- Previous studies in medically healthy individuals have shown that cyberchondria and intolerance of uncertainty are associated with health anxiety
- In this cross-sectional study of 104 patients with orthopedic conditions, increased cyberchondria was significantly associated with increased health anxiety
- Increased intolerance of uncertainty was significantly associated with increased cyberchondria
- Cyberchondria accounted for 33% of health anxiety
- Cyberchondria, health anxiety and intolerance of uncertainty are associated with pain, disability and the risk of unnecessary medical procedures, so surgeons should assess and educate patients about these relationships
The blended term cyberchondria refers to a process of compulsively searching the internet for medical information that results in heightened emotional distress. These searches may be particularly upsetting to people who have a high intolerance of uncertainty—those who are likely to overestimate the likelihood of a negative outcome, even for events that are unlikely to occur.
Studies have shown that cyberchondria can be fueled by—or result in—health anxiety, which is an excessive worry about health and misinterpretation of normal body sensations or minor symptoms as severe illness. Both cyberchondria and health anxiety have been closely linked to intolerance of uncertainty. However, those studies included only medically healthy individuals.
In a study devoted to orthopedic patients, Fulbright Scholar Julia Blackburn, MBChB, MD, Neal Chen, MD, chief of the Hand & Arm Center, Ana-Maria Vranceanu, PhD, director of the Integrated Brain Health Clinical and Research Program, and colleagues at Massachusetts General Hospital determined that intolerance of uncertainty affects health anxiety and that cyberchondria mediates the association. Their report appears in Clinical Orthopaedics and Related Research.
The researchers studied 104 adults, average age 49, from their two outpatient orthopedic clinics at Mass General between June and August 2016. Patients had searched the internet for medical information about their current condition.
The participants completed three psychological questionnaires:
- The Cyberchondria Severity Scale
- The Intolerance of Uncertainty Scale, short version
- The Short Health Anxiety Inventory
The team found that increased cyberchondria was significantly associated with increased health anxiety, and increased intolerance of uncertainty was significantly associated with increased cyberchondria. The indirect effect of intolerance of uncertainty on health anxiety through cyberchondria was statistically significant. The direct effect of intolerance of uncertainty on health anxiety was also statistically significant, leading the researchers to conclude that cyberchondria partially mediates the effect of intolerance of uncertainty on health anxiety.
After controlling for potential confounding variables including pain intensity, multiple pain conditions and education level, the researchers calculated that cyberchondria accounted for 33% of health anxiety in the study participants (95% CI, 6.98–114.72).
Applying the Findings to Practice
The researchers emphasize that cyberchondria, intolerance of uncertainty and health anxiety are not distinct conditions that a patient does or does not have. They are constructs, and all people can display varying amounts of each one.
In patients with orthopedic illnesses, these constructs increase the risk of pain, disability, unnecessary medical procedures and increased health care costs. Therefore, orthopedic surgeons should educate patients that the quality of medical information online isn't regulated, excess internet searches can have negative consequences and the timeline of recovery after an orthopedic condition develops is often unclear.
They recommend that patients be assessed for intolerance of uncertainty with either the questionnaire used in this study or a conversation.
Patients should also be assessed and educated about cyberchondria and health anxiety. This can actually save time in a busy clinic, as the surgeon will be alerted to patients who are likely to struggle with their recovery. Patients with a high intolerance of uncertainty may benefit from referral to other resources to support their recovery, such as skills-based cognitive behavioral therapy.
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