Internet addiction and cyberchondria - Their relationship with Well-Being

Abstract

The current paper presents the results from some research on the relationship between Internet addiction, cyberchondria, and different aspects of well-being. The information available on the Internet, which is not necessarily truthful and accurate, can unreasonably amplify users health concerns. Problematic Internet use, health anxiety aroused by online searches for health information and escalation of health concerns as an indicator of
cyberchondria, are all associated with a decrease in subjective and eudaimonic well-being as well as in self-esteem. The analyses indicate positive relationships between depressive
symptoms on the one hand, and Internet addiction and health anxiety, on the other. A conclusion regarding the existence of a relationship between Internet addiction, cyberchondria and decreased levels of well-being could be drawn from the research.
Furthermore, the results suggest that self-esteem and eudaimonic well-being correlate positively with the number of people with whom users communicate online.

Full text

57
Journal of Education Culture and Society No. 1_2013
Eliza Ivanova
elizaxivanova@gmail.com
Internet addiction and cyberchondria
- Their relationship with Well-Being
Abstract
The current paper presents the results from some research on the relationship between In-
ternet addiction, cyberchondria, and different aspects of well-being. The information available
on the Internet, which is not necessarily truthful and accurate, can unreasonably amplify users
health concerns. Problematic Internet use, health anxiety aroused by online searches for health
information and escalation of health concerns as an indicator of cyberchondria, are all associated
with a decrease in subjective and eudaimonic well-being as well as in self-esteem. The analyses
indicate positive relationships between depressive symptoms on the one hand, and Internet ad-
diction and health anxiety, on the other. A conclusion regarding the existence of a relationship
between Internet addiction, cyberchondria and decreased levels of well-being could be drawn
from the research. Furthermore, the results suggest that self-esteem and eudaimonic well-being
correlate positively with the number of people with whom users communicate online.
Key words: Internet addiction, health anxiety, cyberchondria, well-being
Introduction
The purpose of this paper is to study the relationships between Internet addic-
tion, cyberchondria and well-being. To broaden the scope of fi ndings, the concept
of well-being has been elaborated by measuring subjective well-being, eudaimonic
well-being, self-esteem and depression. The assumption is that self-esteem is con-
sistent with well-being, while depression is negatively associated with well-being
(Ryff, & Keyes, 1995; Wood, & Joseph, 2010).
Internet addiction
There are not only terminological differences between researches in the fi eld of
problematic Internet use, but there are also contrasts between their views on the nature
of Internet addiction. Most widely the criteria for pathological gambling from DSM-IV
have been adapted for problematic Internet use. Thus Internet addiction is commonly
defi ned as impulse control disorder (Young, 1996). As far as the variations of Internet
addiction are concerned, there are also some contrasting opinions. David Greenfi eld
(1999) distinguishes between a primary problem and a secondary problem with the In-
ternet. The primary problem is characterized with the Internet itself being the focus of
problematic behaviour, while the secondary problem arises when a pre-existing com-
DOI: 10.15503/jecs20131-57-70

