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ORIGINAL ARTICLE
Year : 2022  |  Volume : 31  |  Issue : 2  |  Page : 228-234  Table of Contents     

Prevalence and effect of cyberchondria on academic performance among undergraduate dental students: An institutional based study


1 Department of Public Health Dentistry, Kamineni Institute of Dental Sciences, Narketaplly, Nalgonda, Telangana, India
2 Department of Public Health Dentistry, Positive Dental Pvt. Ltd, Dilsukhnagar, Hyderabad, Telangana, India
3 Department of Public Health Dentistry, Clove Dental Pvt. Ltd, Hyderabad, Telangana, India
4 Department of Public Health Dentistry, SVR Dental Hospital, Nalgonda, Telangana, India

Date of Submission31-Dec-2021
Date of Acceptance08-Jun-2022
Date of Web Publication18-Aug-2022

Correspondence Address:
Dr. Siva Kumar Patanapu
Department of Public Health Dentistry, Kamineni Institute of Dental Sciences, Narketaplly Nalgonda, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ipj.ipj_272_21

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   Abstract 


Background: Cyberchondria has been used to describe an increase in anxiety about one's health status as a result of excessive online searches. These online health research studies were associated with a small but reliable increase in depression and anxiety which may decrease concentration of a student on academics. Methods: The questionnaire was distributed among 302 undergraduate dental students (second year, third year, fourth year, and interns) of Kamineni Institute of Dental Sciences and Hospital. The survey tool comprised Cyberchondria Severity Scale–Short form (CSS-15) questionnaire and percentage of marks obtained in the previous University examination. Statistically significance was set at P < 0.05. Results: A significant difference was observed for subscale Compulsion (p = 0.05*), Distress (p = 0.001*) with a higher mean score among 24-26 years old dental students. Females had significant higher mean score subscales Distress (4.63 ± 2.93; P = 0.02*) and Reassurance (5.99 ± 2.90; P = 0.001*) than males. Regarding overall CSS, significant higher mean scores were observed among the students who scored less than 65% (7.90 ± 2.01) in their last year university academic examination (0.000*). Conclusion: Scheduling educational programs and strengthening easily accessible health services for the students has a particular importance in solving the health problems of young people.

Keywords: Cyberchondria, distress, health anxiety, internet


How to cite this article:
Patanapu SK, Sreeja CS, Veeraboina N, Reddy KV, Voruganti S, Anusha P. Prevalence and effect of cyberchondria on academic performance among undergraduate dental students: An institutional based study. Ind Psychiatry J 2022;31:228-34

How to cite this URL:
Patanapu SK, Sreeja CS, Veeraboina N, Reddy KV, Voruganti S, Anusha P. Prevalence and effect of cyberchondria on academic performance among undergraduate dental students: An institutional based study. Ind Psychiatry J [serial online] 2022 [cited 2022 Dec 2];31:228-34. Available from: https://www.industrialpsychiatry.org/text.asp?2022/31/2/228/353883




   Background Top


The internet has swiftly become a primary source of health-related information for many individuals and has become an integral part of their everyday life.[1] New technology breakthroughs, on the other hand, have expedited the use of the internet to obtain health-related information due to advantages such as being widely available, anonymous, and inexpensive.[2] Access to convenient and affordable health information has a number of advantages, including improved health literacy and the ability to make more educated health decisions.[3]

However, there are certain drawbacks to consider, such as the vast amount of unregulated information available, which can lead to greater anxiety and concern about one's health. Many experts suggest that the internet has a harmful impact on people's personal health through altering their communication, thoughts, and behaviors, as well as their daily life.[4],[5] In studies, online health research has been proven to induce negative emotional responses, which serve as fuel for a person's original concern, anxiety, and suffering.[6],[7] Norr et al. have discovered that cyberchondia is produced by increased anxiety over one's own health status as a result of an online search for health information.[8]

Cyberchondria is a word used to describe an increase in health-related concern as a result of frequent online searches.[7],[9] It combines a reassuring mental state (concern about health) with a behavioural propensity (e.g., excessive web searches).[10] The more health-conscious a person is, the more frequently he or she conducts such searches and, as a result, the more concerned he or she becomes.[9] The Cyberchondria Severity Scale (CSS)[11] was developed by McElroy and Shevlin as a self-report psychometric instrument to evaluate health anxiety caused by extensive internet health search. The CSS was expected to be multidimensional, indicating anxiety and a desire to search.

