The relationship between neuroticism and cyberchondria: the mediating role of intolerance of uncertainty and metacognitive beliefs about health

The relationship between neuroticism and cyberchondria: the mediating role of intolerance of uncertainty and metacognitive beliefs about health | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The relationship between neuroticism and cyberchondria: the mediating role of intolerance of uncertainty and metacognitive beliefs about health Seyedeh Serveh Torabi, Parisa Pourmohammad This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6675727/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract The present study aimed to examine the mediating role of intolerance of uncertainty and health-related metacognitive beliefs in the association between neuroticism and cyberchondria. In this cross-sectional study, 396 students from the University of Tabriz in Iran were recruited through online advertisements. Participants completed self-report questionnaires, including the Cyberchondria Severity Scale (CSS), the Revised NEO Personality Inventory (NEO-PI-R), the Intolerance of Uncertainty Scale (IUS-12), and the Meta-Cognitions about Health Questionnaire (MCQ-HA). Data were analyzed using Pearson correlation analysis and mediation analysis via the PROCESS macro. The results indicated a significant positive association between neuroticism and cyberchondria (r = .25, p < .01), neuroticism and intolerance of uncertainty (r = .31, p < .01), and neuroticism and metacognitive beliefs about health (r = .37, p < .01). Additionally, a significant positive correlation was found between intolerance of uncertainty and cyberchondria (r = .31, p < .01), as well as between metacognitive beliefs about health and cyberchondria (r = .32, p < .01). Mediation analysis with 5,000 bootstrap resamples revealed that intolerance of uncertainty (95% CI [0.0882, 0.3744]) and metacognitive beliefs (95% CI [0.1186, 0.3277]) positively mediated the association between neuroticism and cyberchondria. By confirming the mediating roles of intolerance of uncertainty and metacognitive beliefs about health in the relationship between neuroticism and cyberchondria, our findings highlight the importance of addressing these variables in developing preventive and therapeutic interventions for cyberchondria. cyberchondria intolerance of uncertainty metacognitive beliefs neuroticism Figures Figure 1 Introduction In recent times, the utilization of the Internet to access health-related information has become progressively widespread ( 1 ). Approximately 60 to 80% of internet users explore the internet for health information ( 2 , 3 ). Searching for health information online can accelerate health anxiety. Consequently, instead of reducing fear, users might panic more, and a behavior pattern called "cyberchondria" may develop ( 4 , 5 ). Cyberchondria is a form of online search in which a person excessively and repeatedly investigates for health-related information, and the acquisition of this information is linked to heightened apprehension and distress about health, potentially leading to cyberchondria ( 6 – 8 ). As a multi-dimensional structure, Cyberchondria encompass four components: repetition (excessive searching), distress (experiencing negative emotions while surfing on the Internet), disruption in daily life, and increasing reassurance seeking ( 9 ). Overall, there are two primary ways to define cyberchondria. The first perspective highlights the link between health anxiety and the concept of cyberchondria as an extreme or repetitive engagement with online medical information searching, which is associated with heightened health anxiety and concern ( 7 ). The second perspective is more expansive, suggesting that cyberchondria resembles a syndrome and is a multidimensional phenomenon, incorporating both "anxiety" and a "compulsion" component ( 10 ). It is assumed that some personality characteristics are more prone to developing cyberchondria ( 11 ). This is compatible with the research demonstrating that the five-factor model of personality is associated with various mental health disorders the five-factor model of personality is associated with various mental health disorders ( 12 ). Neuroticism, one of the five dimensions of personality, represents a genetic and temperamental predisposition to dysfunction and is associated with a proneness to experience unfavorable feelings such as fear, despair, and rage, as well as maladaptive thoughts and behaviors ( 13 ). Studies have shown that neuroticism is considered a higher-level vulnerability factor to approximately every psychological pathology in children, youth, and adults ( 14 ). It has also been proven that high neuroticism is connected to more negative beliefs about health ( 15 ), online research about health ( 15 ), excessive Internet use ( 14 ), and internet addiction ( 14 ). Neuroticism is associated with a propensity to feel anxiety, stress, aggression, sadness, and low self-worth. ( 16 ) and has demonstrated an association with various psychiatric disorders such as MDD, anxiety disorders, and OCD ( 14 ), it is conceivable to consider its unique role in the evolution of cyberchondria ( 16 ). So far, various studies have identified a relationship between neuroticism and cyberchondria ( 14 , 17 ). For instance, one study involving 880 healthy individuals, demonstrated that neuroticism predicts cyberchondria ( 18 ). Additionally, some studies have established a relationship between neuroticism and health-related search behaviors ( 17 ), ( 19 ). However, several studies suggest no direct relationship between neuroticism and cyberchondria, indicating that this relationship is indirect and mediated by other variables ( 15 ). However, studies addressing the mediating variables between high neuroticism and cyberchondria are rare. One potential mediator is the intolerance of uncertainty. The intolerance of uncertainty refers to the difficulty individuals encounter in managing distressing responses that arise from the perception of insufficient, crucial, and salient information coupled with a sense of uncertainty ( 20 ). It encompasses behavioral responses such as compulsive information seeking, cognitive responses like unreasonable beliefs regarding uncertainty, and emotional responses including feelings of distress and frustration when confronted with uncertain circumstances ( 21 ). It can also be viewed as a cognitive bias that affects individual's understanding, interpretation, and reactions to unconfident circumstances in emotional, cognitive, and behavioral aspects ( 22 ). The integrated model of intolerance of uncertainty posits that personality traits can either mitigate or exacerbate an individual's response to perceived uncertainties ( 23 ). Specifically, research has indicated that individuals with elevated psychotic personality traits tend to experience heightened negative emotions and distress in uncertain situations ( 14 ). As a result, they demonstrate a greater degree of intolerance to uncertainty when encounter ambiguous, threatening, or distressing health information ( 24 ). Several studies have established a positive association between neuroticism and intolerance of uncertainty ( 20 , 24 , 25 ). Additionally, the intolerance of uncertainty is associated with worry, rumination, and compulsive behaviors and is considered a meta-diagnostic factor for anxiety and mood disorders ( 21 , 26 ). A meta-analysis has further demonstrated a positive relationship between intolerance of uncertainty and increased anxiety levels ( 14 , 17 , 27 ). Specifically, some studies have indicated that an inability to tolerate increased uncertainty predicts health anxiety ( 28 ) and may also serve as a vulnerability factor for excessive online searching for health-related information ( 8 ). Studies have revealed that individuals with elevated levels of intolerance to uncertainty tend to engage frequently in online searches for information, thereby participating in cyberchondriac behaviors as a strategy to alleviate uncertainty ( 3 , 14 , 29 ). So far, the mediating effect of intolerance of uncertainty in the association between neuroticism and cyberchondria has been investigated solely in one study by ( 14 ). Further research is required to examine this relationship in greater depth. Neuroticism, as a background mood state, can also trigger maladaptive metacognitive responses ( 15 ). Metacognitions encompass strategies, information, and methods used to monitor or regulate an individual's cognitive processes ( 30 ). According to the metacognitive model of psychological disorders, the cognitive-attentional syndrome involves a pattern of thinking that leads to ineffective internal responses, such as threat monitoring, thought inhibition, attempts to suppress thoughts, and avoidance, where these responses ultimately contribute to the persistence of negative emotions and reinforce negative beliefs ( 31 ). Thus far, frequent studies have demonstrated the role of metacognitions in Axis I disorders ( 32 ). Some studies have also identified a relationship between metacognitive beliefs and addictive behaviors, including problematic Internet surfing ( 33 ). Additionally, metacognitions correlate with attentional biases toward threats ( 34 ), and individuals with dysfunctional metacognitions might perceive promising information about health as threatening ( 35 ). Several researches have also indicated that that metacognitions predict health anxiety and its various aspects, including beliefs about illness, physical complaints, and frequent medical consultations ( 15 , 30 ). For instance, in one study, researchers ( 36 ) identified a relationship between negative metacognitions, such as the perceived uncontrollability of thoughts, and an increased risk of worry associated with health anxiety. Hence, it can be proposed that individuals with metacognitive beliefs are more likely to be concerned about their health and seek medical information online to alleviate their health anxiety ( 2 ). Consequently, they may report higher levels of anxiety and engage in behaviors related to cyberchondria more frequently than typical users ( 37 , 38 ). Furthermore, metacognitions associated with health anxiety and health cognition, by activating ineffective thinking patterns about health, can lead individuals to exhibit cyberchondriac behaviors in response to health-related stimuli ( 39 ). One study on 500 participants by ( 30 ) demonstrated that metacognitive beliefs, particularly biased thinking and perceived uncontrollability of thoughts, are strongly associated with symptoms of cyberchondria. Additionally, in a mediating-moderating model, metacognitive beliefs were observed to moderate the relationship between health anxiety and cyberchondria ( 30 ). To date, the role of neuroticism, as a personality trait associated with emotional distress, has been explored in only a few studies within research literature on cyberchondria. Therefore, additional study is crucial for a more comprehensive understanding of its link to cyberchondria. Furthermore, the mediating role of intolerance of uncertainty in the relationship between neuroticism and cyberchondria has been examined in only one study ( 14 ). However, the mediating effect of metacognitive beliefs in this relationship has not been investigated. Accordingly, the present study aims to explore the mediating effects of intolerance of uncertainty and metacognitive beliefs about health in the association between neuroticism and cyberchondria. We hypothesize that neuroticism influences cyberchondria by intensifying intolerance of uncertainty and metacognitive beliefs about health. Methods Participants In the current cross-sectional study, 396 students of Tabriz University in Iran were recruited by convenience sampling method. Age over 18 years and access to the internet were the inclusion criteria and incomplete completion of the questionnaires was considered as the exclusion criterion. The sample included 324 women and 72 men with a mean age of 23.16 years and a standard deviation of 5.236. Two hundred and seventy-six individuals in the sample were bachelor's students, 81 were master's students, and 39 were doctoral students (see Table 1 ). Procedure The present study is part of the master's thesis of the first author in clinical psychology at the Azad University of Medical Sciences, Tabriz, Iran. The research plan was approved by the Research Ethics Committee of Tabriz Azad University of Medical Sciences (IR.IAU.TABRIZ.REC.1402.247). Sampling took place from April 2024 to June 2024 using internet advertising. Participants completed the questionnaires online. The informed consent form, in which the goals and process of the