Int J Curr Pharm Res, Vol 15, Issue 1, 59-62Original Article


INTERNET ADDICTION AND ITS ASSOCIATION WITH ANXIETY IN MEDICAL UNDERGRADUATES–A CROSS-SECTIONAL STUDY

MOUNIKA MANDLA1, BALAJI GARUGU 2, SHASHANKA VUNNAM3, VAIDYANATH GOTTUMUKKULA4*

1,2,4*Department of Psychiatry, Government Medical College, Ananthapuramu, Andhra Pradesh, India, 3Consultant Psychiatrist Deaddiction Department, Department of Psychiatry, Government Medical College, Ananthapuramu, Andhra Pradesh, India
Email: drgvaidyam@gmail.com

Received: 12 Oct 2022, Revised and Accepted: 15 Dec 2022

ABSTRACT

Objective: To study the prevalence of Internet Addiction among Medical undergraduates and Interns and exploration of its association with anxiety disorders.

Methods: It is a cross-sectional survey conducted among 540 undergraduate medical students and 93 Interns at Government Medical College, Ananthapuramu. Young’s Internet Addiction Test and Zung’s self-rated Anxiety scale were applied to measure Internet addiction and Anxiety, respectively.

Results: From the results, it was 36.3% of subjects had Internet Addiction, of which 2% had severe Internet Addiction. Anxiety prevalence was about 19.14 %, of which 16.8% had mild to moderate anxiety symptoms and 2.34% had severe anxiety. There was a significant association between Internet Addiction and Anxiety (p<0.0001). There is a negative correlation between the year of study and Internet Addiction (p<0.018).

Conclusion: Internet addiction was found among medical students and there was a significant association between Internet addiction and Anxiety among participants.

Keywords: Internet, Medical students, Addiction, Anxiety, Prevalence

© 2023 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open-access article under the CC BY license (https://creativecommons.org/licenses/by/4.0/)
DOI: https://dx.doi.org/10.22159/ijcpr.2023v15i1.2076 Journal homepage: https://innovareacademics.in/journals/index.php/ijcpr

INTRODUCTION

Internet use has become a very important and necessary part of everyday life. In recent years, internet users worldwide have increased many folds. In India, according to a report published by the Internet and Mobile Association of India (IAMAI), Internet users rose to 4% (323 million) in 2020 and are estimated to have 900 million active users by 2025 [1]. Internet Addiction has been defined as Excessive or poorly controlled preoccupations, urges, or behaviours regarding computer use and internet access that leads to impairment or distress [2]. This may lead to serious mental health Issues. There are few studies from India on the prevalence of internet addiction among school children but its prevalence and relationship to mental health in vulnerable groups such as medical studentsremain to be explored. The information thus built will help the medical personnel to identify and go for early screening of internet addiction and its associated psychological issues. The study aims to estimate the prevalence of Internet Addiction and its association with anxiety among undergraduate medical students and Interns.

MATERIALS AND METHODS

This is a cross-sectional study conducted at a Government Medical College and Hospital in the Ananthapuramu district of Andhra Pradesh. The data was collected using a semi-structured socio-demographic questionnaire, an Young’s Internet Addiction questionnaire [3] and Zung’s Anxiety Scale [4]. Young’s Internet Addiction questionnaire is used to evaluate internet Addiction among the subjects. It consists of 20 questions related to internet usage and it is scaled on a Likert scale from 1 rarelyto 5 always. The maximum score is 100 points. 0-30 normal users, 31-49-mild addiction, 50-79-moderate addiction, 80-100-severe addiction. Zung’s anxiety scale [4] is a self-report scale whose 20 items cover a variety of anxiety symptoms, both psychological and somatic. Responses are given on a 4-point scale which ranges from 1 (none, or a little of the time) to 4 (most, or all of the time). Participants are instructed to base their answers on their experiences over the last week. Raw scale scores for the SAS range from 20 to 80. Permission to collect data was obtained from the Head of the Institution and the Institutional ethics committee. Questionnaires were given to the students in the form of Google forms. Consent to participate in the study was taken before filling out the forms. Out of 633 subjects, 490 members expressed their willingness to participate in the study. Only 470 gave their consent and participated in the study.