Students nowadays are influenced by social media and other internet sources, as well as information provided by several health websites. Online health research, according to Bessière et al.,[12] was connected to a slight but constant increase in despair and anxiety, which could interfere with a student's ability to concentrate on academics. It is probable that they are more likely to look up medical symptoms online, putting them at a higher risk of developing an online-health-related anxiety.[13]

A high grade point average (GPA) or academic performance score is considered an achievement by university students. Higher levels of online health information search are linked to lower academic performance[12],[14],[15] which leads to student's discomfort and worry. Excessive health-related web searches may harm a student's academic performance. As a result, this study was carried out to investigate the prevalence of Cyberchondria and its impact on the academic performance of undergraduate dental students.

Procedure

Second, third, and fourth year dental students and interns from Kamineni Institute of Dental Sciences took part in the study. The privacy and confidentiality of respondents were maintained, and participation was fully voluntary. The Institutional Review Board of the Kamineni Institute of Dental Sciences and Hospital gave ethical permission to this work. The research, on the other hand, was conducted in accordance with the ethical principles outlined in the 1964 Declaration of Helsinki.

As part of the survey instrument, McElroy E and Shevlin M (2014)[11] developed the Cyberchondria Severity Scale–Short form (CSS-15) questionnaire. The 15 items on this self-report scale correspond to five correlated domains: I excessiveness (escalating/repeated nature of searches), (ii) compulsion (web searches interfering with other aspects of on/offline life), (iii) distress (negative emotional response), (iv) reassurance (searches driving individuals to seek professional medical advice), and (v) mistrust (searches driving individuals to seek professional medical advice) (conflict arising when medical professional and online self-diagnosis do not align).

The responses were recorded on a 5-point Likert type scale from 0 (Never) to 4 (Always). All items were positively worded and the subscale scores were calculated by summing the item responses for that subscale. This provided a mean subscale score and reduces weighted effect of the different number of items on the subscale. The subscale Compulsion included items (3, 4, 7), Distress (6, 9, 14), Excessiveness (1, 2, 13), Reassurance (8, 10, 11), Mistrust (5, 12, 15), and score ranges from 0 to 12, respectively. The total mean score was not the average of all responses. Instead, it was calculated by summing the subscale scores and then divided by 5 (the no. of subscales) with a possible range from 0 to 12. A higher score indicates a greater degree of health anxiety due to wide internet health search. Their university academic performance was recorded as, percentage of marks obtained in the previous university examination as >75%, 65-75%, and <65%.

The questionnaire was administered to undergraduate dental students in the classroom during lecture hours, with the participants being asked not to discuss the questions with one another. If participants were uncomfortable in any manner during the study, they were offered the choice to leave at any moment. After completing the survey, participants were thanked for their time.

The data was input and analyzed using the Statistical Package for Social Sciences Software after the completed questionnaire was gathered (SPSS version 21). For comparison between items of the questionnaire depending on variables, the Mann-Whitney U test and the Kruskal-Wallis ANOVA test were used. Differences were tested at a P ≤ 0.05 significance level.


   Results Top


The questionnaire was distributed among 302 undergraduate dental students (second year, third year, fourth year and interns) of Kamineni Institute of Dental Sciences and Hospital. Among the study population who completed the questionnaire, nearly half of the students belong to age groups 18-20 (47%) and 21-23 years (51.7%). However, among the total population, 56 (18.5%) were males and 246 (81.5%) were females with mean age of 21.16 ± 1.32 years. Majority of subjects belongs to second year 89 (29.5%) followed by fourth year 80 (26.5%), third-year dental students 70 (23.2%), and interns 63 (20.9%). However, majority of the study population (81.1%) scored 65-75% in their last year university academic examination. On the other hand, only a few students secured less than 65% (6.3%) and more than 75% (12.6%) marks in last year university examination. [Table 1].
Table 1: Demographic distribution of study population based on variables

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Majority of the study population responded for the option 'Sometimes' and 'Never' for most of the items of CSS-15. However, mean responses were comparable for various items of CSS and ranging from 3.10 ± 1.46 (item 6: I start to panic when I read online that a symptom I have is found in a rare/serious condition) to 3.90 ± 2.10 (item 9: I feel more anxious or distressed after researching symptoms or perceived medical conditions online).

A statistically significant difference was observed for subscale Compulsion (p = 0.05*), Distress (p = 0.001*) with a higher mean score among 24-26 years old dental students compared to subjects aged 18-20 and 21-23 years. Likewise, the subscales Excessiveness (6.57 ± 2.37) and Reassurance (6.29 ± 2.36) also showed higher mean score for 24-26 years old students compared to other age groups but the difference was not statistically significant (p > 0.05). In contrast, significant difference was noted among age groups for a subscale Mistrust (p = 0.04*) with higher mean score (9.12 ± 2.81) among the students with 21-23 years. Similar trend was observed among all other age groups for overall CSS score but the difference was not significant (p = 0.80).

