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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 7  |  Issue : 2  |  Page : 154-162

Cyberchondria: Implications of online behavior and health anxiety as determinants


Basic Medical Sciences, Saint James School of Medicine, Park Ridge, IL, USA

Date of Submission31-Jul-2019
Date of Decision25-Oct-2019
Date of Acceptance03-Nov-2019
Date of Web Publication16-Dec-2019

Correspondence Address:
Dr. Rana Zeine
Saint James School of Medicine, 1480 Renaissance Drive, Park Ridge, IL 60068
USA
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/amhs.amhs_108_19

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  Abstract 


Background: Cyberchondria is excessive worrying about one's health that develops following internet search for medical and health information. Aim: This study investigates how the development of cyberchondria relates to characteristics of the person searching the internet including their medical history, age, and health-related anxiety. Materials and Methods: A cross-sectional survey was conducted between 2015 and 2016. The “Dr. Net” survey consisted of 32 questions based on previously published surveys probing the use of internet search for health-related information. Participants were recruited from the authors' own social network by receiving a hyperlink through social media platforms and e-mails. One hundred and ninety-one English-speaking individuals, majority from Canada and the USA, completed the “Dr. Net” questionnaire online and anonymously through SurveyMonkey®. Results: Females sought health-care advice earlier than males (**P = 0.005). Younger age groups exhibited higher frequencies of internet search, daily versus weekly, versus monthly versus yearly, with differences between the 21 and 30 versus >60 (***P = 0.000), 21–30 versus 51–60 (**P = 0.011), 21–30 versus 31–40 (**P = 0.019), 31–40 versus 51–60 (**P = 0.012), 41–50 versus 51–60 (**P = 0.021), and <20 versus >60 years' age groups (**P = 0.024). 30.7% reported developing cyberchondria. Indicators of cyberchondria correlated with older age (r = 0.154, P=**0.036), negative medical history (r = 0.191, **P = 0.013), health anxiety (r = 0.268, ***P = 0.000), and hypochondria (r = 0.142, P = 0.062). Less than four percent perceived their internet search as disadvantageous. Conclusion: Cyberchondria was reported by a third of those who conducted health-related internet searches, with higher frequencies in older, previously healthy individuals who had health anxiety.

Keywords: Anxiety, internet-based intervention, patient participation, patient preference, physician–patient relations, self-care, self-management, social media


How to cite this article:
Mohammed D, Wilcox S, Renee C, Janke C, Jarrett N, Evangelopoulos A, Serrano C, Tabassum N, Turner N, Theodore M, Dusic A, Zeine R. Cyberchondria: Implications of online behavior and health anxiety as determinants. Arch Med Health Sci 2019;7:154-62

How to cite this URL:
Mohammed D, Wilcox S, Renee C, Janke C, Jarrett N, Evangelopoulos A, Serrano C, Tabassum N, Turner N, Theodore M, Dusic A, Zeine R. Cyberchondria: Implications of online behavior and health anxiety as determinants. Arch Med Health Sci [serial online] 2019 [cited 2020 Jun 7];7:154-62. Available from: http://www.amhsjournal.org/text.asp?2019/7/2/154/273048




  Introduction Top


Cyberchondria refers to the unfounded escalation of anxiety regarding the state of one's health as a result of searching for medical information on the World Wide Web.[1] The U.S. National Library of Medicine defines the scope of the term internet-based intervention as the use of the internet to facilitate the dissemination of health-related information and to connect patients to support. Patients perform Google searches for self-help and self-management, a phenomenon termed “Dr. Google.”[2] However, studies have shown that people, especially those who have little or no medical training, have the potential of developing cyberchondria as they search online for advice for themselves or others.[1],[3],[4] Web search engines can escalate queries about common innocuous symptoms to distracting content on serious, life-threatening, or rare diseases.[1] Furthermore, people with higher levels of health anxiety are more likely to seek online health information more frequently, spend longer searching, escalate queries, and find searching more distressing and anxiety provoking.[3],[4]

This study sets out to determine how the development of cyberchondria relates to characteristics of the person searching for health-related information including their gender, age, health status, and degree of health-related anxiety.


