Abstract
Background:
The Internet has become an important tool in day-to-day life. Reading medical data from Internet sources can have a negative impact on the common man. Anxiety due to excess searching for medical information online is known as cyberchondria.
Aim:
To evaluate the cyberchondria construct among the computer engineering students in Pune (India) using Cyberchondria Severity Scale (CSS-15).
Settings and Design:
A cross-sectional study was conducted among third- and fourth-year computer engineering students.
Methods:
The study recruited 180 students. A self-administered, English-translated CSS-15 questionnaire was used to collect the data. The responses were based on the Likert scale. Four constructs were scored from 0 to 4 while the mistrust of medical professional construct was scored in reverse order.
Statistical Analysis:
Descriptive statistics in the form of numbers and percentages were calculated.
Results:
The survey was completed by 171 (95%) participants, 77 females and 94 males with the mean age of 19.77 ± 1.07 years. All (100%) participants were affected by excessiveness and reassurance construct, 92% by distress, and 75% by compulsion. Only 19% were found to be affected by mistrust of a medical professional. Among all the domains, reassurance was severely affected among 52.04% of the participants.
Conclusion:
All the computer engineering students were affected by some or the other constructs of cyberchondria. This indicates that the Internet can affect an individual's mental, physical, and social activity by giving a vast amount of information and cause anxiety or distress related to their search.
Keywords: Anxiety, cyberchondria, health, Internet, software engineer, students
INTRODUCTION
Very often, the Internet is used for finding medical information and health knowledge. The search results can affect the quality of life (QoL)[1] and lead to online-search-related anxiety.[2,3] This unexplained anxiety is termed as cyberchondria. Cyberchondria has been defined as excessive or repeated online searching for health-related information, which is driven by a need to alleviate distress or anxiety surrounding health, but instead, it results in getting worse.[1] For a single symptom, such as a headache, the Internet can lead the person to the diagnosis of a brain tumor, which only increases anxiety in the person, and without the help of any medical professional, it can lead to depression. Lauckner and Hsieh reported that searching for health information online results in negative emotional outcomes like the feeling of overwhelm and fright.[4] Muse et al. conducted a study among students using different questions to check their anxiety levels and found that the participants who were in the high anxiety group were using more Internet for health information than those in the low anxiety group.[5]
McElroy and Shevlin[6] constructed a cyberchondria questionnaire called the Cyberchondria Severity Scale with 33 Items (CSS-33). The purpose was to help medical professionals in diagnosing and treating cyberchondriac patients. As cyberchondria is a multifactorial/multiconstruct anxiety disorder, the CSS-33 questionnaire was multifactor, using five constructs (compulsion, distress, excessiveness, reassurance, and mistrust of medical professional). The CSS-33 has been translated in German and shortened to 15 items (CSS-15). The reliability and validation of CSS-15 have resulted in retaining good psychometric properties as the original questionnaire.[7]
Computer engineering students are constantly using the Internet as a part of their education. It can be hypothesized that they may be more prone to check medical symptoms online, which makes them high-risk individuals for developing online-health-related anxiety (cyberchondria). Hence, this study was undertaken to evaluate the cyberchondria construct among computer engineering students using the CSS-15 questionnaire.
MATERIALS AND METHODS
Ethical clearance was obtained from the institutional ethics committee. The study was conducted from April 2017 to July 2017. Hundred and eighty computer engineering students, having the habit of checking medical information on the Internet, from Dr. D. Y. Patil College of Engineering, Pune (India) were recruited. Data were collected using a self-administered [Figure 1] CSS-15, English-translated German questionnaire [Figure 1].[7] All the psychometric properties for the questionnaire were checked before its use.
Figure 1.
CSS-15 Questionnaire
The questionnaire contained five constructs, i.e., compulsion, distress, excessiveness, reassurance, and mistrust of medical professional. Each construct was represented by three questions. Each question had five options (No way, Rarely, Sometimes, Frequently, and Always), and they were scored from 0 to 4 with the exception of the last construct (mistrust of medical professional), which was scored from 4 to 0. The score range per construct was 0 to 12. For the first four domains, the scores were interpreted as follows:
Score 0- Not affected
Score 1–6- Moderately affected
Score 7–12- Severely affected
This order was reversed for the mistrust of the medical professional domain. Data were analyzed descriptively, and the number and percentages were calculated.
RESULTS
Hundred and seventy-one students completed the questionnaire fully and were considered for analysis. Of which, 77 were females and 94 were males with the mean age of 19.77 ± 1.07 years.
