The relationships between health anxiety, online health information seeking, and cyberchondria: Systematic review and meta-analysis.

BACKGROUND Cyberchondria refers to an abnormal behavioral pattern in which excessive or repeated online searches for health-related information are distressing or anxiety-provoking. Health anxiety has been found to be associated with both online health information seeking and cyberchondria. The aims of the present systematic review and meta-analysis were to examine the magnitude of these associations and identify any moderator variables. METHODS A systematic literature search was performed across several databases (PsycINFO, PubMed, Embase) and reference lists of included studies. RESULTS Twenty studies were included across two independent meta-analyses, with 7373 participants. Random effects meta-analyses showed that there was a positive correlation between health anxiety and online health information seeking [r = 0.34, 95% CI (0.20, 0.48), p < .0001], and between health anxiety and cyberchondria [r = 0.62, 95% CI (0.52, 0.71), p < .0001]. A meta-regression indicated that the age of study participants [Q(1) = 4.58, p = .03] was partly responsible for the heterogeneity found for the relationship between health anxiety and cyberchondria. LIMITATIONS The generalizability and validity of our findings are restricted by the methodological limitations of the primary studies, namely, an over-reliance on a single measure of cyberchondria, the Cyberchondria Severity Scale. CONCLUSIONS Our review found a positive correlation between health anxiety and online health information seeking, and between health anxiety and cyberchondria. Further research should aim to explore the contexts for these associations as well as address the identified limitations of the extant literature.

[1]  Mental Health in the Digital Age: Grave Dangers, Great Promise , 2017, BJPsych Bulletin.

[2]  Thomas A. Fergus,et al.  Problematic Internet Use and Internet Searches for Medical Information: The Role of Health Anxiety , 2014, Cyberpsychology Behav. Soc. Netw..

[3]  A. L. Lucchetti,et al.  Association between depression and resilience in older adults: a systematic review and meta‐analysis , 2017, International journal of geriatric psychiatry.

[4]  Carolyn Lagoe,et al.  Health anxiety in the digital age: An exploration of psychological determinants of online health information seeking , 2015, Comput. Hum. Behav..

[5]  T. Fergus Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria: A replication and extension examining dimensions of each construct. , 2015, Journal of affective disorders.

[6]  J. Zarocostas Non-communicable diseases must have greater priority, says WHO , 2009, BMJ : British Medical Journal.

[7]  A. Norr,et al.  Cyberchondria: Overlap with health anxiety and unique relations with impairment, quality of life, and service utilization , 2018, Psychiatry Research.

[8]  I. Pilowsky,et al.  Dimensions of Hypochondriasis , 1967, British Journal of Psychiatry.

[9]  T. Fergus,et al.  Does cyberchondria overlap with health anxiety and obsessive-compulsive symptoms? An examination of latent structure and scale interrelations. , 2016, Journal of anxiety disorders.

[10]  J. Powell,et al.  Empirical studies assessing the quality of health information for consumers on the world wide web: a systematic review. , 2002, JAMA.

[11]  D. Moher,et al.  Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement , 2009, BMJ.

[12]  Matthew S. Eastin,et al.  Worried and Wired: Effects of Health Anxiety on Information-Seeking and Health Care Utilization Behaviors , 2006, Cyberpsychology Behav. Soc. Netw..

[13]  M. E. Oglesby,et al.  Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria. , 2015, Journal of affective disorders.

[14]  Eszter Hargittai,et al.  Inquiring Minds Acquiring Wellness: Uses of Online and Offline Sources for Health Information , 2012, Health communication.

[15]  T. Fergus The Cyberchondria Severity Scale (CSS): an examination of structure and relations with health anxiety in a community sample. , 2014, Journal of anxiety disorders.

[16]  C. Begg,et al.  Operating characteristics of a rank correlation test for publication bias. , 1994, Biometrics.

