Sonia Khodabakhsh1*, Shamala Ramasamy2, Tan Yen Teng3, Chan Siaw Leng4
1Psychology and Counselling Department, UniversitiTunku Abdul Rahman (UTAR), Kampar, Malaysia
2Psychology Department,International Medical University (IMU), Kuala Lumpur, Malaysia
3Psychology Department, UCSI University, Kuala Lumpur, Malaysia
4Department of Social Science and Management,University Putra Malaysia (UPM), Sarawak, Malaysia
*Corresponding Author’s Email: soniak@utar.edu.my
ABSTRACT
The COVID-19 The pandemic affected the mental health of people. Individuals prefer to collect information from the Internet about the virus, disease, symptoms, reports on statistics, treatments, and any other information related to the pandemic. In this study, we aimed to explore the impact of Internet use in three different levels of users (Internet addicts, over-users, and average-users) on health anxiety during the pandemic among the young population in Malaysia. Four hundred and forty-eight young adult in Malaysia completed the online survey including demographic questionnaire, Short-form Health Anxiety Inventory, and Internet Addiction Test. Results showed that the Internet addict users have higher scores in the Total Health Anxiety and Health Anxiety factors (Illness Likelihood and Negative Consequences) compared to the average-users and over-users. It seems that high Internet usage is associated with high health anxiety. People may search more on the Internet for information related to the COVID-19 and the symptoms and it may increase their health anxiety. This study provides knowledge implications for mental health professionals about the association between Internet addiction and health anxiety. The findings may provide awareness to the public and professionals about one of the factors that are linked to individuals’ health anxiety during the pandemic.
INTRODUCTION
The coronavirus disease 2019 (COVID-19) has a profound influence on the lives of people and cultures around the world. People face problems in various facets of their lives, such as psychological, social, financial, educational, and physiological aspects. The pandemic has a direct and indirect effect on people's mental health in a number of ways. Social distancing, living under quarantine, shutting down colleges and institutions, halting a variety of jobs, and the general shutdown in cities intensify residents' frustration throughout the pandemic.
In this situation when people seek information about the COVID-19, symptoms, news, statistical reports, treatment, etc. from the Internet. Many people panic when they face this unknown virus and the uncertain situation. In this scenario, some of them will get information to gain knowledge and be updated about the pandemic news and some of them may worry about their health by reading any information or news about the situation.
In general, the Internet is one of the most widely and conveniently used media to assess information and all over the world. While the accessibility to Internet has become convenient, its excessive use convincingly causing a serious impairment in several aspects of life such as social, academic, career, and physical health (Kandasamy et al., 2019; Khodabakhsh & Ahmadi, 2020;Khodabakhsh &Leng, 2020; Rezaei et al., 2020;Young, 1998). Moreover, studies show that stress, depression, and anxiety are associated with excessive Internet use (Saikia et al., 2019). Moreover, it is shown that sadness, feeling down, having a loss of interest in daily activities are some of the symptoms of Internet addiction (Masih & Rajkumar, 2019).
During the pandemic and in quarantine time, the usage of the Internet will be increased in many people. Therefore, overuse of the Internet and its consequences are increasingly becoming an area of concern for researchers. Accessibility of the Internet makes the communication of information faster than before that people are developing dependence online sources to obtain information and the latest updates in various areas related to their lives. One important aspect among them is health for which they rely on the Internet to ascertain their health condition.
Internet access is easily available in most countries and young adults view the Internet as an essential tool for their learning, social connection, work, etc.It has numerous benefits widely ranging from speedy communication, online education, online shopping to online access to medical and health care professionals and information. Over-use of the Internet also appears among Malaysian youth (Khodabakhsh et al., 2020). Internet addiction refers to Internet usage to elude negative sentiments, persistent use of the Internet despite the desire to cease usage, having disagreeable emotions when unable to surf the Internet, or engaging in recurring thoughts about the Internet as well as facing other contrast or even self-conflicts following Internet use (Chou et al., 2005; Ostovaret al., 2016; Van der Aa et al., 2008). In this regard among many other influences of Internet addiction, it is becoming a major source for health-related information seeking, particularly among people with health anxiety problems (Brown et al., 2019; Eastin &Guinsler, 2006; Singh et al., 2016).