Females had a higher mean score for all subscales except for a subscale “Excessiveness” but significant gender difference was observed for subscales Distress (4.63 ± 2.93; P = 0.02*) and Reassurance (5.99 ± 2.90; P = 0.001*). Likewise, even the total mean CSS score (8.20 ± 2.17) was higher among females than males (6.29 ± 2.19) and the difference was statistically significant (p = 0.01*). [Table 2].
Table 2: Subscale wise and total mean score comparison of Cyberchondria Severity Scale (CSS) based on variables

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A statistically significant difference was observed for subscales “Distress (p = 0.04*) and Excessiveness” (p = 0.02*) with a higher mean score among fourth year undergraduate dental students (D = 4.76 ± 3.12; E = 6.05 ± 2.83). Similar trend was observed for subscale Compulsion but the difference was not statistically significant. Regarding total CSS mean score, fourth-year undergraduate dental students showed higher mean score (8.90 ± 3.39) when compared to second year (7.21 ± 3.34), third-year (7.59 ± 3.57) students and interns (7.67 ± 2.59). However, third-year and second-year dental students showed higher mean score for subscale Reassurance (5.97 ± 3.02) and Mistrust (9.15 ± 2.63). Surprisingly, compared to other subscales interns showed a lesser mean score for the subscale Compulsion (2.95 ± 2.54). However, none of the above comparison showed a significant difference.

A significant higher mean score was noted for subscales “Compulsion (3.13 ± 2.58; P = 0.005*) and Mistrust” (9.02 ± 2.70; P = 0.04*) among the students who gain 65-75% of marks in their last university examination. Regarding overall CSS, significant higher mean scores were observed among the students who scored less than 65% (7.90 ± 2.01) in their last year university academic examination (0.000*). In other hand, comparable mean score was noted with the subscales Distress (D), and Reassurance (R) subscales. Surprisingly, students who attain less than 65% marks showed higher means score for only subscale Excessiveness (E) compared to all other subscales of CSS. [Table 3].
Table 3: Subscale wise and total mean score comparison of Cyberchondria Severity Scale (CSS) based on variables

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   Discussion Top


The internet and social media have both positive and negative effects on people's lives, according to numerous research.[8],[15],[16] A phenomenon known as cyberchondria1 has evolved in recent years as a result of broad and easy access to the internet, which has consistently laid out information in a variety of areas.[17] The individual gains access to information that makes them fearful and distressed. This can have a severe impact on a student's personal and academic life, as well as jeopardise important day-to-day tasks.[13],[14]

Repeated internet searches regarding medical information results in anxiety disorder characterised by worry about one's own health as a result of a search for health information on the internet.[10] People who spend more time looking for health-related information are more likely to be distressed, leading to more online searching for relief and less time for their studies.[14] As a result, high scores have been connected to a decrease in psychological well-being, which has been linked to poor academic performance on university exams.

According to the literature, this type of anxiety is more common in younger persons with higher levels of education than in the general population.[13],[14],[15],[18] The vast majority of the participants were university graduates, and no assessment of the impact on education was made. As a result, the current study was conducted to investigate the prevalence of person's anxiety about their health that is created or exacerbated by using the internet to search for medical information among undergraduate university dental students and its impact on academic performance. The CSS -15 was developed by McElory E and Shevlin M[11] to quantify health concern in the face of unnecessary internet health inquiries with great internal reliability and good psychometric properties.

Females made up the majority (81.5%) of respondents, which is typical of most dental colleges in India. Female enrolment in dental schools has increased, partly due to women's belief that they will be able to balance their personal and professional life more effectively if they pursue dentistry, which offers a more flexible work schedule.

The majority of students (81.1%) earned 65-75% on their final year university academic tests because they were able to function at the pinnacle of their intellectual abilities while under minimal academic stress, according to the current study. These findings were consistent with those of Patanapu SK et al,[19] who discovered that the majority (67.9%) of students received 65-75% on their final year university academic tests. These findings are in contrast to those of Lakshminarayan N et al.,[20] who discovered that a higher percentage of dental students in Davangere scored 60% on their university examination. According to the authors, this could be owing to their inability to balance their academic and clinical responsibilities, resulting in low work quality and grades.