58 Transgression
pulsive behaviour is released via the Internet. According to Greenfi eld (1999) aspects of
the Internet such as: easy access, anonymity, no time and space restrictions, and disin-
hibition, turn it into an object of addiction and a tool for augmenting it. Richard Davis
(2001, as cited in Caplan, 2005), similarly to Greenfi eld, differentiates between specifi c
and generalized pathological Internet use. The specifi c pathological use is devoted to
a single activity online: gambling, auctions, sexual content and so on. The generalized
pathological use is versatile and encompasses many Internet applications.
Internet addiction could be connected with depressive affect, loneliness and unful-
fi lling relationships (Caplan, 2003, 2005; Young, & Rodgers, 1998). D. Greenfi eld (1999)
argues that the Internet is used as a coping tool for distraction from negative thoughts
and for mood alteration. Kimberly Young (1999) stated that people with low self-es-
teem and depressive people are highly prone to Internet addiction, because they use
the Internet predominantly for communication, in order to cope with their problems
or compensate for them online. Findings suggest that users addicted to the Internet are
more depressive and mainly introverted, in contrast with users who do not consider
themselves problematic (Petrie & Gunn, 1998, as cited in Widyanto, & Griffi ths, 2005).
Gert-Jan Meerkerk, Regina Eijnden, Ad Vermulst, and Henk Garretsen (2007)
established that real time Internet communication could be connected with com-
pulsive tendencies, namely loss of control and preoccupation with the Internet. The
authors inferred a relationship between Internet communication and depressive af-
fect for a six-month period. They noted that communicating with strangers is associ-
ated with higher depressive affect, than communicating with friends and relatives.
Katherine Bessiere, Sara Kiesler, Robert Kraut, and Bonka Boneva (2004) claimed
that social skills in real-world situations could benefi t from online communication
with strangers. In opposition to this view of social compensation is the hypothesis
“the rich get richer”, according to which people with better interpersonal skills are
those who avail themselves of online communication.
In his cognitive-behavioural theory, R. Davis (2001, as cited in Caplan, 2005) con-
tends that depression and loneliness are distant predispositions to problematic Inter-
net use. On the other hand, there is the view that excessive Internet use could lead to
social isolation and loneliness, through neglect of important aspects of personal life. K.
Young (1999) described the outcomes of Internet addiction as depression, loneliness,
joylessness. The typical addiction symptoms are: tolerance, withdrawal, constant in-
crease in the time spent online, unsuccessful attempts to cut down the time online,
negative repercussions on other aspects of life. As the addiction intensifi es, the user’s
feelings become more and more negative. In turn, the addicted person tries to com-
pensate by increasing the time spent online, on order to experience positive feelings.
Junghyun Kim, Robert LaRose, and Wei Peng (2009) confi rmed both assump-
tions in their fi ndings. It is not so much the social applications of the Internet, but
the entertainment ones, such as downloading of fi les and watching videos online,
that are connected with decreased well-being. Downloading and watching videos
are activities associated with loneliness to a greater extent than online communica-
tion is. Yair Amichai-Hamburger (2009) shares the opinion that online relationships
could have a positive effect on the well-being of people, due to the unique context of
openness, self-disclosure and support of the Internet.

59
Journal of Education Culture and Society No. 1_2013
Health anxiety
Health anxiety can be defi ned as unfounded health concerns for personal health,
when there is no pathology, or excessive worries, when there is an insignifi cant
health problem (Lucock & Morley, 1996, as cited in Gravatt & Brown, n.d.). Health
anxiety varies from occasional worries to intense fear and anxiety, leading to poor
well-being (Asmundson, Taylor, Sevgur, & Cox, 2001, as cited in Gravatts, & Brown,
n.d.). The cognitive-behavioural theory postulates that health anxiety is the result
of misinterpreting information regarding a person’s own bodily sensations, in line
with the arisen concerns for a serious illness (Salkovskis, Warwick, & Deale, 2003).
The desire of people with health anxiety is to fi nd solace in the information they
continually look through. But usually the consequences are intensifi ed worries due
to anxious people’s inaccurate interpretation of medical data or their inability to
integrate positive information (Gravatt & Brown, n.d.).
Mathew Eastin and Natalie Guinsler (2006, as cited in White, & Horvitz, 2009) reg-
istered a relationship between looking for health information online and visiting a
doctor, in which health anxiety is a moderator. The fi ndings from Ryen White and
Eric Horvitz’s (2009) research demonstrate an even distribution between participants
who report that their health anxiety decreases after using the Internet and participants
who claim that it increases. Trait anxiety could contribute to high levels of health anxi-
ety and the escalation of health concerns caused by information on the Internet.
Finding health information on the Internet could be potentially benefi cial to users.
Learning more about their own health status and whether they should visit a doc-
tor could lead people to a more responsible attitude towards their condition, such as
keeping to a suitable diet, exercising, healthy living, adhering to the prescribed treat-
ment and so on. Another advantage of using the Internet for health related issues is
the social support one could receive from others with similar conditions, especially
in cases of socially intolerable illnesses or problems which could hardly be discussed
in everyday situations. Anonymity in virtual space enables people with stigmatiz-
ing problems to overcome the burden of not being able to talk about their condition.
Furthermore, by learning more about one’s illness, one can better understand the pre-
scribed treatment, become actively involved in it, and thus assist the professionals.
Broadening the knowledge of a problem widens the perspective of the person and
increases the probability of higher responsibility. The Internet could serve as a tool for
empowering patients (Jones, 2000; Powell, Darvell, & Gray, 2003).
Health oriented websites designed on the principle of self-diagnosis addition-
ally stimulate health anxiety. Furthermore these sites attract people with tendency
for cyberchondria, who can only suffer the negative consequences of using such
resources (Ryan, & Wilson, 2008). There is also a possibility of misinterpreting or
only partially understanding medical information. The user might be overwhelmed
by complex medical terminology and subsequently might become increasingly con-
cerned. The result may be a bleak self-diagnosis (Benigeri, & Pluye, 2003, as cited
in Whites, & Horvitz, 2009). Further, it should be considered that even if the user
were able to fully comprehend the information, there would be a possibility that
the patient-doctor relationship might suffer. Patients might unreasonably raise their

