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The outbreak of the COVID-19 pandemic has caused great panic among the public, with many people suffering from adverse stress reactions. To control the spread of the pandemic, governments in many countries have imposed lockdown policies. In this unique pandemic context, people can obtain information about pandemic dynamics on the internet. However, searching for health-related information on the internet frequently increases the possibility of individuals being troubled by the information that they find, and consequently, experiencing symptoms of cyberchondria.
We aimed to examine the relationships between people’s perceived severity of the COVID-19 pandemic and their depression, anxiety, and stress to explore the role of cyberchondria, which, in these relationship mechanisms, is closely related to using the internet. In addition, we also examined the moderating role of lockdown experiences.
In February 2020, a total of 486 participants were recruited through a web-based platform from areas in China with a large number of infections. We used questionnaires to measure participants’ perceived severity of the COVID-19 pandemic, to measure the severity of their cyberchondria, depression, anxiety, and stress symptoms, and to assess their lockdown experiences. Confirmatory factor analysis, exploratory factor analysis, common method bias, descriptive statistical analysis, and correlation analysis were performed, and moderated mediation models were examined.
There was a positive association between perceived severity of the COVID-19 pandemic and depression (β=0.36,
The higher the perceived severity of the COVID-19 pandemic, the more serious individuals’ symptoms of depression, anxiety, and stress. In addition, the associations were partially mediated by cyberchondria. Individuals with higher perceived severity of the COVID-19 pandemic were more likely to develop cyberchondria, which aggravated individuals’ depression, anxiety, and stress symptoms. Negative lockdown experiences exacerbated the COVID-19 pandemic’s impact on mental health.
Since 2020, hundreds of millions of people have been infected with COVID-19 and millions of people have died [
Previous studies [
The ABC theory of emotions [
With the advent of the digital age, health-related information can be easily and quickly accessed via the internet at little to no cost. Statistics published by the Office for National Statistics [
Cyberchondria has many negative effects on individuals’ mental health. Research has found that there is a positive correlation between cyberchondria and anxiety during the pandemic [
To effectively control the spread of the COVID-19 pandemic and reduce the risk of public infection, many governments adopted public lockdown measures, which included school closures, travel restrictions, and public-gathering bans [
Individuals in quarantine may suffer from insomnia and show emotional reactions such as depression, anxiety, stress, anger, and confusion [
Theoretical model: a moderated mediation model.
From late January to late February 2020, we used a web-based platform to administer questionnaires. A total of 539 participants completed the questionnaires, and 486 participants (137 males and 349 females) were selected, yielding a qualified rate of 90.17%. Participants’ ages ranged from 14 to 50 years (mean 22.94, SD 5.68).The research was approved by the Ethics Committee of the School of Psychology, Shandong Normal University; anonymous testing was used, and the instructions indicated that the data would be used only for scientific research. A small fee was paid to all participants via the internet for their participation.
We used a self-designed questionnaire to measure the participants’ subjective feelings about the severity of the COVID-19 pandemic. While preparing the questionnaire, we first interviewed 18 people from COVID-19 pandemic areas via web-based videoconference. According to the interview results, perceived severity of the COVID-19 pandemic is divided into 3 dimensions: health risk, emotion, and behavior. Second, we compiled items based on web-based interview results to measure individuals’ perceived severity of the COVID-19 pandemic. Two psychometrics professors were invited to evaluate the questionnaire items and to modify any unclear or ambiguous questions, forming a 26-item preliminary version of the perceived severity of the COVID-19 pandemic questionnaire. Third, 174 participants were recruited and tested using the preliminary questionnaire. The Kaiser-Meyer-Olkin value was 0.83, and Bartlett test of sphericity was significant (
We used a self-designed questionnaire to measure lockdown experience. While preparing the questionnaire, we first interviewed 16 people from areas in lockdown via web-based videoconference during the COVID-19 pandemic. Based on the interview results, we divided lockdown experience into 3 dimensions: feeling, behavior, and economic situation. Second, we compiled items based on the web-based interview results to measure individuals’ lockdown experiences. Two psychometrics professors were invited to evaluate the questionnaire items and to modify any unclear or ambiguous questions, which formed a 30-item preliminary version of the lockdown experience questionnaire. Third, 174 participants were recruited and tested using the preliminary questionnaire. The Kaiser-Meyer-Olkin value was 0.78, and Bartlett test of sphericity was significant (
When Liu et al [
Depression, anxiety, and stress were measured using the 21-item Depression Anxiety Stress Scale [
To assess cyberchondria, we used the Cyberchondria Scale [
AMOS software (version 7.0; IBM Corp) was used for confirmatory factor analysis. SPSS software (version 24.0; IBM Corp) was used for exploratory factor analysis, common method bias, descriptive statistical analysis, and correlation analysis. SPSS PROCESS macro (version 3.5) was used to verify the moderated mediation models [
Because a questionnaire method was used to collect data, which can lead to common method bias, we used the Harman 1-factor test to detect common method bias [
We found that perceived severity of the COVID-19 pandemic was positively correlated with depression, anxiety, stress, and cyberchondria and negatively associated with lockdown experience (
Means, standard deviations, and correlations among key variables.
