Effect of Internet addiction on marital life.

CONTEXT: Certain behaviors exceed to an extent such that control becomes difficult and tolerance, dependence, and withdrawal are evident, it is regarded as behavior addiction. Internet addiction is defined as "the forced and excessive use of the Internet and the irritation that occurs when the Internet is deprived." Internet connects people to the World Wide Web and provides an easy escape for people from their immediate environment and people tend to move away from their intimate relations. AIMS: We intend to find the effect of Internet addiction on marital life. SETTINGS AND
DESIGN: It was a cross-sectional study with purposive sampling from the community. SUBJECTS AND METHODS: Standardized instruments were used for the assessment of Internet addiction and marital satisfaction. The correlation was estimated and the level of significance was calculated. The marriage quality scale by Shah was used as an instrument for marital satisfaction. Youngs Internet addiction test was used for checking for the presence of Internet addiction. STATISTICAL ANALYSIS USED: The mean, standard deviation, and correlation were estimated and the level of significance calculated.
RESULTS: Regular users of the Internet had a relative risk of 52.5% with 1.5% showing severe addiction. Trust, dominance, and dissolution potential did not show a significant correlation.
CONCLUSIONS: The risk of Internet addiction was high among regular internet users. The level of psychological comorbidity was also high. It affected marital satisfaction adversely. However, trust, dominance, and dissolution potential were least affected. In the case of marital disharmony, Internet addiction needs to be looked at as an etiological factor. Copyright:

Many behaviors are considered as part of normal daily life, forexample, sex, entertainment. However, when the need for these behaviors exceed to an extent such that control becomes difficult and tolerance, dependence, and withdrawal are evident, it is regarded as behavior addiction.[1] Excessive use of the internet is also regarded as an impulse control disorder and exhibits the following attributes:[23]

Salience (precedes all other activities in cognition and behavior)

Mood modification (e.g. euphoria)

Tolerance (constantly changing need for advanced hardware and software)

Withdrawal symptoms (tension, anxiety, depression, irritability)

Conflict (arguments, deception, social isolation, and disintegration)

Relapse.

Various studies report the prevalence of Internet addiction in the range of 1% to 14%.[2] It is mainly of three types; excess gaming, sexual preoccupation, and over-involvement with text messages. However, the common element in all these is the disruption of daily routine.[4]

Ivan Goldberg, in 1996 at the American Psychology Congress had first described Internet addiction as a disorder that was rapidly spreading among the youth. They defined internet addiction as “the forced and excessive use of the Internet and the irritation that occurs when the Internet is deprived.”[25] Individuals typically have an unpleasant feeling if devoid of the internet and feel better only when they get online.[6] Deprived of Internet people feel agitated and left off from updated information and perceive a threat of loss or break of relation.[7] People frequently exceed the time spent online, tell lies about usage, and are preoccupied with the upcoming session when offline.[8] In the study “The world unplugged” 1000 students from 12 universities in 9 countries were asked to stay away from their online device for a day. The urge to get back online was so strong that most people failed to stay away for the whole day and went online, they felt lonely and were unable to discover another alternate activates.[6] Employees have lost jobs, caused losses of millions of dollars to organizations for being hooked to net. There have been several attempts to explain the psychological basis of Internet addiction proposing various models, namely, the cognitive-behavioral model of problematic Internet use the anonymity, convenience, and escape model, the access, affordability, anonymity (Triple-A) engine, a phases model of pathological Internet use by Grohol.[9101112]

Being married showed better mental health and it was affected by marital disturbances.[1314] Even in the Indian context, where the principles of marriage differ a lot from that of the Western world, similar findings were noted.[15] The roles played by partners in marriage differ, and that contributes to the difference in marital quality.[16] Extramarital affairs have always affected marital bliss. Internet connects people to the World Wide Web and provides an easy escape for people from their immediate environment. In the developed countries online affairs have been regarded as a rising cause of marital disharmony.[17] One of the areas affecting marital relations is cyber infidelity. People have been addicted to pornographic sites, searched for partners online. Multiple sites provide the opportunity to find new partners online and have been a source of initiation and maintenance of extramarital relationships. Many go for searching for their ex-partners for interest or re-initiation. Internet addiction has been recognized as a major health hazard in South East Asia and is a target of research and Intervention.[18] We intend to investigate the relationship between marital disharmony and Internet addiction.

SUBJECTS AND METHODS

It was a cross-sectional study carried out from a medical college in Eastern India. The study was approved by the Institutional ethical committee. Written informed consent was obtained from all the members. Samples consisted of voluntary participants from the community who were using the internet regularly. A semi-structured questionnaire was prepared, consisting of demographic detail, general physical examination, and mental status examination. A total of 212 samples were collected of which 12 were excluded as the questionnaire was incomplete. Of the 200 samples analyzed, 38 were married and were accessed for marital satisfaction.

Study tools

General health questionnaire-28:[19] To screen patients for psychiatric co-morbidity

HAM-D (Hamilton Depression Scale):[20] A widely used and validated instrument for diagnostic confirmation and assessment of depression

HAM-A (Hamilton Anxiety Scale):[21] A widely used and validated instrument for diagnostic confirmation and assessment of anxiety

Marriage quality scale by Shah:[22] An instrument for marital dissatisfaction. It provides a net score and individual scores for various items of marital satisfaction such as affection, dependence, trust, despair, understanding, and decision-making. It is developed in India and standardized for the Indian population

Youngs Internet addiction test:[23] The first validated instrument for checking for the presence of Internet addiction and measures it. It is an internationally accepted rating instrument and validated. It has 20 items arranged on a Likert scale to be rated 1 to 5. Scores obtained are classified as mild, moderate, and severe.

