Original Research April 27, 2023

Cyberchondria Severity and Quality of Life Among Lebanese Adults: The Moderating Effect of Emotions

Christina Tarabay, MD; Zeinab Bitar, MSc; Marwan Akel, PhD; Souheil Hallit, PharmD, MSc, MPH, PhD; Sahar Obeid, PhD; Michel Soufia, MD

Prim Care Companion CNS Disord 2023;25(2):22m03252

ABSTRACT

Objective: To examine the correlation between cyberchondria and quality of life (QOL) among Lebanese adults during the COVID-19 pandemic, taking into consideration the moderating role of emotions (emotion regulation and positive and negative affect). The following questions were examined: (1) Do greater cyberchondria severity and fear of COVID-19 lead to poorer quality of physical and mental health? (2) How is positive and negative affect related to physical and mental QOL? and (3) How do emotion suppression and cognitive reappraisal correlate with physical and mental QOL, particularly in those with higher cyberchondria?

Methods: This cross-sectional study was performed between December 2020 and January 2021 during the COVID-19 pandemic. The study enrolled 449 participants who completed an online questionnaire. The questionnaire included sociodemographic questions and the following scales: Cyberchondria Severity Scale, Quality of Life Short Form‐12 Health Survey, Fear of COVID-19 Scale, Emotion Regulation Questionnaire, and Positive and Negative Affect Schedule.

Results: The results showed that more positive affect (B = 0.17) and negative affect (B = 0.19) were positively correlated with higher physical QOL scores. More positive affect (B = 0.33) and cognitive reappraisal (B = 0.09) were significantly associated with higher mental QOL scores. The interactions between cyberchondria severity by cognitive reappraisal and cyberchondria severity by emotion suppression were significantly associated with mental QOL (P < .001 for both). In people with high cyberchondria severity, having high cognitive reappraisal was strongly correlated with better mental QOL. In people with high cyberchondria severity, having low emotion suppression was significantly correlated with better mental QOL (P < .001).

Conclusions: Exposure to copious amounts of information, whether from verifiable sources or not, can instigate anxious symptoms in individuals who lack adaptive emotion regulation ability. Further studies are needed to identify factors related to health crisis response and their moderators, which can be useful to better understand the incidence and development of anxiety and allow health professionals to develop and implement preventive and therapeutic interventions.