research were presented, was signed by the participants before participating in the study. In addition, in cases where participants were willing to receive the test results, they also registered their contact information and were informed of their results upon completion of the study. Measures Cyberchondria Severity scale (CSS) This 33-item self-report scale consists of four subscales of compulsion, stress, excess, reassurance, and distrust ( 10 ). In addition to a general score, this questionnaire also gives a separate rating for each of its four components ( 9 ). In this study, the Persian version of this material was used, which showed respectable internal consistency (Cronbach's alpha for compulsion: 0.86, distress: 0.86, reassurance/distrust: 0.82, and excessive behavior: 0.81) and acceptable validity ( 40 ). Revised NEO Personality Inventory (NEO-PI-R) The Neuroticism subscale of Revised NEO Personality Inventory ( 41 ) was used in this study. This subscale consists of 12 items with five-point Likert scale. In the current study, the Persian version of this questionnaire was used, the validity and reliability of which were confirmed ( 42 ). Intolerance of Uncertainty Scale (IUS-12) This 12-item self-report scale ( 43 ) includes two components: inhibitory anxiety and prospective anxiety. It is rated on a 5-point Likert scale, and the total score is calculated by summing all the items. For this study, the Persian version of the scale was used, which has been found to have acceptable validity and reliability ( 44 ). Meta-Cognitions about Health questionnaire (MCQ-HA) This 14-item self-report scale ( 45 ) measures metacognitive health beliefs related to health anxiety. Responses are scored using a four-point Likert scale (1 = disagree and 4 = strongly agree). This scale comprises three subscales: ( 1 ) the belief that thoughts can lead to illness (MCQ-HAC), ( 2 ) the belief regarding biased thinking (MCQ-HAB), and ( 3 ) the belief that thoughts are beyond one's control (MCQ-HAU). We utilized the Persian version of this questionnaire which has demonstrated good psychometric properties ( 46 ). Statistical analyses In the first part, Pearson's correlation analysis was conducted to investigate the association between main variables using SPSS-22. Before performing this analysis, the assumptions of parametric statistics were examined. The PROCESS macro for SPSS (Model 4, with 5000 re-samplings) ( 47 ) was also used to examine mediation hypotheses. In parallel mediation analyses, neuroticism was included in the model as an independent variable, metacognitive beliefs about health and intolerance of uncertainty as mediators, and cyberchondria as a dependent variable. The examined model is presented in Figure (1). Results The mean age of the sample was 23.16 years, with the standard deviation of 5.236. Most participants (82%) were female undergraduate students. Table 1 presents descriptive and demographic information of the sample. Table 1 Demographic and descriptive characteristics of the studied variables variable N (%) M (S.D.) Skewness Kurtosis gender female 324 (81.8) male 72 (18.2) Age 18–23 252 (63.6) 24–29 91 (.23) 30–35 39 (9.8) 36–40 8 ( 2 ) 41–50 6 (1.5) degree Bachelor 276 (69.7) senior 89 (22.5) Doctoral 31 (7.8) Cyberchondria - 79/31 (17.76) 0.60 -0.072 neuroticism - 23/29 (7.08) 0.52 -0.228 metacognitive belief - 27/72 (6.65) 0.430 0.058 Intolerance of Uncertainty - 37/51 (8.01) -0.022 0.113 Note. M = Mean, S.D.=Standard. Deviation Correlation Analysis As shown in Table 2 , Pearson's correlation analysis revealed a significant positive association between neuroticism and cyberchondria (r = .25, p < .01), and between neuroticism and the intolerance of uncertainty (r = .31, p < .01). ) and between neuroticism and metacognitive beliefs about health (r = .37, p < .01). Additionally, a significant positive correlation was found between the intolerance of uncertainty and cyberchondria (r = .31, p < .01) and between metacognitive beliefs about health and cyberchondria (r = .32, p < .01). Table 2 Pearson correlation among the main study variables 1 2 3 4 1. Cyberchondria - 2. neuroticism .25 ** - 3. Intolerance of Uncertainty .31 ** .51 ** - 4. metacognitive beliefs .37 ** .30 ** .32 ** - P < 0.01** Mediation Analysis: A parallel multiple mediation analysis was conducted where neuroticism was considered as an independent variable (X), intolerance of uncertainty (M1) and metacognitions about health (M2) as mediating variables, and cyberchondria (Y) as a dependent variable. As shown in Table 3 , neuroticism had a significant positive effect on intolerance of uncertainty (b = 0.678, p < .001). Furthermore, intolerance of uncertainty demonstrated a significant positive impact on cyberchondria severity (b = 0.391, p < .001). The total effect of neuroticism on cyberchondria was significant (b = 0.609, p < .001). However, the direct effect of neuroticism on cyberchondria was not significant (b = 0.169, p = .203). The indirect effect of neuroticism on cyberchondria through intolerance of uncertainty, using 5000 bootstrap resampling, revealed that intolerance of uncertainty had a positive mediation effect on the relationship between neuroticism and cyberchondria (a1b1 = 0.226, bootstrap 95% CI = 0.088 to 0.374). Furthermore, neuroticism predicted metacognitive beliefs (p < .001, b = 0.271), and metacognitive beliefs positively and significantly predicted cyberchondria (p < .001, b = 0.786). According to Table 3 , the analysis of the indirect effect of neuroticism on cyberchondria through metacognitive health beliefs, based on 5000 bootstrap resampling, indicated that metacognitive beliefs positively mediated the association between neuroticism and cyberchondria (a2b2 = 0.12, bootstrap 95% CI = 0.118 to 0.327) Table 3 Summary of Parallel Mediation Model. paths Effects Boot-LLCI Boot-ULCI SE P X-M1(a 1 ) .678 .480 .675 .495 .001 M1-Y(b1) .391 .161 .622 .117 .009 X-M2(a2) .271 .186 .357 .043 001 M2-Y(b2) .786 .524 1.04 .113 001 X-M1-Y(a1b1) .226 .088 .374 .074 001 X-M2-Y (a2b2) .213 .118 .327 .053 001 Total effect (C) .609 .373 .845 .120 001 Direct effect (c') .169 − .091 .429 .132 .203 Note . SE = standard error, X = independent variable (Neuroticism), Y = dependent variable (Cyberchondria), M1 = mediator1 (intolerance of Uncertainty), M2 = mediator2 (metacognitive beliefs), Boot-LLCI = lower limit bootstrap confidence interval, Boot-ULCI = upper limit bootstrap confidence interval. Discussion This study sought to examine the mediating role of intolerance of uncertainty and metacognitive beliefs in the relationship between neuroticism and cyberchondria. The findings revealed a positive relationship between neuroticism and metacognitive beliefs, intolerance of uncertainty, and cyberchondria. While the direct impact of neuroticism on cyberchondria was not significant, both the total and indirect effects were found to be significant. Additionally, the mediation analysis revealed that intolerance of uncertainty and metacognitive beliefs about health mediated the association between neuroticism and cyberchondria. Several studies have replicated our findings about the positive relationship between neuroticism and cyberchondria ( 15 , 17 , 18 ). Individuals with heightened neuroticism are more prone to experiencing anxiety and worry, and they may take longer to return to their emotional baseline ( 16 ). High levels of neuroticism linked to increased anxiety regarding health-related concerns ( 48 ). Furthermore, it has been suggested that these health concerns are associated with health-related online searches ( 49 ). It can be argued that cyberchondria refers to a recurring behavior of searching for health information online, which is linked to increased concern and distress about one’s health ( 7 ). Our findings align with established perspectives on the association between Big Five personality dimensions and various psychiatric disorders ( 14 ). Individuals with elevated neuroticism tend to overrate the likelihood of developing the disease, perceive themselves as incapable of managing its effects, and anticipate negative outcomes that heighten their anxiety and distress ( 15 ). One way to address these concerns is to seek health-related information online ( 15 ). Although these searches are conducted to alleviate anxiety and discomfort regarding health, they often lead to an increase in anxiety and the development subsequent repetitive search behaviors for medical information ( 50 ). Several studies have demonstrated a genetic connection between neuroticism and obsessive-compulsive behaviors ( 51 , 52 ) In the first mediation model, intolerance of uncertainty positively mediated the association between neuroticism and cyberchondria. Individuals with neuroticism often experience a heightened fear of the unknown when confronted with health-related issues, which can lead to cyberchondria-an excessive and anxiety-driven search for health information online ( 14 ). Our findings on the positive relationship between neuroticism and the intolerance of uncertainty are consistent with several previous studies ( 14 , 24 , 26 , 53 ). Neuroticism increases sensitivity to stimuli ( 26 ), and individuals with heightened neuroticism often experience distress in response to uncertain situations ( 24 ). A person with intolerance to uncertainty and high levels of neuroticism tends to exaggerate negative feelings regarding uncertain future events ( 26 ). Therefore, it appears that people with a high level of neuroticism exhibit greater difficulty tolerating uncertainty when confronted with uncertain, threatening, and distressing medical information ( 14 , 24 ). On the other hand, individuals who are intolerant of uncertainty assume that uncertainty is distressing, that uncertainty about the future is intolerable, that that unanticipated occurrences are negative and should be avoided, and uncertainty leads to a person's inability to act ( 54 ). Searching for health information online may serve as a reassurance-seeking behavior for individuals with an intolerance of uncertainty attempting to gain certainty about their physical symptoms. This behavior aims to reduce anxiety; however, if it fails, it can lead to increased anxiety and further information-seeking ( 55 ). As a result, cyberchondria may develop due to an intolerance of uncertainty. The relationship between the intolerance of uncertainty and cyberchondria has also been demonstrated in several previous studies ( 21 , 29 , 55 – 57 ). Also, individuals with high intolerance of uncertainty exhibit a negative and distorted bias in threat assessment. This set of negative beliefs contributes to developing pessimistic views about the future, which can hinder performance and result in cognitive avoidance ( 58 ). Essentially, individuals who encounter ambiguities regarding physical symptoms often turn to the internet as a resource due to their limited understanding of medical science. However, this search process can be time-consuming, as they tend to read through multiple articles for information. Because the internet offers various explanations, this search often proves ineffective. Consequently, the individual seeks more comprehensive information. However, this only creates a cycle of ambiguity and further searching, which can contribute to the development of cyberchondria ( 57 ). The second path indicated that metacognitions positively mediate the association between neuroticism and cyberchondria. Accordingly, high levels of neuroticism initiate increased metacognitive beliefs about health, which, in turn, result in increased cyberchondria. Studies have shown that neuroticism is a potential basis for triggering maladaptive metacognitions ( 33 , 59 ). Indeed, it has been argued that specific temperament traits may contribute to the development of dysfunctional metacognition ( 60 ). Given that mental distress is one of the underlying factors contributing to cyberchondria, metacognitive beliefs may exacerbate anxiety and the emergence of cyberchondria symptoms ( 15 , 61 ). Maladaptive metacognition induces maintaining a specific cognitive processing and attention focus style known as cognitive-attentional syndrome (CAS). CAS generates the prolongation of negative emotional states as a symptom of emotional disorders through association with repetitive thinking about the past or future (rumination, worry), focusing attention on threats, and choosing coping strategies such as avoidance or reassurance-seeking ( 60 ). In fact, neuroticism causes individuals to respond to stressful life events with feelings of distress and helplessness. To alleviate these unpleasant states, they often attempt to identify stressful events. This observation of stressful events, on the one hand, activates