According to the national survey in 2018 (Malaysian Communications and Multimedia, 2018), Malaysia has almost 87.4% Internet users and among them, an average of 12.1% of youth in their 20s spend approximately 8.0 hours daily to go online. The report from Malaysia Ministry of Health Malaysia and Institute for Health Behavioral Research by Malaysian Communications and Multimedia (2017) they concluded that among 86.9% of Internet users 77.2% depend on the Internet to seek online information about their health. The most commonly searched health-related information was on symptoms and diseases (91.4%), followed by health care tips 89.8% and treatment method 83.5%. Majority of them (73.7%). seek for information related to medications/drugs and treatment place. Surprisingly, according to that survey, 82.7% of them trusted the online health-related information, irrespective of the resources.
Health anxiety is a multidimensional concept encompassing mild forms to clinically significant health- related fear, combined with disease convection. Health anxiety exists on a continuum, ranging from mild and temporary to serious and chronic, being quantitative rather than qualitative (Taylor, 2004). As Salkovskis et al., (2003) mentioned, the main risk factors for development and maintenance of health anxiety are dysfunctional health-related beliefs derived from previous experiences with illness and medical factors, which may remain latent. They could be triggered when a precipitating critical incident, such as bodily change, interacts with predisposed maladaptive/dysfunctional assumptions/beliefs about health. Singh et al., (2016) concluded in an athematic analysis that along with dysfunctional beliefs activated by internal or external stimuli to creating health misinterpreted health-related beliefs in the individuals. These beliefs are further supported by “cognitive (e.g., catastrophic misinterpretation), behavioural (e.g., reassurance seeking), physiological (e.g., increase autonomic arousal), and affective (e.g., depression) factors” are considered as major maintaining factors of health anxiety and are thought to maintain anxiety and constant concern and worry that one has or can develop a health-related issue or critical illness. In other words, these beliefs enhance the risk of developing disastrous awareness when individuals are exposed to situations where a person’s attention becomes focused on health concerns. For example, reading/hearing about the illness of people around them, words connoting diseases, health information from professionals, media, Internet and related sources (e.g., about avian flu, SARS, or AIDS), or changes in the body (comprising but not limited to bodily sensations, e.g., blemish, headache) (Abramowitz et al., 2007). This usage of the Internet is more highlighted during the COVID-19 pandemic as people use the Internet to search and get more information about the virus, the disease, symptoms, treatment, and any other information to know more about the pandemic.
Although the obvious benefits ofInternethave attracted the young population towardsonline health resources, researchers anticipate hazardous impacts of the Internet on young adults (Abdel-Salam et al., 2019) or online health-related information on provoking anxiety (Muse et al., 2012; Singh & Brown, 2014, 2015; Starcevic&Berle, 2013). It is indicated that health anxious people are more inclined towards excessive Internet use, which augmented the likelihood of anguish and excessive visitation to doctors as some of the usualresponses to excessive Internet use among health anxious people (Baumgartner & Hartmann, 2011; Eastin &Guinsler, 2006; Muse et al., 2012). Moreover, health anxious folks were inclined to validate factors proposing potential infatuation to Internet use related to health care issues (Singh & Brown, 2014), confirming the assumption that excessive usage could become challenging in its way. Those duly concerned with health endeavour to seek information provides them with a sense of security from health-related threats, reassurance and satisfies their sense of uncertainty and anxiety about their health (Singh & Brown, 2016). Although these behavioural strategies lessenthe anxiety for a minimumperiod it could serve as a sustaining factor for health anxiety (McMullan et al., 2019; Salkovskis& Warwick, 1986). Health anxiety will return, and reassurance will result in increased anxiety and negative cognition if the bodily sensations recur, or if there is a lack of certainty about the results of any medical tests (Taylor, 2004; Te Poel et al., 2016).