  Materials and Methods Top


Survey

Approval for this study was obtained from the Research Committee (IRB) at Saint James School of Medicine, St. Vincent campus. The authors created the “Dr. Net Survey” to include 32 questions based on previously published surveys probing the use of internet search for health-related and medical information.[2],[5],[6] The questions were either modified from previously published studies or created by the authors' to answer specific questions. The survey questions that were specifically designed to assess the factors associated with cyberchondria are presented in [Table 1].
Table 1: Dr. “Net” survey questions probing health-related internet search and cyberchondria

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Participants were invited to participate in the Dr. Net study through word of mouth, by e-mail, and through social media including Facebook. Individuals contacted were from the authors' own social networks and were encouraged to recruit further participants. Eligibility criteria for this study were broad to determine an average response from a wide subset of individuals. Participants were required to be able to speak English and be able to access and navigate the 20-min online questionnaire on SurveyMonkey® (www.surveymonkey.com). Participants were directed by hyperlink to the questionnaire on the SurveyMonkey® website and only participants who were sent the hyperlink were able to access the survey. Participants provided consent to being part of the study by opening and completing the survey. Responses were self-reported and the completed surveys were submitted anonymously by 191 participants between May 2015 and April 2016. The majority resided in North America, with some responding from Europe, the Caribbean, the Middle East, Australia, and China.

Statistical analysis

The raw data were downloaded from SurveyMonkey® in April 2016. The data were further downloaded into the Statistical Package for the Social Sciences (SPSS) format and analyzed with SPSS software, version 23 (IBM Corp., Armonk, NY, USA). Adjustments were made for missing data. Statistical analysis was performed using the Kruskal–Wallis H test (“one-way ANOVA on ranks”), Mann–Whitney test, and the Spearman's correlation coefficient, with significance levels at **P< 0.05 and ***P< 0.001.


  Results Top


Demographics of respondents

The demographics of respondents detailing distribution by gender, age, country, and occupation are presented in [Table 2]. Types of websites searched for medical information included WebMD (n = 120, 63%), Mayo Clinic (n = 89, 47%), Wikipedia (n = 66, 35%), Miscellaneous (n = 61, 32%), blogs (n = 30, 16%), Healthline (n = 26, 14%), and the news (n = 13, 7%). With regard to medical history, participants reported hypertension 14.1% (n = 25); asthma or a respiratory condition 10.1% (n = 17); gastrointestinal disorders 9.4% (n = 16); diabetes 5.8% (n = 10); mental health disorders 5.8% (n = 10); cancer 5.2% (n = 9); other not specified 9.3% (n = 15); and none 65% (n = 124). 78.4% (n = 149) of participants indicated that they had health insurance, 17.4% (n = 33) currently did not have health coverage, 1.6% (n = 3) were unaware if they currently had health insurance, and 2.6% (n = 5) preferred not to answer.
Table 2: Distribution of participants by gender, country, age, and occupation

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Gender differences when seeking health advice and searching the internet

When participants were asked the question “within the past 2 months, have you had a serious medical emergency where you sought help from a primary care physician, health-care provider, a clinic, or the Emergency Department (ER)?,” only 22.8% (n = 43) responded yes, 76.2% (n = 144) responded no, and 1.1% (n = 2) preferred not to answer. Nevertheless, 46.1% (n = 88) of participants responded to the follow-up question “if so, where did you first seek health advice in regard to this matter?,” whereby 56.8% (n = 50) first sought advice from a health-care provider, 15.9% (n = 14) first searched the internet, 15.9% (n = 14) first sought advice from other sources, and 10.2% (n = 9) consulted family [Figure 1].
Figure 1: Responses to “Where did you first seek health advice … within last 2 months?” showing trend for more females to seek professional help and search the internet; “How long … to schedule an appointment…?” females earlier than males (**P = 0.005)

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Differences by gender did not reach statistical significance; however, more females consulted health-care providers and searched the internet, whereas higher proportions of males turned to family and others. Specifically, 59.6% (n = 28) of females sought advice from a health-care provider as opposed to 52.5% (n = 21) of males, 19.1% (n = 9) of females searched the internet compared to 12.5% (n = 5) of males, 12.8% (n = 6) of females sought other outlets for medical advice as compared to 20% (n = 8) of males, and 8.5% (n = 4) of females consulted family members as compared to 12.5% (n = 5) of males (P = 0.72) [Figure 1].