positive metacognitive beliefs ( 62 ), while on the other hand, it places the individual in a heightened state of alertness to avoid stressful situations and events ( 63 , 64 ). However, in the long term, avoidance coping is an ineffective strategy for preventing stressful events because a person cannot avoid all negative experiences ( 64 ). In such cases, negative metacognitions about the uncontrollability and danger of thought may be triggered ( 63 ). The positive relationship between neuroticism and metacognitive beliefs has been replicated in several studies ( 15 , 54 , 59 , 65 ). Regarding neuroticism is linked to elevated psychological desperation and maladaptive coping strategies ( 66 ), individuals with heightened neuroticism often develop more pessimistic views regarding their physical health ( 15 ). Additionally, metacognitive beliefs about health are apparent in conditions like health anxiety and cyberchondria ( 17 ). Individuals with negative metacognitive beliefs may seek information about diseases to alleviate the uncertainty and inadequacy of their knowledge. During this process, there is a possibility that the person may encounter threatening information or become involved in various guarantees that arise from online searches. These negative metacognitions not only lead to cyberchondria but also predict cognitive biases of health-related information. These cognitive distortions are closely linked to addictive behaviors, particularly evident in cyberchondria, characterized by frequent online medical searches ( 15 ). These beliefs, particularly those concerning the uncontrollability of thoughts, create a cycle of self-regulatory inconsistency that ultimately results in negative emotions (such as worry, sadness, and anxiety), as well as increased problematic use of the Internet ( 67 ). Consistent with our findings, the research by ( 61 ) and ( 30 ) indicates that metacognitive beliefs, including biased beliefs regarding the uncontrollability of cyberchondria thoughts, serve as predictors. The positive association between metacognitions and cyberchondria has been reported in the studies of ( 15 , 68 ). The findings of this research on the mediating role of intolerance of uncertainty and metacognitive beliefs about health in the relationship between neuroticism and cyberchondria indicate that cyberchondria is multifactorial, with a combination of temperamental, cognitive, and emotional factors contributing to its development. Therefore, therapeutic interventions should be integrated. As a therapeutic goal, modifying metacognitive beliefs and increasing tolerance for uncertainty can be associated with the reduction in hypochondriacal behaviors. Limitations and Suggestions The current used a cross-sectional design. It is not possible to make definite conclusions about causality. In this study, the variables were measured with self-report measures, which are vulnerable to bias. Additionally, considering that the sample group primarily consisted of female students, different results may be observed in a group with a majority of male participants or an equal distribution of women and men. It is suggested that future studies examine the moderating role of gender and Internet addiction in this mediation model. Declarations Ethics approval and consent to participate This study was approved by the Research Ethics Committee of Tabriz Azad University of Medical Sciences (IR.IAU.TABRIZ.REC.1402.247). All Participants gave written consent to participate in the study after being informed of the study objective and procedure. We confirm that All procedures of this study, were in accordance with 1964 Helsinki Declaration and its later amendments. Consent for publication Not applicable. Competing interests The authors have no competing interests to declare that are relevant to the content of this article. Funding No funding was received to assist with the preparation of this manuscript. Author Contribution P.P. conceived the original idea, designed and directed the project, and developed the theoretical framework; S. S.T. contributed to sample preparation; S.S.T. carried out the implementation; P.P. and S.S.T. performed the analytic calculations; P.P. and S.S.T. wrote the article. Both authors helped shape the research, analysis, and manuscript. Acknowledgement We would like to appreciate all the research participants. Data Availability The data supporting the results of this study are available from the corresponding author upon reasonable request. References Jungmann SM, Gropalis M, Schenkel SK, Witthöft M. Is Cyberchondria specific to Hypochondriasis? J Anxiety Disord. 2023:102798. Hashemi SGS, Hosseinnezhad S, Dini S, Griffiths MD, Lin C-Y, Pakpour AH. The mediating effect of the cyberchondria and anxiety sensitivity in the association between problematic internet use, metacognition beliefs, and fear of COVID-19 among Iranian online population. Heliyon. 2020;6(10). Berle D, Starcevic V, Khazaal Y, Viswasam K, Hede V, McMullan RD. Relationships between online health information seeking and psychopathology. Gen Hosp Psychiatry. 2020;62:96–7. Hu Y, Shao Y, Zhang X, Maguire P, Wang D. Research and Evaluation of a Cyberchondria Severity Scale in a Chinese Context. 2020. Norr AM, Oglesby ME, Raines AM, Macatee RJ, Allan NP, Schmidt NB. Relationships between cyberchondria and obsessive-compulsive symptom dimensions. Psychiatry Res. 2015;230(2):441–6. McMullan RD, Berle D, Arnáez S, Starcevic V. The relationships between health anxiety, online health information seeking, and cyberchondria: Systematic review and meta-analysis. J Affect Disord. 2019;245:270–8. Starcevic V. Cyberchondria: challenges of problematic online searches for health-related information. Psychother Psychosom. 2017;86(3):129–33. Starcevic V, Baggio S, Berle D, Khazaal Y, Viswasam K. Cyberchondria and its relationships with related constructs: A network analysis. Psychiatr Q. 2019;90:491–505. Fergus TA. The Cyberchondria Severity Scale (CSS): an examination of structure and relations with health anxiety in a community sample. J Anxiety Disord. 2014;28(6):504–10. McElroy E, Shevlin M. The development and initial validation of the cyberchondria severity scale (CSS). J Anxiety Disord. 2014;28(2):259–65. Starcevic V, Berle D, Cyberchondria. An old phenomenon in a new guise. Mental health in the digital age: Grave dangers, great promise. 2015:106 – 17. Kotov R, Gamez W, Schmidt F, Watson D. Linking big personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychol Bull. 2010;136(5):768. McCrae RR, Costa PT Jr. The stability of personality: Observations and evaluations. Curr Dir Psychol Sci. 1994;3(6):173–5. Bajcar B, Babiak J. Neuroticism and cyberchondria: The mediating role of intolerance of uncertainty and defensive pessimism. Pers Indiv Differ. 2020;162:110006. Nasiri M, Mohammadkhani S, Akbari M, Alilou MM. The structural model of cyberchondria based on personality traits, health-related metacognition, cognitive bias, and emotion dysregulation. Front Psychiatry. 2023;13:960055. Jeronimus B, Kotov R, Riese H, Ormel J. Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants. Psychol Med. 2016;46(14):2883–906. Fergus TA, Spada MM. Moving toward a metacognitive conceptualization of cyberchondria: Examining the contribution of metacognitive beliefs, beliefs about rituals, and stop signals. J Anxiety Disord. 2018;60:11–9. Maftei A, Holman AC. Cyberchondria during the coronavirus pandemic: the effects of neuroticism and optimism. Front Psychol. 2020;11:567345. Jacobs W, Amuta AO, Jeon KC. Health information seeking in the digital age: An analysis of health information seeking behavior among US adults. Cogent social Sci. 2017;3(1):1302785. Carleton RN. Into the unknown: A review and synthesis of contemporary models involving uncertainty. J Anxiety Disord. 2016;39:30–43. Vujić A, Volarov M, Latas M, Demetrovics Z, Kiraly O, Szabo A. Are cyberchondria and intolerance of uncertainty related to smartphone addiction? Int J Mental Health Addict. 2023:1–19. Karsazi H, Nasiri M, Osfouri M, MAHMOOD AM. Prediction of cyberchondria based on components of anxiety sensitivity and intolerance of uncertainty among students of Tabriz universities in. 2015. 2016. Hillen MA, Gutheil CM, Strout TD, Smets EM, Han PK. Tolerance of uncertainty: Conceptual analysis, integrative model, and implications for healthcare. Soc Sci Med. 2017;180:62–75. Fergus TA, Rowatt WC. Intolerance of uncertainty and personality: Experiential permeability is associated with difficulties tolerating uncertainty. Pers Indiv Differ. 2014;58:128–31. Berenbaum H, Bredemeier K, Thompson RJ. Intolerance of uncertainty: Exploring its dimensionality and associations with need for cognitive closure, psychopathology, and personality. J Anxiety Disord. 2008;22(1):117–25. Yang Z, Wang R, Chen H, Ding J. Personality and worry: The role of intolerance of uncertainty. Social Behav Personality: Int J. 2015;43(10):1607–16. Carleton RN, Desgagné G, Krakauer R, Hong RY. Increasing intolerance of uncertainty over time: The potential influence of increasing connectivity. Cogn Behav Ther. 2019;48(2):121–36. Fergus TA, Bardeen JR. Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety. Pers Indiv Differ. 2013;55(6):640–4. Norr AM, Albanese BJ, Oglesby ME, Allan NP, Schmidt NB. Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria. J Affect Disord. 2015;174:64–9. Nadeem F, Malik NI, Atta M, Ullah I, Martinotti G, Pettorruso M, et al. Relationship between health-anxiety and cyberchondria: Role of metacognitive beliefs. J Clin Med. 2022;11(9):2590. Hjemdal O, Hagen R, Nordahl HM, Wells A. Metacognitive therapy for generalized anxiety disorder: Nature, evidence and an individual case illustration. Cogn Behav Pract. 2013;20(3):301–13. Hamonniere T, Varescon I. Metacognitive beliefs in addictive behaviours: A systematic review. Addict Behav. 2018;85:51–63. Spada MM, Caselli G, Nikčević AV, Wells A. Metacognition in addictive behaviors. Addict Behav. 2015;44:9–15. Kaur A, Butow PN, Sharpe L. Health threat increases attentional bias for negative stimuli. J Behav Ther Exp Psychiatry. 2013;44(4):469–76. Kaur A, Butow P, Thewes B. Do metacognitions predict attentional bias in health anxiety? Cogn Therapy Res. 2011;35:575–80. Bouman TK, Meijer KJ. A preliminary study of worry and metacognitions in hypochondriasis. Clin Psychol Psychotherapy: Int J Theory Pract. 1999;6(2):96–101. Norr AM, Capron DW, Schmidt NB. Medical information seeking: impact on risk for anxiety psychopathology. J Behav Ther Exp Psychiatry. 2014;45(3):402–7. El Sherif R, Pluye P, Thoër C, Rodriguez C. Reducing negative outcomes of online consumer health information: qualitative interpretive study with clinicians, librarians, and consumers. J Med Internet Res. 2018;20(5):e169. Eşkisu M, Çam Z, Boysan M. Health-related cognitions and metacognitions indirectly contribute to the relationships between impulsivity, fear of COVID-19, and Cyberchondria. J Rational-Emot Cognitive-Behav Ther. 2024;42(1):110–32. Sarafraz MR, Pourshahbazi M, Afshari M. Psychometric Properties of Cyberchondria Severity Scale (CSS) in Iranian َAdult Population. J Clin Psychol. 2020;12(3):67–76. Costa PT, McCrae RR. The revised neo personality inventory (neo-pi-r). SAGE Handb personality theory Assess. 2008;2(2):179–98. Roshan Chesly R, Shaeeri M, Atrifard M, Nikkhah A, Ghaem Maghami B, Rahimierad A. Investigating psychometric properties of â NEO-five factor inventoryâ (NEO-FFI). Clin Psychol Personality. 2006;4(1):27–36. Carleton RN, Norton MPJ, Asmundson GJ. Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. J Anxiety Disord. 2007;21(1):105–17. Ahi Q, Hasanzade F, Tabatabaii SS. Relationship shame, self-compassion and intolerance of uncertainty with eating attitudes in female students. J Psychol Achievements. 2019;26(2):179–98. Bailey R, Wells A. Development and initial validation of a measure of metacognitive beliefs in health anxiety: The MCQ-HA. Psychiatry Res. 2015;230(3):871–7. Mohammadkhani S, Akbari M, Shahbahrami M, Seydavi M, Kolubinski DC. Metacognitions about health in relation to coronavirus anxiety: The mediating role of Cognitive Attentional Syndrome And Distress Tolerance. J Rational-Emot Cognitive-Behav Ther. 2023;41(1):222–36. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior research methods, instruments, & computers. 2004;36:717 – 31. Cox BJ, Borger SC, Asmundson GJ, Taylor S. Dimensions of hypochondriasis and the five-factor model of personality. Pers Indiv Differ. 2000;29(1):99–108. Lagoe C, Atkin D. Health anxiety in the digital age: An exploration of psychological determinants of online health information seeking. Comput Hum Behav. 2015;52:484–91. Bordbar FT, Esmaili M. The Relationship between Health Literacy and Cyberchondria Based on the Mediating Role of Health Anxiety. J Tolooebehdasht. 