Eastin and Guinsler (2006) studied the association between health anxiety and online health search in the United States. Their findings postulated that even individuals with moderate anxietiestend to seek health- related information more frequently online than those lacking anxiety. Though lack of information may lead to health-related concerns and information seeking may also intensify anxious feelings, particularly in those with cognitive distortions.
Some studies on the Internet and health among the clinical and non-clinical sample, have examined the behaviour patterns of Internetusers communities (Powell et al., 2003), constructed and analyzed online interventions, such as Internet-based health therapy (Andersson et al., 2005; Christensen et al., 2004),reviewed the quality of mental health information available on websites (Eysenbach, & Kohler, 2002), assessed online mental health information search (Powell & Clarke, 2006), determined the important criteria for selecting websites (Turner, 2009), and evaluated the use of the Internet for obtaining health information (Zhang et al., 2009). These studies showed that 8 out of 10 American adults sought healthcare information online (White & Horvitz, 2009). Powell and Clarke (2006) also conducted a cross-sectional survey on 18 years old individuals and above from the databank of Oxfordshire general practice patients. The results showed that 18% of Internetconsumers depended on online resources for acquiring mental health-related information. Researchers are also concerned about investigating the role of gender as a moderating feature for Internet addiction and developing health-related issues. Ha and Hwang (2014) investigated the gender difference among adolescents in Internet addiction and its relationship with psychological health indicators. The study suggested higher Internet addiction among boys (3.6%) as compared to girls and factors like poor self-rated health, subjective unhappiness, and depressive symptoms were suggestively contributing to their Internet addiction.
Considering the increasing use of the Internet among young adults and the importance of mental health in individuals and societies, this study aimed to explore the differences among three Internet Addiction groups and Health Anxiety moderated by gender to explore this important concern among young adults in Malaysia.
METHODOLOGY
For this study, quantitative cross-sectional design was utilized. Data was collected during the COVID-19 pandemic from May 2020 to August 2020 through the online survey in the Malaysian youth population.
Four hundred and forty-eightyoung adult in Malaysia completed the online survey. The link of the online survey was shared through social media such as Facebook, Twitter, Telegram, WhatsApp, and other networks. Valid completed survey forms were 243 (54.2%) male and 205 (45.6%) females.
The average age of participants was 27.69 years old (SD = 5.13), with ages ranging from 22 to 48 years old. The average time of Internet use per day was 4.98 (SD = 3.53) hours; males a mean of 5.11 (SD = 3.61) hours and females a mean of 4.82 (SD = 3.44) hours. Participants reported a mean of 8.06 (SD = 3.45) years of internet experience with a range between 1 to 17 years.
Consequences”). The SHAI has demonstrated good internal consistency (α = .89) (Salkovskiset al., 2002). In a subsequent study, Abramowitz et al., (2007) evaluated the psychometric properties and factor structure of the SHAI in a non-clinical sample and found evidence of sound psychometrics (α = .86).
Average-users (scores 20 to 39): average online users who may use the Internet forlonger times but can regulate their Internet usage; Over-users (scores 40 to 69): those occasionally experiencing problems due to excessive Internet usage; Addictive users (scores 70 to 100): those having substantial problems due to excessive Internet usage. In another research, Cronbach’s alpha .92 for the IAT, and its test-retest reliability was reported acceptable (Yang et al., 2005).
RESULTS
Using descriptive statistics, the information about the participants’ age, years of having Internet experience/exposure, and hours spend on the Internet per day on average, has reported in Table 1.