Table 1a shows the distribution of the percentage of participants according to the four constructs and subgroup scores. The “Compulsion” construct (Question 3, 4, and 7) measures attributes related to searching symptoms online and interrupting the time to be used for work-related and leisure activities. The majority of the participants (62.57%) were moderately affected while 25.14% were not affected and 12.28% of the participants were affected severely. The “Distress” construct (Question 6, 9, and 14) measures attributes related to panic, anxiety, and disturbed sleep. In terms of this construct, 63.74% of the participants were moderately affected while 29.23% were affected severely and 7.01% were not affected. The “Excessiveness” construct (Question 1, 2, and 13) measures attributes related to the repetition and spending unnecessary time researching the same symptom and health condition on the Internet. Here, 54.97% of the participants were affected moderately and 45.02% were affected severely. The “Reassurance” construct (Question 8, 10, and 11) measures attributes related to anxiety, manifesting in the need for reassurance from a more qualified person, i.e. a medical professional. In this construct, 52.04% of the participants were affected severely while 47.95% of the participants were moderately affected.
Table 1a.
Distribution of the percentage of people according to the subgroup scores and the constructs
| Constructs | Score 0 (Not Affected) | Score 1-6 (Moderately Affected) | Score 7-12 (Severely Affected) |
|---|---|---|---|
| Compulsion | 43 (25.14%) | 107 (62.57%) | 21 (12.28%) |
| Distress | 12 (7.017%) | 109 (63.74%) | 50 (29.23%) |
| Excessiveness | 0 (0%) | 94 (54.97%) | 77 (45.02%) |
| Reassurance | 0 (0%) | 82 (47.95%) | 89 (52.04%) |
Table 1b shows the distribution of the percentage of people according to the “Mistrust of Medical Professional” construct (Question 5, 12, and 15) and subgroup scores. This construct measures attributes related to trusting the expert (medical professional) diagnosis than self-diagnosis. Here, 80.70% were not affected while 19.29% were moderately affected.
Table 1b.
Distribution of the percentage of people according to the subgroup scores and the construct
| Construct | Score 0 (Severely Affected) | Score 1-6 (Moderately Affected) | Sore 7-12 (Not Affected) |
|---|---|---|---|
| Mistrust of medical professional | 0 (0%) | 33 (19.29%) | 138 (80.70%) |
DISCUSSION
The overall results indicate that the participants were getting affected by the five constructs (to a varying extent) after searching online health information. Among all the constructs studied, excessiveness (n = 171) and reassurance (n = 171) constructs had an impact on greater number of study participants, more than distress (n = 159) and compulsion (n = 128). The least impact was of the mistrust of medical professional construct (n = 33).
The “Compulsion” construct can negatively impact the social, professional, and academic lives of people.[8] Such finding was observed among 74.85% of the study participants. Similar results were found in the studies conducted by White and Horvitz[1] and McElroy and Shevlin.[6] Internet helps in increasing knowledge, but it makes the patient overwhelmed by the information.[8]
The “Distress” construct is more subjective and suggests that there is a feeling of distress associated with online health search. Such a finding was observed in 92.97% of the participants. Singh and Brown also found a positive correlation between anxiety and searching for illness and wellness information.[9] The most common health searches were about possible causes of symptoms, information on diagnosed medical conditions, and treatment options.[4]
The “Excessiveness” construct suggests that the individual searches the Internet for the health-related symptoms repeatedly. In the present study, this construct was reported by 100% of the participants. These results are like the study conducted by Muse et al.[5]
The “Reassurance” construct suggests that the cyberchondriac needs assurance from the doctors about the conditions they have read online. Such findings were reported among 100% of the participants. The literature shows that cyberchondriac searches the Internet for their second or third opinion, and they start to identify themselves with the most serious cases.[10]
The “Mistrust of Medical Professional” construct suggests the individual has paranoia and fails to take any comfort from their medical professionals. Such a finding was observed in 19.29% of the participants while 80.70% of the participants got reassured after discussing their online health research with their medical professional. This result is supported by the study conducted by Hart et al., which reported that the patients are more confident with the information given by their family doctor than the Internet.[8]
The Internet searching habit could impact and delay professional help because people may consider themselves capable of conducting their own diagnosis based on search results. Additionally, this behavior may promote self-medication, considering that this type of information can also be shown explicitly on Internet sites. This information is throwing light on a new aspect of the doctor–patient relationship. The doctors will need more patience and time to interact with an Internet-literate patient, making them assured about their search and giving reassurance if the information they have searched is correct or not. The search results through scientific and trustworthy sites to some extent give correct information, but if the people are surfing lay forums, then there is a great deal to worry for the patient and the doctor too.
To conclude, the computer engineering students, who reported to use the Internet for health-related searches are affected by the cyberchondria constructs of varying severity. This indicates that the Internet can affect an individual's mental, physical, and social activity by giving a vast amount of information and cause anxiety or distress related to that search.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Acknowledgements
The authors wish to thank Dr Eoin McElroy for the support.
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