2023. Hur Y-M. Genetic and environmental covariations among obsessive–compulsive symptoms, neuroticism, and extraversion in South Korean adolescent and young adult twins. Twin Res Hum Genet. 2009;12(2):142–8. Bergin J, Verhulst B, Aggen SH, Neale MC, Kendler KS, Bienvenu OJ, et al. Obsessive compulsive symptom dimensions and neuroticism: an examination of shared genetic and environmental risk. Am J Med Genet Part B: Neuropsychiatric Genet. 2014;165(8):647–53. Clarke E, Kiropoulos LA. Mediating the relationship between neuroticism and depressive, anxiety and eating disorder symptoms: The role of intolerance of uncertainty and cognitive flexibility. J Affect Disorders Rep. 2021;4:100101. van der Heiden C, Melchior K, Muris P, Bouwmeester S, Bos AE, van der Molen HT. A hierarchical model for the relationships between general and specific vulnerability factors and symptom levels of generalized anxiety disorder. J Anxiety Disord. 2010;24(2):284–9. Fergus TA. Cyberchondria and intolerance of uncertainty: examining when individuals experience health anxiety in response to Internet searches for medical information. Cyberpsychology Behav Social Netw. 2013;16(10):735–9. Nesibe GM, Ceylan B. Intolerance to Uncertainty and Cyberchondria During the COVID-19 Pandemic. Int J Caring Sci. 2022;15(2):1556–64. Mohammadinia N, Nasehi A, Niusha B. Predicting Health Anxiety Based on Intolerance of Uncertainty: Investigating the Mediating Role of Cognitive Flexibility and Cyberchondria in Breast Cancer Survivors. Iran J Breast Dis. 2023;16(3):65–79. Alizadehfard S, Alipour A. The path analysis model in prediction of corona phobia based on intolerance of uncertainty and health anxiety. J Res Psychol Health. 2020;14(1):16–27. Dragan M, Dragan WŁ, Kononowicz T, Wells A. On the relationship between temperament, metacognition, and anxiety: independent and mediated effects. Anxiety Stress Coping. 2012;25(6):697–709. Dragan M, Dragan W. Temperament and anxiety: The mediating role of metacognition. J Psychopathol Behav Assess. 2014;36:246–54. Marino C, Fergus TA, Vieno A, Bottesi G, Ghisi M, Spada MM. Testing the Italian version of the Cyberchondria Severity Scale and a metacognitive model of cyberchondria. Clin Psychol Psychother. 2020;27(4):581–96. Morrison AP, Pyle M, Chapman N, French P, Parker SK, Wells A. Metacognitive therapy in people with a schizophrenia spectrum diagnosis and medication resistant symptoms: a feasibility study. J Behav Ther Exp Psychiatry. 2014;45(2):280–4. Singer AR, Dobson KS. An experimental investigation of the cognitive vulnerability to depression. Behav Res Ther. 2007;45(3):563–75. Besharat M, Baharamizade H, Fati L, Hasanabadi H. Mediating role of metacognitive beliefs and anxiety sensitivity on the relationship between nauroticism with comorbidity of anxiety and depression. J Appl Psychol. 2015;9(34):7–23. Spada MM, Gay H, Nikčevic AV, Fernie BA, Caselli G. Meta-cognitive beliefs about worry and pain catastrophising as mediators between neuroticism and pain behaviour. Clin Psychol. 2016;20(3):138–46. Widiger TA, Oltmanns JR. Neuroticism is a fundamental domain of personality with enormous public health implications. World psychiatry. 2017;16(2):144. Bailey R, Wells A. Metacognitive beliefs moderate the relationship between catastrophic misinterpretation and health anxiety. J Anxiety Disord. 2015;34:8–14. Fergus TA, Spada MM, Cyberchondria. Examining relations with problematic Internet use and metacognitive beliefs. Clin Psychol Psychother. 2017;24(6):1322–30. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 05 Jul, 2025 Reviewers invited by journal 25 Jun, 2025 Editor invited by journal 26 May, 2025 Editor assigned by journal 20 May, 2025 Submission checks completed at journal 20 May, 2025 First submitted to journal 15 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6675727","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":477635971,"identity":"e69a6d65-927c-4545-aefb-c5c7c3b03491","order_by":0,"name":"Seyedeh Serveh Torabi","email":"","orcid":"","institution":"TaMS.C., Islamic Azad University","correspondingAuthor":false,"prefix":"","firstName":"Seyedeh","middleName":"Serveh","lastName":"Torabi","suffix":""},{"id":477635972,"identity":"e0966ecc-5d30-4c95-8d6e-9b0c44da7991","order_by":1,"name":"Parisa Pourmohammad","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+0lEQVRIiWNgGAWjYFADCTDJLMcG5fMQrcWYdC2JDYQUmrMfYHvwse1eNL9089NNN2qs0/vYzxgw/KhhkDHHodmyJ4HdcGZbce7MOcfMbuccS89t48kxYOw5xsAjcwC7FoMDCWzSvG0JuRtuJAC1sB3ObWPIMWDgbWDgkcDhMIPzD2Ba0r/dzvl3OJ2N/40B4198Wm7Abckxu53bdjiBTSLHgBmfLZYzHrYbzjiXkDtzRk7Z7dy+dMM2iWcFh2WOSeDUYs6ffOzBh7KE3H6J9G23c75Zy8v3J298+KbGxh6nwxgY2zBFD8CiCbsWBjackqNgFIyCUTAKwAAAvFNVkOnvgrgAAAAASUVORK5CYII=","orcid":"","institution":"TaMS.C., Islamic Azad University","correspondingAuthor":true,"prefix":"","firstName":"Parisa","middleName":"","lastName":"Pourmohammad","suffix":""}],"badges":[],"createdAt":"2025-05-15 22:08:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6675727/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6675727/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85778654,"identity":"cb7e7053-4d76-4aae-a647-e5c6c2f688a7","added_by":"auto","created_at":"2025-07-01 14:49:45","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":33614,"visible":true,"origin":"","legend":"\u003cp\u003eParallel mediation model of the relationship between neuroticism and Cyberchondria\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6675727/v1/5ebf6f757e4d516894599706.png"},{"id":85779772,"identity":"32feb023-f3fa-458d-b760-ae0924a9d340","added_by":"auto","created_at":"2025-07-01 14:57:50","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":738488,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6675727/v1/4588d7d4-6ba2-42b4-9a7f-56ac98a766a3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The relationship between neuroticism and cyberchondria: the mediating role of intolerance of uncertainty and metacognitive beliefs about health","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIn recent times, the utilization of the Internet to access health-related information has become progressively widespread (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Approximately 60 to 80% of internet users explore the internet for health information (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Searching for health information online can accelerate health anxiety. Consequently, instead of reducing fear, users might panic more, and a behavior pattern called \"cyberchondria\" may develop (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Cyberchondria is a form of online search in which a person excessively and repeatedly investigates for health-related information, and the acquisition of this information is linked to heightened apprehension and distress about health, potentially leading to cyberchondria (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). As a multi-dimensional structure, Cyberchondria encompass four components: repetition (excessive searching), distress (experiencing negative emotions while surfing on the Internet), disruption in daily life, and increasing reassurance seeking (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Overall, there are two primary ways to define cyberchondria. The first perspective highlights the link between health anxiety and the concept of cyberchondria as an extreme or repetitive engagement with online medical information searching, which is associated with heightened health anxiety and concern (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). The second perspective is more expansive, suggesting that cyberchondria resembles a syndrome and is a multidimensional phenomenon, incorporating both \"anxiety\" and a \"compulsion\" component (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIt is assumed that some personality characteristics are more prone to developing cyberchondria (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). This is compatible with the research demonstrating that the five-factor model of personality is associated with various mental health disorders the five-factor model of personality is associated with various mental health disorders (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Neuroticism, one of the five dimensions of personality, represents a genetic and temperamental predisposition to dysfunction and is associated with a proneness to experience unfavorable feelings such as fear, despair, and rage, as well as maladaptive thoughts and behaviors (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Studies have shown that neuroticism is considered a higher-level vulnerability factor to approximately every psychological pathology in children, youth, and adults (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). It has also been proven that high neuroticism is connected to more negative beliefs about health (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), online research about health (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), excessive Internet use (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), and internet addiction (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Neuroticism is associated with a propensity to feel anxiety, stress, aggression, sadness, and low self-worth. (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e) and has demonstrated an association with various psychiatric disorders such as MDD, anxiety disorders, and OCD (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), it is conceivable to consider its unique role in the evolution of cyberchondria (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). So far, various studies have identified a relationship between neuroticism and cyberchondria (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). For instance, one study involving 880 healthy individuals, demonstrated that neuroticism predicts cyberchondria (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Additionally, some studies have established a relationship between neuroticism and health-related search behaviors (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). However, several studies suggest no direct relationship between neuroticism and cyberchondria, indicating that this relationship is indirect and mediated by other variables (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). However, studies addressing the mediating variables between high neuroticism and cyberchondria are rare.\u003c/p\u003e \u003cp\u003eOne potential mediator is the intolerance of uncertainty. The intolerance of uncertainty refers to the difficulty individuals encounter in managing distressing responses that arise from the perception of insufficient, crucial, and salient information coupled with a sense of uncertainty (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). It encompasses behavioral responses such as compulsive information seeking, cognitive responses like unreasonable beliefs regarding uncertainty, and emotional responses including feelings of distress and frustration when confronted with uncertain circumstances (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). It can also be viewed as a cognitive bias that affects individual's understanding, interpretation, and reactions to unconfident circumstances in emotional, cognitive, and behavioral aspects (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). The integrated model of intolerance of uncertainty posits that personality traits can either mitigate or exacerbate an individual's response to perceived uncertainties (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Specifically, research has indicated that individuals with elevated psychotic personality traits tend to experience heightened negative emotions and distress in uncertain situations (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). As a result, they demonstrate a greater degree of intolerance to uncertainty when encounter ambiguous, threatening, or distressing health information (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). Several studies have established a positive association between neuroticism and intolerance of uncertainty (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAdditionally, the intolerance of uncertainty is associated with worry, rumination, and compulsive behaviors and is considered a meta-diagnostic factor for anxiety and mood disorders (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). A meta-analysis has further demonstrated a positive relationship between intolerance of uncertainty and increased anxiety levels (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Specifically, some studies have indicated that an inability to tolerate increased uncertainty predicts health anxiety (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e) and may also serve as a vulnerability factor for excessive online searching for health-related information (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). Studies have revealed that individuals with elevated levels of intolerance to uncertainty tend to engage frequently in online searches for information, thereby participating in cyberchondriac behaviors as a strategy to alleviate uncertainty (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). So far, the mediating effect of intolerance of uncertainty in the association between neuroticism and cyberchondria has been investigated solely in one study by (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Further research is required to examine this relationship in greater depth.