60 Transgression
requirements to their doctors, causing tension in the interactions and therefore im-
peding the healing process. Doctors might perceive patients’ Internet research as an
indication of mistrust, especially if a patient argues with the specialist and tries to
interfere. If a patient decides to believe what they have read online instead of what
their doctors say, the outcome might be detrimental on the treatment.
A focus group study by Gunther Eysenbach and Christian Köhler (2002) of two
groups of participants, completing health related web search tasks, indicated that users
rarely check which organisation is behind the web site and whether the information on
it is reliable. People also do not usually enter combinations of words when searching
for medical problems, which contributes to the decline in the accuracy of the results.
Users are most likely to pick one of the fi rst few results from the search and easily para-
phrase their key word, changing the focus of the search (Atkinson, Saperstein, & Pleis,
2009; Eysenbach, & Köhler, 2002). G. Eysenbach and C. Köhler (2002) registered that
97% of the followed links are amongst the fi rst ten results from the search and 71% are
amongst the fi rst fi ve. Moreover, the majority of users look for medical information not
in specialized health portals, but rather in the search engines, which display links to
all kinds of sources, including forums and blogs (Atkinson, Saperstein, & Pleis, 2009).
Christina Zarcadoolas, Mercedes Blanco, John Boyer and Andrew Pleasant (2002, as
cited in Atkinson, Saperstein, & Pleis, 2009) found that health is one of the main top-
ics being researched on the Internet by the less educated. On the other hand, Nancy
Atkinson, Sandra Saperstein, and John Pleis (2009) report more women and people
with a bachelor’s or higher degree looking for health information online, compared to
men and people with lower education. The authors conclude that people who use the
Internet daily for at least one hour are prone to search for medical information.
Cyberchondria
The term cyberchondria has been used by the researches from Harris Interactive
since 1999 (The Harris Poll, 1999) in their research on looking for health informa-
tion on the Internet. The authors who have carried out the most extensive research
on the topic are R. White and E. Horvitz (2009). They defi ne cyberchondria as the
“unfounded escalation of concerns about common symptomatology, based on the
review of search results and literature on the Web” (White, & Horvitz, 2009, p. 1).
A key concept for understanding cyberchondria is the escalation of concerns, con-
nected with changing the focus of attention from nonspecifi c symptoms to serious
illnesses, following the results of a web search. The authors also single out persis-
tence of concerns, search habits and cognitive bias as vital aspects of cyberchondria.
Hypochondria is typically rare – 1-5% of the population (Barsky, & Klerman,
1983) and 3% of primary care patients (Escobar, Gara, Waitzkin, Silver, Holman,
& Compton, 1998) experience it. It is characterized with fears that insignifi cant non-
specifi c symptoms indicate a serious illness (Barsky, & Klerman, 1983). Hypochon-
driacs have tendencies for self-examination, self-diagnosis, and are fi xated on their
own body. They do not trust the assurances of their doctors that they are not ill. The
Internet is therefore a stimulating medium for unfounded health concerns.