When participants were asked “have you searched the Internet for information about a symptom regarding yourself?,” 89.1% (n = 164) responded yes, 9.8% (n = 18) no, and 1.1% (n = 2) “I do not know.” Gender differences were noted as more females, 94.4% (n = 101), searched the internet regarding self as compared to males, 82.7% (n = 62) (**P = 0.01). Only 5.6% (n = 6) of females responded negatively to searching the internet for personal symptoms as compared to 14.7% (n = 11) of males, and 2.7% (n = 2) of males responded “I do not know.”

Similarly, when asked the question “have you ever searched the Internet for information about a symptom for others such as a friend, family member, or a colleague?,” 84.7% (n = 160) responded yes and 15.3% (n = 29) no. Once again, more females, 90.8% (n = 99), responded positively than males, 75.6% (n = 59) (**P = 0.005). Only 9.2% (n = 10) of females responded negatively to searching the internet about symptoms for others as compared to 24.4% (n = 19) of males.

Gender and age differences when prediagnosing from the internet

When participants were asked the question “have you ever prediagnosed yourself from information obtained from the Internet?,” 72.7% (n = 136) responded yes with a greater proportion females, 80.7% (n = 88), than males, 63.2% (n = 48) (**P = 0.007). Only 18.3% (n = 20) of females responded no to self-diagnosing themselves as compared to 34.2% (n = 26) of males, with a total of 25.7% (n = 48) responding no overall. 0.9% (n = 1) of females responded “I do not know” compared to 2.6% (n = 2) of males, with a total of 1.6% (n = 3) responding “I do not know” overall.

The proportions who reported prediagnosing themselves from the internet within various age groups were 88.9% (n = 8) for under 20, 74.6% (n = 53) for 21–30, 80.4% (n = 37) for 31–40, 72.2% (n = 13) for 41–50, 84.2% (n = 16) for 51–60, and only 39.1% (n = 9) for the 60 + years' age group in which 60.9% (n = 14) responded no. Overall, the younger study population diagnosed themselves more than the older population (**P = 0.006), with intergroup differences reaching statistical significance between those 60 + years of age and each of the younger age groups including 51–60 (**P = 0.02), 31–40 (**P = 0.007), 21–30 (**P = 0.021), and 20 or younger (P = 0.078).

In response to the follow-up question “after self-diagnosing, did you seek further health advice from a health-care practitioner?,” 70.9% (n = 124) responded positively, more females, 76.2% (n = 77), than males, 63.9% (n = 46) (*P = 0.077).

In response to a further follow-up question “was your diagnosis obtained from the Internet correct and verified from a health-care provider?,” slightly more than half of the participants, 57.7% (n = 101), responded yes, and 24.6% (n = 43) responded no. Interestingly, 16.6% (n = 29), 13.9% (n = 14) of females and 19.4% (n = 14) of males, indicated that they did not know whether or not their self-diagnosis was confirmed, and the remaining 1.1% preferred not to answer this question.

Speed of scheduling an appointment after internet search

When asked how long it had taken them to schedule an appointment with a health-care provider in regard to a health matter that had arisen, 31.9% (n = 37) of participants responded that they had scheduled an appointment in under 24 h, 22.4% (n = 26) scheduled within 1–3 days, 8.6% (n = 10) scheduled within 4–7 days, 7.8% (n = 9) scheduled within 1–2 weeks, 6% (n = 7) waited more than a month to schedule, 9.5% (n = 11) responded “other,” and 13.8% (n = 16) never scheduled an appointment to visit a health-care provider [Figure 1].

There was a significant gender difference whereby females scheduled an appointment earlier than males (**P = 0.005). Specifically, 40.7% (n = 24) of females scheduled an appointment in under 24 h in contrast to 21.4% (n = 12) of males, 23.7% (n = 14) and 21.4% (n = 12) of males scheduled within 1–3 days, 10.2% (n = 6) of females scheduled within 4–7 days as compared to 7.1% (n = 4) of males, and 6.8% (n = 4) of females scheduled within 1–2 weeks compared to 8.9% (n = 5) of males [Figure 1]. Only 3.4% (n = 2) of females waited more than a month as opposed to 8.9% (n = 5) of males, and 6.8% (n = 4) of females were completely outside of these timeframes compared to 12.5% (n = 7) of males. Only 8.5% (n = 5) of females never scheduled an appointment to visit a health-care provider in contrast to 19.6% (n = 11) of males [Figure 1].