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  1. Starcevic V, Berle D. Cyberchondria: towards a better understanding of excessive health-related Internet use. Expert Rev Neurother. 2013;13(2):205–213. PubMed CrossRef
  2. Vismara M, Caricasole V, Starcevic V, et al. Is cyberchondria a new transdiagnostic digital compulsive syndrome? a systematic review of the evidence. Compr Psychiatry. 2020;99:152167. PubMed CrossRef
  3. Kalckreuth S, Trefflich F, Rummel-Kluge C. Mental health related Internet use among psychiatric patients: a cross-sectional analysis. BMC Psychiatry. 2014;14(1):368. PubMed CrossRef
  4. Prescott J, Mackie L. “You sort of go down a rabbit hole...you’re just going to keep on searching”: a qualitative study of searching online for pregnancy-related information during pregnancy. J Med Internet Res. 2017;19(6):e194. PubMed CrossRef
  5. Maftei A, Holman AC. Cyberchondria during the coronavirus pandemic: the effects of neuroticism and optimism. Front Psychol. 2020;11:567345. PubMed CrossRef
  6. Kim S-W, Su K-P. Using psychoneuroimmunity against COVID-19. Brain Behav Immun. 2020;87:4–5. PubMed CrossRef
  7. Pulido CM, Villarejo-Carballido B, Redondo-Sama G, et al. COVID-19 infodemic: more retweets for science-based information on coronavirus than for false information. Int Sociol. 2020;35(4):377–392. CrossRef
  8. WHO. Coronavirus disease (COVID-19) [Internet]. WHO website. Accessed September 8, 2021. https://www.who.int/emergencies/diseases/novel-coronavirus-2019?adgroupsurvey={adgroupsurvey}&gclid=CjwKCAjwvuGJBhB1EiwACU1AieA05vjCzOy5BJqV-nUjtyP3ijeGg28h86NiD-eyYR9YppdQ63MpjxoCjIUQAvD_BwE
  9. Garfin DR, Silver RC, Holman EA. The novel coronavirus (COVID-2019) outbreak: amplification of public health consequences by media exposure. Health Psychol. 2020;39(5):355–357. PubMed CrossRef
  10. Seyed Hashemi SG, Hosseinnezhad S, Dini S, et al. The mediating effect of the cyberchondria and anxiety sensitivity in the association between problematic internet use, metacognition beliefs, and fear of COVID-19 among Iranian online population. Heliyon. 2020;6(10):e05135. PubMed CrossRef
  11. Varma R, Das S, Singh T. Cyberchondria amidst COVID-19 pandemic: challenges and management strategies. Front Psychiatry. 2021;12:618508. PubMed CrossRef
  12. Laato S, Islam AKMN, Islam MN, et al. What drives unverified information sharing and cyberchondria during the COVID-19 pandemic? Eur J Inf Syst. 2020;29(3):288–305. CrossRef
  13. Starcevic V. Cyberchondria: challenges of problematic online searches for health-related information. Psychother Psychosom. 2017;86(3):129–133. PubMed CrossRef
  14. McElroy E, Shevlin M. The development and initial validation of the cyberchondria severity scale (CSS). J Anxiety Disord. 2014;28(2):259–265. PubMed CrossRef
  15. Harper CA, Satchell LP, Fido D, et al. Functional Fear Predicts Public Health Compliance in the COVID-19 Pandemic. Int J Ment Health Addiction [Internet]. Springer website. 2020. Accessed September 19, 2021. https://link.springer.com/10.1007/s11469-020-00281-5
  16. Asmundson GJG, Taylor S. Coronaphobia: fear and the 2019-nCoV outbreak. J Anxiety Disord. 2020;70:102196. PubMed CrossRef
  17. Engelhard IM, van Uijen SL, van Seters N, et al. The effects of safety behavior directed towards a safety cue on perceptions of threat. Behav Ther. 2015;46(5):604–610. PubMed CrossRef
  18. Bitar Z, Haddad C, Obeid S, et al. Treatment satisfaction and its association with anxiety, depression and fear of COVID-19 among Lebanese inpatients with schizophrenia. Pharm Pract (Granada). 2021;19(3):2364. PubMed CrossRef
  19. Mertens G, Boddez Y, Sevenster D, et al. A review on the effects of verbal instructions in human fear conditioning: Empirical findings, theoretical considerations, and future directions. Biol Psychol. 2018;137:49–64. PubMed CrossRef
