Death anxiety and cyberchondria in patients with chronic obstructive pulmonary disease A cross-sectional study
Keywords:
Chronic obstructive pulmonary disease, Anxiety disorders, Death anxiety, Cyberchondria, Internet use, Internet-based intervention, Internet addiction disorder, Compulsive behavior, Outpatients, COPDMain Article Content
Introduction
It is suggested that chronic obstructive pulmonary disease (COPD) patients have high death anxiety and the majority of them tend to search for COPD-related information on the internet.
Objective
Explore the association between death anxiety and cyberchondria in patients with COPD
Methods
This descriptive, cross-sectional study included 143 patients diagnosed with COPD aged 45 years or older, who had no sensory impairments affecting communication, were cognitively intact, and actively used the internet
Results
A multiple regression analysis examining the Cyberchondria Scale (CS-12) total score in relation to sociodemographic and clinical characteristics found that marital status, regular use of medications, having a COPD exacerbation in the last 6 months, and daily internet use time together explained 35.8% of the variance in the Cyberchondria Scale (CS) score (Adj R2= 0.358, p <0.001). Additionally, it was discovered that doing regular breathing exercises, being hospitalized in the last 6 months, searching for information about the COPD on the internet and use any medication other than those prescribed (such as analgesic, antipyretics, anti-emetics, etc.) by their doctor in the last year explained 37.3% of the variance in the Death Anxiety Score (Adj R2= 0.373, p <0.001)
Conclusion
The findings indicate that patients with COPD exhibited moderate levels of cyberchondria and high levels of death anxiety, highlighting the relevance of psychological factors in this patient group.
1. World Health Organisation. Chronic obstructive pulmonary disease (COPD). World Health Organisation. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/chronic-obstructive-pulmonary-disease-(COPD).
2. Kocabas A, Hancioglu A, Turkyilmaz S, Unalan T, Umut S, Cakir B, et al. Prevalence of COPD in Adana, Turkey (BOLD-Turkey Study). Proc Am Thorac Soc. 2006;3:A543[CR5.1]
3. Martinez CH, St Jean BL, Plauschinat CA, Rogers B, Beresford J, Martinez FJ, et al. Internet access and use by COPD patients in the National Emphysema/COPD Association Survey. BMC Pulm Med. 2014;14(1):66. https://doi.org/10.1186/1471-2466-14-66. PMid:24755090. PMCid:PMC4021217.
4. Long H, Li S, Chen Y. Digital health in chronic obstructive pulmonary disease. Chronic Dis Transl Med. 2023;9(2):90-103. doi: 10.1002/cdt3.68. https://doi.org/10.1002/cdt3.68. PMid:37305103. PMCid:PMC10249197.
5. Stellefson ML, Shuster JJ, Chaney BH, Paige SR, Alber JM, Chaney JD, et al. Web-based Health Information Seeking and eHealth Literacy among Patients Living with Chronic Obstructive Pulmonary Disease (COPD). Health Communication. 2018;33(12):1410-1424. https://doi.org/10.1080/10410236.2017.1353868. PMid:28872905. PMCid:PMC6097958.
6. Delgado CK, Gazzotti MR, Santoro IL, Carvalho AK, Jardim JR, Nascimento OA. Internet Use for Health-Care Information by Subjects With COPD. Respir Care. 2015;60(9): 1276-81. https://doi.org/10.4187/respcare.03716. PMid:26152467.
7. Mahler DA, Cerasoli F, Della L, Rudzinski M. Internet Health Behaviors of Patients with Chronic Obstructive Pulmonary Disease and Assessment of Two Disease Websites. Chronic Obstr Pulm Dis. 2018;5(3):158-166. https://doi.org/10.15326/jcopdf.5.3.2017.0173. PMid:30584579. PMCid:PMC6296793.
8. Aiken M, Kirwan G. The psychology of cyberchondria and cyberchondria by proxy. In: Power A, Kirwan G, editors. Cyberpsychology and new media: a thematic reader. 1st ed. London: Psychology Press; 2013. p.158-169.
9. Starcevic V, Berle D. Cyberchondria: towards a better understanding of excessive health-related Internet use. Expert Rev Neurother. 2013;13(2):205-13. https://doi.org/10.1586/ern.12.162. PMid:23368807.
10. Koç H. Higher levels of intolerance of uncertainty predict greater levels of smartphone addiction among college students: the serial mediating roles of death anxiety and cyberchondria. International Online Journal of Education and Teaching. 2023;10(4):2331-2343.