\u003c/p\u003e \u003cp\u003eNeuroticism, as a background mood state, can also trigger maladaptive metacognitive responses (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Metacognitions encompass strategies, information, and methods used to monitor or regulate an individual's cognitive processes (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). According to the metacognitive model of psychological disorders, the cognitive-attentional syndrome involves a pattern of thinking that leads to ineffective internal responses, such as threat monitoring, thought inhibition, attempts to suppress thoughts, and avoidance, where these responses ultimately contribute to the persistence of negative emotions and reinforce negative beliefs (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). Thus far, frequent studies have demonstrated the role of metacognitions in Axis I disorders (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). Some studies have also identified a relationship between metacognitive beliefs and addictive behaviors, including problematic Internet surfing (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). Additionally, metacognitions correlate with attentional biases toward threats (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e), and individuals with dysfunctional metacognitions might perceive promising information about health as threatening (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e). Several researches have also indicated that that metacognitions predict health anxiety and its various aspects, including beliefs about illness, physical complaints, and frequent medical consultations (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). For instance, in one study, researchers (\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e) identified a relationship between negative metacognitions, such as the perceived uncontrollability of thoughts, and an increased risk of worry associated with health anxiety. Hence, it can be proposed that individuals with metacognitive beliefs are more likely to be concerned about their health and seek medical information online to alleviate their health anxiety (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Consequently, they may report higher levels of anxiety and engage in behaviors related to cyberchondria more frequently than typical users (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). Furthermore, metacognitions associated with health anxiety and health cognition, by activating ineffective thinking patterns about health, can lead individuals to exhibit cyberchondriac behaviors in response to health-related stimuli (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). One study on 500 participants by (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) demonstrated that metacognitive beliefs, particularly biased thinking and perceived uncontrollability of thoughts, are strongly associated with symptoms of cyberchondria. Additionally, in a mediating-moderating model, metacognitive beliefs were observed to moderate the relationship between health anxiety and cyberchondria (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo date, the role of neuroticism, as a personality trait associated with emotional distress, has been explored in only a few studies within research literature on cyberchondria. Therefore, additional study is crucial for a more comprehensive understanding of its link to cyberchondria. Furthermore, the mediating role of intolerance of uncertainty in the relationship between neuroticism and cyberchondria has been examined in only one study (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, the mediating effect of metacognitive beliefs in this relationship has not been investigated. Accordingly, the present study aims to explore the mediating effects of intolerance of uncertainty and metacognitive beliefs about health in the association between neuroticism and cyberchondria. We hypothesize that neuroticism influences cyberchondria by intensifying intolerance of uncertainty and metacognitive beliefs about health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eIn the current cross-sectional study, 396 students of Tabriz University in Iran were recruited by convenience sampling method. Age over 18 years and access to the internet were the inclusion criteria and incomplete completion of the questionnaires was considered as the exclusion criterion. The sample included 324 women and 72 men with a mean age of 23.16 years and a standard deviation of 5.236. Two hundred and seventy-six individuals in the sample were bachelor's students, 81 were master's students, and 39 were doctoral students (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eProcedure\u003c/h3\u003e\n\u003cp\u003eThe present study is part of the master's thesis of the first author in clinical psychology at the Azad University of Medical Sciences, Tabriz, Iran. The research plan was approved by the Research Ethics Committee of Tabriz Azad University of Medical Sciences (IR.IAU.TABRIZ.REC.1402.247). Sampling took place from April 2024 to June 2024 using internet advertising. Participants completed the questionnaires online. The informed consent form, in which the goals and process of the research were presented, was signed by the participants before participating in the study. In addition, in cases where participants were willing to receive the test results, they also registered their contact information and were informed of their results upon completion of the study.\u003c/p\u003e\n\u003ch3\u003eMeasures\u003c/h3\u003e\n\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eCyberchondria Severity scale (CSS)\u003c/h2\u003e \u003cp\u003eThis 33-item self-report scale consists of four subscales of compulsion, stress, excess, reassurance, and distrust (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In addition to a general score, this questionnaire also gives a separate rating for each of its four components (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). In this study, the Persian version of this material was used, which showed respectable internal consistency (Cronbach's alpha for compulsion: 0.86, distress: 0.86, reassurance/distrust: 0.82, and excessive behavior: 0.81) and acceptable validity (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRevised NEO Personality Inventory (NEO-PI-R)\u003c/h3\u003e\n\u003cp\u003eThe Neuroticism subscale of Revised NEO Personality Inventory (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e) was used in this study. This subscale consists of 12 items with five-point Likert scale. In the current study, the Persian version of this questionnaire was used, the validity and reliability of which were confirmed (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eIntolerance of Uncertainty Scale (IUS-12)\u003c/h2\u003e \u003cp\u003eThis 12-item self-report scale (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e) includes two components: inhibitory anxiety and prospective anxiety. It is rated on a 5-point Likert scale, and the total score is calculated by summing all the items. For this study, the Persian version of the scale was used, which has been found to have acceptable validity and reliability (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMeta-Cognitions about Health questionnaire (MCQ-HA)\u003c/h3\u003e\n\u003cp\u003eThis 14-item self-report scale (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) measures metacognitive health beliefs related to health anxiety. Responses are scored using a four-point Likert scale (1\u0026thinsp;=\u0026thinsp;disagree and 4\u0026thinsp;=\u0026thinsp;strongly agree). This scale comprises three subscales: (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e) the belief that thoughts can lead to illness (MCQ-HAC), (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) the belief regarding biased thinking (MCQ-HAB), and (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e) the belief that thoughts are beyond one's control (MCQ-HAU). We utilized the Persian version of this questionnaire which has demonstrated good psychometric properties (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eStatistical analyses\u003c/h3\u003e\n\u003cp\u003eIn the first part, Pearson's correlation analysis was conducted to investigate the association between main variables using SPSS-22. Before performing this analysis, the assumptions of parametric statistics were examined. The PROCESS macro for SPSS (Model 4, with 5000 re-samplings) (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e) was also used to examine mediation hypotheses. In parallel mediation analyses, neuroticism was included in the model as an independent variable, metacognitive beliefs about health and intolerance of uncertainty as mediators, and cyberchondria as a dependent variable. The examined model is presented in Figure (1).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe mean age of the sample was 23.16 years, with the standard deviation of 5.236. Most participants (82%) were female undergraduate students. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents descriptive and demographic information of the sample.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and descriptive characteristics of the studied variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003evariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eM (S.D.)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSkewness\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eKurtosis\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003egender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003efemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e324 (81.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e72 (18.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e252 (63.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91 (.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39 (9.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u0026ndash;40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e41\u0026ndash;50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003edegree\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e276 (69.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003esenior\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e89 (22.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctoral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (7.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCyberchondria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e79/31 (17.76)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.072\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eneuroticism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23/29 (7.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.228\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emetacognitive belief\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27/72 (6.65)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntolerance of Uncertainty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37/51 (8.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.113\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote. M\u0026thinsp;=\u0026thinsp;Mean, S.D.=Standard. Deviation\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCorrelation Analysis\u003c/h2\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, Pearson's correlation analysis revealed a significant positive association between neuroticism and cyberchondria (r\u0026thinsp;=\u0026thinsp;.25, p\u0026thinsp;\u0026lt;\u0026thinsp;.01), and between neuroticism and the intolerance of uncertainty (r\u0026thinsp;=\u0026thinsp;.31, p\u0026thinsp;\u0026lt;\u0026thinsp;.01). ) and between neuroticism and metacognitive beliefs about health (r\u0026thinsp;=\u0026thinsp;.37, p\u0026thinsp;\u0026lt;\u0026thinsp;.01). Additionally, a significant positive correlation was found between the intolerance of uncertainty and cyberchondria (r\u0026thinsp;=\u0026thinsp;.31, p\u0026thinsp;\u0026lt;\u0026thinsp;.01) and between metacognitive beliefs about health and cyberchondria (r\u0026thinsp;=\u0026thinsp;.32, p\u0026thinsp;\u0026lt;\u0026thinsp;.01).