internet addiction thesis statement

Internet Addiction

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• Ana Paula Monteiro 7 , 9 ,
• Inês Carvalho Relva 7 , 8 , 9 &
• Margarida Simões 7 , 9  

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The Internet is increasingly interconnected with the society; the tendency is to increase this connection over time as a work tool, a vehicle of communication, as a form of entertainment and socialization. Despite the multiplicity of potentialities, a set of problems related to addictive and dysfunctional Internet use may also arise. Internet addiction is a pertinent problem that can lead to significant damage at the social, psychological, relational, and academic levels, among others. The interest of researchers and health professionals in studying the problem of Internet addiction is growing, particularly in the last two decades. This chapter provides an overview of the problem, discussing conceptualizations and terminologies, types, and consequences of addiction. Data on the prevalence of populations at greatest risk of addiction (adolescents and young adults) are presented. It is also address the main risk and protection factors, namely, personal, family, and social. In conclusion, a set of guidelines for the management of online behaviors by young people, families, and school organizations is suggested.

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Preventing and Combating Internet Addiction: A Concept Review

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Acknowledgements

The work of Inês Relva is funded by national funds through FCT – Fundação para a Ciência e a Tecnologia, I.P., under the Scientific Employment Stimulus – Institutional Call – CEECINST/ 00127/2018 and by national funds through FCT under the project UID04045/2020.

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Department of Education and Psychology, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal

Ana Paula Monteiro, Inês Carvalho Relva & Margarida Simões

Research Center in Sports Sciences, Health Sciences and Human Development (CIDESD), Vila Real, Portugal

Inês Carvalho Relva

Centre for Research and Intervention in Education (CIIE), University of Porto, Porto, Portugal

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Correspondence to Ana Paula Monteiro , Inês Carvalho Relva or Margarida Simões .

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Monteiro, A.P., Relva, I.C., Simões, M. (2023). Internet Addiction. In: The Palgrave Handbook of Global Social Problems. Palgrave Macmillan, Cham. https://doi.org/10.1007/978-3-030-68127-2_4-1

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DOI : https://doi.org/10.1007/978-3-030-68127-2_4-1

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A study of internet addiction and its effects on mental health: A study based on Iranian University Students

Javad yoosefi lebni.

1 Health Education and Health Promotion, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran

Razie Toghroli

2 Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

Jaffar Abbas

3 Antai College of Economics and Management/School of Media and Communication, Shanghai Jiao Tong University, Shanghai-China

Nazila NeJhaddadgar

4 Department of Health Care Services and Health Education, School of Health, Ardabil University of Medical Science, Ardabil, Iran

Mohammad Reza Salahshoor

5 Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran

Morteza Mansourian

6 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran

Hadi Darvishi Gilan

Neda kianipour.

7 Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran

Fakhreddin Chaboksavar

Seyyed amar azizi, arash ziapour, introduction:.

The Internet has drastically affected human behavior, and it has positive and negative effects; however, its excessive usage exposes users to internet addiction. The diagnosis of students' mental dysfunction is vital to monitor their academic progress and success by preventing this technology through proper handling of the usage addiction.

MATERIALS AND METHODS:

This descriptive-analytical study selected 447 students (232 females and 215 males) of the first and second semesters enrolled at Kermanshah University of Medical Sciences, Iran, in 2018 by using Cochrane's sample size formula and stratified random sampling. The study applied Young's Internet Addiction Test and Goldberg General Health Questionnaire 28 for data collection. The study screened the data received and analyzed valid data set through the t -test and Pearson's correlation coefficient by incorporating SPSS Statistics software version 23.0.

The results of the current study specified that the total mean score of the students for internet addiction and mental health was 3.81 ± 0.88 and 2.56 ± 0.33, correspondingly. The results revealed that internet addiction positively correlated with depression and mental health, which indicated a negative relationship ( P > 0.001). The multiple regression analysis results showed students' five significant vulnerability predictors toward internet addiction, such as the critical reason for using the Internet, faculty, depression, the central place for using the Internet, and somatic symptoms.

CONCLUSIONS:

The study findings specified that students' excessive internet usage leads to anxiety, depression, and adverse mental health, which affect their academic performance. Monitoring and controlling students' internet addiction through informative sessions on how to use the Internet adequately is useful.

Introduction

In recent years, technological advancements have taken place in the modern world. In the complexity of today's world, internet use is playing a vital role in educational institutions to attain different learning skills, which have become a necessity for university students. However, scholars have shown concerns about the excessive use of this technology and the hidden risk factors of internet users, such as physical and mental health.[ 1 , 2 ] The Internet is an easy and quick medium of interaction to gain the required information for communication with others around the world. However, a lack of control over excessive internet use can disturb individuals' living standards and relationships between family members, and it can bring instability of feelings.[ 3 , 4 ] The users of the Internet have increased incredibly worldwide, with the peak of a digital industrial revolution in progress, and new technological revolution will undoubtedly create new problems and predicaments.[ 4 , 5 ] The history of internet users goes back some decades at present. The Internet has become one of the most fast-growing and transformative technologies. Globally, the users of the Internet have increased from 414 million in 2000, 665 million in 2002, and over 4.574 billion by December 31, 2019. The US National Science Foundation specified that the internet users enabled by smartphones access would increase to 5 billion in 2020.[ 6 , 7 ] In recent years, internet users in Iran have grown dramatically. According to the reported statistics, the Iranian users of the internet have risen from 11.0 million in 2006, 33.0 million in 2002, and over 62 million by July 1, 2019. Hence, the users of the Internet in Iran have increased drastically over 25 times, and recent research conducted in Iran indicated that the young population makes up the majority of internet users.[ 8 ] Previous research specified that the Iranian users devote 35% of their time to chat rooms, 28% to online games, 30% to checking E-mails, and 25% to surfing the net on averages, while connected to the Internet. Besides, another study reported that Iranian users spend 52 min/week as an average time, while linked to the Internet.[ 9 ]