Health-related anxiety in segment of participants

Thirty-four percent (n = 65) of participants answered that they felt distress, anxiety, or depression regarding their health. A trend was noted for more women, 39.1% (n = 43) to have health-related anxiety as compared to males, 26.6% (n = 21) (P = 0.30), whereas 40.9% (n = 45) of women did not feel distressed about their health with 62% (n = 49) of men responding similarly [Figure 2]b. 19.1% (n = 21) of females and 10.1% (n = 8) of males responded “I do not know” [Figure 2]b. 0.9% (n = 1) of females and 1.3% (n = 1) of males preferred not to answer [Figure 2]b. The proportion of participants who answered yes to feeling distress after internet search was lower for those who were previously healthy (36% distressed, n = 23) as compared to those who had some medical condition (64% distressed, n = 42); however, this difference did not reach statistical significance (P = 0.78).
Figure 2: Trend for more females to answer yes to (a) “…worry that doctors have incorrectly diagnosed you …?” (P = 0.60); (b) “…feel distress, anxiety … regarding your health?” (P = 0.30); (c) “…worry that you may have a disease upon learning about (it) on the internet?” (P = 0.60)

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Hypochondria in segment of participants

41.1% (n = 79) of respondents exhibited signs of hypochondria by answering yes to the question “do you often worry that doctors have not correctly diagnosed you when they are unable to find something wrong with you?” A trend was noted for more females, 43.6% (n = 48), to show hypochondria than males, 38% (n = 30) (P = 0.60) [Figure 2]a. 47.3% (n = 52) of females and 51.9% (n = 41) of males did not worry that they were incorrectly diagnosed; 8.2% (n = 9) of females and 7.6% (n = 6) of males did not know, whereas 0.9% (n = 1) of females and 1.3% (n = 1) of males preferred not to answer [Figure 2]a. The proportion of participants exhibiting this sign of hypochondria was lower for those who were previously healthy (34% worry, n = 27) as compared to those who had some medical condition (68% worry, n = 54); however, this difference did not reach statistical significance (P = 0.79).

Cyberchondria in relation to population characteristics

30.7% (n = 59) of all participants replied yes to the question “upon learning about a disease on the Internet, do you often worry that you may have that illness or disease?” Further analysis of this hallmark of cyberchondria showed that it correlated with older age (r = 0.154, **P = 0.036), lack of prior medical conditions (r = 0.191, **P = 0.013), health anxiety (r = 0.268, ***P = 0.000), and signs of hypochondria (r = 0.142, P = 0.062). There was a trend for more females, 34.5% (n = 38), to develop cyberchondria as compared to males, 25.3% (n = 20) (P = 0.60) [Figure 2]c. 57.3% (n = 63) of females and 67.1% (n = 53) of males denied having cyberchondriasis [Figure 2]c. 5.5% (n = 6) of females and 3.8% (n = 3) of males responded “I do not know,” and 0.9% (n = 1) of females and 1.3% (n = 1) of males preferred not to answer [Figure 2]c. The proportion of participants who answered yes to worrying that they have an illness that they have researched on the internet was lower for those who had some medical condition (35% worry, n = 21) as compared to those who were previously healthy (65% worry, n = 38), and the difference was statistically significant (**P = 0.013).

