteria for severe symptoms. Key determinants of intense cyberchondria corresponded with employment stability, mental resilience and accessibility of healthcare services, which could be greatly challenged amid the pandemic.

Examination of the relationship between smartphone addiction and cyberchondria in adolescents

In this descriptive and correlational study, it was aimed to examine the relationship between adolescents' smartphone addiction and cyberchondria. Data were obtained from 384 adolescent high school students in Istanbul between December 2020 and January 2021, using a Personal Information Form, the Smartphone Addiction Scale, and Cyberchondria Severity Scale. The data were collected through face-to-face interviews with the students. The adolescents' smartphone use duration was 3.67 ± 1.66 years. Almost all (97.9%) connected to the internet via smartphones and 39.3% spent 3-4 h per day on the internet. It was determined that 61.7% of them checked their phones as soon as they woke up in the morning and 75.3% of them before going to bed in the evening. For those whose smartphone use duration is high, their cyberchondria also increases. The authors suggest that nurses should understand smartphone addiction and cyberchondria to identify and apply nursing interventions when necessary in adolescents.

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.

Dermatology 2.0- How the Internet is Changing us, our Patients and our Practice

The internet, in a short span of time relative to the history of modern medicine, has changed us doctors, our patients and our practice. This article reviews these changes and how they have occurred. The write- up was conceptualized after the authors started noticing subtle and overt differences in the consultation and treatment paths of patients who were internet savvy vs. those who were internet naïve. A survey was conducted in the clinic to understand the behavioral changes brought about by the internet among patients of clinical as well as aesthetic dermatology. It must be remembered that these changes are completely new to the practice of dermatology; even small numbers of positive replies are noteworthy. The Covid 19 pandemic has made teledermatology a requisite of the time, rather than an option. Our dependence on technology has never before been so profound. As modern-day dermatologists, we need to be updated about the interactions of dermatology and technology. We must constantly try to optimize the benefits of the internet and minimize its pitfalls. Needless to say, most of the facts mentioned here have been gleaned from the internet itself, from a wide range of sources including but not limited to medical journals, books, news reports, commercial websites and magazines.

Cost-effectiveness of a mobile phone text messaging program (KIDNEYTEXT) targeting dietary behaviours in people receiving haemodialysis

BACKGROUND

There is little information available to inform the cost-effectiveness of eHealth interventions in improving patient health outcomes. A trial-based economic evaluation was undertaken aiming to inform the feasibility of conducting a mobile phone text messaging programme targeting dietary behaviours in people receiving haemodialysis.

METHODS

A trial-based economic evaluation from a health system perspective of a 6-month pilot randomised controlled trial was undertaken. One hundred and thirty patients receiving haemodialysis from six dialysis units across Sydney, Australia, were enrolled into the KIDNEYTEXT study. Usual care (inperson dietary counselling) was compared with usual care plus three semi-personalised dietary mobile phone text messages per week over a 6-month period. The outcomes of this economic evaluation included: cost of intervention, cost-effectiveness and marginal effects on total costs.

RESULTS

The cost of developing and maintaining the KIDNEYTEXT intervention was US $110 per participant. Total costs were US $1418 higher in the usual care arm compared to the intervention arm. The incremental benefits for quality-adjusted life adjusted years were 0.01 [95% confidence interval (CI) = -0.03 to 0.06] and dietary adherence (i.e., adherent to three or more dietary guidelines at 6 months) being 0.04 (95% CI = -0.15 to 0.24). The largest component of total costs was related to unplanned admissions to hospital.

CONCLUSIONS

Mobile phone text messages targeting dietary behaviours may be cost saving, at the same time as maintaining similar or improved dietary behaviours. A larger trial with a longer follow-up time is warranted.

Individuals' Self-Reactions Toward COVID-19 Pandemic in Relation to the Awareness of the Disease, and Psychological Hardiness in Saudi Arabia

The coronavirus (COVID-19) outbreak around the world has caused public health concerns and changes in peoples' behaviors and psychological distress. The pandemic impacts on human behavior, emotions, and cognition, leading to diverse reactions in relation to awareness of the disease. However, there is little understanding around the psychological impacts of the pandemic and strategies to overcome this impact. This study aimed to examine individuals' reactions toward the COVID-19 pandemic in relation to their psychological hardiness, their degree of awareness toward the pandemic, and precautionary measures taken. Individuals living in Saudi Arabia were invited to complete an online questionnaire which included demographic items, psychological responses to the pandemic, awareness of COVID-19, and measures of psychological hardiness. A total of 1272 individuals were recruited into the study, with the majority being female (85%). Results indicated that the average psychological responses to the COVID-19 pandemic in the study sample were 75.85%. This indicates that the sample generally has a high level of positive psychological responses to the COVID-19 pandemic. The awareness of COVID-19 among Saudi was 91.50%. This indicates a high level of awareness among the study sample.

General practitioners' challenges and strategies in dealing with Internet-related health anxieties-results of a qualitative study among primary care physicians in Germany

Time and again, it is discussed that in medical practices, the number of patients who develop health anxieties due to extensive health information searches on the Internet is increasing. The objective of this study is to explore and describe general practitioners’ experiences and attitudes towards cyberchondria patients as well as strategies to stabilize affected patients. Following a qualitative approach, oral personal semi-standardized interviews with general practitioners (N = 38) in Rhineland-Palatinate, Germany, were conducted in 2019. In the course of a content analysis, one can see that most interviewees see the emergence of Internet-related health anxieties as an increasing problem in everyday care. Affected patients not only show marked levels of doubt and nervousness as well as hypersensitivity to their own state of health, but also low confidence in the physician. In addition to compliance-related difficulties, the high need for advice and the demand for further diagnostics are regarded as major problems. Various approaches were identified by which general practitioners respond to unsettled patients (more consultation time, recommendation of reputable websites, information double-checking, expanded history questionnaire, additional psychosocial training).

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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