# Relationship Between Adolescent Health Anxiety and Health-Related Internet Use: 3-Wave Longitudinal Survey Study

## TL;DR

This study shows that health-related internet use can increase health anxiety in adolescents with low or medium anxiety, but not in those with high anxiety.

## Contribution

The study reveals how initial health anxiety levels influence the longitudinal relationship between health-related internet use and health anxiety in adolescents.

## Key findings

- Adolescents with medium health anxiety showed increased health anxiety from health-related internet use over time.
- Adolescents with high base-level health anxiety did not experience worsening or improvement in anxiety from health-related internet use.
- Low health anxiety adolescents experienced significant increases in anxiety after health-related internet use.

## Abstract

Health anxiety among adolescents is understudied yet concerning. Health-related internet use (HRIU) is a common coping strategy, but disconcerting content may heighten, rather than mitigate, the health anxiety. While research has been conducted, within-person evidence for long-term fluctuations is lacking. Furthermore, adolescents with different base-level (initial) health anxiety may react differently to health-related content, making the effect dependent on health anxiety level compared to others.

This study focused on the longitudinal relationship between HRIU and health anxiety on the within-person level in adolescents. We also considered their initial health anxiety, comparing adolescents with low, medium, and high base-level health anxiety.

We analyzed data from 2500 Czech adolescents, aged 11-16 years (mean 13.43, SD 1.69 years; 1250/2500, 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 (eg, 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 were collected in 3 waves, 6 months apart from June 2021 to June 2022, and analyzed using a random intercept cross-lagged panel model, chosen for its ability to separate within- and between-person effects.

On the between-person level, adolescents with higher base-level health anxiety were more frequent health-related internet users (β=.52; P<.001). On the within-person level, change in health anxiety did not predict change in HRIU, or vice versa, for those with high base-level health anxiety. In contrast, for adolescents with medium health anxiety, change in HRIU positively predicted health anxiety with large effects across all waves (β=.16; P=.03 from Wave 1 to Wave 2; β=.18; P=.01 from Wave 2 to Wave 3), 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).

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 counselors should recommend 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 includes fostering eHealth literacy (eg, recognizing personally irrelevant information and awareness of sensationalism in media) and coping mechanisms (eg, time or topic limits, or intentional rather than compulsive searching).