Inclusion criteria

Male/female patients

Age: 18–60 years (prevalence of dementia increases >60)

Ability to read and write in English

Daily access to electronic media for at least half an hour daily.

Exclusion criteria

Those with co-morbid conditions such as drug abuse (drug abuse affects mental health and family life), except nicotine dependence, affective disorders, or other comorbid conditions such as dementia or mental retardation

Who refused to give consent

Those with any history of head injury or attacks of seizure in the past 1 year.

All the data were tabulated in Microsoft Excel. It was imported in Epi Info 7 developed by Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia (US). Means, standard deviation, and percentages were calculated. Spearman's coefficient of correlation with the level of significance (P < 0.05) was calculated.

RESULTS

The mean of Internet Addiction Test score among the whole group was 31.71 ± 16.09 and a prevalence of 52.5%.

Table 1 Correlation of Internet addiction with domains of marital satisfaction.

Table 1

Correlation of internet addiction with domains of marital satisfaction

	Mean score	Spearmans correlation coefficient	t	P
Marital satisfaction	88	−0.51	2.56	0.019
Rejection	15	0.94	12.87	<0.001
Self disclosure	4	−0.94	12.3	<0.001
Despair	4	−0.87	7.68	<0.001
Discontaint	4	−0.87	7.68	<0.001
Satisfaction	13	−0.82	6.3	<0.001
Role function	9	−0.71	4.26	0.005
Understanding	22	−0.68	3.97	<0.001
Decission making	16	−0.64	3.59	0.002
Affection	13	0.48	2.34	0.031
Dominance	4	−0.43	2.07	0.053
Trust	2	−0.31	1.4	0.177
Dissolution potential	1	−0.13	0.56	0.576

DISCUSSION

The problem of internet addiction is widely prevalent among users of the internet to the extent of 52.5% [Figure 1]. Some of the recent studies on the Indian population report rates of 19.85%.[24] These studies had samples where subjects could have had access to the internet or not at all. The inclusion criteria for our study were the use of the Internet through any device for at least half an hour daily. Hence, our estimate is higher but more relevant as it is indicative of relative risk among the susceptible population. Of this 52.5% [Table 2] majority, i.e., 29% had a mild addiction, whereas only 1.5% had a severe addiction.

Figure 1

Depicts the distribution of Internet Addiction (Mean 22.5 ± 9.8) against marital satisfaction (Mean 88.2 ± 11.4). A significant inverse relation (P < 0.001) with a correlation of −0.51

Table 2

Prevalence of internet addiction

Level of addiction	Range	n	Male (n=108)	Female (n=92)	P	Percentage in total samples
Normal range	0-30	95	45	50	0.61	47.5
Mild range	31-49	58	31	27	0.60	29
Moderate range	50-79	44	29	15	0.03	22
Severe range	80-100	3	3	0	0.08	1.5

The prevalence of depression and anxiety was also noted among the regular users of the internet [Table 3]. The biggest question that remains unanswered is a causal relation. Internet addiction could result in mental illness, again internet addiction could be secondary to mental illness. People tend to seek an easy escape in the World Wide Web to escape from the distress of mental illness. However, the relation between depression and Internet addiction is already established.[25]

Table 3

Demographic variables

Variable	Group-1 patient (n=200), n (%)
Sex (male)	108 (54)
Age (years)	30.88±8.24
Education
School	71 (35.5)
High school	35 (17.5)
Graduate	41 (20.5)
Postgrade	12 (6)
Professional	41 (20.5)
GHQ score	2.00±0.81
Prevalence of depression (HAM-D score>7 )	24 (12)
Prevalence of anxiety (HAM-A score>13)	38 (19)

The extent of Internet addiction showed a significant difference between males and females. Male participants showing a moderate level of Internet addiction was significantly higher (P = 0.03). A higher prevalence of Internet addiction was also noted in other studies.[26] Males have been found to have a higher susceptibility to Internet addiction.[27]

Internet addiction affected family life significantly (P < 0.001) with a negative correlation of 0.51. Marital satisfaction is based on many areas[Table 1]. Based on the findings of our rating instrument which was standardized for the Indian population we accessed several areas of satisfaction. Domains of satisfaction like rejection, self-disclosure, despair, discontaint, and role function were domains that showed a significantly (P < 0.05) high correlation. As people spend more time online, the time invested in intimate relation decreases. This is bound to produce anguish. Partner may be left off, perceiving a threat to their cherished relation and this experience often makes them anticipate online affairs and online dating. Affection showed a moderate (0.48) correlation, though significant. Trust, dominance, and dissolution potential did not show a significant correlation. Needless to mention when partners trust each other, anxiety about the relationship reduces. This leaves us with the question that, is trust the strongest pillar in the relationship that remains unaffected by odds?

This being an unexplored area we could hardly come across much of existing data to compare with. In India, research into marital issues has been on for decades. Areas of stress in the relationship, impact of income, roles played by partners, division of work and psychological correlates of marital satisfaction have been explored. Lately, the effect of the digitalization of the subcontinent on marital satisfaction has become an area of concern.

CONCLUSIONS

Internet addiction is a growing concern for regular users of the Internet having the relative risk of 52.5% with 1.5% showing severe addiction. Further, in the case of marital discord Internet addiction needs to be looked at as an etiological factor.

Strengths:

Using appropriate validated and standardized instruments

Community-based sampling

Quantifies the relative risk among susceptible populations

No observer-rated scale used, hence no observer bias

Weakness: Detail of usage from the devices used could have been more accurate but was not technically feasible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.