Cyberchondria and its Relationships with Related Constructs: a Network Analysis

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.

Can't stop, won't stop - understanding anxiety's role in cyberchondria among pregnant women

Online health research is common during pregnancy, especially if women are facing complications. Given the unpleasant emotions women experience after research, it is surprising that cyberchondria, excessive and repeated online health research caused by anxiety that intensifies such anxiety, has not been studied in pregnant women. Therefore, the aim of this study was to examine the predictors of cyberchondria among women with and without pregnancy complications, accounting for health anxiety (a worry regarding personal health) and pregnancy-specific anxiety (concerns related to pregnancy and childbirth). A total of 360 pregnant women completed a questionnaire consisted of Short Health Anxiety Inventory, Pregnancy Concerns Scale and Short Cyberchondria Scale. The results of one-way MANOVA showed that women who had medically complicated pregnancy had higher levels of health anxiety, pregnancy-specific anxiety and cyberchondria compared to those without complications. A hierarchical multiple regression analysis showed that health anxiety and pregnancy-specific anxiety were predictors of cyberchondria but had different roles depending on complications. Pregnancy-specific anxiety predicted cyberchondria in both groups above health anxiety. Health anxiety predicted cyberchondria only in women without complications. In conclusion, women with complications have a higher chance of experiencing cyberchondria. Pregnancy-specific and health anxiety are risk factors for cyberchondria in pregnant women.

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.

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.

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

Purpose

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

Methods

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

Results

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

Conclusion

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

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.

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

OBJECTIVE

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

DESIGN

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

RESULTS

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

CONCLUSION

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

The mediating role of rumination between stress appraisal and cyberchondria

Cyberchondria, defined as excessive concern about one's health and looking for solutions to health problems on the Internet, is becoming increasingly common. This paper examines the relations between the dimensions of stress appraisal (threat, challenge-activity, challenge-passivity, harm/loss) and cyberchondria. We also tested whether these relations were mediated by rumination. The study included a nonclinical sample of N = 615 participants aged 18 to 83 years (M = 43.86, SD = 14.57, 53 % women), who completed the short version of the Cyberchondria Severity Scale, the Rumination Scale, and the Stress Appraisal Questionnaire. We used the Computer-Assisted Web Interview (CAWI) method. The results revealed that rumination was a partial mediator between stress as a threat and cyberchondria and between stress as a harm/loss and cyberchondria. Cyberchondria was positively related to rumination, stress as a threat, and stress as a harm/loss and negatively related to the challenge-activity dimension of stress appraisal. The study indicates that stress appraisal is linked to cyberchondria and that rumination plays an important role in this relationship.

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

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

Are Cyberchondria and Intolerance of Uncertainty Related to Smartphone Addiction?

Smartphones are a medium for performing online activities, and one such activity could be the compulsive online health information search - cyberchondria. This study aimed to test whether cyberchondria and intolerance of uncertainty (IU) positively predict smartphone addiction (SA), adjusted for age, gender, daily use duration, the reason for using smartphones, and symptoms of anxiety and depression. The sample consisted of 471 adults (55.2% women) from the general population without chronic diseases (Mage = 38.67). Regression analysis showed that IU was a positive predictor of SA (β = .17, p < .001), as well as cyberchondria (β = .14, p < .001), which had a unique contribution to the explanation of SA, relative to IU. Other significant predictors were average daily smartphone use and entertainment use, the latter being the strongest predictor in the model. These results revealed cyberchondria as a unique predictor of SA.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

PURPOSE

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

DESIGN AND METHODS

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

RESULTS

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

CONCLUSIONS

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

PRACTICE IMPLICATION

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

Psychological Effect of Discrete Outbreak Events of COVID-19 on Health Information Search in China

Community transmission events occasionally happened in the long-term pandemic, which led to repeated outbreaks of COVID-19. In addition to potential physical threats, the outbreaks could also lead to psychological stress and influence their health behaviors, especially for vulnerable people. It poses a great challenge to both physical and mental health management. However, little is known about the impacts of discrete outbreak events of COVID-19 on people's reactions to health concerns in the long-term pandemic period. In the current study, we discussed the impact of discrete outbreak events of COVID-19 on health information search for specific symptoms in China from a perceptive of susceptibility. The empirical study was conducted after the first wave of outbreak events ended in China from June to October 2020. Three typical outbreak events happened during this period, and a total of 1800 search index data for 60 cities in China crawled from Baidu search engine were included in the data set. Using the real-world searching data, we conducted a panel data analysis to examine the psychological effect of discrete outbreak events on the symptom search and the moderation effect of the geographical distance. It was found that discrete outbreak events significantly increased the symptom search, and its impacts were various in different regions. More health information search caused by discrete outbreak events was found in cities which were closer to the outbreak area. Implications for healthcare were discussed.

