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|Cyberchondria: An emerging form of health anxiety
Sujana Devi Gandla1, Prasanth P Dayala2, Pavan Kumar Kadiyala3
1 Post Graduate, Department of Psychiatry, Alluri Sitarama Raju Academy of Medical Sciences, Dr. NTRUHS, Eluru, Andhra Pradesh, India
2 Assistant Professor, Department of Psychiatry, Alluri Sitarama Raju Academy of Medical Sciences, Dr. NTRUHS, Eluru, Andhra Pradesh, India
3 Associate Professor, Department of Psychiatry, Alluri Sitarama Raju Academy of Medical Sciences, Dr. NTRUHS, Eluru, Andhra Pradesh, India
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|Date of Submission||12-Apr-2021|
|Date of Acceptance||07-Jul-2021|
|Date of Web Publication||06-Sep-2021|
Background: It is common among medical students to incorrectly believe that they have contracted certain diseases they have recently studied. This belief can be seen in the form of health anxiety and investigating health-related information via the Internet. Cyberchondria denotes repeated online searches for health-related information that are associated with increasing levels of health anxiety.
Aims: We aimed to study the prevalence and severity of cyberchondria among medical students and its correlation with sociodemographic and clinical data.
Materials and Methods: A cross-sectional study was conducted on 400 consented medical students using online Google Forms. The form included demographic and clinical details and the Cyberchondria Severity Scale-15 (CSS-15) questionnaire. Means and standard deviations were calculated for continuous variables and percentages for categorical variables. The k-means clustering was done for grouping the participants. Spearman correlation and linear regression were done for analyzing the data.
Results: The mean age of the participants was 19.28 ± 1.75 years. Females constituted 54.3% of the sample. About 24.5% of the students had previously diagnosed (medical/surgical/psychiatric) illness. The mean score of the CSS was 30.86 ± 9.44. Three clusters with 28%, 66%, and 6% of the students represented the CSS cluster center scores of 19.22 (mild), 34.10 (moderate), and 49.63 (severe), respectively. There was a significant positive correlation between total CSS score and previously diagnosed illness (r = 0.233, P = 0.000) and negative correlation with age (r = −0.151, P = 0.003) and year of study (r = −0.254, P = 0.000).
Conclusion: The increasing prevalence of cyberchondria is an example of how digital technology may play an important role in facilitating the development of psychopathology.
Keywords: Cyberchondria, health anxiety, hypochondriasis
| Introduction|| |
The Internet and related technologies are permeating our everyday functioning to the extent that it has become difficult to imagine life without them. India had 451 million monthly active Internet users as of March 2019, ranking second following China, and 504 million active users by November 2019 with a total growth of 12% from March 2019. The Internet offers information on topics such as healthy lifestyles and health services.,, Using the Internet as a primary source for health information has become a common practice and part of everyday life for many people.
When entering symptoms in a search engine, the respective results or diagnoses will be listed in the order of access popularity, not prevalence, or probability of correctness., Internet usage thus increases the likelihood that users will be exposed to conflicting or confusing information or to unreliable, inaccurate, or outdated information. This misunderstanding seems familiar in online health research and may fuel health anxiety., A focus group study by Eysenbach and Köhler indicated that users rarely check which organization is behind the website and whether the information on it is reliable.
Health anxiety is a psychological state in which somatic and mental concerns are stimulated by health-related threat perceptions. In fact, individuals with elevated levels of health anxiety have been shown to seek online medical information at a greater frequency and for a longer duration than those with low levels of health anxiety., At this point, we cannot definitively say that health anxiety leads to increased online medical information seeking or vice versa. However, it is believed that there is a positive feedback loop that increases both frequencies of online medical information seeking and health anxiety.,
Mild health anxiety experienced by many people is a tolerable situation that will go away on its own. On the other hand, severe health anxiety indicates primary psychiatric disorders such as hypochondriasis or health phobia., In recent times, the term ”cyberchondria” (“cyber” and ”hypochondriasis”) is being used as a form of hypochondriasis related to the Internet or computer use. ”Cyberchondria” is defined as ”an excessive or repeated search for health-related information on the Internet, driven by distress or anxiety about health, which amplifies such distress or anxiety.” The study done among information technology sector employees in Chennai by Makarla et al. showed that more than half of the sample population (55.6%) had some form of cyberchondria.
Health anxiety is not an exception for medical students. The study of medicine puts them under continuous pressure arising from the fast pace of studies, the demanding examinations, and the competitive environment. This stress intensifies somatic sensations with autonomic activations and causes them to be perceived as symptoms. Unlike students in other professional programs, medical students are also exposed to a vast amount of clinical knowledge during their studies., Further, students rely more on easy and immediately accessible Internet-based information instead of standard books. This erroneous information makes them misinterpret their perceived symptoms as medical evidence for a disease. A few studies were done to assess cyberchondria among medical students, especially in India. A study done by Kanganolli and Kumar in Karnataka, in the year 2018, showed that 37.5% of the undergraduate medical students had cyberchondria.
The main objective of this study was to study the prevalence and severity of cyberchondria among medical students and to correlate with the sociodemographic and clinical variables (age, gender, year of study, and history of medical illness).
| Materials and Methods|| |
A cross-sectional observational study was conducted from August 2019 to September 2019 using an online questionnaire after obtaining ethical approval. Undergraduate students and interns, who gave consent and completely filled the online questionnaire, were included in the study.