Age group differences in internet search frequencies

The frequency of health-related internet search was 11.2% (n = 21) daily, 18.6% (n = 35) weekly, 39.4% (n = 74) monthly, 25% (n = 47) yearly, and 5.9% (n = 11) never. In the up to 20 years' age bracket, 22.2% (n = 2) used the internet daily, 11.1% (n = 1) weekly, 44.4% (n = 4) monthly, 11.1% (n = 1) yearly, and 11.1% (n = 1) never used the internet to search for health-related information [Figure 3]. In the 21–30 years' age bracket, 21.4% (n = 15) used it daily, 22.9% (n = 16) weekly, 38.6% (n = 27) monthly, 10% (n = 7) yearly, and 7.1% (n = 5) never used the internet to search for health-related information [Figure 3]. In the 31–40 years' age group, 4.3% (n = 2) used the internet daily, 19.1% (n = 9) used it weekly, 46.8% (n = 22) used it monthly, 25.5% (n = 12) yearly, and 4.3% (n = 2) never used the internet to search for health-related information [Figure 3]. In the 41–50 years' category, 11.1% (n = 2) of respondents used the internet daily to search for health-related information, 22.2% (n = 4) used it weekly, 33.3% (n = 6) used it monthly, 27.8% (n = 5) yearly, and 5.6% (n = 1) of respondents never used the internet [Figure 3]. In the 51–60 years' age bracket, no respondents used the internet daily, 15.8% (n = 3) used it weekly, and 42.1% (n = 8) used it both monthly and yearly, whereas no respondents denied use of the internet to look for health-related information [Figure 3]. In the over 60 years' age group, no respondents used the internet daily, 8.3% (n = 2) used it weekly, 25% (n = 6) used it monthly, 58.3% (n = 14) used it yearly, and 8.3% (n = 2) never used the internet to search for health-related information [Figure 3].
Figure 3: Frequency of health-related internet search by age groups showing statistically significant differences between 21 and 30 versus >60 (***P = 0.000), 21–30 versus 51–60 (**P = 0.011), 21–30 versus 31–40 (**P = 0.019), 3–40 versus 51–60 (**P = 0.012), 41–50 versus 51–60 (**P = 0.021), and <20 versus >60 (**P = 0.024)

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Subgroup analysis by age group revealed statistically significant differences in frequencies of internet search between the 21 and 30 versus over 60 years' age group (***P = 0.000), the 21–30 versus 51–60 years' age group (**P = 0.011), the 21–30 versus 31–40 years' age group (**P = 0.019), the 31–40 versus 51–60 years' age group (**P = 0.012), the 41–50 versus 51–60 years' age group (**P = 0.021), and <20 versus over 60 years' age group (**P = 0.024).

Health-related internet search perceived as advantageous

Seventy-seven percent (n = 147) of participants, 79.7% (n = 63) of males and 76.4% (n = 84) of females, viewed the internet as an advantage when searching for health-related information [Figure 4]. 3.8% (n = 3) of males and 3.6% (n = 4) of females thought it was a disadvantage, whereas 16.4% (n = 18) of females and 13.9% (n = 11) of males thought that it was neither advantageous nor disadvantageous [Figure 4].
Figure 4: Responses by gender to “do you perceive the use of the internet for health-related information as an advantage, disadvantage or neither?” The majority felt that the internet was advantageous with regard to searching for health-related information

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  Discussion Top


This cross-sectional study explored the factors that influence the development of cyberchondria including gender, age group, health status with regard to presence or not of previously diagnosed medical conditions, baseline health-related anxiety, and hypochondria.

Although the participant pool in this study was diverse, it included 28% students, mostly medical students from Canada and the United States, who may have contributed to the robust overall frequencies of health-related internet search activity. It has been reported that 98% of students use the internet for educational and personal purposes, and that 74% of them use it for health-related information.[7] Students in general are motivated to spend time performing health-related internet searches for seeking reassurance about their own health conditions, neutralization of their health-related worrying, and elimination of doubts when an imminent threat to health is perceived.[8]

In this study, self-reported distress, anxiety, or depression about health, and self-reported hypochondriasis (worry about doctors being wrong), correlated with self-reported cyberchondria (worry they have the disease they discovered on the internet). Our findings are in agreement with studies that have shown a correlation between anxiety about one's health and increased tension and anxiety postsearch and an increased likelihood of visiting a physician to quell those worries.[7],[9] Attempting to neutralize health distress in such a manner has been found to lead to an incongruous increase in health-related anxiety and to intensified efforts to attain even more information by additional internet search.[10] Anxiety is a common consequence of searching the internet for a self-diagnosis, as 38% of individuals who search the internet for medical information experience an escalation in anxiety.[11] One study showed that females had a higher rate of health-related anxiety and metaworry which was defined as “worrying about worry.”[12] Those who had higher health-related anxiety levels tended to use online support groups and public digital health forums more than those unaffected by high health anxiety.[3]