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePearson correlation among the main study variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Cyberchondria\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. neuroticism\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.25\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Intolerance of Uncertainty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.31\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.51\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. metacognitive beliefs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.37\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.30\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.32\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.01**\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eMediation Analysis:\u003c/h2\u003e \u003cp\u003eA parallel multiple mediation analysis was conducted where neuroticism was considered as an independent variable (X), intolerance of uncertainty (M1) and metacognitions about health (M2) as mediating variables, and cyberchondria (Y) as a dependent variable.\u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, neuroticism had a significant positive effect on intolerance of uncertainty (b\u0026thinsp;=\u0026thinsp;0.678, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). Furthermore, intolerance of uncertainty demonstrated a significant positive impact on cyberchondria severity (b\u0026thinsp;=\u0026thinsp;0.391, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). The total effect of neuroticism on cyberchondria was significant (b\u0026thinsp;=\u0026thinsp;0.609, p\u0026thinsp;\u0026lt;\u0026thinsp;.001). However, the direct effect of neuroticism on cyberchondria was not significant (b\u0026thinsp;=\u0026thinsp;0.169, p\u0026thinsp;=\u0026thinsp;.203). The indirect effect of neuroticism on cyberchondria through intolerance of uncertainty, using 5000 bootstrap resampling, revealed that intolerance of uncertainty had a positive mediation effect on the relationship between neuroticism and cyberchondria (a1b1\u0026thinsp;=\u0026thinsp;0.226, bootstrap 95% CI\u0026thinsp;=\u0026thinsp;0.088 to 0.374).\u003c/p\u003e \u003cp\u003eFurthermore, neuroticism predicted metacognitive beliefs (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, b\u0026thinsp;=\u0026thinsp;0.271), and metacognitive beliefs positively and significantly predicted cyberchondria (p\u0026thinsp;\u0026lt;\u0026thinsp;.001, b\u0026thinsp;=\u0026thinsp;0.786). According to Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e, the analysis of the indirect effect of neuroticism on cyberchondria through metacognitive health beliefs, based on 5000 bootstrap resampling, indicated that metacognitive beliefs positively mediated the association between neuroticism and cyberchondria (a2b2\u0026thinsp;=\u0026thinsp;0.12, bootstrap 95% CI\u0026thinsp;=\u0026thinsp;0.118 to 0.327)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of Parallel Mediation Model.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003epaths\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffects\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBoot-LLCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eBoot-ULCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eX-M1(a\u003csub\u003e1\u003c/sub\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.678\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.675\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.495\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM1-Y(b1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.622\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eX-M2(a2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.357\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eM2-Y(b2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.786\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.524\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eX-M1-Y(a1b1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.088\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.374\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.074\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eX-M2-Y (a2b2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.327\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal effect (C)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.609\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDirect effect (c')\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.429\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.203\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cem\u003eNote\u003c/em\u003e. SE\u0026thinsp;=\u0026thinsp;standard error, X\u0026thinsp;=\u0026thinsp;independent variable (Neuroticism), Y\u0026thinsp;=\u0026thinsp;dependent variable (Cyberchondria), M1\u0026thinsp;=\u0026thinsp;mediator1 (intolerance of Uncertainty), M2\u0026thinsp;=\u0026thinsp;mediator2 (metacognitive beliefs), Boot-LLCI\u0026thinsp;=\u0026thinsp;lower limit bootstrap confidence interval, Boot-ULCI\u0026thinsp;=\u0026thinsp;upper limit bootstrap confidence interval.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study sought to examine the mediating role of intolerance of uncertainty and metacognitive beliefs in the relationship between neuroticism and cyberchondria. The findings revealed a positive relationship between neuroticism and metacognitive beliefs, intolerance of uncertainty, and cyberchondria. While the direct impact of neuroticism on cyberchondria was not significant, both the total and indirect effects were found to be significant. Additionally, the mediation analysis revealed that intolerance of uncertainty and metacognitive beliefs about health mediated the association between neuroticism and cyberchondria. Several studies have replicated our findings about the positive relationship between neuroticism and cyberchondria (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Individuals with heightened neuroticism are more prone to experiencing anxiety and worry, and they may take longer to return to their emotional baseline (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). High levels of neuroticism linked to increased anxiety regarding health-related concerns (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Furthermore, it has been suggested that these health concerns are associated with health-related online searches (\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e). It can be argued that cyberchondria refers to a recurring behavior of searching for health information online, which is linked to increased concern and distress about one\u0026rsquo;s health (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Our findings align with established perspectives on the association between Big Five personality dimensions and various psychiatric disorders (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Individuals with elevated neuroticism tend to overrate the likelihood of developing the disease, perceive themselves as incapable of managing its effects, and anticipate negative outcomes that heighten their anxiety and distress (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). One way to address these concerns is to seek health-related information online (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Although these searches are conducted to alleviate anxiety and discomfort regarding health, they often lead to an increase in anxiety and the development subsequent repetitive search behaviors for medical information (\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). Several studies have demonstrated a genetic connection between neuroticism and obsessive-compulsive behaviors (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn the first mediation model, intolerance of uncertainty positively mediated the association between neuroticism and cyberchondria. Individuals with neuroticism often experience a heightened fear of the unknown when confronted with health-related issues, which can lead to cyberchondria-an excessive and anxiety-driven search for health information online (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Our findings on the positive relationship between neuroticism and the intolerance of uncertainty are consistent with several previous studies (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e). Neuroticism increases sensitivity to stimuli (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e), and individuals with heightened neuroticism often experience distress in response to uncertain situations (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). A person with intolerance to uncertainty and high levels of neuroticism tends to exaggerate negative feelings regarding uncertain future events (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Therefore, it appears that people with a high level of neuroticism exhibit greater difficulty tolerating uncertainty when confronted with uncertain, threatening, and distressing medical information (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOn the other hand, individuals who are intolerant of uncertainty assume that uncertainty is distressing, that uncertainty about the future is intolerable, that that unanticipated occurrences are negative and should be avoided, and uncertainty leads to a person's inability to act (\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e). Searching for health information online may serve as a reassurance-seeking behavior for individuals with an intolerance of uncertainty attempting to gain certainty about their physical symptoms. This behavior aims to reduce anxiety; however, if it fails, it can lead to increased anxiety and further information-seeking (\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). As a result, cyberchondria may develop due to an intolerance of uncertainty. The relationship between the intolerance of uncertainty and cyberchondria has also been demonstrated in several previous studies (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan additionalcitationids=\"CR56\" citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e). Also, individuals with high intolerance of uncertainty exhibit a negative and distorted bias in threat assessment. This set of negative beliefs contributes to developing pessimistic views about the future, which can hinder performance and result in cognitive avoidance (\u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). Essentially, individuals who encounter ambiguities regarding physical symptoms often turn to the internet as a resource due to their limited understanding of medical science. However, this search process can be time-consuming, as they tend to read through multiple articles for information. Because the internet offers various explanations, this search often proves ineffective. Consequently, the individual seeks more comprehensive information. However, this only creates a cycle of ambiguity and further searching, which can contribute to the development of cyberchondria (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe second path indicated that metacognitions positively mediate the association between neuroticism and cyberchondria. Accordingly, high levels of neuroticism initiate increased metacognitive beliefs about health, which, in turn, result in increased cyberchondria. Studies have shown that neuroticism is a potential basis for triggering maladaptive metacognitions (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e). Indeed, it has been argued that specific temperament traits may contribute to the development of dysfunctional metacognition (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). Given that mental distress is one of the underlying factors contributing to cyberchondria, metacognitive beliefs may exacerbate anxiety and the emergence of cyberchondria symptoms (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e). Maladaptive metacognition induces maintaining a specific cognitive processing and attention focus style known as cognitive-attentional syndrome (CAS). CAS generates the prolongation of negative emotional states as a symptom of emotional disorders through association with repetitive thinking about the past or future (rumination, worry), focusing attention on threats, and choosing coping strategies such as avoidance