JMIR Publications

ABSTRACT

Background:

Health anxiety among adolescents is understudied, yet of concern. Health-related internet use (HRIU) is a common coping strategy for health anxiety. Unfortunately, disconcerting content may prompt, rather than mitigate, the health anxiety. While this has been researched, within-person evidence for the long-term relationship is lacking. Furthermore, adolescents with different base-level health anxiety may react differently to health-related content; thus, the effect of HRIU might depend on their initial health anxiety.

Objective:

This study focused on the longitudinal relationship between HRIU and health anxiety on the within-person level in adolescents. We considered their base-level health anxiety, studying separately adolescents with low, medium, and high base-level health anxiety compared to others.

Methods:

We analysed data from 2,500 Czech adolescents, aged 11-16 (M=13.43, SD=1.69, 50% girls, in Wave 1). Health anxiety was measured by the affective subscale of the Multidimensional Inventory of Hypochondriacal Traits and HRIU was captured by 6 items reflecting health-related behaviors (e.g., reading articles or watching videos with health-related content). The level of health anxiety in Wave 1 also served as a grouping factor. The data was collected in three waves six months apart in June 2021, December 2021 and May/June 2022 and analysed using random-intercept cross-lagged panel model, allowing us to study within-person effects.

Results:

On the between-person level, adolescents with higher base-level health anxiety were more frequent HRI users (β=.52, P<.001). On the within-person level, change in health anxiety did not predict change in HRIU, or vice versa, for the sub-group with high base-level health anxiety. On the other hand, for adolescents with medium health anxiety, change in HRIU positively predicted health anxiety with large effects across all waves (β=.16, P=.03 from W1 to W2; β=.18, P=.01 from W2 to W3) and increase in health anxiety affected HRIU from Wave 2 to Wave 3 (β=.15, P=.03). For adolescents with low base-level health anxiety, change in their HRIU had large positive effect on changes in health anxiety from Wave 1 to Wave 2 (β=.17, P<.001), and health anxiety positively affected HRIU with medium effect from Wave 2 to Wave 3 (β=.11, P=.03).

Conclusions:

This study shows that adolescents with lower, rather than high health anxiety are susceptible to the negative long-term effects of HRIU. For adolescents with high health anxiety, HRIU neither worsens nor relieves health anxiety over time, suggesting that counsellors should guide them towards other coping strategies besides HRIU. Adolescents with medium to low health anxiety should be guided toward mindful HRIU to prevent increased health anxiety after HRIU. This should include fostering eHealth literacy (e.g., recognizing personally irrelevant information, awareness about the tendency for sensation in media) and coping mechanisms (e.g., time or topic limits, or seeking health information with clear intention, not compulsively).