Other studies have shown that individuals with increased levels of health-related anxiety tend to search the internet for information that may appease them and alleviate the distress felt by the particular condition they believe they are afflicted by.[13] The internet seemed to be a place where their health fears were either amplified or diminished based on the information that they found. As a result, although several people did not return to the internet after finding discomforting information, several more experience cyberchondria where they continuously search the internet and find more information that contributes to their health-related anxiety and are not deterred by it.[13] This in turn creates a cycle of cyberchondria.

Reasons for this cycle of cyberchondria include the fact that many people searching the internet for health-related information were more likely to click on the search results that were more tantalizing and even petrifying, such as clicking on HIV as opposed to the common flu.[1] In addition, the results of online searches are populated based on users clicking on them, and as a result, the likelihood of a disease is usually unrelated to the results of the online searches.[1] Those searching for health-related information can become affected by an escalation of cyberchondria based on the presentation of search results even though their likelihood is diminished.[13] The cycle continues as a serious medical pathology may be considered as compared to something more benign and lead to terrifying conclusions about one's health which can lead to a continuous return to the internet for information and a heightened fear of having a particular disease.[13]

Anxiety is seen to be more uncontrollable in females as compared to males where there seems to be a relationship between health-related anxiety and metacognition.[14] Metacognition is defined as being affected by health anxiety if that anxiety was unable to be controlled.[14] In addition, our study showed that females sought health-care advice from a practitioner significantly sooner than their male counterparts. Studies have purported that females are more likely than males to seek health-care providers for both physical and mental health concerns.[15] In addition, women who formed a trusting relationship based on mutual communication with their physicians were more likely than men to seek the services of a health-care provider.[16] Our findings that 53% of men performed health-related internet searches were almost identical to the results from a recent German study which reported 52% for men and higher than the 33% reported for males in a recent Belgian study.[17],[18] The proportion of women searching the internet for health advice in our study was 60%, which is higher than the 48% figure reported in the study from Germany, and slightly lower but closer to the 67% reported for females in the study from Belgium.[17],[18] This consensus that approximately two-thirds of females engage in health-related internet search, and that women seek medical advice and schedule visits to health-care providers earlier than men, most likely relates to the social role of women as primary caregivers for their children, spouses, and parents.[17] By contrast, men have been found to be less likely to go to the doctor due to busy schedules, fear of the result of the doctor visit, uncomfortable physical examinations, and personal questions that may be asked, in descending order of importance.[19] Men are also more likely to be embarrassed during interactions with their doctors and tend to suffer from symptoms for longer periods of time before seeking help as compared to their female counterparts, especially when symptoms do not impede their daily activities.[20]

Our findings of generational differences most likely relate to the tendency for younger age groups to spend more time on the internet than older persons, perhaps due to their greater propensity toward embracing technological advancements and acquiring digital learning skills. Particularly, younger age groups feel favorably about using the internet for health-related information, regardless of whether they are suffering from a particular ailment or not.[21] Younger age groups are also more likely to use the internet with regard to sensitive topics including sexual health, interpersonal violence, cyber support for diagnosed conditions, treatment regimens, and networking among others affected by the disease.[22] Furthermore, younger generations are more likely to use the internet to seek support groups as opposed to the preference for in-person interactions preferred by older generations.[23],[24] This preference relates to the private nature of being able to share thoughts, feelings, and emotions with regard to their medical conditions and to be well informed about particular diagnoses and their health.[24] In one study where senior citizens used the internet sparingly for health-related information, additional resources were used including television and radio media and paper-based information such as leaflets and handouts; however, senior citizens were more likely to expect comprehensive explanation of health-related information from their health-care providers instead.[25]

Our finding that older age groups worry more than younger age groups after learning about a disease on the internet highlights advancing age as a risk factor for cyberchondria. The complex nature of vocabulary used on the internet to describe various diseases can be responsible for older age groups worrying more than younger age groups about diseases discovered via the internet.[23]