or reassurance-seeking (\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e). In fact, neuroticism causes individuals to respond to stressful life events with feelings of distress and helplessness. To alleviate these unpleasant states, they often attempt to identify stressful events. This observation of stressful events, on the one hand, activates positive metacognitive beliefs (\u003cspan citationid=\"CR62\" class=\"CitationRef\"\u003e62\u003c/span\u003e), while on the other hand, it places the individual in a heightened state of alertness to avoid stressful situations and events (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e, \u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). However, in the long term, avoidance coping is an ineffective strategy for preventing stressful events because a person cannot avoid all negative experiences (\u003cspan citationid=\"CR64\" class=\"CitationRef\"\u003e64\u003c/span\u003e). In such cases, negative metacognitions about the uncontrollability and danger of thought may be triggered (\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). The positive relationship between neuroticism and metacognitive beliefs has been replicated in several studies (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e, \u003cspan citationid=\"CR65\" class=\"CitationRef\"\u003e65\u003c/span\u003e). Regarding neuroticism is linked to elevated psychological desperation and maladaptive coping strategies (\u003cspan citationid=\"CR66\" class=\"CitationRef\"\u003e66\u003c/span\u003e), individuals with heightened neuroticism often develop more pessimistic views regarding their physical health (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Additionally, metacognitive beliefs about health are apparent in conditions like health anxiety and cyberchondria (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Individuals with negative metacognitive beliefs may seek information about diseases to alleviate the uncertainty and inadequacy of their knowledge. During this process, there is a possibility that the person may encounter threatening information or become involved in various guarantees that arise from online searches. These negative metacognitions not only lead to cyberchondria but also predict cognitive biases of health-related information. These cognitive distortions are closely linked to addictive behaviors, particularly evident in cyberchondria, characterized by frequent online medical searches (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). These beliefs, particularly those concerning the uncontrollability of thoughts, create a cycle of self-regulatory inconsistency that ultimately results in negative emotions (such as worry, sadness, and anxiety), as well as increased problematic use of the Internet (\u003cspan citationid=\"CR67\" class=\"CitationRef\"\u003e67\u003c/span\u003e). Consistent with our findings, the research by (\u003cspan citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e) and (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e) indicates that metacognitive beliefs, including biased beliefs regarding the uncontrollability of cyberchondria thoughts, serve as predictors. The positive association between metacognitions and cyberchondria has been reported in the studies of (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR68\" class=\"CitationRef\"\u003e68\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe findings of this research on the mediating role of intolerance of uncertainty and metacognitive beliefs about health in the relationship between neuroticism and cyberchondria indicate that cyberchondria is multifactorial, with a combination of temperamental, cognitive, and emotional factors contributing to its development. Therefore, therapeutic interventions should be integrated. As a therapeutic goal, modifying metacognitive beliefs and increasing tolerance for uncertainty can be associated with the reduction in hypochondriacal behaviors.\u003c/p\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eLimitations and Suggestions\u003c/h2\u003e \u003cp\u003eThe current used a cross-sectional design. It is not possible to make definite conclusions about causality. In this study, the variables were measured with self-report measures, which are vulnerable to bias. Additionally, considering that the sample group primarily consisted of female students, different results may be observed in a group with a majority of male participants or an equal distribution of women and men. It is suggested that future studies examine the moderating role of gender and Internet addiction in this mediation model.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003e This study was approved by the Research Ethics Committee of Tabriz Azad University of Medical Sciences (IR.IAU.TABRIZ.REC.1402.247). All Participants gave written consent to participate in the study after being informed of the study objective and procedure. We confirm that All procedures of this study, were in accordance with 1964 Helsinki Declaration and its later amendments.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eCompeting interests\u003c/strong\u003e \u003cp\u003eThe authors have no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003eNo funding was received to assist with the preparation of this manuscript.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eP.P. conceived the original idea, designed and directed the project, and developed the theoretical framework; S. S.T. contributed to sample preparation; S.S.T. carried out the implementation; P.P. and S.S.T. performed the analytic calculations; P.P. and S.S.T. wrote the article. Both authors helped shape the research, analysis, and manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eWe would like to appreciate all the research participants.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe data supporting the results of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eJungmann SM, Gropalis M, Schenkel SK, Witth\u0026ouml;ft M. Is Cyberchondria specific to Hypochondriasis? J Anxiety Disord. 2023:102798.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHashemi SGS, Hosseinnezhad S, Dini S, Griffiths MD, Lin C-Y, Pakpour AH. The mediating effect of the cyberchondria and anxiety sensitivity in the association between problematic internet use, metacognition beliefs, and fear of COVID-19 among Iranian online population. Heliyon. 2020;6(10).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerle D, Starcevic V, Khazaal Y, Viswasam K, Hede V, McMullan RD. Relationships between online health information seeking and psychopathology. Gen Hosp Psychiatry. 2020;62:96\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu Y, Shao Y, Zhang X, Maguire P, Wang D. Research and Evaluation of a Cyberchondria Severity Scale in a Chinese Context. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNorr AM, Oglesby ME, Raines AM, Macatee RJ, Allan NP, Schmidt NB. Relationships between cyberchondria and obsessive-compulsive symptom dimensions. Psychiatry Res. 2015;230(2):441\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcMullan RD, Berle D, Arn\u0026aacute;ez S, Starcevic V. The relationships between health anxiety, online health information seeking, and cyberchondria: Systematic review and meta-analysis. J Affect Disord. 2019;245:270\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStarcevic V. Cyberchondria: challenges of problematic online searches for health-related information. Psychother Psychosom. 2017;86(3):129\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStarcevic V, Baggio S, Berle D, Khazaal Y, Viswasam K. Cyberchondria and its relationships with related constructs: A network analysis. Psychiatr Q. 2019;90:491\u0026ndash;505.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFergus TA. The Cyberchondria Severity Scale (CSS): an examination of structure and relations with health anxiety in a community sample. J Anxiety Disord. 2014;28(6):504\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcElroy E, Shevlin M. The development and initial validation of the cyberchondria severity scale (CSS). J Anxiety Disord. 2014;28(2):259\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eStarcevic V, Berle D, Cyberchondria. An old phenomenon in a new guise. Mental health in the digital age: Grave dangers, great promise. 2015:106\u0026thinsp;\u0026ndash;\u0026thinsp;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKotov R, Gamez W, Schmidt F, Watson D. Linking big personality traits to anxiety, depressive, and substance use disorders: a meta-analysis. Psychol Bull. 2010;136(5):768.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMcCrae RR, Costa PT Jr. The stability of personality: Observations and evaluations. Curr Dir Psychol Sci. 1994;3(6):173\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBajcar B, Babiak J. Neuroticism and cyberchondria: The mediating role of intolerance of uncertainty and defensive pessimism. Pers Indiv Differ. 2020;162:110006.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNasiri M, Mohammadkhani S, Akbari M, Alilou MM. The structural model of cyberchondria based on personality traits, health-related metacognition, cognitive bias, and emotion dysregulation. Front Psychiatry. 2023;13:960055.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeronimus B, Kotov R, Riese H, Ormel J. Neuroticism's prospective association with mental disorders halves after adjustment for baseline symptoms and psychiatric history, but the adjusted association hardly decays with time: a meta-analysis on 59 longitudinal/prospective studies with 443 313 participants. Psychol Med. 2016;46(14):2883\u0026ndash;906.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFergus TA, Spada MM. Moving toward a metacognitive conceptualization of cyberchondria: Examining the contribution of metacognitive beliefs, beliefs about rituals, and stop signals. J Anxiety Disord. 2018;60:11\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaftei A, Holman AC. Cyberchondria during the coronavirus pandemic: the effects of neuroticism and optimism. Front Psychol. 2020;11:567345.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJacobs W, Amuta AO, Jeon KC. Health information seeking in the digital age: An analysis of health information seeking behavior among US adults. Cogent social Sci. 2017;3(1):1302785.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarleton RN. Into the unknown: A review and synthesis of contemporary models involving uncertainty. J Anxiety Disord. 2016;39:30\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVujić A, Volarov M, Latas M, Demetrovics Z, Kiraly O, Szabo A. Are cyberchondria and intolerance of uncertainty related to smartphone addiction? Int J Mental Health Addict. 2023:1\u0026ndash;19.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKarsazi H, Nasiri M, Osfouri M, MAHMOOD AM. Prediction of cyberchondria based on components of anxiety sensitivity and intolerance of uncertainty among students of Tabriz universities in. 2015. 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHillen MA, Gutheil CM, Strout TD, Smets EM, Han PK. Tolerance of uncertainty: Conceptual analysis, integrative model, and implications for healthcare. Soc Sci Med. 2017;180:62\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFergus TA, Rowatt WC. Intolerance of uncertainty and personality: Experiential permeability is associated with difficulties tolerating uncertainty. Pers Indiv Differ. 2014;58:128\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerenbaum H, Bredemeier K, Thompson RJ. Intolerance of uncertainty: Exploring its dimensionality and associations with need for cognitive closure, psychopathology, and personality. J Anxiety Disord. 2008;22(1):117\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang Z, Wang R, Chen H, Ding J. Personality and worry: The role of intolerance of uncertainty. Social Behav Personality: Int J. 2015;43(10):1607\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarleton RN, Desgagn\u0026eacute; G, Krakauer R, Hong RY. Increasing intolerance of uncertainty over time: The potential influence of increasing connectivity. Cogn Behav Ther. 2019;48(2):121\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFergus TA, Bardeen JR. Anxiety sensitivity and intolerance of uncertainty: Evidence of incremental specificity in relation to health anxiety. Pers Indiv Differ. 2013;55(6):640\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNorr AM, Albanese BJ, Oglesby ME, Allan NP, Schmidt NB. Anxiety sensitivity and intolerance of uncertainty as potential risk factors for cyberchondria. J Affect Disord. 