Prevalence of excessive internet use and its association with psychological distress among university students in South India.

BACKGROUND: Excessive internet use, psychological distress, and its inter-relationship among university students can impact their academic progress, scholastic competence, career goals, and extracurricular interests. Thus, a need exists to evaluate the addictive internet use among university students.
OBJECTIVES: This study was set up to examine the internet use behaviors, internet addiction (IA), and its association with psychological distress primarily depression among a large group of university students from South India.
METHODS: Totally 2776 university students aged 18-21 years; pursuing undergraduate studies from a recognized university in South India participated in the study. The patterns of internet use and socioeducational data were collected through the internet use behaviors and demographic data sheet, IA test (IAT) was utilized to assess IA and psychological distress primarily depressive symptoms were evaluated with Self-Report Questionnaire-20.
RESULTS: Among the total n = 2776, 29.9% (n = 831) of university students met criterion on IAT for mild IA, 16.4% (n = 455) for moderate addictive use, and 0.5% (n = 13) for severe IA. IA was higher among university students who were male, staying in rented accommodations, accessed internet several times a day, spent more than 3 h per day on the Internet and had psychological distress. Male gender, duration of use, time spent per day, frequency of internet use, and psychological distress (depressive symptoms) predicted IA.
CONCLUSIONS: IA was present among a substantial proportion of university students which can inhibit their academic progress and impact their psychological health. Early identification of risk factors of IA can facilitate the effective prevention and timely initiation of treatment strategies for IA and psychological distress among university students.

Internet addiction (IA) is a quickly growing global phenomenon among adolescents and young adults[12] and is one among the most significant challenges emerging from the use of the Internet.[345] The prevalence of IA among young adults is reportedly high and is known to vary from 1.5% to 24.2%.[6789] To make communication easier, quicker, and to facilitate safe exchange of information Internet was developed. Over the years, ever-increasing use of the Internet for work and leisure activities has led to its omnipresent presence across all activities of the day, and this has disguised the boundaries between functional and dysfunctional internet use. The use of the Internet in a healthy manner can be understood as achieving a desired goal within an appropriate time frame without experiencing intellectual or behavioral discomfort.

The emergence of the Internet as a medium to interact is turning into an absolute need and an effective space for interchange of ideas, establishing risk free social connections with strangers, free expression of thoughts, possibility to access prohibited content, involvement in unique games, and use of numerous other functions in substantial privacy draws individuals of divergent interests which has led to exponential rise in use of the Internet.[101112] Internet use is becoming an unavoidable requirement for many of the individuals, mostly young adolescents and adults.[1314]

Some individuals cannot control their use of the Internet whereas others can limit their use. Excessive use of the Internet has been termed by researchers by use of varied terminologies such as compulsive internet use,[15] problematic internet use,[16] pathological internet use, and IA.[1718] This research study would use the term IA which describes it as an individual's inability to control his or her own use of the Internet causing disturbances and impairment in fulfillment of work, social and personal commitments.[219]

Research literature suggests that depression is a leading comorbid disorder with IA.[2021] Self-esteem is one of the core components of depression.[22] It is individual's attitude to himself, and it can be either negative or positive.[23] Thus, individuals with negative self-esteem are potential candidates who engage in addictive internet behaviors which helps to momentarily free themselves of their negative self-esteem, irrational cognitive assumptions, and associated unpleasant emotions.[2425]

The occurrence of depression among the young individuals with IA and existence of IA among the depressed individuals has been observed.[21] The presence of low self-esteem, low motivation, fear of negative evaluation, social avoidance observed in depressed individuals are hypothesized to lead to excessive/addictive usage of the Internet in depressed individuals.[26] Social isolation caused by IA may also lead to depression.[27]

The primary mental illness is depression or IA is debatable with respect to research evidence. The objective of this study is to investigate the severity of IA and depression and its interrelationship among the university students. Research information offered by this study can be of use to a wide array of health professionals such as psychiatrists, psychologists, psychosocial counselors, and mental health professionals at primary care levels to understand the severity of the phenomenon and the relationships between psychological factors and IA.

METHODS

Participants

The present study employed a cross-sectional study design. Totally 2776 students pursuing undergraduate studies aged between 18 and 21 years, studying in science, commerce, and humanities subject streams at recognized universities, participated in the study. All these university students were using the Internet for at least 1 year duration, were fluent in their ability to read, write, and comprehend English and gave written informed consent for the study were included in the study. Two university colleges situated in South Indian city of Mangalore were considered to collect the sample as per the convenience of the research team.