61
Journal of Education Culture and Society No. 1_2013
R. White and E. Horvitz (2009) conducted a research with 515 Microsoft em-
ployees, using their logs from Internet health search as well as administering a
questionnaire. The questions relate to online health search behaviour and the im-
pact of the information on health concerns. Participants demonstrated low levels
of health anxiety, but escalation of health concerns after web search was registered
in one out of every fi ve people. It was confi rmed that the escalation of concerns
can lead to temporary or long-term increase in the levels of health anxiety and
additional doctor visits. A considerable number of the respondents used the In-
ternet as a differential diagnosis tool, by looking through a list of illnesses and
deciding which one was applicable to their condition. More than half of the re-
spondents stated that often or sometimes they considered the order of the results
from the web search a refl ection of the probability of having a certain illness. Bi-
ases of judgement, such as availability bias and base-rate neglect, are regarded as
important aspects of cyberchondria (White, & Horvitz, 2009). Availability bias is
an increase in the evaluated probability that something will happen, because of re-
cent and intense exposure to particular events. Base-rate neglect is associated with
ignoring the low probability that something will happen, on account of viewing
evidence in support of the event.
R. White and E. Horvitz (2010) establish an escalation of concerns in two thirds
of the cases when a serious illness is mentioned before an alternative explanation for
a certain symptom on a web page. Should the alternative explanation precede the
serious illness, an escalation is registered in one third of the cases.
Objectives
The main objective of this study is to identify and clarify the relationships be-
tween Internet addiction, cyberchondria and well-being. In this context, the aim of
the research is to examine the relationships between excessive Internet use, using
the Internet for health information and well-being indicated by: subjective well-be-
ing, eudaimonic well-being, self-esteem and depression.
Method
Participants. The study was conducted in Bulgaria in 2012. We collected data
from 378 participants (41% male and 59% female). According to age, three groups
were set apart: up to 20 years of age (34%), from 21 to 26 years of age (33%) and
over 26 years of age (33%). As far as marital status was concerned, two groups were
formed: living without a partner (73%) and living with a partner (27%). According
to the education acquired up to the moment, participants were divided into two
groups: with secondary education (56%) and with higher education (44%). Univer-
sity and high school students composed 47% of all participants. The distribution
of respondents’ place of residence is uneven: 72% live in Sofi a (the capital city of
Bulgaria), 15% live in another large city in the country, and 9% live in a small town
and 4% - in a village.

62 Transgression
Measures
Internet addiction. The Internet Addiction Test (IAT), designed by K. Young (1998,
in Widyanto, & McMurran, 2004), consists of 20 items describing behaviours which
depending on their frequency could be linked to different aspects of Internet addic-
tion. Factor analyses revealed six factors: salience, excessive use, neglecting work, ne-
glecting social life, anticipation, and lack of control. For the purpose of the present
research, we used a fi ve-point Likert scale ranging from 1 (never) to 5 (always). The
score on the IAT ranges from 20 to 100. K. Young defi ned three groups of users ac-
cording to the score: 20–39 - an average user without control issues; 40–69 - a user with
problems; 70-100 – a user with signifi cant problems due to uncontrolled Internet use.
We included additional questions regarding Internet use from the research of
Oliver Egger and Matthias Rauterberg (1996): questions concerning the positive and
negative infl uence of the Internet on users’ lives; questions, regarding the number
of people with whom users communicate via the Internet, the number of acquain-
tances made solely on the Internet and the number of Internet acquaintances met in
person.
Health anxiety. The second questionnaire measures anxiety aroused by online
health information seeking (Gravatt, & Brown, n.d.). It consists of 14 items concern-
ing the use of Internet for health information, as well as the cognitions and affects
provoked by that use. The responses were measured with a fi ve-point Likert scale
ranging from 1 (strongly disagree) to 5 (strongly agree). The authors formed three
factors: belief that online health information is accurate; extent of online health infor-
mation seeking; anxiety aroused by online health information seeking.
Cyberchondria. The questions concerning cyberchondria were taken from R.
White, and E. Horvitz’s (2009) research. We included items concerning users’ per-
ceptions of health information on the Internet, their experience with searching the
web for health information, and the infl uence of the Internet on their health con-
cerns. A few different response scales were used: a dichotomous scale with yes/no
answers; Likert type scales ranging from 1 (never) to 5 (always) and from 1 (I do not
worry at all) to 5 (I worry excessively).
Subjective well-being. The Satisfaction with Life Scale (Pavot, & Diener, 1993)
was used for assessing subjective well-being. The scale consists of fi ve items refl ect-
ing satisfaction from the way a person lives their life and from who they are. We
applied a fi ve-point Likert scale ranging from 1 (Strongly disagree) to 5 (Strongly
agree).
Eudaimonic well-being. The questionnaire measuring eudaimonic well-being
was designed by Alan Waterman, Seth Schwartz, Byron Zamboanga, Russel Ravert,
Michelle Williams, Bede Agocha, Su Kim, and Brent Donnellan (2010). The authors
defi ne eudaimonic well-being as incorporating subjective as well as objective ele-
ments. Subjective elements are feelings of personal expressiveness and objective ele-
ments are all behaviours directed at self-realisation, through the recognition and
development of personal potential, so that one leads a meaningful life. The ques-
tionnaire is comprised of 21 items. The scale we applied was a fi ve-point Likert one,
ranging from 1 (Strongly disagree) to 5 (Strongly agree).