Minimum | Maximum | Mean | SD | |
Age | 22 | 48 | 27.69 | 5.13 |
Internet Experience (years) | 1 | 17 | 8.06 | 3.45 |
Average time of Internet use (hours per day) | ||||
Total | 4.98 | 3.53 | ||
Male | 5.11 | 3.61 | ||
Female | 4.82 | 3.44 | ||
Before the administration of scales, a verbal debriefing was done with the participants to explain the purpose of the study and to explain the procedure of answering the questionnaires. The participants were requested to complete the questionnaire anonymously to reduce the possible reporting bias. It was also explained to them that the confidentiality of the data would be maintained. Participants’ privacy and anonymity were fully protected. Before conducting any analysis, the data were assessed to ensure accuracy (data were assessed for missing data, outliers, reliability, and normality). The analysis was done using SPSS. The three groups of Internet users were compared on Total Health Anxiety (THA) and Health Anxiety factors (Table 2).
scale | Level of Internet use | Mean | SD | F | sig |
Total Health Anxiety (THA) | Average-use | 14.64 | 5.96 | 19.751 | 0.000** |
Over-use | 19.15 | 7.71 | |||
Internet addict | 20.64 | 8.44 | |||
Illness Likelihood | Average-use | 11.95 | 5.07 | 18.182 | 0.000** |
Over-use | 15.61 | 6.42 | |||
Internet addict | 16.70 | 7.08 | |||
Negative Consequences | Average-use | 2.69 | 2.07 | 7.552 | 0.001** |
Over-use | 3.54 | 2.42 | |||
Internet addict | 3.94 | 2.50 |
Note: ** p<.01 (2-tailed)
DISCUSSION
The three IAT groups were compared on total Health Anxiety (THA) and Health Anxiety factors (SHAI Illness Likelihood and SHAI Negative Consequences factors). Group differences were found for THA; similarly, were significant group differences in both SHAI Illness Likelihood and SHAI Negative Consequences factors. THA, SHAI Illness Likelihood, and SHAI Negative Consequences factors scores differed significantly between all three IAT groups.
The level of THA was significantly higher in the Internet addict group than in the other two Internet use groups (over-use and average -use) combined. Besides, the Internet addict group reported a higher level in both HA factors (SHAI Illness Likelihood and SHAI Negative Consequences factors) than over-user and average-use groups. Therefore, the Internet addict users were higher in Total Health Anxiety and Health Anxiety factors than the average-user and over-user. It seems thatthe Internet can provide youth high on the trait of health anxiety a chance to seek websites offering valuable medical information. As Lewis (2006) indicated, there is a rising trend toward the general population accessing information about health-related matters online. Sufferers of health anxiety seek frequent reassurance from health information sources (Salkovskis et al., 2003).
Since the Internet has become one of the most popular and readily accessible health information sources, it is not surprising that many youths with a high level of health anxiety have redirected their reassurance- seeking habits online. However, after reassurance-seeking, anxiety soon re-emerges, because they are unable to sustain the comfort from that reassurance; as a result, they may spend more time surfing the Internetand use it excessively to find more reassuring information.
CONCLUSION
The present study provided valuable information about the relationship between Internet addiction and developing health anxiety among young adults. The study was done during the COVID-19 pandemic that many people were preoccupied with their health issues and the news and information about the pandemic situation in the country and the world. It can be assumed that youth are among the most potential population groups who have excessive and easy exposure to the Internet, which sometimes leads to its irresponsible and hazardous use regarding acquiring health-related information. Due to the attractive nature of this medium and feasible attainment of the health-related information, it has already become an integral part of their daily lives, while enhancing their knowledge information and getting reassurance about their health, it is depicting its negative impacts on their emotional, social and psychosomatic well-being and making them ultimately overly dependent on the online available health-related information. This study has implications for individuals and professionals by increasing the awareness that how excessive use of the Internet may be associated with health anxiety. This may increase the general anxiety in youth during the pandemic. It is required that health care providers and counsellors should design some intervention programs to educate these potential high Internet users to reduce the probability of developing health anxiety and other psychosomatic problems in the adversity times such as COVID-19 pandemic.
Conflict of Interest
The authors declare that there is no conflict of interest.
ACKNOWLEDGEMENT
We would like to thank all who had encouraged me to complete the article successfully.
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