Variables | Mean (SD) | Variables | ||||||
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Perceived severity | Depression | Anxiety | Stress | Cyberchondria | Lockdown experience |
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53.66 (8.90) |
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1 | 0.36 | 0.41 | 0.46 | 0.36 | 0.51 |
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—a | <.001 | <.001 | <.001 | <.001 | <.001 | |
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6.68 (7.55) |
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0.36 | 1 | 0.84 | 0.84 | 0.38 | 0.52 |
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<.001 | — | <.001 | <.001 | <.001 | <.001 | |
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6.20 (7.57) |
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0.41 | 0.84 | 1 | 0.85 | 0.38 | 0.50 |
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<.001 | <.001 | — | <.001 | <.001 | <.001 | |
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9.57 (9.60) |
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0.46 | 0.84 | 0.85 | 1 | 0.39 | 0.54 |
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<.001 | <.001 | <.001 | — | <.001 | <.001 | |
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31.64 (8.20) |
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0.36 | 0.38 | 0.38 | 0.39 | 1 | 0.33 |
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<.001 | <.001 | <.001 | <.001 | — | <.001 | |
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33.30 (7.06) |
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0.51 | 0.52 | 0.50 | 0.54 | 0.33 | 1 |
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<.001 | <.001 | <.001 | <.001 | <.001 | — |
aNot applicable.
In the absence of cyberchondria, the positive predictive effects of perceived severity of the COVID-19 pandemic on depression (β=0.36,
When cyberchondria was added to the analysis as a mediator, the direct relationships between perceived severity of the COVID-19 pandemic and depression (β=0.26,
The results suggested that cyberchondria partially mediated the link between perceived severity of the COVID-19 pandemic and depression (indirect effect 0.11, 95% CI 0.07-0.15). This indirect effect accounted for 30.56% of the total effect. In addition, cyberchondria partially mediated the link between perceived severity of the COVID-19 pandemic and anxiety (indirect effect 0.10, 95% CI 0.06-0.14). This indirect effect accounted for 24.39% of the total effect. Finally, cyberchondria partially mediated the link between perceived severity of the COVID-19 pandemic and anxiety (indirect effect 0.09, 95% CI 0.06-0.14). This indirect effect accounted for 19.57% of the total effect. Thus, hypothesis 2 was supported.
After lockdown experience (
The moderation of the relationship between cyberchondria and depression by lockdown experience.
The product of perceived severity of the COVID-19 pandemic and lockdown experience (β=0.07,
The moderation of the relationship between perceived severity of the COVID-19 pandemic and anxiety by lockdown experience.
Similarly, simple slope analysis (
The moderation of the relationship between cyberchondria and anxiety by lockdown experience.
The product of perceived severity of the COVID-19 pandemic and lockdown experience had a significant predictive effect on stress (β=0.09,
These results indicated that individuals’ higher negative lockdown experience strengthened the positive effect of perceived severity of the COVID-19 pandemic on anxiety and stress and the positive effect of cyberchondria on depression and anxiety. Thus, hypothesis 3 was partially supported.
The moderation of the relationship between perceived severity of the COVID-19 pandemic and stress by lockdown experience.