  20. Mertens G, Gerritsen L, Duijndam S, et al. Fear of the coronavirus (COVID-19): predictors in an online study conducted in March 2020. J Anxiety Disord. 2020;74:102258. PubMed CrossRef
  21. Wu X, Nazari N, Griffiths MD. Using fear and anxiety related to COVID-19 to predict cyberchondria: cross-sectional survey study. J Med Internet Res. 2021;23(6):e26285. PubMed CrossRef
  22. Vizueta N, Patrick CJ, Jiang Y, et al. Dispositional fear, negative affectivity, and neuroimaging response to visually suppressed emotional faces. Neuroimage. 2012;59(1):761–771. PubMed CrossRef
  23. Watson D, Clark LA, Tellegen A. Development and validation of brief measures of positive and negative affect: the PANAS scales. J Pers Soc Psychol. 1988;54(6):1063–1070. PubMed CrossRef
  24. Schachter S, Singer JE. Cognitive, social, and physiological determinants of emotional state. Psychol Rev. 1962;69(5):379–399. PubMed CrossRef
  25. P AS, Mariette TM, Majid SA. Positive and negative affect on quality of life: a review. IHRJ. 2017;1(5):7–9. CrossRef
  26. Fredrickson BL. The role of positive emotions in positive psychology: the broaden-and-build theory of positive emotions. Am Psychol. 2001;56(3):218–226. PubMed CrossRef
  27. Brown RJ, Skelly N, Chew-Graham CA. Online health research and health anxiety: a systematic review and conceptual integration. Clin Psychol Sci Pract. 2020;27(2)e12299. CrossRef
  28. Bakhshaie J, Rogers AH, Kauffman BY, et al. Emotion dysregulation as an explanatory factor in the relation between negative affectivity and non-medical use of opioid in a diverse young adult sample. Addict Behav. 2019;95:103–109. PubMed CrossRef
  29. El Archi S, Brunault P, De Luca A, et al. Do emotion dysregulation, alexithymia and personality dimensions explain the association between attention-deficit/hyperactivity disorder and binge eating among bariatric surgery candidates? Front Psychol. 2021;12:745857. PubMed CrossRef
  30. Fergus TA, Valentiner DP. Disease phobia and disease conviction are separate dimensions underlying hypochondriasis. J Behav Ther Exp Psychiatry. 2010;41(4):438–444. PubMed CrossRef
  31. John OP, Gross JJ. Healthy and unhealthy emotion regulation: personality processes, individual differences, and life span development. J Pers. 2004;72(6):1301–1333. PubMed CrossRef
  32. Jafari N, Farajzadegan Z, Loghmani A, et al. Spiritual well-being and quality of life of Iranian adults with type 2 diabetes. Evid Based Complement Alternat Med. 2014;2014:619028. PubMed CrossRef
  33. Mok MMY, Liu CKM, Lam MF, et al. A longitudinal study on the prevalence and risk factors for depression and anxiety, quality of life, and clinical outcomes in incident peritoneal dialysis patients. Perit Dial Int. 2019;39(1):74–82. PubMed CrossRef
  34. Staquet M, Berzon R, Osoba D, et al. Guidelines for reporting results of quality of life assessments in clinical trials. Qual Life Res. 1996;5(5):496–502. PubMed CrossRef
  35. Fayers PM, Machin D. Quality of Life: The Assessment, Analysis and Interpretation of Patient-Reported Outcomes. 2. Chichester: Wiley; 2007:544.
  36. The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;41(10):1403–1409. PubMed CrossRef
  37. Bessière K, Pressman S, Kiesler S, et al. Effects of internet use on health and depression: a longitudinal study. J Med Internet Res. 2010;12(1):e6. PubMed CrossRef
  38. Doherty-Torstrick ER, Walton KE, Fallon BA. Cyberchondria: parsing health anxiety from online behavior. Psychosomatics. 2016;57(4):390–400. PubMed CrossRef
  39. White RW, Horvitz E. Experiences with web search on medical concerns and self diagnosis. AMIA Annu Symp Proc. 2009;2009:696–700. PubMed
  40. Mathes BM, Norr AM, Allan NP, et al. Cyberchondria: overlap with health anxiety and unique relations with impairment, quality of life, and service utilization. Psychiatry Res. 2018;261:204–211. PubMed CrossRef
  41. Geng Y, Gu J, Zhu X, et al. Negative emotions and quality of life among adolescents: a moderated mediation model. Int J Clin Health Psychol. 2020;20(2):118–125. PubMed CrossRef
