网络疑病症发生机制及影响的质性研究
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摘要
目的了解网络疑病症的发生机制及影响。方法于2016年1月在北京市选取网络疑病症量表、短版健康焦虑量表得分均处于较高水平(网络疑病症量表得分≥36.50分,短版健康焦虑量表得分≥44.52分)的6例网络疑病症个体进行"一对一"的半结构化访谈,主要访谈内容包括搜索健康/疾病相关信息的频率、来源、搜索后感受、对自身影响等。采用NVivo 11软件,基于扎根理论,对访谈所得资料进行整理和分析。结果网络疑病症个体对网络健康/疾病信息的优缺点有较清晰的认知,搜索健康/疾病信息后的反应主要表现在认知、情绪、行为3个方面。认知反应:网络搜索健康/疾病信息对自身有帮助,花费时间去搜索网络疾病/健康信息是值得且有必要的;情绪反应:恐慌/担心、焦虑/迷茫;行为反应:做出诊断、尝试疗法/药物、不做出诊断、到医院就诊、继续搜索。网络疑病症的维持原因包括:正规医生的解答模糊,自觉身体状况不良,对不确定性的忍受力较差,完美主义。结论网络疑病症个体的情绪与认知存在矛盾性,对于网络健康/疾病信息的监管、网络疑病症的临床干预,可以从这种矛盾性和网络疑病症产生的原因方面考虑。
Objective To explore the pathogenesis of cyberchondria and its impact on individuals.Methods Study design was qualitative.In January 2016,one-to-one semi-structured interviews were carried out in a random sample of 6 persons who scored high on Chinese version of Cyberchondria Severity Scale( ≥ 36.50)and Chinese version of Short Health Anxiety Inventory(≥ 44.52) for collecting the data about the frequencies of searching the information concerning health/illness,source of information,reactions after searching,and impact of searching on oneself.Data obtained were organized and analyzed using NVivo 11 and grounded theory.Results Participants demonstrated a good understanding of the strengths and limitations of online health/illness-related information.Reactions after searching mainly include the following 3 aspects——cognitive reactions:spending time on searching for such information online was thought to be helpful,worthwhile and necessary;emotional reactions:being scared/confused of and worried/anxious about their own conditions;behavioral reactions:self-diagnosis and self-treatment/medication were attempted to be conducted,or seeking healthcare in hospitals or continuing to search the relevant information.Causes for long-term prevalence of cyberchondria cover the following 4 aspects:insufficient explanations related to treatment given by professional physicians,self-perceived poor health status,poor tolerance of uncertainty and perfectionism.Conclusion Contradictory emotional and cognitive reactions can be found in individuals with cyberchondria after searching health/illness-related information online,which,together with the causes of cyberchondria,can be used as the basis for monitoring such information and delivering clinical interventions.
Objective To explore the pathogenesis of cyberchondria and its impact on individuals.Methods Study design was qualitative.In January 2016,one-to-one semi-structured interviews were carried out in a random sample of 6 persons who scored high on Chinese version of Cyberchondria Severity Scale( ≥ 36.50)and Chinese version of Short Health Anxiety Inventory(≥ 44.52) for collecting the data about the frequencies of searching the information concerning health/illness,source of information,reactions after searching,and impact of searching on oneself.Data obtained were organized and analyzed using NVivo 11 and grounded theory.Results Participants demonstrated a good understanding of the strengths and limitations of online health/illness-related information.Reactions after searching mainly include the following 3 aspects——cognitive reactions:spending time on searching for such information online was thought to be helpful,worthwhile and necessary;emotional reactions:being scared/confused of and worried/anxious about their own conditions;behavioral reactions:self-diagnosis and self-treatment/medication were attempted to be conducted,or seeking healthcare in hospitals or continuing to search the relevant information.Causes for long-term prevalence of cyberchondria cover the following 4 aspects:insufficient explanations related to treatment given by professional physicians,self-perceived poor health status,poor tolerance of uncertainty and perfectionism.Conclusion Contradictory emotional and cognitive reactions can be found in individuals with cyberchondria after searching health/illness-related information online,which,together with the causes of cyberchondria,can be used as the basis for monitoring such information and delivering clinical interventions.
引文
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[11]张钰群,袁勇贵.健康焦虑的研究现状[J].医学与哲学,2013,34(14):71-74.ZHANG Y Q,YUAN Y G.The research status of health anxiety[J].Medicine and Philosophy,2013,34(14):71-74.
[12]赵卫忠.从医生角度浅析医源性疾病的发生[J].医学与哲学,2000,21(7):49-50.ZHAO W Z.Discussion on the occurrence of iatrogenic diseases from the perspective of doctors[J].Medicine and Philosophy,2000,21(7):49-50.
[2]ASSOCIATION A P.Diagnostic and statistical manual of mental disorders[M].Chicago:American Psychiatric Association,2013.
[3]丁佳丽,杨智辉.网络疑病症:概念界定、影响因素与干预方法[J].中国全科医学,2015,18(16):1984-1988.DOI:10.3969/j.issn.1007-9572.2015.16.028.DING J L,YANG Z H.Cyberchondria:definition,influencing factors and intervention methods[J].Chinese General Practice,2015,18(16):1984-1988.DOI:10.3969/j.issn.1007-9572.2015.16.028.
[4]WHITE R W,HORVITZ E.Captions and biases in diagnostic search[J].Acm Transactions on the Web,2013,7(4):1-28.DOI:10.1145/2486040.
[5]SCHULTE K L.Cyberchondria in relation to uncertainty and risk perception[D].Enschede:University of Twente,2016.
[6]DOHERTYTORSTRICK E R,WALTON K E,FALLON BA.Cyberchondria:parsing health anxiety from online behavior[J].Psychosomatics,2016,57(4):390-400.DOI:10.1016/j.psym.2016.02.002.
[7]FERGUS T A.Cyberchondria and intolerance of uncertainty:examining when individuals experience health anxiety in response to Internet searches for medical information[J].Cyberpsychology Behavior&Social Networking,2013,16(10):735-739.DOI:10.1089/cyber.2012.0671.
[8]SAKAI R,NESTORIUC Y N.The prevalence of personality disorders in hypochondriasis[J].Journal of Clinical Psychiatry,2010,71(1):41-47.DOI:10.4088/JCP.08m04838blu.
[9]DUGAS M J,HEDAYATI M,KARAVIDAS A,et al.Intolerance of uncertainty and information processing:evidence of biased recall and interpretations[J].Cognitive Therapy and Research,2005,29(1):57-70.DOI:10.1007/s10608-005-1648-9.
[10]丁佳丽.网络疑病的特点及影响因素研究[D].北京:北京林业大学,2016.DING J L.The characteristics and influential factors research of cyberchondria[D].Beijing:Beijing Forestry University,2016.
[11]张钰群,袁勇贵.健康焦虑的研究现状[J].医学与哲学,2013,34(14):71-74.ZHANG Y Q,YUAN Y G.The research status of health anxiety[J].Medicine and Philosophy,2013,34(14):71-74.
[12]赵卫忠.从医生角度浅析医源性疾病的发生[J].医学与哲学,2000,21(7):49-50.ZHAO W Z.Discussion on the occurrence of iatrogenic diseases from the perspective of doctors[J].Medicine and Philosophy,2000,21(7):49-50.