Internet addiction disorder, pathological internet use, or problematic internet use typically refers to the questionable or compulsive use of the Internet, which results in substantial impairment in the function of individuals in their different life domains over prolonged time. Internet addiction and other relationships based on the usage of digital media and mental health are vital considerable research fields, arguments, and discussions among numerous experts and researchers in various disciplines. This addictive behavior has made controversy from the areas of scientific, medical, and technological communities. Internet addiction is an interdisciplinary phenomenon, and different researchers have investigated it from different perspectives from various disciplines, such as medicine, computer science, sociology, law, and psychology.[ 10 ] Some scholars have considered internet addiction as a social crisis, and it has attracted the attention of different researchers and experts. This phenomenon is a biological, psychological, social, economic, and cultural problem, which is impossible to be taken into account as a simple matter because different factors influence it.[ 11 ] The excessive and pathological use of the Internet refers to internet addiction.[ 6 ] Therefore, with the growing number of internet users and its widespread psychological and sociological implications, it is necessary to determine and recognize the contribution of predictive factors in internet addiction. By conducting pathological studies about internet addiction to judge the addictive behaviors, it would enable us to utilize this technology with a balanced approach better and more usefully.[ 12 ] Internet addiction generally refers to a type of applying the Internet, which leads to psychological, social, educational, or occupational problems in a person's life.[ 13 , 14 ] Scholars have described this phenomenon as internet addiction dysfunction[ 15 ] and the problematic application of the Internet,[ 16 ] or habitual use of the Internet,[ 17 ] which determines it as one of the forms of behavioral addiction.[ 18 ] Researchers have also described internet addiction as “the modern addiction.” In practice, this type of addiction is true dependency, like drug addiction and other kinds of dependency. Although this kind of dependency does not have the somatic problems of chemical addiction, its resultant social problems are like other types of addiction.[ 1 ] In the 2015 World Statistics report, the number of internet users and the population of countries were specified; it was reported that the total world population was 7,264,623,793, of which 3,079,339,857 were using the Internet, and the young made up the majority of users.[ 8 ] While taking into account many points of proper and practical use of the Internet and prevention of mental illness, these reported statistics underscore the importance of the Internet and social networks. Internet addiction is an etymological process of using the Internet that creates a psychological state in which the user's behavior is disturbed, thereby leading to a dysfunction in his/her cognitive status.[ 19 ] Mental health is one of the main pillars of healthy human societies, which plays a vital role in ensuring the dynamism and efficiency of any society. As university students are among the most prestigious layers of societies, they present future builders in any country, and newly arrived students in universities from far-away cities are the first who fall victim to internet addiction. The mental health of the students is essential for raising their learning and scientific awareness.[ 19 ] Mental health is a concept that reflects our thinking, feelings, and functioning in dealing with various life situations.[ 20 ] In this modern world, the disease patterns are shifting toward no communicable diseases, and the rising rate of mental dysfunction and the resultant costs imposed on societies have attracted the attention of health promotion specialists.[ 8 ] In this regard, the Global Burden of Disease statistics has introduced mental illnesses as one of the three primary causes of lost years of life due to disability.[ 21 ] According to the WHO, mental health is defined as one's ability to communicate with others harmoniously; modify the personal and social environment; and resolve conflicts and personal preferences logically, fairly, and appropriately.[ 22 ] Besides, the statistics announced by the WHO reported that 52 million people of different age groups suffer from severe illnesses worldwide and 250 million have mild mental dysfunction. In Iran, these statistics are not lower than those in other countries.[ 23 ] The results of the epidemiological studies conducted to examine psychiatric dysfunction in Iran are indicative of the variability of the prevalence of dysfunction between 11.9% and 30.2%.[ 24 , 25 ]

Concerning internet addiction, addressing the problems of individuals' mental health is of great importance. An earlier study conducted by Fallah reported that depression was more prevailing among internet users with addictive behavior as compared with average internet users. The finding specified that individuals having internet addiction showed anxious behavior and their mental health was more exposed to higher risks.[ 23 ] Lashgarara et al . described that 34% of university students had addictive behavior to the Internet based on the Young's categorization.[ 26 ]

In a previous study, Fonia et al . reported that students' mental health and internet addiction showed a negative relationship, and their internet addictive behavior was not significant. It was different from the students' gender and marital status variables.[ 27 ] Another study of Nastizai claimed that students' internet addiction developed a higher risk of mental health than ordinary users of the Internet.[ 28 ] Fonia et al . reported that there was a significant difference between internet addiction among male and female students.[ 27 ] Similarly, the relationship between internet addiction and users' mental health received more considerable attention, and previous studies have emphasized this matter, such as the investigations of Fallah Mehneh,[ 29 ] Alavi et al .,[ 30 ] Mirzaian et al .,[ 31 ] and Taheri Mobarakeh et al .[ 32 ] The tendency of using the Internet among students is higher, and they are more vulnerable to the risk of internet addiction. Thus, more attention to students' mental health needs should be considerable paid for their future as well as the development of the nation.[ 22 , 25 ] Universities need to pay attention to boosting students' mental health, personal growth, and well-being. Because internet addiction prevails worldwide, it also exists in Iran for several years, and young individuals have shown greater engagement toward internet use, while students make up the majority of internet users. The excessive use of the Internet leads to psychological injury, mental health damage, and other health problems. Experts have suggested necessary measures to prevent internet addiction among students and treat disorders and health problems where appropriate.[ 33 ] The present research emphasized investigating internet addiction and its effects on the mental health of medical students at Kermanshah University of Medical Sciences, and its findings provide valuable insights.