63
Journal of Education Culture and Society No. 1_2013
Self-esteem. The Rosenberg Self-Esteem Scale (Rosenberg, 1989), consisting of
10 items, was used with a four-point Likert scale ranging from 1 (Strongly agree) to
4 (Strongly disagree).
Depression. We applied the short eight-item version of the Center for Epidemio-
logic Studies Depression Scale by Lenore Radloff (1977, in Van de Velde, Bracke,
& Levecque, 2008) – CES-D 8. Participants had to answer with regard to their state
during the past week. The response scale we used was four-point Likert type rang-
ing from 1 (rarely) to 4 (most of the time).
Results and Discussion
The data were analysed with the computer program SPSS.
Internet Addiction
The conducted research indicates that participants experience problems with
their Internet use (M=40.23; SD=11.53). Those participants who did not demonstrate
problematic Internet use were 55%. The problematic users were 43% of the partici-
pants in the study, and the last 2% experienced signifi cant problems as a result of
their online activity. The data shows that generally participants did not display high
levels of the factors of Internet addiction described by K. Young (1998, in Widyanto,
& McMurran, 2004) (see table 1).
Table 1. Results from a descriptive analysis of the Internet Addiction Test
Mean (M) Standard
deviation (SD)
Minimum Maximum
Internet addiction 40.23 11.53 20 86
Salience 1.73 0.65 1 4.50
Lack of control 2.28 0.89 1 4.60
Neglecting work 1.82 0.72 1 5.00
Neglecting social life 1.92 0.72 1 4.67
Anticipation 2.22 0.86 1 5.00
Excessive use 2.19 0.70 1 4.67
Source: Author
The results indicate a tendency for Internet addiction, anticipation of the next
session, and use of the Internet for longer than intended, which is connected with
lack of control. However, the scores are not high enough to suggest a considerable
disturbance in the way of life of respondents due to Internet use.
Health Anxiety
The data from the questionnaire for health anxiety aroused by online searching
for health information were analysed with the methods of descriptive statistics. The
levels of: health anxiety (M=25.56; SD=7.73), belief that online health information
is accurate (M=8.34; SD=2.60), and extent of online information seeking (M=7.70;
SD=2.61) are moderate.