All the students of these two colleges who were present on the day of data collection were invited to participate in the study. Totally 2776 students who gave a written informed consent were included in the study. The undergraduate students were chosen as sample for this study as presence of addictive internet behaviors in this population can have far-reaching consequences on the individual's academic progress in their respective field and at a larger level impact the professional progress of these individuals. Ethical approval was received from the institute ethics board of K. S. Hegde Medical Academy, NITTE University, Mangalore, Karnataka, India before initiation of the study.

Tools

Semi-structured schedule

The schedule was constructed by the research team to document information about sociodemographic data and internet usage variables, namely duration, frequency, devices used, time spent on the Internet, craving for internet use, attempts to reduce internet use, and similar other variables.

Internet addiction test

It is a 20 item self-report scale based on a 5-point Likert scale to assess the IA and its severity.[2829] The scores for the individual items were summed up for obtaining a total scale which ranges from 20 to 100. The total score was interpreted with the norm criteria of the scale which indicates mild, moderate, or severe categories IA. IA test (IAT) shows good-to-moderate internal consistency (alpha coefficients - 0.54–0.82). IAT has been evaluated for its content and convergent validity, internal consistency (ἀ = 0.88), and test-retest reliability (r = 0.82).

Self-Reporting Questionnaire

The Self-Report Questionnaire (SRQ) is a 20-item self-administered tool developed by the World Health Organization specifically for the use in developing countries for screening of mental health conditions at community settings. SRQ-20 offers a Yes/No response format to the individual and is designed to identify psychological distress, inclusive of depression, and suicidality.[30] This study had utilized the original form of the questionnaire.

Procedure

The research team had approached two university colleges situated in the South Indian city of Mangalore who were offering undergraduate and postgraduate degrees in science, commerce, and humanities subject streams. On gaining the permission from each of the university colleges for conducting this research study, the research assistants approached the undergraduate students during their free hour in the classroom setup on the days of data collection designated by the university college. Each of these university undergraduate students was explained about the nature of the study and was invited to participate in this research survey. Totally 2776 undergraduate university students who showed willingness to participate and gave a written informed consent were included in the study. Each of these university undergraduate students then completed a set of assessment tools which included a sociodemographic interview schedule, IAT, and the SRQ. Each Individual took around 45–60 min to complete the self-report tools. It took around 6 months for the collection of data across the two university colleges.

There were a total of around 10 research professionals/research assistants who were involved in different capacities for this nonfunded research project. Out of the 10, three were Faculty from Department of Psychiatry; K. S. Hegde Medical Academy, NITTE University, Mangalore, Karnataka, India; one faculty and six research assistants from the Department of Psychology, St. Aloysius College, Mangalore, Karnataka. The qualifications of this research team ranged from M.D. in Psychiatry, M. Phil and PhD in Psychiatric Social Work, and Master's Degree and PhD in Psychology.

Statistical analysis

All the study data were analyzed using IBM SPSS Version 22 for Windows (IBM Corporate, Armonk, New York, USA). Spearman's rank correlation was used to assess the relationship among the IA and SRQ scores. Mann-Whitney U test and Kruskal- Wallis tests were utilized to detect the difference among groups. Logistic Regression analysis was carried out to identify the predictors of IA. The significance value for the study results has been set at P<0.05.

RESULTS

Sociodemographic characteristics of the sample [Table 1]

The study sample of n = 2776 comprised undergraduate university students of which 1680 (60.50%) were female, and 1096 (39.50%) were male participants. The ages of the study sample ranged from 18 to 21 years with the mean age being 18.61 (1.03) years. One-third of the samples (35.50%) initiated internet use between the ages of 10 and 15 years and more than half of the study samples (52.00%) had the first use of the Internet between ages of 16 and 18 years. Mental health consultation was reportedly sought by around (n = 49) 1.80% of the study sample for engaging in problematic/excessive use of the Internet.

Internet use characteristics and internet addiction test scores [Table 2]

Of the total n = 2776, 29.9% (n = 831) of university students met criterion on IAT for mild addictive internet use, 16.4% (n = 455) for moderate addictive internet use, and 0.5% (n = 13) for severe IA. Addictive internet use behaviors were significantly higher among male university students (P ≤ 0.001). A trend toward positive correlation (rs= 0.163; P ≤ 0.001) was observed between age and IA scores which suggests that as an individual's age increases (in this age range of 18–21 years) their risk for addictive internet use becomes higher. University students who engaged in excessive/addictive use of internet were staying in rented accommodations (P ≤ 0.765), used both laptops and mobiles (P ≤ 0.001), spent 180 min or more in a day on the Internet (P ≤ 0.001), accessed internet several times in a day (P ≤ 0.001), used internet for >4 years (P ≤ 0.001), expressed craving for use of the Internet (P ≤ 0.001) and had made lesser attempts to reduce excessive internet use (P ≤ 0.003).