Materials and Methods

This descriptive-analytical study selected 447 students (232 females and 215 males) of the first and second semesters enrolled at Kermanshah University of Medical Sciences, in 2018 (May 2017–October 2018) by applying Cochrane's sample size formula and stratified random sampling methods. This method draws the statistical population according to the hierarchy of the types of population units. The study applied Young's Internet Addiction Test (IAT) and Goldberg General Health Questionnaire (GHQ-28) for data collection. The study screened the data received and analyzed valid data set through the t -test and Pearson's correlation coefficient by incorporating SPSS Statistics software version 24.0. Hence, the authors randomly selected nine faculties (medicine, dentistry, pharmaceutical medicine, nursing and midwifery, paramedics, public health, nutrition sciences, and food industries, and self-governing college). In the next step, we selected majors and classes from each faculty (as many as the number of research samples) and evaluated the data. The inclusion criterion was the right to choose the courses freely, and the investigators have excluded incomplete questionnaires from the study. Besides, we assured participants about the confidentiality of the collected information and lack of disclosure of their personal information. Besides, the ethical principles employed in the present study included critical steps, such as obtaining the necessary permits, retaining the right for the schools under investigation to either accept or reject to participate in the research study, and ensuring confidentiality and nondisclosure of agreement. The investigators distributed the questionnaires among the target respondents. The authors explained the objectives of the present study to the target individuals and obtained informed consent from all participants before to execute the research. Not to mention, the exclusion criteria were the sample's disinterest in participating in the study and handing over incomplete questionnaires.

Demographic questionnaire

The first section of the self-administered instrument contained the demographics and comprised questions on gender, age, marital status, place of residence, faculty, education, having a personal computer, central location, and time of using the Internet, and the primary reason for using the Internet.

Internet Addiction Test

Young developed this 20-item scale for measuring the internet addiction, which affects a variety of aspects in users' lives.[ 17 ] The study applied the Persian translation of Young's IAT developed by Alavi et al .[ 30 ] The questions showed the scores on a selected 5-point Likert scale (5 = always, 4 = usually, 3 = most of the time, 2 = sometimes, and 1 = seldom). The ranges of minimum and maximum scores showed 20–100. The scores divided internet users into the following three groups: typical users indicating a score of 20–49; at-risk users, specifying a score of 50–79; and the internet users having an addiction with a score of 80–100. The highest scores represent the highest levels of students' dependency on the Internet, which leads to addictive behavior. Recent studies evidenced that a score of 50 or above shows internet addiction. Besides, this study confirmed the questionnaire's validity from three experts by applying the content validity index (0.84), while the survey confirmed reliability through the t -test (0.88). The Cronbach's alpha provided a satisfactory value (0.87) with a sample of twenty medical students within 2-week process of data collection. The findings of the reliability and validity of this instrument/tool are consistent with the results of previous studies, which indicated over 90%.[ 34 , 35 , 36 , 37 , 38 ]

The General Health Questionnaire

This prospective study used GHQ-28 for gathering data.[ 39 ] The study screened the data received and analyzed valid data set through the t -test and Pearson's correlation coefficient by using the SPSS Statistics software version 24.0. The self-reported Goldberg's 28-item questionnaire examines the individual's mental health in the recent month and includes symptoms such as abnormal thoughts and feelings and aspects of visible behavior. This questionnaire consists of the following four subscales: somatic symptoms (questions 1–7), anxiety (questions 8–14), social dysfunction (questions 15–21), and depression (questions 22–28). Each subscale contains seven questions that measure the various aspects of mental health, ranging from somatic to psychological dysfunction.[ 39 ] The questions presented scores with a 4-point Likert scale (0 = not at all, 1 = average, 2 = more than average, and 3 = far more than average). The minimum and maximum ranges illustrated 0–84, which showed categories into four levels of mental health, for instance, normal (0–22), weak (21–40), balanced (41–60), and severe (61–84). The highest ratings/scores represented the lowest level of students' mental health status. The study examined and confirmed the questionnaire's reliability for each section by using content validity (0.80). The sought the opinion from three experts by using the content validity index (0.80) and confirmed reliability through several tests, such as test-retest (0.87). The study calculated the Cronbach's alpha (0.93) value from the sample of twenty medical students. The results derived from the tests of reliability and validity of this instrument are in line with the findings of previous global studies, which specified the same results.[ 9 , 40 , 41 , 42 ]

The study applied descriptive statistics (percentage, mean, and standard deviation) and inferential statistics ( t -test and Pearson's correlation coefficient) to analyze the data received by using the SPSS Statistics software (version 23.0, SPSS Inc., Chicago, IL, USA), and applied required analysis at the statistical significance level of 0.05 ( P < 0.01).