64 Transgression
Cyberchondria
The items of the questionnaire for cyberchondria were analysed with the meth-
ods of descriptive statistics. It was registered that participants rarely look for health
information online (M=1.91; SD=3.04) and even more so for undiagnosed health is-
sues (M=0.96; SD=1.70). These results are considerably lower than those reported by
R. White and E. Horvitz (2009). Regarding the nature of the health information which
participants search for, the results indicated that physical symptoms were what users
check online most of the time (45% looked symptoms up online). The fi ndings sug-
gested that 36% of participants looked for information shared by others with a similar
condition to theirs. This might be a possibility for people to be infl uenced by other non-
professionals. The results revealed that 33% of respondents searched for information
on diagnosed conditions and 26% looked for information about serious illnesses. The
latter might be an indicator for cyberchondria. In the present study, 6% of participants
defi ned themselves as hypochondriacs, while 11% had been referred to as such.
The questions regarding the level of hypochondria and health anxiety, as well as
the tendency for reviewing websites for serious illnesses, when looking for information
on non-specifi c symptoms, represent the escalation of health concerns. We found that
34% of respondents were prone to change the focus of their search, while 26% claimed
they never did that. In contrast with our fi ndings, R. White and E. Horvitz (2009) reg-
istered 63% of users as likely to change the focus of their search. Our Bulgarian sample
seems to be stricter in health searches, although the percentage of people who tend to
change the search topic from a benign symptom to a serious illness is still considerable.
As for the questions on the topic of persistence of health concerns, we registered
that 46% of users continued to look for information after they had had their doubts
raised about a serious illness by information on the Internet. Only 19% reported having
disturbances in their online activities and 14% experienced disturbances in their usual
everyday activities, as a result of raised concerns. 81% declared that worrying health
information rarely or never infl uenced their online activities and respectively 86%
stated that regarding their offl ine activities. It can be concluded that respondents are
generally more skeptical about a possible connection between the order of the search
results and the probability of the illnesses described in each of them. According to 51%
of respondents there was no such connection, while 28% found it rarely. Only 21%
believed that there was a direct connection between the rank of the result and its rel-
evance for the searched symptom. In R. White and E. Horvitz’s (2009) study, 51% of the
sample shared that opinion. In the present study 25% of respondents used the Internet
as a diagnostic tool. This is a premise for the development of unfounded concerns. The
powerful infl uence of Internet information is notable in the following results: 45% of
users visited a doctor after reviewing disturbing health information online and 86%
declared that a checkup reassured them that their concerns were unsubstantiated.
Relationships between Internet addiction, health anxiety, cyberchondria and
well-being
To investigate the relationships between Internet addiction, health anxiety
aroused by online health search, and escalation and persistence of health concerns
as aspects of cyberchondria, we conducted correlation analyses (see Table 2).

65
Journal of Education Culture and Society No. 1_2013
Table 2. Results from correlation analyses of Internet addiction, health anxiety
and cyberchondria
Internet
addiction
Health
anxiety
Belief that
online health
information is
accurate
Extent
of online
information
seeking
Escalation
of
concerns
Persistence
of
concerns
Internet addiction 1 0.192* 0.033 0.144* 0.267** 0.171**
Health anxiety 1 0.372** 0.788** 0.367** 0.439**
Belief that online
health information
is accurate
10.486** 0.108* 0.214**
Extent of online
information
seeking
10.230* 0.421**
Escalation of
concerns 10.354*
Persistence of
concerns 1
** p<0.01; * p<0.05
Source: Author
The results showed the following tendencies. Positive relationships were regi-
stered between the studied phenomena. We established that Internet addiction was
positively correlated with escalations (r=0.267) and persistence (r=0.171) of health
concerns as indicators of cyberchondria, with health anxiety (r=0.192), and with the
extent to which respondents use the Internet for health information (r=0.144).
As expected health anxiety was correlated with the belief that online health infor-
mation is accurate (r=0.372) and with the extent to which Internet is used for health
information (r=0.788). Health anxiety was also correlated with escalation (r=0.367)
and persistence of concerns (r=0.439). Escalation of concerns correlated with persi-
stence of concerns (r=354), which was also expected, since they are both aspects of
cyberchondria. Logically the belief that online health information is accurate was
in positive relationship with the extent of online information seeking (r=0.486). We
registered weaker correlations between the belief that online health information is
accurate and escalation (r=0.108) and persistence of concerns (r=0.214). The extent
to which a user looks for health information online was positively correlated with
escalation (r=0.230) and persistence (r=0.421) of concerns.
For the revelation of the relationships between Internet addiction, health anxiety,
cyberchondria, subjective and eudaimonic well-being, self-esteem and depression,
correlation analyses were carried out. The results are presented in table 3.