Investigating the Potential Connection Between Cyberchondria and Vaccine Hesitancy in High School Students

BACKGROUND

Internet use, which provides the opportunity to access information from anywhere, and anytime, is increasing among adolescents and young adults. In studies examining the effect of technology use in adults, it has been observed that there is a relationship between cyberchondria and vaccine hesitancy. This study aimed to uncover the potential relationship between cyberchondria and vaccine hesitancy in adolescents and to obtain data for combating anti-vaccination in this age group.

MATERIALS AND METHODS

A total of 2.353 high school students were enrolled within the scope of this research. The forms were delivered to the students online and 531 volunteers participated in the survey. The Cyberchondria Severity Scale and Vaccine Hesitancy Scale were used to evaluate the details of the relationship between cyberchondria and vaccine hesitancy levels in adolescents.

RESULTS

The compulsion subscales of the Cyberchondria Severity Scale in males and vaccine repugnance subscales of the Vaccine Hesitancy Scale in females were statistically significantly higher. Cyberchondria and vaccine hesitancy have a strong relationship with each other except benefits and protective value of vaccines subscale of vaccine hesitancy.

CONCLUSION

Health policymakers should be aware of this relationship and there is a need to develop novel online intervention programs for combating anti-vaccination, particularly among cyberchondriac adolescents who have relatively high vaccination hesitancy, particularly during the pandemic.

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.

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

Objective

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

Method

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

Result

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

Conclusion

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

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

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

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

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

Supplementary Information

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

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.

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

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

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

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

Obsessive-Compulsive Disorder and Illness Anxiety: Examining Commonalities and Comorbidity

Obsessive-compulsive disorder (OCD) and illness anxiety disorder (IAD) often co-occur. Cognitive-behavioral models of both disorders overlap and include maladaptive attentional processes, misinterpretation of thoughts and physical sensations, and engagement in repetitive behaviors in an attempt to reduce associated distress. Given commonalities in their presentation and their common co-occurrence, it is important to understand how illness anxiety affects the presentation and treatment of OCD. In this article, theoretical conceptualizations of OCD and IAD and their comorbid presentation are outlined, and assessment and differential diagnosis of these conditions are discussed. Despite shared cognitive vulnerabilities and behavioral patterns, well-validated symptom measures, along with careful functional analysis, can be used to distinguish between OCD, IAD, and comorbid presentations. Best practices for the cognitive-behavioral treatment of these co-occurring conditions are also presented, with suggestions based on both the empirical literature and detailed case studies. Finally, recommendations for future research on co-occurring OCD and IAD and their treatment are explored.

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.

A preliminary investigation of Cyberchondria and its correlates in a clinical sample of patients with obsessive-compulsive disorder, anxiety and depressive disorders attending a tertiary psychiatric clinic

Objectives. This cross-sectional study aimed to investigate the frequency and presentation of cyberchondria (CYB) in patients with obsessive-compulsive disorder (OCD), anxiety disorders (ADs), and major depression disorder (MDD).Methods. Seventy-seven patients (OCD:25, ADs:26, MDD:26) referred to a tertiary psychiatry outpatient clinic and 27 healthy controls (HCs) were included. A 'working' definition of CYB was used to measure CYB frequency. CYB severity was measured with the Cyberchondria Severity Scale (CSS).Results. CYB as currently defined was present in just 1.3% of the combined patients' sample. Using a broader definition (omitting the disability criterion), we found a higher distribution (OCD:12%, ADs:19.2%, MDD:15.4%, HCs:3.7%) and greater CYB symptom severity. Patients with OCD (63.3 ± 18.9) and ADs (63.3 ± 25.9) showed a higher CYB severity, compared with HCs (48.4 ± 9.9, p<.05). In the combined patients' sample, a positive correlation was found between the CSS scores and measures of health anxiety or hypochondriasis. Higher CYB symptom severity emerged in patients with a positive family history of psychiatric disorders and in those prescribed benzodiazepines or mood-stabilisers.Conclusion. CYB represents a common transdiagnostic syndrome in patients with OCD, ADs, and MDD with a spectrum of severity and indicates a variable burden of illness, supporting the need for specific clinical considerations and interventions.Key pointsCyberchondria (CYB) represents a common transdiagnostic syndrome in patients with obsessive-compulsive disorder, anxiety, and depressive disorders.CYB's frequency as a syndrome of compulsive online health searches associated with an increased anxiety and distress was reported in 10-20% patients.Health anxiety/hypochondriasis showed a strong correlation with CYB.Patients with a positive family history of psychiatric disorders and those prescribed benzodiazepines or mood-stabilisers showed higher CYB symptom severity.Considering the spread of Internet use for health-related information, additional studies investigating CYB in clinical samples are encouraged.