Ethical consideration

This study is the part of the research project (IR.KUMS.REC.1397.108, No. 97056) sponsored by the Deputy of Research and Technology from Kermanshah University of Medical Sciences, Iran. The authors maintained all the protocols before performing all the procedures engaged in this study involving human participants in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The total population comprised of 447 participants in the present study, including 215 male (48.1%) and 232 female (51.9%) students. The average age of the respondents under investigation was 23.47 ± 4.58 years, and the majority of respondents' age ranged between 19 and 24 years (69.6%). Concerning the marital status, there were 360 single participants (80.50%) in this population. The second majority of the study indicated bachelor's degree students (202 students or 45.20%), and the majority of the discipline was a school of medicine (71 students or 15.90%). The majority of the dormitory students comprised 48.30% (216/447). The study findings specified that 356 students possessed their computers (356/447 = 79.60%), and the number of students using the Internet at their dormitories comprised 205 respondents (205/447 = 45.90%). The results indicated that the majority of the students used the Internet either in the morning or in the evening (367/447 = 82.10%).

The main reason for using the internet application was chatting with friends and family members. The mean and standard deviation of students with internet addiction was 3.81 ± 0.88. Besides, the mean and standard deviation of students' mental health was 2.56 ± 0.33, which stated that the general mental health of students was not in good condition. Regarding the mental health of the students' sample, the study results indicated that the highest and lowest rates showed linkage to depression with a mean and standard deviation of 2.84 ± 0.21 and somatic dysfunction with a mean and standard deviation of 2.16 ± 0.79, respectively, as indicated in Table 1 . This specific study applied the Pearson's correlation coefficient to determine the relationship between the students' internet addiction and mental health. The results of the correlation matrix demonstrated that they did not statistically significantly correlate with each other ( P < 0.001, r = 0.052). The study results specified that students' depression and somatic symptoms had the highest ( P = 0.001, r = 0.166) and lowest ( P > 0.001, r = 0.006) relationships with internet addiction, as indicated in Table 2 .

Internet addiction and mental health scores for different genders

The results of Pearson’s correlation coefficient between internet addiction and mental health among students

**Correlation was significant at the 0.01 level (two tailed)

The present study aimed to investigate internet addiction and its effects on the mental health of medical students at Kermanshah University of Medical Sciences. The results of the present study demonstrated that 45.5% of students at Kermanshah University of Medical Sciences were addicted to the Internet. This finding was concurrent with the results of studies conducted by Farhadinia et al .,[ 43 ] Sepehrian and Jokar,[ 44 ] Fonia et al .,[ 27 ] and Dargahi and Razavi.[ 45 ] Those who use the Internet more than others can replace stronger relationships in real life with low-quality social relationships, thereby resulting in more loneliness and depression. To further explicate the matter, the Internet may serve as a substitute for lives without vitality. Loneliness and isolation may cause people to spend more time on the Internet, thereby decreasing the quality of their social relationships.

As for the demographic characteristics, the results demonstrated that there was a significant difference between male and female students in terms of internet addiction. In addition, 23% of male students were internet addicts, which exceeded that of female students by 22.4%. In this study, male students should be given priority in prevention programs for internet addiction. These results were consistent with the results of studies conducted by Alavi et al .,[ 30 ] Orsal et al .,[ 46 ] and Fonia et al .,[ 27 ] whereas inconsistent with the results of studies performed by Atashpour et al .[ 47 ] and Shahbazirad and Mirderikvand.[ 48 ] Male students seem to have more internet addiction than girls. In fact, the present research, in line with the findings of previous studies, shows that men are more exposed to internet addiction, not because of biological differences between the two genders, but due to different social and environmental factors to which each gender is exposed. According to the results, it seems that this finding can be an alarm at the increase in this disorder among students, and it is better that proper planning be done in this area in cooperation with university officials.

Based on the results of the present study, the mean score of male students' mental health was higher than that of female students, and no significant difference was seen between gender and mental health. However, the finding of the present study was consistent with the results of studies conducted by Taji and Verdinejad,[ 49 ] Namdar et al .,[ 50 ] and Imani et al .[ 51 ] In studies done by Asadi et al .,[ 52 ] Gorgich et al .,[ 9 ] Fonia et al .,[ 27 ] and Xu and Liu,[ 23 ] it was expressed that female students had more mental disorders than male students, which was inconsistent with the results of the present study. It should be noted that the mean score of male students' mental health was higher than that of female students, possibly due to men's ability to communicate with others in the society and university, the ability to deal with problems and difficulties, and the ability to earn money, as well as women's excessive emotional dependency on their families and lack of social security in the society.

The results of this study revealed that half of the students had poor mental health, and there was a significant difference between the mean scores of depression and internet addiction. These results were consistent with the results of studies done by Nastizai,[ 28 ] Anderson et al .,[ 12 ] and Chung and Wong.[ 53 ] In a study done by Abdollahi on nursing students at Tehran University of Medical Sciences, it was shown that 32.1% of students had suspected mental disorders, which was 29.7% in women and 34.3% in men.[ 54 ] In addition, Rafiei and Mosavipour showed that 67.9% of students at Arak University of Medical Sciences had symptoms of mental disorders, and only 32.1% of them had normal mental health.[ 55 ] Similarly, Masoudi et al . concluded that 52.4% of students at Tehran University of Medical Sciences were suffering from mental health disorders.[ 56 ] Similarly, in a study done by Yavarian et al . on students at Uromia University of Medical Sciences, it was demonstrated that 45.8% of students had different degrees of mental health disorders. In their study, it was also revealed that 10%, 0.5%, and 3.2% of students had severe disorders in terms of somatic symptoms, anxiety and insomnia, and depression, respectively. This finding was concurrent with the results of the present study.[ 57 ] It seems that the different prevalence of psychiatric disorders in various studies can be attributed to several factors, including the differences in groups under study.