Cyberchondria Severity Scale (CSS), a five-point Likert scale, was used to measure the level of cyberchondria among the sample. It is a 33-item self-report measure developed by McElroy and Shevlin in 2014. The scale contains five factors to mirror the multidimensional construct of cyberchondria: compulsion, distress, excessiveness, reassurance, and mistrust of medical professionals.
A brief version (CSS-15) with 15 items was developed and validated by Barke et al. in 2016, with the internal consistency of α = 0.93 and split-half reliability α = 0.95.
Data were analyzed using Microsoft Office and IBM Statistical Package for Social Sciences (SPSS, Version 25, IBM Inc, Armonk, NY). Manufacturer: IBM Inc. The arithmetic mean (x̄) and standard deviation for continuous variables and frequencies and percentages for categorical variables were calculated. A nonhierarchical classification protocol, k-means cluster analysis, was performed for CSS scores. Correlations and significance were assessed using Spearman correlation. Linear regression analysis was performed to determine the predictors of cyberchondria.
| Results|| |
A total of 400 (n) students responded to the study. The mean age of the participants was 19.28 ± 1.75 years. Female respondents were 217 (54.3%), and males were 183 (45.8%). Ninety-eight students (24.5%) had previously diagnosed (medical/surgical/psychiatric) illness [Table 1].
The mean score of CSS was 30.86 ± 9.44, with the means of the subscales being 5.5 ± 2.2 for compulsion, 5.7 ± 2.6 for distress, 6.8 ± 2.8 for excessiveness, 7.1 ± 3.4 for reassurance, and 5.5 ± 2.9 for mistrust of medical professional [Table 2]. Three clusters with 28% (112), 66% (264), and 6% (24) of the students with the CSS cluster center scores of 19.22, 34.10, and 49.63, respectively, were formed, indicating mild, moderate, and severe levels of cyberchondria.
The mean CSS score among females and males was 30.64 and 31.12, respectively. Participants with previously diagnosed (medical/surgical/psychiatric) illness reported a slightly higher CSS score (34.9 ± 9.5) than with no illness (29.5 ± 9), with a significant positive correlation (r = 0.233, P = 0.000). A significant negative correlation was found between total CSS scores with the year of study (r = −0.254, P = 0.000) and age (r = −0.151, P = 0.003) [Table 3]. Logistic linear regression analysis showed age, previous illness, and year of study as the predictors of the severity of cyberchondria [Table 4].
|Table: 2: Mean scores of total Cyberchondria Severity Scale and its subscales|
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|Table 4: Linear regression analysis to assess predictors of cyberchondria|
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| Discussion|| |
Our study assessed the prevalence and severity of cyberchondria and their correlation with clinical and sociodemographic variables among medical students. The study showed a mean CSS score of 30.86 ± 9.44. The k-means cluster analysis showed that 66% of the students had moderate and 6% had severe cyberchondria with mean CSS cluster scores of 34.10 and 49.63, respectively. These results indicate a high severity of cyberchondria among the medical students, similar to the study by Bati et al. in Turkey.
Our data showed that the prevalence and severity of cyberchondria among medical students are similar to studies on nonmedical populations. This concludes, medical students are no exception, and expressing health concerns is common irrespective of profession. However, a study done by Aulia et al. in 2018 revealed that the total CSS score of medical students was higher than those in studies of other populations.
Our study showed a dominance of excessiveness and reassurance constructs, indicating that most students are engaged in frequent online search and repeatedly seeking assurance from the doctors for their search results. This result was similar to the study done by Makarla et al., which showed a prevalence of 55.6% of cyberchondria, with a dominance of excessiveness and reassurance constructs. The study done on computer engineering students in Pune, India, by Dagar et al. also revealed that excessiveness and reassurance constructs were more affected among the CSS subscales.
The mean CSS score in our study among 1st-year students (33.04 ± 9.2) was greater than that of interns (28.43 ± 8.9). This negative correlation of the CSS score with the year of the study and age suggests that the students become less anxious about their health as they get to learn in detail about medical illnesses. It was similar to the study done by Zahid et al. in which students demonstrated a significant rise in health anxiety and preoccupation with and fear of illness while entering the clinical years, followed by a substantial decrease later on.
In the present study, there was no significant difference in the mean CSS scores between females and males. This finding is similar to the study conducted by Aulia et al. among 1st-year medical students in Indonesia. In the study done by Akhtar and Fatima, men reported a higher mean in total CSS score and all its subscales compared to women except ”mistrust of medical professionals” where women scored higher compared to the men (P > 0.05). No such differences with subscales were observed among males and females in our study.
Participants with previously diagnosed (medical/surgical/psychiatric) illness reported slightly higher means (34.93 ± 9.55) than with no illness (29.54 ± 9.03). It may indicate that persons who have experienced prior health problems will become more concerned and anxious about their health, and even a slight disturbance in their bodily function might trigger health anxiety in them.
Strengths and limitations of the study
Only a few studies were done on cyberchondria in India, particularly on undergraduate medical students, providing scope for further studies. Being a cross-sectional study, it is challenging to establish the causal association of Internet usage with the growing severity of cyberchondria.
| Conclusion|| |
Knowledge and empowerment can be considered as positive aspects of health-related online search. However, it is still debatable whether these benefits outweigh the anxiety that can be induced by them. As cyberchondria is the newer form of presentation of health anxiety, measures need to be adopted for evaluation, prevention, and treatment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Sujana Devi Gandla,
Flat No. 202, 3rd Floor, Sri Ramana Nivas, Chanakyapuri Colony, A-Camp, Kurnool - 518 002, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3], [Table 4]
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