11. Boysan M, Eşkisu M, Çam Z. Relationships between fear of COVID-19, cyberchondria, intolerance of uncertainty, and obsessional probabilistic inferences: A structural equation model. Scand J Psychol. 2022;63(5):439-448. https://doi.org/10.1111/sjop.12822. PMid:35430750. PMCid:PMC9115459.
12. Arsenakis S, Chatton A, Penzenstadler L, Billieux J, Berle D, Starcevic V, et al. Unveiling the relationships between cyberchondria and psychopathological symptoms. J Psychiatr Res. 2021;143: 254-261. https://doi.org/10.1016/j.jpsychires.2021.09.014. PMid:34509786
13. Karakuş G, Öztürk Z, Tamam L. Death and death anxiety. Arşiv Kaynak Tarama Dergisi. 2012;21(1):42-79.
14. Nal B, Avcı AI, Ayyildiz M. The correlation between death anxiety and anxiety in elderly with chronic obstructive pulmonary disease. Prog Health Sci. 2016;6(1):63-69. https://doi.org/10.5604/01.3001.0009.5111.
15. Güzel S, Özer Z. Cyberchondria Levels and Affecting Factors in Heart Patients. Turk J Card Nur. 2021;12(27):36-46. https://doi.org/10.5543/khd.2021.94940
16. Zhang Y, Xu P, Sun Q, Baral S, Xi L, Wang D. Factors influencing the e-health literacy in cancer patients: a systematic review. J Cancer Surviv. 2023;17(2):425-440. https://doi.org/10.1007/s11764-022-01260-6. PMid:36190672. PMCid:PMC9527376.
17. Erdoğan A, Hocaoglu C. Cyberchondria: a review. Psikiyatride Güncel Yaklaşımlar. 2020;12(4):435-443. doi:10.18863/pgy.654648.
https://doi.org/10.18863/pgy.654648
18. Genç ZB. Analysis of the relationship between perceived stress level and death anxiety in individuals with COPD. Rev Esc Enferm USP. 2024;57:e20230273. https://doi.org/10.1590/1980-220x-reeusp-2023-0273en. PMid:38315806. PMCid:PMC10843329.
19. Erdoğan Z, Demirel U, Ceylan G. Determining E-Health Literacy, Cyberchondria, and Affecting Factors in Cancer Patients: A Cross-sectional Study. Comput Inform Nurs. 2025;43(6):e01303. https://doi.org/10.1097/CIN.0000000000001303. PMid:40167510.
20. McElroy E, Kearney M, Touhey J, Evans J, Cooke Y, Shevlin M. The CSS-12: Development and Validation of a Short-Form Version of the Cyberchondria Severity Scale. Cyberpsychol Behav Soc Netw. 2019;22(5): 330-335. https://doi.org/10.1089/cyber.2018.0624. PMid:31013440
21. Yorgancıoğlu TG, Karahan A, Sebik NB. Validity and reliability of the short form cyberchondry (CSS-12) severity scale: a specific application for health informatics. Hacettepe Sağlık İdaresi Dergisi. 2023;26(1):207-218.
22. Templer DI. The construction and validation of a Death Anxiety Scale. J Gen Psychol. 1970;82(2d Half):165-77. https://doi.org/10.1080/00221309.1970.9920634. PMid:4394812.
23. Akça F, Köse İA. Adaptation of Death Anxiety Scale (DAS): validity and reliability studies. Klinik Psikiyatri Dergisi. 2008;11(1):7-16.
24. Christiansen CF, Løkke A, Bregnballe V, Prior TS, Farver-Vestergaard I. COPD-Related Anxiety: A Systematic Review of Patient Perspectives. Int J Chron Obstruct Pulmon Dis. 2023;18: 1031-1046. https://doi.org/10.2147/COPD.S404701. PMid:37304765. PMCid:PMC10257401.
25. Öztürk YE, Kahveci Ş, Ünal S, Türktemiz H. The relationship between internet self-efficacy and cyberchondria severity in adults. KTO Karatay Üniversitesi Sağlık Bilimleri Dergisi. 2024;5(1):39-53. https://doi.org/10.59244/ktokusbd.1424558.
26. El-Zayat A, Namnkani SA, Alshareef NA, Mustfa MM, Eminaga NS, Algarni GA. Cyberchondria and its Association with Smartphone Addiction and Electronic Health Literacy among a Saudi Population. Saudi J Med Med Sci. 2023;11(2):162-168. https://doi.org/10.4103/sjmms.sjmms_491_22. PMid:37252023. PMCid:PMC10211420.