The results revealed that internet addiction and mental health were negatively related, which was consistent with the results of studies conducted by Shahbazirad and Mirderikvand,[ 48 ] Fallah Mehneh,[ 58 ] and Mousavomoghadam et al .[ 59 ] Hosseini et al . showed that 4.2% of students at Payam Noor University of Charm had severe addiction to the Internet. In addition, a significant relationship was observed between internet addiction and mental health.[ 60 ] Similarly, in a study performed by Farhadinia et al ., it was demonstrated that internet addiction and mental health significantly correlated among the students of Lorestan University of Medical Sciences,[ 43 ] which seems to lay the groundwork for the internet addicts. Some people resort to the Internet to reduce their depression. In this case, the Internet may provide a substitute for the joyless lives of depressed people, or they may get depressed as a result of internet addiction. In other words, the internet addicts will experience the negative consequences, such as depression.

In justifying the relationship between depression and internet addiction, it can be expressed that the excessive use of the Internet can lead to social isolation and depression through reducing familial, social, and local connection. Therefore, depression may occur as a result of internet addiction, and in this case, the internet addicts experience the resultant negative consequences, such as depression.[ 28 ]

The results revealed that the five major predictors of vulnerability to internet addiction in university students were as follows: the key reason for using the Internet, faculty, depression, the main place for using the Internet, and somatic symptoms.

Limitations of the study

Concerning the limitations, this study evaluated medical students in the classrooms based on different groups. The discussions among students could present bias in their feedback. There was no face-to-face interview session, and the data set reported on a self-reported questionnaire, which increases the risk of social desirability biases among medical students of medicine, dentistry, and pharmaceutical departments at self-governing Education Incubator of Kermanshah, Iran. The limitations of the current study specify that researchers can consider a large sample size based on medical students as well as other departments to execute their investigations in western part of Iran. Scholars can find experimental and longitudinal methods with larger samples to examine different results.

Conclusions

According to the findings of the present study, it can be concluded that students' excessive use of the Internet leads to depression, anxiety, and reduced mental health, thereby affecting their academic performance. Hence, it is suggested that further monitoring and control be exercised on how the Internet is used by university students, and they should be informed of the detrimental effects of this technology in the case of misuse or overuse. The findings of the present study are also indicative of the significance of preventative measures in the form of educational and counseling programs for students regarding the proper and practical use of the Internet. In addition, addressing the issues and problems relating to communication technologies, such as the Internet, can lay the groundwork for proper education and instigate parents' and families' further attention to proper and effective use of the Internet.

Financial support and sponsorship

Conflicts of interest.

There are no conflicts of interest.

Acknowledgments

The authors hereby bestow their gratitude to the students in the for-profit Schools of Medicine, Dentistry, Paramedics, Nursing and Midwifery, Paramedicine, Nutrition Sciences and Food Industries, Public Health and Self-Governing College in Kermanshah University of Medical Sciences for their participation in the present study.

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A study of internet addiction and its effects on mental health: A study based on Iranian University Students

Affiliations.

• 1 Health Education and Health Promotion, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
• 2 Social Determinants in Health Promotion Research Center, Hormozgan Health Institute, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.
• 3 Antai College of Economics and Management/School of Media and Communication, Shanghai Jiao Tong University, Shanghai-China.
• 4 Department of Health Care Services and Health Education, School of Health, Ardabil University of Medical Science, Ardabil, Iran.
• 5 Department of Anatomical Sciences, Medical School, Kermanshah University of Medical Sciences, Kermanshah, Iran.
• 6 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
• 7 Students Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran.
• PMID: 33062738
• PMCID: PMC7530416
• DOI: 10.4103/jehp.jehp_148_20

Introduction: The Internet has drastically affected human behavior, and it has positive and negative effects; however, its excessive usage exposes users to internet addiction. The diagnosis of students' mental dysfunction is vital to monitor their academic progress and success by preventing this technology through proper handling of the usage addiction.

Materials and methods: This descriptive-analytical study selected 447 students (232 females and 215 males) of the first and second semesters enrolled at Kermanshah University of Medical Sciences, Iran, in 2018 by using Cochrane's sample size formula and stratified random sampling. The study applied Young's Internet Addiction Test and Goldberg General Health Questionnaire 28 for data collection. The study screened the data received and analyzed valid data set through the t -test and Pearson's correlation coefficient by incorporating SPSS Statistics software version 23.0.

Results: The results of the current study specified that the total mean score of the students for internet addiction and mental health was 3.81 ± 0.88 and 2.56 ± 0.33, correspondingly. The results revealed that internet addiction positively correlated with depression and mental health, which indicated a negative relationship ( P > 0.001). The multiple regression analysis results showed students' five significant vulnerability predictors toward internet addiction, such as the critical reason for using the Internet, faculty, depression, the central place for using the Internet, and somatic symptoms.