Internet use characteristics and Self-Report Questionnaire scores [Table 3]

Psychological distress on SRQ was nearly equal among female and male university students (P = 0.337). University students who experienced psychological distress were staying away from home in rented accommodations (P = 0.013), used both laptops and mobiles to access internet (P ≤ 0.001), spent 180 min or more in a day on the Internet (P ≤ 0.001), used internet for >2 years (P ≤ 0.001), accessed internet several times a day (P ≤ 0.001), expressed craving for use of the Internet (P ≤ 0.001) and had made no significant attempts to reduce the usage of the Internet (P ≤ 0.703).

Stepwise regression analysis [Table 4]

The stepwise regression analysis indicated that university students who were male (odds ratio [OR] = 2.801, P ≤ 0.001), used the Internet for duration of > 4 years (OR = 1.959; P ≤ 0.001), spent more than 180 min in day on internet (OR = 6.357, P ≤ 0.001), accessed internet several times a day (OR = 2.471, P ≤ 0.001) and were experiencing psychological distress, namely depression (OR = 1.175; P ≤ 0.001) were at higher risk for engaging in IA.

The university students (n = 2776) attained a mean score of 4.87 (standard deviation [SD] = 3.90) on the SRQ and 29.62 (SD = 18.95) on the IAT. A positive correlation was found between psychological distress (depression) and IA (rs= 0.363; P ≤ 0.001). The students who have higher SRQ scores were likely to engage in the addictive use of the Internet.

DISCUSSION

Internet addiction and prevalence

The university students engaged in severe addictive use of the Internet were 0.5% and 16.4% qualified for moderate IA as per the criteria offered by IAT.[17] The present study findings on the prevalence of severe IA are similar to those indicated by other studies on university students - medical (1.2%; 0.7%) and dental students (2.3%; 4.7%) from India.[3132] The studies on undergraduate university students too have indicated a prevalence rate of severe IA ranging from 0.3% in India,[33] 2.2% in Iranian university students[34] 2.8% in Iran medical students,[35] 5.6% in Greece,[36] 9.7% in Turkey,[37] 11.5% in Chile,[38] and 13.2% in Iran.

The present study findings are similar to prevalence rates of moderate IA reported by other Indian studies which ranged from 7.45% in medical students[39] to 7.4%[33] and 15.2% in university undergraduates.[40] A study from Iran indicated 8% of university students were engaged in moderate levels of IA.[34] The variations in sample sizes, instruments used, and different populations which were assessed across different periods of time may be the likely factors for the difference in results of prevalence reported across studies.

Internet addiction and sociodemographic characteristics

The regression and correlation analysis findings of the study indicate that university students who are comparatively older in the study age range were at higher risk for indulging in IA. These findings are in overall agreement to those reported among university students in China.[41] The initial years of university education offer a sudden shift to minimal parental control and increases opportunities for self-expression, use of self-control, and coping strategies. Those young individuals who lack self-control in context of decreased parental monitoring are at higher risk for IA.[42]

Our study indicated that IA behaviors were significantly higher among male university students in comparison to female university students (P ≤ 0.001). In our study, male gender also predicted IA. The present study finding is similar to other study results from India.[3343] Studies conducted in Iran,[34] Greece,[44] Taiwan,[7] also reveal similar findings with respect to gender differences. The findings of meta-analytic research of studies conducted between 1996 and 2006 support the vulnerability of male gender to IA.[45] It can be understood that since socialization offers lesser restriction to males in a majority of cultural contexts, there is a higher involvement of males in internet chatting, online gaming, online gambling, virtual sex, and pornography[46474849] which increases the probability of males becoming addicted to the Internet. In addition, the potential risk for males for IA increases as they are more efficient at using computers, mobile phones, internet tools, receive lesser supervision by parents and thus end up using the Internet more for entertainment needs and in the process intensifying their opportunities for IA.[50]

University students staying away from their families, in rented accommodations, were at a higher risk of developing IA. This study finding is in alignment with studies done in India[39] and Iran[50] which too suggested IA is higher among students who stay independently. The experience of boredom, loneliness, and availability of privacy, ease of the Internet access, and minimal presence of parental supervision are factors which likely escalate the excessive use of the Internet.

Internet addiction and internet use characteristics

The amount of time an individual spends on the Internet is a crucial factor which increases risk of IA. Our study findings suggest that university students who were engaging in more than 3 h of internet use per day in nonacademic internet activities had higher levels of IA (P ≤ 0.001). Our study indicated that time spent on internet per day and daily frequencies of internet use were variables which predicted IA. The severity levels of IA increase with increase in duration of internet use is consistently suggested by research evidence from many studies.[515253] Thus, findings apparently imply that when the time spent by students on internet use becomes greater, the risk of becoming addicted to internet multiplies and becomes higher.