  42. Dryman MT, Gardner S, Weeks JW, et al. Social anxiety disorder and quality of life: how fears of negative and positive evaluation relate to specific domains of life satisfaction. J Anxiety Disord. 2016;38:1–8. PubMed CrossRef
  43. Arraras JI, Ibañez B, Pereda N, et al. The association of clinical insight and depression with quality of life in schizophrenia. Psychiatry Res. 2019;279:350–352. PubMed CrossRef
  44. Cohn MA, Fredrickson BL, Brown SL, et al. Happiness unpacked: positive emotions increase life satisfaction by building resilience. Emotion. 2009;9(3):361–368. PubMed CrossRef
  45. Harker L, Keltner D. Expressions of positive emotion in women’s college yearbook pictures and their relationship to personality and life outcomes across adulthood. J Pers Soc Psychol. 2001;80(1):112–124. PubMed CrossRef
  46. Danner DD, Snowdon DA, Friesen WV. Positive emotions in early life and longevity: findings from the nun study. J Pers Soc Psychol. 2001;80(5):804–813. PubMed CrossRef
  47. Moskowitz JT. Positive affect predicts lower risk of AIDS mortality. Psychosom Med. 2003;65(4):620–626. PubMed CrossRef
  48. Lewis T. Seeking health information on the internet: lifestyle choice or bad attack of cyberchondria? Media Cult Soc. 2006;28(4):521–539. CrossRef
  49. Allcott H, Gentzkow M. Social media and fake news in the 2016 election. J Econ Perspect. 2017;31(2):211–236. CrossRef
  50. Kata A. A postmodern Pandora’s box: anti-vaccination misinformation on the Internet. Vaccine. 2010;28(7):1709–1716. PubMed CrossRef
  51. Bitar Z, Hallit S, Khansa W, et al. Phubbing and temperaments among young Lebanese adults: the mediating effect of self-esteem and emotional intelligence. BMC Psychol. 2021;9(1):87. PubMed CrossRef
  52. Rahme C, Akel M, Obeid S, et al. Cyberchondria severity and quality of life among Lebanese adults: the mediating role of fear of COVID-19, depression, anxiety, stress and obsessive-compulsive behavior-a structural equation model approach. BMC Psychol. 2021;9(1):169. PubMed CrossRef
  53. Melki IS, Beydoun HA, Khogali M, et al; National Collaborative Perinatal Neonatal Network (NCPNN). Household crowding index: a correlate of socioeconomic status and inter-pregnancy spacing in an urban setting. J Epidemiol Community Health. 2004;58(6):476–480. PubMed CrossRef
  54. Fergus TA. The Cyberchondria Severity Scale (CSS): an examination of structure and relations with health anxiety in a community sample. J Anxiety Disord. 2014;28(6):504–510. PubMed CrossRef
  55. Haddad C, Sacre H, Obeid S, et al. Validation of the Arabic version of the “12-item short-form health survey” (SF-12) in a sample of Lebanese adults. Arch Public Health. 2021;79(1):56. PubMed CrossRef
  56. Ahorsu DK, Lin C-Y, Imani V, et al. The Fear of COVID-19 Scale: Development and Initial Validation. Int J Ment Health Addiction [Internet]. Springer website. Accessed September 8, 2021. https://link.springer.com/10.1007/s11469-020-00270-8
  57. Kahwagi RM, Zeidan RK, Haddad C, et al. Emotion regulation among Lebanese adults: validation of the Emotion Regulation Questionnaire and association with attachment styles. Perspect Psychiatr Care. 2021;57(2):809–820. PubMed CrossRef
  58. Gross JJ, John OP. Individual differences in two emotion regulation processes: implications for affect, relationships, and well-being. J Pers Soc Psychol. 2003;85(2):348–362. PubMed CrossRef
  59. George D. SPSS for Windows Step by Step : A Simple Guide and Reference, 17.0 Update. Boston: Allyn & Bacon; 2010.
  60. Vandekerckhove J, Matzke D, Wagenmakers E-J. In: Busemeyer JR, Wang Z, Townsend JT, et al, eds. Model Comparison and the Principle of Parsimony. Vol. 1. Oxford University Press; 2015. [Internet]. Accessed April 15, 2021. http://oxfordhandbooks.com/view/10.1093/oxfordhb/9780199957996.001.0001/oxfordhb-9780199957996-e-14