66 Transgression
Table 3. Results from correlation analyses of the relationships between Internet
addiction, health anxiety, cyberchondria, well-being, self-esteem and depression
Subjective
well-being
Eudaimonic
well-being Self-esteem Depression
Internet addiction -0.134** -0.199** -0.231** 0.276**
Health anxiety -0.074 -0.145** -0.154** 0.159**
Belief that online health
information is accurate 0.006 0.042 0.030 0.011
Extent of online
information seeking -0.015 -0.054 -0.088 0.087
Escalation of concerns -0.135** -0.169** -0.107* 0.187**
Persistence of concerns -0.060 -0.102 -0.014 0.108*
** p<0.01; * p<0.05
Source: Author
The analyses showed that Internet addiction correlated signifi cantly and positi-
vely with depression (r=0.276) and signifi cantly but negatively with subjective well-
-being (r=-0.134), eudaimonic well-being (r=-0.199) and self-esteem (r=-0.231). These
results, indicating that uncontrolled Internet use is associated with lowered levels of
well-being and self-esteem, are consistent with previous research (Young, & Rogers,
1998; Caplan, 2003, 2005).
Health anxiety was also positively correlated with depression (r=0.159) and negati-
vely correlated with self-esteem (r=-0.154) and eudaimonic well-being (r=-0.145). Esca-
lation of concerns correlated negatively with both subjective (r=-0.135) and eudaimonic
(r=-0.169) well-being as well as with self-esteem (r=-0.107). On the other hand, we re-
gistered positive correlations between escalation of concerns and depression (r=0.187)
and between persistence of concerns and depression (r=0.108). These fi ndings suggest
that health anxiety and escalation of concerns as an aspect of cyberchondria are negati-
vely associated with well-being and self-esteem and positively – with depression.
To examine the relationships between well-being, self-esteem and depression,
on the one hand, and the infl uence of the Internet and some communication aspects,
on the other, we preformed correlation analyses (see Table 4).
The fi ndings show that subjective well-being did not correlate signifi cantly
either with perceived positive infl uence of the Internet or with its negative infl uen-
ce. Eudaimonic well-being was weakly and positively correlated with positive in-
fl uence of the Internet (r=0.112) and weakly and negatively correlated with negative
infl uence of the Internet (r=-0.162). We could speculate that eudaimonic well-being
is a more complex construct than subjective well-being which incorporates perso-
nal expressiveness as well as development of the personal potential (Waterman,
Schwartz, Zamboanga, Ravert, Williams, Agocha, Kim, & Donnellan, 2010), and
therefore eudaimonic well-being more sensitively refl ects the infl uence of the Inter-
net on the person. We could conclude that eudaimonic well-being is connected with
the positive infl uence of the Internet on one’s life. The perceived negative infl uence
of using the Internet correlated weakly and negatively with self-esteem (r=-0.142)
and positively with depression (r=0.177).