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.

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.

New challenges in facing Cyberchondria during the COVID-19 pandemic

Cyberchondria (CYB) is characterized by excessive online searching for medical information and is associated with increasing levels of distress, anxiety, and interference with daily activities. As the use of digital devices and the Internet as a source of everyday information has increased, particularly during the current coronavirus disease (COVID-19) pandemic, so has CYB, becoming an object of interest to clinicians and researchers. The present review will provide an overview of the latest updates in CYB research. Emerging evidence draws attention to various vulnerability factors for developing CYB, including personal characteristics such as female gender, younger age, or a history of mental disorder, as well as engagement in particular forms of online behavior, such as increased use of social media, increased acceptance of online information, and information overload. Additionally, recent studies suggest that CYB may itself act as a mediating factor for increased COVID-19-related psychological burden. However, the data are still very sparse. Knowledge gaps include a universally accepted definition of CYB, severity thresholds to help differentiate nonpathological online health searches from CYB, as well as robustly evidence-based interventions.

Relationships between fear of COVID ‐19, cyberchondria, intolerance of uncertainty, and obsessional probabilistic inferences: A structural equation model

The study was set out to explore the structural relationships between fear of COVID‐19, cyberchondria, intolerance of uncertainty, and obsessional probabilistic inferences. The data were recruited online from a community population (n = 1,049) subjected to a confirmatory factor analytic procedure. The structural model specified according to the previous findings in the literature showed that a general tendency to negative expectations in terms of probabilistic thinking was significantly associated with both COVID‐19‐related‐fear and intolerance of uncertainty. Fear of COVID‐19 was significantly associated with cyberchondria. Probabilistic thinking style and intolerance of uncertainty contributed to cyberchondria through fear of COVID‐19 as well. We concluded that a tendency to engage in a probabilistic thinking style and intolerance of uncertainty seems to play role in the etiology of fear of infection and cyberchondria.

The association between intolerance of uncertainty and Internet addiction during the second wave of the coronavirus disease 2019 pandemic: A multiple mediation model considering depression and risk perception

Repeated outbreaks of coronavirus disease 2019 (COVID‐19) have forced people to shift most of their work and life activities from offline to online, leading to a growing problem of Internet dependence and even Internet addiction. However, the mechanism of the association between COVID‐19‐related intolerance of uncertainty (COVID‐19 IU) and Internet addiction during the second wave of COVID‐19 is still unclear. The current study explored the association between COVID‐19 IU and Internet addiction as mediated by depression and risk perception based on the Uncertainty‐Depression‐Perception‐Addiction model (UDPA). A total of 1,137 adult participants were recruited, and COVID‐19 IU, depression, risk perception, Internet addiction, and demographic variables were analyzed. The results showed that COVID‐19 IU was significantly and positively associated with Internet addiction and that this relationship was mediated in parallel by depression and risk perception. Our findings further extend the Interaction of Person‐Affect‐Cognition‐Execution (I‐PACE) model from the perspective of applicability in the unique context of COVID‐19. Furthermore, the study suggests that individuals could decrease their dependence on the Internet to prevent Internet addiction during the second wave of the pandemic through effective interventions that include lowering COVID‐19 IU, improving emotion regulation, and developing reasonable perceptions of risk.

Dark side consequences of cyberchondria: an empirical investigation

Purpose

Cyberchondria refers to the repeated and excessive search for health-related information online, associated with increased health anxiety. This paper utilizes the protection motivation theory to investigate the negative behavioral consequences of cyberchondria that pose health risks to users, such as trust in the physician, propensity to self-medicate, and therapy compliance.

Design/methodology/approach

The data for the study were collected from a sample of 317 participants in India using an online survey and form. The analysis was conducted using structural equation modeling.

Findings

Cyberchondria negatively affects the trust in physician and positively affects the propensity to self-medicate. Trust in physician negatively affects the propensity to self-medicate and positively affects therapy compliance. Furthermore, trust in physician partially mediates the relationship between cyberchondria and the propensity to self-medicate and completely mediates the relationship between cyberchondria and therapy compliance. Cyberchondria has no direct significant effect on therapy compliance.

Research limitations/implications

Researchers need to examine other behavioral or psychological factors affected by the reduced trust in physicians due to cyberchondria.