  61. Watson D, Pennebaker JW. Health complaints, stress, and distress: exploring the central role of negative affectivity. Psychol Rev. 1989;96(2):234–254. PubMed CrossRef
  62. DuBois CM, Lopez OV, Beale EE, et al. Relationships between positive psychological constructs and health outcomes in patients with cardiovascular disease: a systematic review. Int J Cardiol. 2015;195:265–280. PubMed CrossRef
  63. Moskowitz JT, Epel ES, Acree M. Positive affect uniquely predicts lower risk of mortality in people with diabetes. Health Psychol. 2008;27(suppl):S73–S82. PubMed CrossRef
  64. Nefs G, Pouwer F, Denollet J, et al. Suboptimal glycemic control in type 2 diabetes: a key role for anhedonia? J Psychiatr Res. 2012;46(4):549–554. PubMed CrossRef
  65. Marsland AL, Pressman S, Cohen S. Positive affect and immune function. Psychoneuroimmunology. 2007;2:761–779. CrossRef
  66. Pressman SD, Cohen S. Does positive affect influence health? Psychol Bull. 2005;131(6):925–971. PubMed CrossRef
  67. Hoppmann CA, Klumb PL. Daily goal pursuits predict cortisol secretion and mood states in employed parents with preschool children. Psychosom Med. 2006;68(6):887–894. PubMed CrossRef
  68. Jacobs N, Myin-Germeys I, Derom C, et al. A momentary assessment study of the relationship between affective and adrenocortical stress responses in daily life. Biol Psychol. 2007;74(1):60–66. PubMed CrossRef
  69. Suls J, Bunde J. Anger, anxiety, and depression as risk factors for cardiovascular disease: the problems and implications of overlapping affective dispositions. Psychol Bull. 2005;131(2):260–300. PubMed CrossRef
  70. Friedman HS. Long-term relations of personality and health: dynamisms, mechanisms, tropisms. J Pers. 2000;68(6):1089–1107. PubMed CrossRef
  71. Leger KA, Charles ST, Almeida DM. Let it go: lingering negative affect in response to daily stressors is associated with physical health years later. Psychol Sci. 2018;29(8):1283–1290. PubMed CrossRef
  72. Joelle M. Abi-Rached, Ishac DIwan. The Socioeconomic Impact of COVID-19 on Lebanon: A Crisis Within Crises : EuroMeSCo – Euro-Mediterranean Research, Dialogue, Advocacy [Internet]. Euromesco.net website. Accessed September 17, 2021. https://www.euromesco.net/publication/the-socioeconomic-impact-of-covid-19-on-lebanon-a-crisis-within-crises/
  73. Shiota MN, Levenson RW. Effects of aging on experimentally instructed detached reappraisal, positive reappraisal, and emotional behavior suppression. Psychol Aging. 2009;24(4):890–900. PubMed CrossRef
  74. Aldao A, Nolen-Hoeksema S, Schweizer S. Emotion-regulation strategies across psychopathology: a meta-analytic review. Clin Psychol Rev. 2010;30(2):217–237. PubMed CrossRef
  75. Garnefski N, Kraaij V. Relationships between cognitive emotion regulation strategies and depressive symptoms: a comparative study of five specific samples. Pers Individ Dif. 2006;40(8):1659–1669. CrossRef
  76. Kraaij V, Pruymboom E, Garnefski N. Cognitive coping and depressive symptoms in the elderly: a longitudinal study. Aging Ment Health. 2002;6(3):275–281. PubMed CrossRef
  77. Jungmann SM, Witthöft M. Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: which factors are related to coronavirus anxiety? J Anxiety Disord. 2020;73:102239. PubMed CrossRef78. Khalaila R, Cohen M. Emotional suppression, caregiving burden, mastery, coping strategies and mental health in spousal caregivers. Aging Ment Health. 2016;20(9):908–917. PubMed CrossRef
  78. Khalaila R, Cohen M. Emotional suppression, caregiving burden, mastery, coping strategies and mental health in spousal caregivers. Aging Ment Health. 2016;20(9):908–917. PubMed CrossRef
  79. Garnefski N, Legerstee J, Kraaij VV, et al. Cognitive coping strategies and symptoms of depression and anxiety: a comparison between adolescents and adults. J Adolesc. 2002;25(6):603–611. PubMed CrossRef
  80. Martin RC, Dahlen ER. Cognitive emotion regulation in the prediction of depression, anxiety, stress, and anger. Pers Individ Dif. 2005;39(7):1249–1260. CrossRef