For most of the CSS-15 items, the majority of the study population chose the options “Sometimes” and “Never.” Similar findings were found in a study by Malik MN et al.[13] among patients of three tertiary care institutions in Islamabad, Pakistan, indicating that everyone uses the internet extensively to research health-related information.

In the current study, there was a significant age difference, with students aged 24-26 years having higher mean scores for subscale compulsion and distress, implying that web searches are interfering with other aspects of on/offline life and eliciting negative emotional responses in older age groups. Young dental students, on the other hand, scored significantly higher on subscales. When medical professionals and internet self-diagnosis disagree, students between the ages of 21 to 23 suffer more than others. Similar findings were reported by Bati AH et al.[15] among Turkish health science students. This could be related to increased sensitivity, which is to be expected in those who often monitor internet health sites for negative comments about somatic symptoms. Surprisingly, Barke et al.[1] discovered that CSS-15 score has no relation to age.

Mohammed D et al.[21] studied 191 people from Canada and the United States, while Bidmon S et al.[22] studied 958 German adults, finding that females had a larger percentage of health-related worry when using the internet. In the current study, however, female individuals had significantly higher mean scores for the subscales Distress, Reassurance, and total CSS than males. This indicates that females have a greater negative emotional reaction to internet health searches, and that these searches are prompting people to seek professional medical counsel. These findings matched those of a research conducted by Barke et al.[1] on 500 German participants. On the other hand, a study by Makarla S et al.[23] found that females had a higher mean score for the subscale Mistrust among 205 individuals working in various IT organizations in and around Chennai.

According to previous research, fourth-year undergraduate dental students had a significantly higher mean score for the subscales Distress and Excessiveness. These findings are similar to those of Muse K et al.[24] This indicates that these students seek frequently, which may result in a negative emotional response. McElroy E & Shevlin M[11] found similar results in a study of UK university students, while Dagar D et al.[14] found similar results in a study of 180 computer engineering students in Pune, India. It's possible that fourth-year dentistry students felt more stressed as a result of their frequent internet searches for health information. In terms of other subscales and overall CSS, however, there was no educational difference.

Undergraduate dental students who scored 65-75% on their last university exams had a significantly higher mean score for the subscale Compulsion and Mistrust, according to this study. It could be because the student's web searches are interfering with other elements of their lives, and it could also be because medical professionals and online self-diagnosis are not the same. As a result of their heightened depression, the individuals are unable to focus fully on their academics, resulting in grades of 65-75% rather than >75%.

Furthermore, students who scored 65% or higher were repeated checking of symptoms of real or imagined illnesses on the internet, a condition in which people become worried when confronted with unreliable, confusing, or uncertain information. These findings corroborated those of Starcevic V et al.[9] and Doherty-Torstrick ER et al.[25] As a result, subjects who repeated checking their symptoms of real or imagined illnesses on the internet are more likely to adapt to unpleasant situations and drive adversely in order to attain greater academic performance. However, individuals with these obsessive-compulsive disorder (OCD) exhibit repetitive behaviors because they have a defect in the mechanism that enables them to inhibit acting.[26] This was confirmed in the current study, which found that students with a lower academic % had a higher CSS score.

In this study, several flaws are also noted. For starters, a convenience sample of dentistry students from a single university could affect interpretation and generalizability. CSS is a complicated natural phenomenon, and it is impossible to assess the impact of amplifying effects of online health-related searches on student academic performance without considering environmental conditions. As a result, more research is needed to examine the CSS structure from numerous perspectives, including various groups within the general population.


   Conclusion Top


Middle-aged dental students believe that web searches interfere with other aspects of their on/offline lives and have a greater negative emotional response, but young undergraduates suffer more when medical experts and online self-diagnosis do not align, according to the current study. Female responders had higher levels of health anxiety while searching in internet and were more distressed, prompting them to seek medical help. Furthermore, fourth-year undergraduate dentistry students had a higher negative emotional response due to the repetitive nature of searches. Additionally, students who scored 65% or higher exhibited severe Cyberchondria, a condition in which people experience anxiety when confronted with unreliable, unclear, or uncertain information.

Acknowledgments

We would like to thank the administration and Principal of Kamineni Institute of dental sciences for giving permission to carry out the study.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of Institutional Review Board of Kamineni Institute of Dental Sciences and Hospital, Narketpally, Nalgonda (Dist), Telangana, India, and with the 1964 Helsinki Declaration and study design follows STROBE guidelines.

Informed consent

Permission from the college authorities was obtained prior to the survey procedure and each participant provided informed written consent after a description of aims and procedure of the present study. Additional informed consent to publish was obtained from all individual participants.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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