Practical implications

Physicians and health care providers should refocus on patients with cyberchondria and regain their trust through quality interactions and services. Policymakers may consider regulating online health information publication to set the standards of information quality and source. Websites and platforms publishing health information online should distinctly label verified information.

Originality/value

This study investigates the damaging effects of cyberchondria's behavioral consequences that pose health risks to users.

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.

Unveiling the relationships between cyberchondria and psychopathological symptoms

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

Investigation of the effect of cyberchondria behavior on e-health literacy in healthcare workers

This study aims to examine the effects of nurses' and other healthcare workers' perceptions of cyberchondria on e-health literacy. No sample was selected in the research, and a total of 220 people were surveyed. According to the result of the regression analysis, the perception of cyberchondria explains 12.4% of the total variance on e-health literacy. Based on the findings of the research, it can be said that the increase in the perception of the participants about the excessiveness dimension increases the levels of e-health literacy statistically.

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.

Anxious temperament and cyberchondria as mediated by fear of COVID-19 infection: A cross-sectional study

This study's main goal was to evaluate the association between anxious temperament and the fear of COVID-19-related self-infection and infection in loved ones (family members, friends, relatives) and cyberchondria. The sample consisted of 499 men and women aged between 18 and 72 who were gathered from the general population via an online recruitment platform. A numerical rating scale comprising 11 degrees of fear was used to assess participants' COVID-19-related fear, and affective temperaments were evaluated using Akiskal's Temperament Evaluation of the Memphis, Pisa, Paris and San Diego Autoquestionnaire (TEMPS-A) scales. Cyberchondria was assessed using McElroy and Shevlin's Cyberchondria Severity Scale (CSS). Small to medium positive correlations were found between depressive, cyclothymic, irritable and anxious temperaments and cyberchondria and between depressive and anxious temperaments and COVID-19 fears. However, no correlation was observed between the hyperthymic temperament and cyberchondria. Cyberchondria positively correlated with both COVID-19 fears scales, though the correlation coefficients were medium. Based on the results of linear regression analysis, only anxious temperament and COVID-19 fear of self-infection were significant predictors of cyberchondria. The analysis also revealed a significant indirect effect of anxious temperament on cyberchondria through fear of COVID-19 self-infection as a mediator between anxious temperament and cyberchondria.

Managing Problematic Usage of the Internet and Related Disorders in an Era of Diagnostic Transition: An Updated Review

INTRODUCTION

Problematic Usage of the Internet (PUI) refers to a broad and likely heterogeneous group of Internet-related conditions associated with behavioural disturbances and functional impairment.

METHODS

Within PUI several conditions have been reported, including Gaming Disorder, Shopping Addiction, Cyberchondria, Gambling Disorder, Cyberpornography Addiction and Cyberbullying. While increasing reports in the field try to define the epidemiologic and clinical boundaries of these conditions, the rapid and continuous evolution of Internet related behaviours as well as their problematic/pathological expressions are often difficult to diagnose, assess, approach with treatment interventions and follow-up.

RESULTS

In addition, some of the PUI-related conditions show characteristics of addiction to the Internet as a preferential tool to engage in specific behaviours, while some others exclusively manifest on the Internet, making it necessary to find distinct assessment and treatment pathways.

CONCLUSION

The inclusion of Internet Gaming Disorder in Section III by the DSM-5 and the recognition of Gaming Disorder by the ICD-11 opened the way for a systematic clinical investigation of this and other PUI-related conditions, particularly in terms of preventive and therapeutic strategies. The present article is aimed at offering an updated clinical overview on the main expressions of PUI, focussing on the latest acquisitions in this evolving field.

Health websites on COVID-19: are they readable and credible enough to help public self-care?

Objective

There are concerns about nonscientific and/or unclear information on the coronavirus disease 2019 (COVID-19) that is available on the Internet. Furthermore, people's ability to understand health information varies and depends on their skills in reading and interpreting information. This study aims to evaluate the readability and creditability of websites with COVID-19-related information.

Methods

The search terms "coronavirus," "COVID," and "COVID-19" were input into Google. The websites of the first thirty results for each search term were evaluated in terms of their credibility and readability using the Health On the Net Foundation code of conduct (HONcode) and Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG), Gunning Fog, and Flesch Reading Ease Score (FRE) scales, respectively.

Results

The readability of COVID-19-related health information on websites was suitable for high school graduates or college students and, thus, was far above the recommended readability level. Most websites that were examined (87.2%) had not been officially certified by HONcode. There was no significant difference in the readability scores of websites with and without HONcode certification.

Conclusion

These results suggest that organizations should improve the readability of their websites and provide information that more people can understand. This could lead to greater health literacy, less health anxiety, and the provision of better preventive information about the disease.