In this study, we found that perceived severity of the COVID-19 pandemic was positively associated with depression, anxiety, and stress. The higher individuals’ perceived severity of the COVID-19 pandemic, the higher their levels of depression, anxiety, and stress. The severity of cyberchondria partly mediated the relationship between perceived severity of the COVID-19 pandemic and depression, anxiety, and stress. Individuals with high perceived severity of the COVID-19 pandemic were more likely to suffer from cyberchondria, and the higher the severity of cyberchondria, the higher their depression, anxiety, and stress levels. The direct effect of perceived severity of the COVID-19 pandemic on anxiety and stress and the indirect effect of cyberchondria on depression and anxiety were moderated by the lockdown experience. Individuals with high negative lockdown experience had stronger relationships between perceived severity of the COVID-19 pandemic and anxiety/stress and between cyberchondria and depression/anxiety.
Perceived severity of the COVID-19 pandemic had a significant positive predictive effect on depression (
Specifically, in the COVID-19 public health emergency, individuals with higher perceived severity of the COVID-19 pandemic perceived a greater threat to their safety; therefore, they were worried and panicked about the spread of the pandemic for an extended time period, which increased their depression, anxiety, and stress levels. In contrast, individuals with lower perceived severity of the COVID-19 pandemic thought that the spread of the pandemic could be effectively controlled; therefore, they did not worry too much about their safety, which allowed their depression, anxiety, and stress levels to be lower.
Cyberchondria moderated the association between perceived severity of the COVID-19 pandemic and depression (
In this study, we found that individuals with higher perceived severity of the COVID-19 pandemic had higher levels of depression, anxiety, and stress when they showed higher levels of cyberchondria. Consistent with the findings of previous studies [
We found that lockdown experience moderated the direct effects of perceived severity of the COVID-19 pandemic on anxiety (
The findings of our study also suggested that lockdown experience moderated the negative effects of cyberchondria on depression (
The public should be guided to calmly seek pandemic-related knowledge, to prevent a series of negative emotional reactions. Countries and governments should also promptly control the spread of the COVID-19 pandemic and curb the spread of false or exaggerated information related to the pandemic, which will help alleviate cyberchondria and reduce depression, anxiety, and stress levels. Simultaneously, lockdown experiences’ impact on individuals’ psychological states should also be considered. Therefore, in implementing a lockdown policy, the government should reduce the public’s degree of negative lockdown experience as much as possible by issuing unemployment benefits and wage subsidies and providing accommodations. These approaches can help the government control the COVID-19 pandemic and alleviate people’s negative mental states and psychological problems due to the outbreak of the pandemic. In addition, previous studies have shown that the most evidence-based treatment for psychiatric symptoms during COVID-19 is cognitive behavioral therapy [
This study also had several limitations. The COVID-19 pandemic was found to cause hemodynamic changes in the brain [
This study showed that the higher individuals’ perceived severity of the COVID-19 pandemic was, the higher their levels of depression, anxiety, and stress. Cyberchondria partially mediated the relationships between perceived severity of the COVID-19 pandemic and depression, anxiety, and stress. Individuals with higher perceived severity of the COVID-19 pandemic were more likely to develop cyberchondria and had higher depression, anxiety and stress levels. The lockdown experience moderated the direct effect of perceived severity of the COVID-19 pandemic on anxiety/stress and the indirect effects of cyberchondria on depression/anxiety. A high degree of negative lockdown experience could exacerbate the negative influence of perceived severity of the COVID-19 pandemic on anxiety/stress as well as the negative influence of cyberchondria on depression/anxiety.
Mediating effect analysis.
Mediating effect analysis with moderation.
We want to express our sincere gratitude to all participants. This work was supported by the National Natural Science Foundation of China (62077034, 31671160), the Major Project of National Social Science Foundation (19ZDA363), and Shandong Provincial Social Science Planning Project (20CJYJ16).
LH contributed to the conception, methodology, supervision, and resources. YZ contributed to the conceptualization, formal analysis, validation, original draft, and final manuscript. WL and Yuqing X contributed to the formal analysis. Yan X contributed to the supervision, validation, resources, and critical revision. JZ contributed to the software, investigation, writing revisions, and editing.
None declared.