Implementation of the Cyberchondria Severity Scale in the Empirical Literature

Introduction: Cyberchondria, a portmanteau of the words “cyber” and “hypochondriasis”, is an emergent digital health concern. This study aims to provide researchers and clinical practitioners with a greater understanding of the extent to which the Cyberchondria Severity Scale (CSS) and its abbreviated version, CSS-12, are used. It also examines the relative utilization of cyberchondria scales in different languages. Additionally, this study adds to the discussion of a debated Cyberchondria subconstruct, “Mistrust of Medical Professionals”, which may be of special relevance to clinicians and those working across digital care settings. Materials and Methods: PubMed Central® was searched for articles published between May 1, 2019, and December 31, 2024, using the term “cyberchondria.” Included articles mentioned the CSS, were empirical studies, and were in English. Each was categorized by CSS version, publication year, and language of scale implementation. Chi-Square tests assessed associations, and Spearman’s Rank Correlation Coefficient evaluated trend monotonicity. Results: Of 65 articles identified, 21 used the CSS, 20 used the CSS-12, and the remainder employed unknown or modified versions. There was no significant association between publication year and instrument choice (p=0.48). Similarly, the relationship between year and the percentage of articles using the CSS-12 was not significantly monotonic (rho=0.75; p=0.084). The largest volume of papers utilizing the CSS were in Turkish, while the largest volume of papers utilizing the CSS-12 were in English. The only language for which there were more papers written using the CSS-12 than the CSS was Chinese. Conclusion: While the CSS-12 has gained some traction in cyberchondria research, the original CSS remains widely used. The scale’s application across languages underscores its global relevance, but further research is needed to explore variations between language-specific adaptations. When choosing a scale, researchers and clinicians should consider whether it measures the desired constructs. For example, the “Mistrust of Medical Professionals” subscale present in the original CSS, but absent in the CSS-12, may represent a construct distinct from the other subscales. As this construct may impact care utilization, clinical alliance, clinical outcomes, and the benefit of clinician-free digital interventions, the necessity of measuring it should be carefully considered. Limitations: This study was limited by the use of PubMed Central, and may not necessarily represent all scholarship, inclusive of a grey literature of unknown size and scope.