[17]  Tilo Hartmann,et al.  Online health anxiety and consultation satisfaction: A quantitative exploratory study on their relations. , 2016, Patient education and counseling.

[18]  V. Starcevic Cyberchondria: Challenges of Problematic Online Searches for Health-Related Information , 2017, Psychotherapy and Psychosomatics.

[19]  P. Tyrer,et al.  Health anxiety , 2019, BMJ.

[20]  Tilo Hartmann,et al.  The Role of Health Anxiety in Online Health Information Search , 2011, Cyberpsychology Behav. Soc. Netw..

[21]  Richard J. Brown,et al.  From headache to tumour: An examination of health anxiety, health-related Internet use and ‘query escalation’ , 2016, Journal of health psychology.

[22]  Richard J. Brown,et al.  Health-related Internet habits and health anxiety in university students , 2014, Anxiety, stress, and coping.

[23]  David Berle,et al.  Cyberchondria: An old phenomenon in a new guise? , 2015 .

[24]  Beata Bajcar,et al.  Cyberchondria and its measurement. The Polish adaptation and psychometric properties of the Cyberchondria Severity Scale CSS-PL. , 2019, Psychiatria polska.

[25]  M. E. Oglesby,et al.  Relationships between cyberchondria and obsessive-compulsive symptom dimensions , 2015, Psychiatry Research.

[26]  Sun Young Lee,et al.  Worry as an Uncertainty-Associated Emotion: Exploring the Role of Worry in Health Information Seeking , 2016, Health communication.

[27]  P. Salkovskis,et al.  The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis , 2002, Psychological Medicine.

[28]  H. Kiene,et al.  Bias in meta-analysis , 2006, Homeopathy.

[29]  W. Rief,et al.  The Cyberchondria Severity Scale (CSS): German Validation and Development of a Short Form , 2016, International Journal of Behavioral Medicine.

[30]  L. Hedges,et al.  Introduction to Meta‐Analysis , 2009, International Coaching Psychology Review.

[31]  Bertrand Baujat,et al.  A graphical method for exploring heterogeneity in meta‐analyses: application to a meta‐analysis of 65 trials , 2002, Statistics in medicine.

[32]  Kate Muse,et al.  Cyberchondriasis: fact or fiction? A preliminary examination of the relationship between health anxiety and searching for health information on the Internet. , 2012, Journal of anxiety disorders.

[33]  B. Fallon,et al.  Cyberchondria: Parsing Health Anxiety From Online Behavior. , 2016, Psychosomatics.

[34]  Hannah R Rothstein,et al.  Basics of meta‐analysis: I2 is not an absolute measure of heterogeneity , 2017, Research synthesis methods.

[35]  S. Taylor Anxiety sensitivity. , 1998, The Harvard mental health letter.

[36]  Ryen W. White,et al.  Cyberchondria: Studies of the escalation of medical concerns in Web search , 2009, TOIS.

[37]  S. Turan,et al.  The Cyberchondria Severity Scale (CSS): Validity and Reliability Study of the Turkish Version - , 2018 .

[38]  Wolfgang Viechtbauer,et al.  Outlier and influence diagnostics for meta‐analysis , 2010, Research synthesis methods.

[39]  Mark Shevlin,et al.  The development and initial validation of the cyberchondria severity scale (CSS). , 2014, Journal of anxiety disorders.

[40]  T. Fergus,et al.  Cyberchondria: Examining relations with problematic Internet use and metacognitive beliefs. , 2017, Clinical psychology & psychotherapy.

[41]  Thomas A. Fergus,et al.  Cyberchondria and Intolerance of Uncertainty: Examining When Individuals Experience Health Anxiety in Response to Internet Searches for Medical Information , 2013, Cyberpsychology Behav. Soc. Netw..

[42]  David Berle,et al.  Cyberchondria: towards a better understanding of excessive health-related Internet use , 2013, Expert review of neurotherapeutics.