Conclusions: The study findings specified that students' excessive internet usage leads to anxiety, depression, and adverse mental health, which affect their academic performance. Monitoring and controlling students' internet addiction through informative sessions on how to use the Internet adequately is useful.

Keywords: Internet addiction; medical sciences; mental health; students; technology advancement.

Copyright: © 2020 Journal of Education and Health Promotion.

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Conflict of interest statement

There are no conflicts of interest.

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Study of internet addiction and its association with depression and insomnia in university students

Jain, Akhilesh 1 ; Sharma, Rekha 2 ; Gaur, Kusum Lata 3 ; Yadav, Neelam 4 ; Sharma, Poonam 5 ; Sharma, Nikita 5 ; Khan, Nazish 5 ; Kumawat, Priyanka 5 ; Jain, Garima 4 ; Maanju, Mukesh 1 ; Sinha, Kartik Mohan 6 ; Yadav, Kuldeep S. 1,

1 Department of Psychiatry, ESIC Model Hospital, Jaipur, Rajasthan, India

2 Department of Ophthalmology, ESIC Model Hospital, Jaipur, Rajasthan, India

3 Department of PSM, SMS Medical College, Jaipur, Rajasthan, India

4 Department of Medicine, ESIC Model Hospital, Jaipur, Rajasthan, India

5 Department of Psychology, University of Rajasthan, Jaipur, Rajasthan, India

6 Manipal University, Jaipur, Rajasthan, India

Address for correspondence: Dr. Kuldeep S. Yadav, Senior Resident, Department of Psychiatry, ESIC Model Hospital, 3-D/162, Chitrakoot, Ajmer Road, Jaipur - 302 021, Rajasthan, India. E-mail: [email protected]

Received December 18, 2019

Received in revised form January 31, 2020

Accepted February 12, 2020

Introduction: 

Use of internet has increased exponentially worldwide with prevalence of internet addiction ranging from 1.6% to 18 % or even higher. Depression and insomnia has been linked with internet addiction and overuse in several studies.

Aims and Objectives: 

Present study has looked in to pattern and prevalence of internet addiction in university students. This study has also explored the association of internet addiction with depression and insomnia.

Material and Methods: 

In this cross sectional study 954 subjects were enrolled who had been using internet for past 6 months. Information regarding pattern of use and socio demographic characteristics were recorded. Internet addiction Test (IAT), PHQ-9,and insomnia Severity Index (ISI) were applied to measure internet addiction, depression and insomnia respectively.

Results: 

Among 954 subjects, 518 (60.59%) were male and 376 (39.41%) were female with mean age of 23.81 (SD ± 3.72). 15.51% study subjects were internet addicts and 49.19% were over users. Several parameters including graduation level, time spent per day on line, place of internet use, smoking and alcohol had significant association with internet addiction. Internet addiction was predominantly associated with depression and insomnia.

Conclusion: 

Internet addiction is a rising concern among youth. Several parameters including gender, time spent on line, alcohol, smoking predicts higher risk of internet addiction. Depression and insomnia are more common in internet addicts and overusers.

Introduction

Exponential growth in internet use has been observed across the world including India in the last decade. About 205 million internet users were reported in India in 2012 including both rural and urban population and it was predicted that India will become the second leading country after China in internet usage.[ 1 ] Internet is used for various reasons such as interpersonal communication, exploring information, business transactions, and entertainment. However, it can also provide an opportunity to engage in excessive chatting, pornography, gaming, or even gambling. There have been growing concerns worldwide for what has been labeled as “internet addiction.”

Dr. Ivan Goldberg suggested the term “internet addiction” in 1995 for pathological compulsive internet use.[ 2 ] Excessive internet use was closely linked to pathological gambling by Young[ 3 ] who adapted the DSM IV criteria to relate to internet use in the internet addiction test (IAT) developed by her. The prevalence of internet addiction has been reported ranging from 1.6% to 18% in different populations.[ 4 5 ]

General population surveys show a prevalence of 0.3–0.7%.[ 6 ] with addicted spending average 38.5 h/week on a computer as compared to the nonaddicted averaged 4.9 h/week. Goel[ 7 ] has reported 24.8% as possible addicts, and 0.7% as addicts in his study of internet addiction among Indian adolescents.

Overuse of the internet has been linked with many psychological conditions including anxiety, depression, and insomnia. Several studies[ 8 9 ] have shown that among users addicted to the internet, depression has much prevalence than normal users. Akini and Iskender[ 10 ] have reported that depression and anxiety are significant predictors of internet addiction in a study among Turkish students.

There is an influence of problematic internet use or internet addiction on sleep patterns. Increased time spent on the internet may disrupt the sleep-wake schedule significantly, and a higher rate of sleep disturbance takes place among heavy internet users.[ 11 ] Wong[ 12 ] studied the impact of online addiction on insomnia and depression on Hong Kong adolescents. The findings showed that “internet addiction was associated significantly with insomnia and depression”. These data imply that possible complex mechanisms exist between insomnia, internet addiction, and depression.

Internet use has been overwhelmingly increasing in India, involving especially the youth population. Since adolescents contribute a significant proportion of the productive life age of our country, their involvement with internet overuse or addiction may lead to significant adverse consequences such as sleep disturbance, psychological and physical problems leading to academic decline. Although many studies have been conducted regarding internet addiction in India, nevertheless, not much has been studied in the state of Rajasthan in this regard. Hence, the present study was planned to investigate the pattern and prevalence of internet usage in young adults and its relationship with insomnia and depression in college-going youth.

