The CSS-12: Development and Validation of a Short-Form Version of the Cyberchondria Severity Scale

Abstract

Cyberchondria is defined as an increase in anxiety about one's health status as a result of excessive online searches. McElroy and Shevlin (2014) developed the first multidimensional, self-report measure of this construct-the Cyberchondria Severity Scale (CSS). The CSS consists of 33 items which can be summed to form a total score, and/or 5 subscale scores. The aim of the present study was to develop a short-formversion of the CSS, removing the 'Mistrust' subscale. Participants were undergraduate students from two UK universities (N=661, 73% female, Mage = 22.19 years, SD =5.88). Students completed the CSS, Short Health Anxiety Inventory (SHAI) and Generalised Anxiety Disorder Assessment (GAD-7). Twelve items were chosen for retention in the short-form based on an exploratory factor analysis. These itemscorresponded to the 4 factors previously identified in the 33-item scale (minus the 'Mistrust' subscale). Confirmatory factor analysis was used to validate the structure of the CSS-12. Confirmatory bifactor modelling indicated that the majority of item covariance was accounted for by a general cyberchondria factor. Construct validity was assessed by examining associations with the SHAI and GAD-7, with stronger correlations observed between the CSS-12 and the SHAI (compared to the GAD-7). The CSS-12 is a brief, reliable, and valid measure of worry/anxiety attributable to excessive online health research.

Cyberchondria, Uncertainty, and Psychological Distress among Omanis during COVID-19: An Online Cross-Sectional Survey

“…An example item is "If I notice an unexplained bodily sensation, I will search for it on the internet." The CSS-12 scale demonstrated reliable internal consistency as stated by the authors, with higher scores indicating increased levels of awareness [13]. Permission to use the survey was obtained from the owner of the instrument prior to the data collection.…”

“…The CSS-12 is a brief, reliable, and valid tool to measure worry/anxiety attributable to excessive online health search [13]. The scale consists of 12 items that are rated on a 5-point Likert-scale ranging from 1 ("never") to 5 ("always").…”

Health anxiety, cyberchondria, and coping in the current COVID-19 pandemic: Which factors are related to coronavirus anxiety?

“…The German short version of the Cyberchondria Severity Scale (CSS-15; Barke, Bleichhardt, Rief, & Doering, 2016;McElroy & Shevlin, 2014) uses 15 items to assess five dimensions of cyberchondria: "compulsion" (interruption of everyday activities due to health-related Internet research), "distress" due to Internet research, "excessiveness", "seeking reassurance", and "mistrust of medical professionals". In previous studies, the subscale "mistrust" tended to be a separate construct, so that this subscale was excluded in the present study as well as in previous studies (Fergus, 2014;McElroy et al, 2019;Norr, Allan, Boffa, Raines, & Schmidt, 2015). This version with four subscales is also equivalent to the English short version with 12 items (CSS-12;McElroy et al, 2019).…”

“…In previous studies, the subscale "mistrust" tended to be a separate construct, so that this subscale was excluded in the present study as well as in previous studies (Fergus, 2014;McElroy et al, 2019;Norr, Allan, Boffa, Raines, & Schmidt, 2015). This version with four subscales is also equivalent to the English short version with 12 items (CSS-12;McElroy et al, 2019). For the current study, the items have been slightly modified so that the Internet research refers to the COVID-19 pandemic (e.g., "I panic when I read online that a symptom I have might be related to the coronavirus pandemic").…”

Recent Insights Into Cyberchondria

“…The concept of cyberchondria was developed on the basis of its hypothesized relationships with health anxiety and hypochondriasis. Many studies [11,12,14,[17][18][19][20][21][22][23][24][25][26] have confirmed moderate to strong correlations between cyberchondria and health anxiety (rs ranging from 0.48 to 0.68, depending on the instrument used for the assessment of health anxiety). Only one study [13] found this correlation to be relatively weak (r = 0.23).…”