Despite the concerns regarding cyberchondria, our study found that the vast majority of participants, regardless of health status and medical history, perceived that health-related internet searches were advantageous. One study showed that up to 45% of people search for health information before attending an appointment with their physician and about three-quarters of this population use that information in discussion with their physicians; also, the majority of patients utilize the internet as an addendum to their doctor's advice and find that a combination of internet information and doctor visits is optimal for their health.[26],[27] The internet seemed to be advantageous for most patients only when doctors are open to the information presented from the internet and to discussing it with patients in a thorough manner.[28] In addition, patients deemed the internet more advantageous because they feel a sense of comfort with the information provided by doctors as a greater sense of clarity was gained.[29] Three factors have been identified that allow for a stronger patient–physician relationship in addition to using health-related information from the internet: (i) viewing an advertisement that could be discussed with a physician, (ii) bringing a companion to the appointment, and (iii) the physician initiating an enquiry with the patient.[30]

Social relationships create a supportive environment for many people, both afflicted and unaffected by a particular disease. Subsequently, the internet has become a way for people to seek social relationships as well as to maintain and create large networks of support.[31] As a result, the internet is vast and expansive and allows for communication with health-care personnel and other people who are affected by a disease or want to converse about health topics in general.[32] Hence, the exchange of information and the social support afforded using the internet for health-related information can provide support for those with and without health issues.[33]

Our results revealed that people with a positive medical history worried less after searching the internet. One study showed that those with a medical history seemed to be less worried after searching the internet because they used it as a means to be active in their decision-making, and they indeed felt more at ease with their physician's advice.[34] Patients may be less worried as they use the internet to prepare themselves better for the visit with their physician, to ask questions that were informative about their health and to use the information as a supplementary addendum to what was told to them by their physicians.[34] Thus, self-directed learning could empower a patient rather than alarm them by helping them to know more about what to expect with their health situation.

For those who have never been diagnosed with an illness before, searching the internet might be more suitable for gathering more easily interpretable information such as lifestyle interventions and disease prevention as opposed to more complex information such as medical and surgical management of diseases, especially diseases they may have never experienced.[35] Furthermore, studies have found that human interaction is better than a technological one due to the added blanket of emotional security that can be provided by a person, and patients are usually confident that they will have the chance to verify all information that they find on their own with their physician, whom they deem to be the most accurate source of information.[36]

Limitations of our study include that a large percentage of our participant pool was geographically located in North America and over a quarter were medical students. As a result of this, cultural attitudes to health care may not have been adequately accounted for among different countries, and some results may have been an overestimate. Furthermore, the “Dr. Net” survey was original and not validated, although it was derived from more extensive instruments previously employed in professional assessments of internet-based intervention.[2],[3],[4],[5],[6] Although using an online survey to probe anxiety-related experiences may have lacked the refinement of in-person interviews, online survey was a suitable screening method for cyberchondriasis and selected for computer-literate, well-educated participants. Another limitation relates to using the terms “health-related anxiety” and “hypochondria” based on the responses to online question items which may not exactly correspond to rigorous clinical diagnoses of these conditions. Furthermore, the sample size of 191 was relatively small for an online survey which was conducted over a whole year period and resulted in even smaller numbers within subgroups like the elderly. Finally, the availability of medical insurance or a universal health-care plan may have influenced the answers to some questions.


  Conclusion Top


We have identified subpopulations that seem to be more prone to experiencing cyberchondria including those with no previously diagnosed health conditions, those with a higher baseline health-related anxiety or hypochondria, and those who are more senior in age. Cyberchondria may be alleviated by the evaluation of one's state of mind before searching, recognizing the reasoning behind the search, and also understanding the limitations of the internet search for health information.[37] We recommend raising awareness about cyberchondria and ways to minimize it including encouragement to seek health advice through alternative strategies.

Acknowledgment

We wish to thank the Head of Research at Saint James School of Medicine, Dr. Branka Filipovic, for her invaluable input into this project. We are also grateful to our collaborators Ola Huzo, Nicole Walters, Ehis Adada, Luckner Roseme, Yuliya Vadymivna Parisi, and Mary Pennington.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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