2015;174:64\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNadeem F, Malik NI, Atta M, Ullah I, Martinotti G, Pettorruso M, et al. Relationship between health-anxiety and cyberchondria: Role of metacognitive beliefs. J Clin Med. 2022;11(9):2590.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHjemdal O, Hagen R, Nordahl HM, Wells A. Metacognitive therapy for generalized anxiety disorder: Nature, evidence and an individual case illustration. Cogn Behav Pract. 2013;20(3):301\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHamonniere T, Varescon I. Metacognitive beliefs in addictive behaviours: A systematic review. Addict Behav. 2018;85:51\u0026ndash;63.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpada MM, Caselli G, Nikčević AV, Wells A. Metacognition in addictive behaviors. Addict Behav. 2015;44:9\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaur A, Butow PN, Sharpe L. Health threat increases attentional bias for negative stimuli. J Behav Ther Exp Psychiatry. 2013;44(4):469\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKaur A, Butow P, Thewes B. Do metacognitions predict attentional bias in health anxiety? Cogn Therapy Res. 2011;35:575\u0026ndash;80.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBouman TK, Meijer KJ. A preliminary study of worry and metacognitions in hypochondriasis. Clin Psychol Psychotherapy: Int J Theory Pract. 1999;6(2):96\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNorr AM, Capron DW, Schmidt NB. Medical information seeking: impact on risk for anxiety psychopathology. J Behav Ther Exp Psychiatry. 2014;45(3):402\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEl Sherif R, Pluye P, Tho\u0026euml;r C, Rodriguez C. Reducing negative outcomes of online consumer health information: qualitative interpretive study with clinicians, librarians, and consumers. J Med Internet Res. 2018;20(5):e169.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEşkisu M, \u0026Ccedil;am Z, Boysan M. Health-related cognitions and metacognitions indirectly contribute to the relationships between impulsivity, fear of COVID-19, and Cyberchondria. J Rational-Emot Cognitive-Behav Ther. 2024;42(1):110\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSarafraz MR, Pourshahbazi M, Afshari M. Psychometric Properties of Cyberchondria Severity Scale (CSS) in Iranian َAdult Population. J Clin Psychol. 2020;12(3):67\u0026ndash;76.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCosta PT, McCrae RR. The revised neo personality inventory (neo-pi-r). SAGE Handb personality theory Assess. 2008;2(2):179\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoshan Chesly R, Shaeeri M, Atrifard M, Nikkhah A, Ghaem Maghami B, Rahimierad A. Investigating psychometric properties of \u0026acirc; NEO-five factor inventory\u0026acirc; (NEO-FFI). Clin Psychol Personality. 2006;4(1):27\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarleton RN, Norton MPJ, Asmundson GJ. Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. J Anxiety Disord. 2007;21(1):105\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhi Q, Hasanzade F, Tabatabaii SS. Relationship shame, self-compassion and intolerance of uncertainty with eating attitudes in female students. J Psychol Achievements. 2019;26(2):179\u0026ndash;98.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBailey R, Wells A. Development and initial validation of a measure of metacognitive beliefs in health anxiety: The MCQ-HA. Psychiatry Res. 2015;230(3):871\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohammadkhani S, Akbari M, Shahbahrami M, Seydavi M, Kolubinski DC. Metacognitions about health in relation to coronavirus anxiety: The mediating role of Cognitive Attentional Syndrome And Distress Tolerance. J Rational-Emot Cognitive-Behav Ther. 2023;41(1):222\u0026ndash;36.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePreacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior research methods, instruments, \u0026amp; computers. 2004;36:717\u0026thinsp;\u0026ndash;\u0026thinsp;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCox BJ, Borger SC, Asmundson GJ, Taylor S. Dimensions of hypochondriasis and the five-factor model of personality. Pers Indiv Differ. 2000;29(1):99\u0026ndash;108.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLagoe C, Atkin D. Health anxiety in the digital age: An exploration of psychological determinants of online health information seeking. Comput Hum Behav. 2015;52:484\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBordbar FT, Esmaili M. The Relationship between Health Literacy and Cyberchondria Based on the Mediating Role of Health Anxiety. J Tolooebehdasht. 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHur Y-M. Genetic and environmental covariations among obsessive\u0026ndash;compulsive symptoms, neuroticism, and extraversion in South Korean adolescent and young adult twins. Twin Res Hum Genet. 2009;12(2):142\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBergin J, Verhulst B, Aggen SH, Neale MC, Kendler KS, Bienvenu OJ, et al. Obsessive compulsive symptom dimensions and neuroticism: an examination of shared genetic and environmental risk. Am J Med Genet Part B: Neuropsychiatric Genet. 2014;165(8):647\u0026ndash;53.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eClarke E, Kiropoulos LA. Mediating the relationship between neuroticism and depressive, anxiety and eating disorder symptoms: The role of intolerance of uncertainty and cognitive flexibility. J Affect Disorders Rep. 2021;4:100101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003evan der Heiden C, Melchior K, Muris P, Bouwmeester S, Bos AE, van der Molen HT. A hierarchical model for the relationships between general and specific vulnerability factors and symptom levels of generalized anxiety disorder. J Anxiety Disord. 2010;24(2):284\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFergus TA. Cyberchondria and intolerance of uncertainty: examining when individuals experience health anxiety in response to Internet searches for medical information. Cyberpsychology Behav Social Netw. 2013;16(10):735\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNesibe GM, Ceylan B. Intolerance to Uncertainty and Cyberchondria During the COVID-19 Pandemic. Int J Caring Sci. 2022;15(2):1556\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohammadinia N, Nasehi A, Niusha B. Predicting Health Anxiety Based on Intolerance of Uncertainty: Investigating the Mediating Role of Cognitive Flexibility and Cyberchondria in Breast Cancer Survivors. Iran J Breast Dis. 2023;16(3):65\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlizadehfard S, Alipour A. The path analysis model in prediction of corona phobia based on intolerance of uncertainty and health anxiety. J Res Psychol Health. 2020;14(1):16\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDragan M, Dragan WŁ, Kononowicz T, Wells A. On the relationship between temperament, metacognition, and anxiety: independent and mediated effects. Anxiety Stress Coping. 2012;25(6):697\u0026ndash;709.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDragan M, Dragan W. Temperament and anxiety: The mediating role of metacognition. J Psychopathol Behav Assess. 2014;36:246\u0026ndash;54.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMarino C, Fergus TA, Vieno A, Bottesi G, Ghisi M, Spada MM. Testing the Italian version of the Cyberchondria Severity Scale and a metacognitive model of cyberchondria. Clin Psychol Psychother. 2020;27(4):581\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorrison AP, Pyle M, Chapman N, French P, Parker SK, Wells A. Metacognitive therapy in people with a schizophrenia spectrum diagnosis and medication resistant symptoms: a feasibility study. J Behav Ther Exp Psychiatry. 2014;45(2):280\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSinger AR, Dobson KS. An experimental investigation of the cognitive vulnerability to depression. Behav Res Ther. 2007;45(3):563\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBesharat M, Baharamizade H, Fati L, Hasanabadi H. Mediating role of metacognitive beliefs and anxiety sensitivity on the relationship between nauroticism with comorbidity of anxiety and depression. J Appl Psychol. 2015;9(34):7\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSpada MM, Gay H, Nikčevic AV, Fernie BA, Caselli G. Meta-cognitive beliefs about worry and pain catastrophising as mediators between neuroticism and pain behaviour. Clin Psychol. 2016;20(3):138\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWidiger TA, Oltmanns JR. Neuroticism is a fundamental domain of personality with enormous public health implications. World psychiatry. 2017;16(2):144.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBailey R, Wells A. Metacognitive beliefs moderate the relationship between catastrophic misinterpretation and health anxiety. J Anxiety Disord. 2015;34:8\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFergus TA, Spada MM, Cyberchondria. Examining relations with problematic Internet use and metacognitive beliefs. Clin Psychol Psychother. 2017;24(6):1322\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"cyberchondria, intolerance of uncertainty, metacognitive beliefs, neuroticism","lastPublishedDoi":"10.21203/rs.3.rs-6675727/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6675727/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eThe present study aimed to examine the mediating role of intolerance of uncertainty and health-related metacognitive beliefs in the association between neuroticism and cyberchondria.\u003c/p\u003e \u003cp\u003eIn this cross-sectional study, 396 students from the University of Tabriz in Iran were recruited through online advertisements. Participants completed self-report questionnaires, including the Cyberchondria Severity Scale (CSS), the Revised NEO Personality Inventory (NEO-PI-R), the Intolerance of Uncertainty Scale (IUS-12), and the Meta-Cognitions about Health Questionnaire (MCQ-HA). Data were analyzed using Pearson correlation analysis and mediation analysis via the PROCESS macro.\u003c/p\u003e \u003cp\u003eThe results indicated a significant positive association between neuroticism and cyberchondria (r\u0026thinsp;=\u0026thinsp;.25, p\u0026thinsp;\u0026lt;\u0026thinsp;.01), neuroticism and intolerance of uncertainty (r\u0026thinsp;=\u0026thinsp;.31, p\u0026thinsp;\u0026lt;\u0026thinsp;.01), and neuroticism and metacognitive beliefs about health (r\u0026thinsp;=\u0026thinsp;.37, p\u0026thinsp;\u0026lt;\u0026thinsp;.01). Additionally, a significant positive correlation was found between intolerance of uncertainty and cyberchondria (r\u0026thinsp;=\u0026thinsp;.31, p\u0026thinsp;\u0026lt;\u0026thinsp;.01), as well as between metacognitive beliefs about health and cyberchondria (r\u0026thinsp;=\u0026thinsp;.32, p\u0026thinsp;\u0026lt;\u0026thinsp;.01). Mediation analysis with 5,000 bootstrap resamples revealed that intolerance of uncertainty (95% CI [0.0882, 0.3744]) and metacognitive beliefs (95% CI [0.1186, 0.3277]) positively mediated the association between neuroticism and cyberchondria. By confirming the mediating roles of intolerance of uncertainty and metacognitive beliefs about health in the relationship between neuroticism and cyberchondria, our findings highlight the importance of addressing these variables in developing preventive and therapeutic interventions for cyberchondria.\u003c/p\u003e","manuscriptTitle":"The relationship between neuroticism and cyberchondria: the mediating role of intolerance of uncertainty and metacognitive beliefs about health","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-01 14:33:40","doi":"10.21203/rs.3.rs-6675727/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"87961525208452841492548455121916754703","date":"2025-07-05T08:27:07+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-26T02:20:43+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-26T16:13:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-20T13:01:21+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-20T13:00:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Psychology","date":"2025-05-15T22:04:35+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-psychology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"psyo","sideBox":"Learn more about [BMC Psychology](http://bmcpsychology.biomedcentral.com/)","snPcode":"","submissionUrl":"","title":"BMC Psychology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a3368dd0-7a69-427f-b6f7-048893d40be0","owner":[],"postedDate":"July 1st, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-07-01T14:33:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-01 14:33:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6675727","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6675727","identity":"rs-6675727","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}