University students who accessed internet several times a day (P ≤ 0.001) and remained online throughout the day also had higher levels of IA. Another study from India[54] corroborated with the findings of the present study. Individuals who were using both mobiles and computer tablets experienced higher levels of IA. Mobile phones and computer tablets have become nearly inseparable gadgets of youth as it offers easy accessibility, affordability, and connectivity to the Internet throughout the day and these characteristics in itself appear to intensify internet addictive behaviors.[26]

Our study also indicates that students who had higher levels of IA scores were using the Internet for more than 4 years and the duration of use was a variable which predicted IA. Duration of internet use was also predictor for IA among university students in Turkey.[55] In our sample, 43.72% of university students had internet use of 4 years and above. However, this finding does not necessarily highlight the time duration required for the emergence of IA since its initial use by the individual. Another study conducted in India suggested time duration of 6 years between first use and development of IA.[56] However, this time duration may steadily reduce over the years with the increase in accessibility of the Internet at cheaper rates in India. It is interesting to note the occurrence that why new challenges keep arising with invention of newer technologies which are created in the first place to solve existing challenges. Nearly 55.5% university students who were aware about IA had made attempts to reduce internet use. This indicates that the first initial step toward the healthy use of technology can be awareness generation about IA among university students and faculty.

Internet addiction and psychological distress

The presence of psychological distress appears to be a significant factor which has the potential to increase the risk of IA. Regression analysis indicated university students who had psychological distress (depressive symptoms) predicted IA or were at risk for engaging in IA behaviors. The correlation between depression and IA observed in this study has been reported by other studies.[4749575859] It is to be observed that a noticeable proportion of the present study sample 1.80% (n = 49) had in the recent past approached a mental health professional for excessive internet use.

The beginning of an undergraduate course in university brings with itself a set of challenges and a phase of transition in youth life. Many students stay in rented accommodations or in university hostel to address the requirements of the course. In addition, this transition requires them to solve everyday challenges of staying out of home, taking care of one's health, form new interpersonal relationships, and gather social and emotional support. The individuals who are vulnerable can experience boredom, loneliness, and depression during this phase of transition in young adulthood.

In this context, the Internet can be viewed by some individuals as a medium to cope up with the psychological distress caused by the new challenges. To establish new interpersonal relationships, seek information, guidance, and for entertainment, the Internet can be used by students. However, the risk for IA increases with excessive use of the Internet which has potential to cause depression. The individuals who are predisposed to depression or are experiencing depression are engaging in addictive use of the Internet.[2760] Individuals with depression understandably experience sadness, loneliness, low self-esteem, decreased energy and lack of motivation[6162] which likely drives them to use the Internet to overcome/escape these unpleasant emotional states including depression[63646566] Gaining of social approval, enhancement of self-esteem, and overcoming of loneliness can be achieved through the Internet.[67] On the contrary, an individual who starts skipping opportunities and diverts time and meant for social gatherings, outdoor events, sports activities, family events toward internet use ends up isolating oneself and predisposes oneself toward depression.[68] University students who are engage in excessive internet use may at a point of time find it difficult to engage in social interactions and relate socially to others; thus they may move away from real people and escape into the online world with virtual people with whom social interactions and rewards are more controllable making emotions predictable.[20656669] Thus, exacerbation of IA and depression can occur when both psychological conditions interact with each other.[2760]

CONCLUSIONS AND SUGGESTIONS

In South India, IA appears to be an emergent and significant mental health condition among university students. Psychological distress (depression) and IA were positively correlated, and it is a variable which predicts IA. University students must be screened for IA and psychological distress as there is a substantial possibility that they coexist and can magnify each other. Early intervention can be offered to young adults if efforts are directed toward the identification and timely referrals to specialized centers of psychological care. Nearly 55.5% of university students who knew about IA had made attempts to reduce internet use. Thus, awareness generation initiatives about IA and its risk factors among students and faculty will be a valuable initial step towards healthy use of the Internet. Upcoming studies can evaluate the relationship of IA and depression in a manner which is more inclusive.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Table 1

The distribution of scores by sociodemographic characteristics of the sample

Table 2

Distribution of mean scores of the students on the Internet addiction test according to some of the characteristics of their internet usage

Table 3

Distribution of the mean scores of the students on the self-report questionnaire according to some of their characteristics of internet usage

Table 4

Stepwise regression analysis for predictors of internet addiction