27. Calvert JK, Aidala AA, West JH. An Ecological View of Internet Health Information Seeking Behavior Predictors: Findings from the CHAIN Study. Open AIDS J. 2013;7:42-6. https://doi.org/10.2174/1874613601307010042. PMid:24222812. PMCid:PMC3821080.
28. Farmer A, Toms C, Hardinge M, Williams V, Rutter H, Tarassenko L. Self-management support using an Internet-linked tablet computer (the EDGE platform)-based intervention in chronic obstructive pulmonary disease: protocol for the EDGE-COPD randomised controlled trial. BMJ Open. 2014;4(1):e004437. https://doi.org/10.1136/bmjopen-2013-004437. PMid:24401729. PMCid:PMC3902407.
29. Starcevic V. Cyberchondria: Challenges of Problematic Online Searches for Health-Related Information. Psychother Psychosom. 2017;86(3):129-133. https://doi.org/10.1159/000465525. PMid:28490037.
30. Doherty-Torstrick ER, Walton KE, Fallon BA. Cyberchondria: Parsing Health Anxiety From Online Behavior. Psychosomatics. 2016;57(4):390-400. https://doi.org/10.1016/j.psym.2016.02.002. PMid:27044514. PMCid:PMC5952212.
31. Gökmen BD, Fırat M. Examination of the relationship between illness perception, death anxiety and self-care agency in COPD patients. Adıyaman Üniversitesi Sağlık Bilimleri Dergisi. 2022;8(1):57-66. https://doi.org/10.30569/adiyamansaglik.1024143.
32. Bülbüloğlu S, Kaplan SE. Effect of Perceived Dyspnea on Attitude Toward Death From the Perspective of COPD Patients. Omega (Westport). 2023;86(3): 913-929. https://doi.org/10.1177/0030222821993629. PMid:33567984
33. Strang S, Ekberg-Jansson A, Henoch I. Experience of anxiety among patients with severe COPD: A qualitative, in-depth interview study. Palliat Support Care. 2014;12(6): 465-72. https://doi.org/10.1017/S1478951513000369. PMid:23916195. PMCid:PMC4413871
34. Özdemir A, Yıldız GP, Arabaci Z, Hasgül E. The effect of respiratory exercise and inhaler device use on some symptoms and psychosocial parameters in individuals with COPD. Sağlık Akademisi Kastamonu. 2022;7(3):469-480. https://doi.org/10.25279/sak.873358
35. Türkiye Solunum Araştırmaları Derneği (TÜSAD). Diagnosis, evaluation and treatment recommendations for COPD exacerbations. İstanbul: Türkiye Solunum Araştırmaları Derneği; 2018. Available from: https://www.solunum.org.tr/TusadData/Book/756/2612201892435-AlevlenmeraporTUSADson.pdf. Accessed 1 May 2025.
36. Yohannes AM, Kaplan A, Hanania NA. Anxiety and Depression in Chronic Obstructive Pulmonary Disease: Recognition and Management. Cleve Clin J Med. 2018;85(2 Suppl 1): S11-S18. https://doi.org/10.3949/ccjm.85.s1.03. PMid:29494328
37. Demi̇rhan H, Eke E. The effects of digitalization on health information search behavior: an investigation on cyberchondria disease. International Journal of Health Sociology. 2021;1(1):1-18. https://doi.org/10.29228/ijheso.49395
38. Baumgartner SE, Hartmann T. The role of health anxiety in online health information search. Cyberpsychol Behav Soc Netw. 2011;14(10): 613-8. https://doi.org/10.1089/cyber.2010.0425. PMid:21548797
39. Yilmaz Y, Bahadir E, Erdoğan A. Investigation of the relationships between cybercondria, anxiety sensitivity, somatosensory amplification, and intolerance to uncertainty (tur). Turkish J Clin Psy. 2021; 24(4): 450-458. https://doi.org/10.5505/kpd.2021.40221
Downloads

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The copy rights of the articles published in Colombia Médica belong to the Universidad del Valle. The contents of the articles that appear in the Journal are exclusively the responsibility of the authors and do not necessarily reflect the opinions of the Editorial Committee of the Journal. It is allowed to reproduce the material published in Colombia Médica without prior authorization for non-commercial use
https://orcid.org/0000-0002-7298-7559