67
Journal of Education Culture and Society No. 1_2013
Table 4. Results from correlation analyses of positive and negative infl uence of
the Internet, communicational aspects of the Internet, well-being, self-esteem and
depression
Subjective
well-being
Eudaimo-
nic well-
-being
Self-esteem Depression
Positive
infl uence of
the Internet
Negative
infl uence of
the Internet
Positive
infl uence of the
Internet
0.053 0.112* 0.074 -0.021 1 0.145**
Negative
infl uence of the
Internet
-0.075 -0.162** -0.142** 0.177** 0.145** 1
People with
whom I
communicate
via the Internet
0.094 0.154** 0.110* -0.092 0.189** -0.005
Acquaintances
made on the
Internet
-0.040 0.067 0.053 -0.007 0.080 0.139**
People from
my Internet
acquaintances I
met in person
0.013 0.039 0.091 -0.010 0.174* 0.001
** p<0.01; * p<0.05
Source: Author
In summary, the negative effect of the Internet on users’ lives was to some ex-
tent connected with decreased levels of eudaimonic well-being and self-esteem, and
increased levels of depression. We found that perceived positive infl uence of the
Internet correlated weakly but positively with the perceived negative infl uence of
the Internet (r=0.145). A possible explanation could be that the positive sides of the
Internet do not exclude the negative ones and users supposedly realise this. As well
as advantages, the Internet has inevitable setbacks - it is time-consuming and as a
result users neglect other areas of their lives.
We established that the number of people with whom respondents communi-
cate via the Internet correlated weakly but positively with eudaimonic well-being
(r=0.154), with self-esteem (r=0.110) and with the perceived positive infl uence of the
Internet (r=0.189) (see Table 4). These fi ndings are consistent with other research on
Internet communication and well-being. Kim, LaRose and Peng (2009) confi rmed
that it is not the social applications of the Internet, but the entertainment ones, that
are connected with decreased well-being. Y. Amichai-Hamburger (2009) underlines
the positive effect of online relationships on well-being.
In contrast, the number of acquaintances made solely on the Internet was posi-
tively and weakly correlated with the negative infl uence of the Internet (r=0.139).
This result leads us to the conclusions drawn by researches like G. Meerkerk, R.v.d.
Eijnden, A. Vermulst, and H. Garretsen (2007), who pointed out that communica-

68 Transgression
tion with strangers is connected with higher depressive affect, than communication
with friends. Although we did not establish the same relationship with depressive
affect, we did register a connection with the negative effects of the Internet.
Nevertheless, meeting in person people met on the Internet was positively and
weakly correlated with the positive infl uence of the Internet (r=0.174). We could
infer that as long as people manage to incorporate their online life with their real
life, they would probably perceive positively the Internet experience. As John Suler
(1999) states, it is important to integrate the Internet use into the real life, so that
the two would complement one another. Meeting the acquaintances made on the
Internet and communicating with friends and relatives using the Internet is a way
of enriching interpersonal relationships.
Conclusion
The present empirical study, conducted in Bulgarian social and cultural envi-
ronment, indicates the following main fi ndings. On the basis of the results it can be
concluded that participants did not demonstrate high levels of cyberchondria and
health anxiety aroused by seeking health information online. The Internet addiction
score was just in the group characterized with problematic control over Internet use.
Signifi cant relationships were indentifi ed between Internet addiction, health anxi-
ety aroused by seeking health information online, and escalation of concerns and per-
sistence of concerns as aspects of cyberchondria. Excessive use of the Internet, search-
ing for health information on the Internet, and subsequent worries for the personal
health, appear to be all associated with one another. Further looking into the relation-
ships between these phenomena and subjective well-being, eudaimonic well-being,
self-esteem and depression, the following was established. Elevated levels of Internet
addiction are associated with lower eudaimonic well-being, subjective well-being and
self-esteem and higher depressive affect. The same relationships were registered for
escalation of health concerns following a web search. As far as health anxiety con-
nected with health information online is concerned, it is associated with decreased
eudaimonic well-being and self-esteem, and with increased depressive affect.
Eudaimonic well-being is associated with perceived positive infl uence of the
Internet on personal life. Furthermore, negative infl uence of the Internet on life is
connected with lower levels of eudaimonic well-being and self-esteem and higher
levels of depression. The more people with whom a user communicates via the In-
ternet, the higher eudaimonic well-being, self-esteem and positive infl uence of the
Internet are registered. The results suggest that communicating with a lot of people
whom the user does not personally know is associated with perceived negative in-
fl uence of the Internet. On the other hand, meeting in person the people originally
met on the Internet, turning them into a part of the real life, is connected with per-
ceived positive infl uence of the Internet.
The present study builds on previous research regarding Internet use, health
anxiety, cyberchondria and well-being by revealing relationships between the phe-
nomena in Bulgarian environment, without the claim to generalise the results.

69
Journal of Education Culture and Society No. 1_2013
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