Material and Method

This cross-sectional study included 1000 students of both sexes using the internet for the past 6 months from different streams in the University of Rajasthan and affiliated colleges. Formula n = z 2 × pq/d 2 was used to determine the study sample size where n represents a total number of sample, z corresponds to value at 95% confidence interval, P stands for the prevalence of internet addiction in the previous study i.e. almost 44 percent,[ 13 ] and d represents allowable error. Thus, a sample size of about 600 students was considered appropriate. This study included 1000 students out of which 46 students opted out in the middle of the study, hence 954 students finally constituted the study sample. The study participants were selected using simple random sampling. Approval was obtained from the concerned authority. Participants were informed about the nature and purpose of the study before including them in the study.

Only those participants constituted the study group who had been using the internet for the past 6 months and were willing to participate in the study. Those who did not choose to participate, having major medical or surgical problems, history of psychosis or mania, MDD, or any other mental disorder were excluded from the study.

Information was collected on a specially designed semi-structured performa containing details of demographics, educational qualification, and status, purpose of using the internet (by choosing among the options like education, entertainment, social networking or other purpose), money spent per month, place of access (home, cybercafé, or workplace if working part-time), the time of day when the internet is accessed the most (by choosing between morning, afternoon, evening, or night), and the average duration of use per day.

Internet addiction, depression, and insomnia were assessed on IAT, patient health questionnaire (PHQ-9), and insomnia severity index (ISI), respectively.

Internet addiction test (IAT)

The IAT[ 3 ] is a 20-item 5-point Likert scale that measures the severity of self-reported compulsive use of the internet. According to Young's criteria, total IAT scores 20–39 represent average users with complete control of their internet use, scores 40–69 represent over-users with frequent problems caused by their internet use, and scores 70–100 represent the internet addicts with significant problems caused by their internet use.

Patient health questionnaire (PHQ-9)

A self-report version of PRIME-MD11 which assesses the presence of major depressive disorder using modified diagnostic and statistical manual, fourth edition (DSM-IV) criteria.[ 14 ] In this study, the Hindi version of PHQ-9 was used. It has been validated in the Indian population and is considered to be a reliable tool for the diagnosis of depression. For the diagnosis of depression, we define clinical significant depression as a PHQ-9 score of 8–9 as minor depression, a PHQ-9 score of 10 or greater as moderate depression; a score of 15 or more and one of the two cardinal symptoms (either depressed mood or anhedonia) as definite major depression. We considered PHQ 9 score of 10 or more as depression in this study.

Insomnia severity index (ISI)

ISI is one of the most commonly used disease-specific measures for self-perceived insomnia severity. The ISI has 7 items describing insomnia-related health impairments.[ 15 ] Each item is rated on a 5-point Likert scale. In clinical assessments, the ISI total summary score falls into 1 of 4 ISI categories; with scores 0–7, 8–14, 15–21, and 22–28 indicating no clinically significant insomnia, sub-threshold insomnia, moderate insomnia and, clinically severe insomnia, respectively.

We used the Hindi version of the ISI[ 16 ] Clinically, significant insomnia was detected only when the ISI score was >14.

Statistical analysis

All data collected were entered into the Microsoft excel 2007 worksheet in the form of a master chart. These data were classified and analyzed as per the aims and objectives. The data on sample characteristics were described in the form of tables. Categorical variables were tabulated using frequencies and percentages. Inferential statistics such as the Chi-square test were used to find out the association of internet usage with various factors. Odds ratio (OR) was used to find out the association of insomnia and PHQ levels with internet usage.

This study was a cross-sectional questionnaire-based study conducted among university students from different faculties.

Around 954 subjects with age ranging from 17 to 34 years were included in this study. The mean age was 23.81 years with a 3.72 standard deviation. Males were 578 (60.59%) and females were 376 (39.41%). Out of total subjects, 412 (43.19%) were internet over users and 148 (15.51%) were addicts [ Table 1 ].

Out of 954 subjects, 537 were postgraduates while 417 were undergraduates [ Table 2 ]. Among postgraduates (PG) 96 (17.88%) had internet addiction and 241 (44.88%) were over users, whereas the proportion of internet addicts and over users among undergraduates (UG) was 12.47% and 41.01%, respectively [ Table 3 ]. This association was statistically significant. Similarly, on application of Chi-square test, significant association was found between place of internet usage and addiction as 68 (25.19%) subjects were addicted and 128 (47.41%) were over users among those who were using internet at workplace as compared to 141 (16.51%) addicts and 360 (47.41%) over users among those using it at home. In this study, 86 subjects were smokers and 88 were alcoholics and the association of these personal habits and internet usage was also significant on the application of the Chi-square test. Out of them 86 smokers, 27 (31.40%) were addicted and 34 (39.53%) were over users and out of 88 alcoholics, 10 (11.36%) were addicted and 45 (51.14%) were over users. Considering duration of internet usage, it was observed that those using internet for more than 2 h a day were more addicted and over users [ 85 (19.81%) and 188 (43.82%), respectively] as compared to those using internet for less than 2 h a day [ 63 (12%) and 224 (42.67%), respectively] and this association was found significant. A total of 437 (45.81%) subjects reported insomnia among whom 107 ((24.49%) were internet addicts and 241 (55.15%) were over users whereas those subjects without insomnia comprised only 47 (7.93%) addicts and 171 (33.08%) over users. This association was again statistically significant. Similar results were noted with regard to the presence of depression. Depression was reported in 421 (44.13%) subjects including 113 (26.84%) internet addicts and 225 (53.44%) over users. Among those subjects without depression number of internet addicts and over users was 35 (6.58%) and 187 (34.96%), respectively. This observation was statistically significant.