The Impact of COVID-19 Pandemic on Searching for Health-Related Information and Cyberchondria on the General Population in Italy

Objectives: The Internet has become one of the most common sources people use to search for health-related information, a behavior rapidly increased during the novel Coronavirus disease 2019 (COVID-19). The present study aimed to investigate behavioral patterns in the online health-related searches and Cyberchondria (CYB) during the COVID-19 pandemic time, in order to explore socio-demographic and psychopathological factors related to CYB. Methods: During the third wave of the COVID-19 pandemic in Italy, a cross-sectional online survey collected the main socio-demographic variables and habits related to Internet use of 572 participants. CYB was measured by the Cyberchondria Severity Scale-Short Version and different psychopathological factors were measured by specific questionnaires: the Coronavirus Anxiety Scale, the Hospital Anxiety and Depression Scale, the Short Health Anxiety Inventory, the Meta-Cognitions about Health Questionnaire, the Internet Addiction Test, the Maudsley Obsessional-Compulsive Questionnaire-Short Version, the Rosenberg's Self-Esteem Scale, and the WHO Quality of Life-BREF. Descriptives, non-parametric ANOVAs, and Spearman correlations were performed. Results: In the present sample, the Internet was the main source participants used to search for health-related information and nearly one-third increased this habit during the pandemic. Higher expression of CYB emerged in females, in younger participants, in students, and in those suffering from a physical/psychiatric illness. CYB showed a positive correlation with different phenomenology of anxiety (i.e., anxiety about COVID-19, health anxiety, general anxiety, metacognitive believes about anxiety) and with depression, obsessive-compulsive symptoms, and problematic usage of the Internet. Conversely, quality of life and self-esteem showed a negative correlation with CYB. Conclusion: During the COVID-19 pandemic, the use of the Internet for health-related information and CYB contribute to the psychological stress affecting individuals and society. Delineating subjects more vulnerable to CYB and associated psychopathological factors will help to elaborate operational indications for prevention and psychological support.

Cyberchondria in the time of the COVID-19 pandemic

Cyberchondria is an excessive or repeated online health information seeking that is associated with increasing levels of health anxiety or distress. This article presents a model of cyberchondria during public health crises such as the COVID‐19 pandemic. The factors that contribute to cyberchondria at this time include (a) a heightened perception of threat and fear of a newly identified and poorly understood disease; (b) difficulty in coping with uncertainty associated with the pandemic; (c) lack of authoritative and trustworthy sources of relevant health information; (d) difficulty in coping with abundance of information that is often confusing, conflicting, unverified and constantly updated, along with a decreased ability to filter out unnecessary information; and (e) inability of excessive online health information seeking to provide the necessary information and deliver reassurance. These factors amplify fear and distress, which increases the perception of threat and uncertainty and perpetuates further online health searches. Cyberchondria has significant public health implications because of the associated distress or functional impairment and effects on health behaviors. Cyberchondria should be addressed by targeting a heightened perception of threat, improving management of uncertainty and online health information and promoting an ability to critically appraise the results of online health searches. This should contribute to a better online health information literacy. The model of cyberchondria during the COVID‐19 pandemic explains the hypothesized rise in cyberchondria during public health emergencies and helps to formulate a framework for prevention of cyberchondria and its effective management.

Cyberchondria: conceptual relation with health anxiety, assessment, management and prevention

There is a need to synthesize available information on the emerging construct of cyberchondria to guide evidence informed practice. With this in mind, electronic search of databases including MEDLINE via PubMed, Cochrane Library, ScienceDirect and Google scholar were carried out from inception till March 2020 to identify relevant English language peer reviewed articles related to cyberchondria. Generated abstracts were grouped according to their thematic focus and summarized. A total of 49 articles were reviewed. Articles directly evaluating cyberchondria were very few and most of the treatment evidence was extrapolated from trials on health anxiety. Cyberchondria appears to be a phenomenologically overlapping entity with, yet distinguishable from, health anxiety and there may be merit in studying the two constructs separately. Four validated self-assessment measures for cyberchondria are available in literature. Cognitive behaviour therapy (CBT) delivered either physically or through the internet (iCBT) have been found to be effective for both health anxiety and cyberchondria. Pharmacologic strategies for health anxiety have mainly involved the use of Selective Serotonin Reuptake Inhibitors, with mean effective dosages higher than for depression/anxiety. Prevention of cyberchondria needs to focus on appropriate harm reduction strategies as well as supply and demand side measures. Internet based CBT therapies hold promise for management of cyberchondria. This finding must be considered preliminary due to limited evidence. Further study is required to establish the diagnostic validity of cyberchondria.

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.