On the application of OR considering internet usage as exposure, it was observed that chances of insomnia were more than five times on the internet over users as compared to average users [OR = 5.62 (4.20 to 7.53)]. Similarly, the estimated risk of PHQ ≥10 was observed more than five times on the internet over users as compared to average users. [OR = 5.70 (4.25 to 7.67]) [ Table 4 ].

The present study is an attempt to understand the pattern of internet use and the prevalence of internet addiction in youth college students. The mean age of the study population was 23.8 years.

Our study showed 15.5% of students with internet addiction. Wide variations ranging from 1.6% to 18% in the prevalence of internet addiction among adolescents have been reported.[ 4 ]

Prevalence of PIU (problematic internet use) among adolescents in a multicentric study in Europe was reported ranging from 1.2% to 11.8%.[ 5 ]

Another study on Indian adolescents reported the prevalence of possible addicts and addicts as 24.8% and 0.7%, respectively.[ 7 ] Similarly Kawabe et al .[ 17 ] in his study among 853 adolescents in Japan determined the prevalence of internet addiction using IAT. The prevalence of possible addicts and addicts was 21.7% and 2.0%, respectively.

In the present study boys were more internet addicts and over user than the girls. Similar observations have been made in several other studies in the past.[ 18 ] Since boys are given more liberty in our society and have more frequent access to use the internet in private than the girls predisposing them to become an addict and over the user. Studies have also shown that boys tend to play more online games and surf adult sites more often than girls.[ 19 ] Male also tend to use more addictive substances than female and it has also been reported in a meta-analysis of internet addiction that a person with a history of addiction to other substances is at higher risk of internet addiction.[ 20 ]

Internet addiction and overuse were more prevalent in postgraduate students than undergraduates. Kwabe et al .[ 17 ] has also reported that the number of students with internet addiction increases as their grades increase. Likewise, XinM.[ 21 ] in his study of 6468 Chinese adolescents also observed more internet addiction among older grade students. It is possible that the study course in PG is more demanding to access the internet and the affordability in this group to bear the expenses of the internet is much stronger than UG. It was also evident in general that educational activity was the most commonly cited purpose for internet use.

The workplace was the most preferred area for internet use among addicts. Goel et al .[ 7 ] in his study has also yielded similar results. Lesser restriction, a company of colleagues, and accessibility to free internet may have been the possible reason for this observation.

Alcohol consumption and smoking were significantly associated with internet addiction in the present study. Several other studies in the past have made similar observations where pathological internet use (PIU) or internet addiction was possibly associated with alcohol and smocking.[ 22 ]

Sung et al .[ 23 ] in his analysis of a large study sample of adolescents established a positive association of internet addiction with alcohol and smoking. Neuropsychological explanation proposes that nicotine and alcohol shares a common reward pathway.[ 24 ] which may also include the nature of internet usage as observed in many studies for e.g. striatal activation in online games when confronted with cues from their favorite games.[ 25 ] Studies have also suggested that adolescents with internet addiction may have personalities vulnerable to any other addiction and hence are at increased risk of substance abuse.[ 26 ]

In this study mean daily time spent on internet use was positively correlated with internet addiction. In a review of research on internet addiction, people at risk of internet addiction were reported to have spent significantly more time online.[ 27 ] In another study by Kuss[ 19 ] daily use of the internet and increased time online was positively correlated with internet addiction.

This study revealed a strong positive association between internet addiction and insomnia. Similar results were also established by Bhandari et al .[ 28 ] in his study of 984 undergraduate students, who reported 35.4% of the study sample having poor sleep quality and internet addiction as well. Cheung[ 29 ] in his study of 719 Chinese adolescents in Hong Kong observed high comorbidity between internet addiction and insomnia; 51.7% of students among internet addicts were insomniacs.

Association between internet addiction and depression in this study corresponds to another study among university students in Turkey by Orsala et al .[ 30 ] who reported an alarming association between internet addiction and depression. A high score of depression has also been reported in a study among Indian adolescents with internet addiction.[ 7 31 32 ] In an article on association between internet addiction and depression, the authors after taking into account several studies proposed four models of such association including escape model, bidirectional model, negative consequence model, and shared mechanism model. Grossly the association between internet addiction and psychological problems including depression are reported to have an interdependent relationship. Depression may lead to internet addiction and vice versa. Internet use in this population serves as a remedy to overcome their problems and negative perception about the situation. Such use over a period of time becomes a habit and eventually addiction, as some positive emotions like happiness and excitement are felt while being on the internet. When internet addict does not use the internet, negative emotions flare up and can only be replaced by positive emotions by using the internet.[ 8 ]

The association between internet addiction, insomnia, and depression was explored in a study that observed that internet addiction and sleep quality independently mediated 16.5% and 30.9% indirect effect of each other on depression.[ 28 ]

Internet addiction among youth has become increasingly a great concern. Various parameters including gender, time spent on the internet, graduation level, place of internet use, smoking, and alcohol have been associated with internet addiction. In addition, insomnia and depression are more common in internet addicts and may have a bidirectional relationship.

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There is no conflict of interest.

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