Inclusion criteria: It includes Undergraduate medical students to final year and interns, subjects who were willing to give consent.

Exclusion criteria: It includes individuals with substance use, individuals with previous psychiatric illnesses, and individuals who were not willing to give consent.

Statistical analysis

Data was entered in a MS X-cel sheet. Software version SPPS 23.0 was used for statistical analysis. Descriptive statistics in the form of proportions, means, and standard deviations have been applied. A Chi-square test was applied for testing the association of Internet Addiction with socio-demographic variables and anxiety status. Independent predictors were determined using Linear regression. Suspected cases of mild Internet Addiction and anxiety were counselled by a trained counsellor and moderate to severe cases were referred to the psychiatry department for further evaluation and management.

RESULTS

A total of 490 subjects were approached of which 470 participated in the study with a response rate of 95.9% of which males 217(46%) and females 253 (54%) (table 1). The mean age of the subjects was 20.90 y. The overall prevalence of Internet Addiction is 36.3%. The prevalence among 1st-year subjects was 24.8%, 2nd-year subjects were 18%, 3rd y subjects were 16%, 4th y subjects were 15% and interns were 26.2% (table 1). The prevalence of Internet addiction among males was 46.17% and among females was 53.8%. The study’s overall prevalence of anxiety was 19.14%. The prevalence of anxiety was 28.2% in first-year students, 17.7% in second-year students, 13.3% in third-year students, 11.5% in fourth-year students, and 22.3% in interns (table 2) (fig. 1, fig. 3). Males were more likely than females to experience anxiety (42% versus 37%). The prevalence of Anxiety in subjects with Internet Addiction was significant statistically (p<0.0001), with 31% of subjects with Internet addiction having Anxiety (table 3 and table 4).

Table 1: Socio-demographic characteristics and internet addiction

Gender Number Percentage
Male 217 46.17%
Female 253 53.8%
Study years
First years 117 24.8%
Second years 85 18%
Third year 75 16%
Final year 71 15%
Interns 122 26.2%
Internet addiction
Normal range 299 63.61%
Mild 102 21.7%
Moderate 60 12.7%
Severe 9 1.91%

Table 2: Internet addiction

Gender Normal Mild Moderate Severe Total p-value
Male n 139 46 27 5 217 0.93
% 64.05% 21.19% 12.44% 2.30% 100%
Female 160 56 33 4 253
63.24% 22.13% 13.4% 1.58% 100%
Total N 299 102 60 9 470
% 63.61and 21.7% 12.7% 1.91% 100%

Fig. 1: Prevalence of anxiety

Fig. 2: Anxiety among different groups

Fig. 3: Anxiety gender wise

Table 3: Linear regression with anxiety

Anxiety B SE OR Significance
Internet addiction 27.64 6.68 0.46 <0.0001*
Year of Study -1.07 0.45 -0.14 0.018*
Age 0.247 0.339 0.04 0.46
Gender -0.188 0.857 -0.009 0.82

Table 4: Chi 2test analysis of internet addiction with anxiety

Internet addiction Anxiety
No anxiety (380) Mild to moderate (79) Marked to severe (11)
No Internet Addiction (299) 263 34 2
Mild (102) 75 25 2
Moderate (60) 40 18 2
Severe (9) 2 2 5
Chi-Square Value: 135.8; df: 6; p<0.00001 Highly Significant

DISCUSSION

The internet has become a significant and important service that has been utilized in several sectors of life. One of these aspects is the acquisition of knowledge for studying. Medical students who require the internet for their medical education. Researchers found a correlation between increased Internet usage and an increase in psychiatric disorders [5]. To our knowledge, very few studies have evaluated the prevalence of internet addiction among medical students. The purpose of this study was to determine the prevalence of Internet Addiction among medical students, to evaluate the relationships between Internet Addiction and participant characteristics (primarily gender and academic year), and to investigate the possible associations between Internet Addiction and anxiety. Regarding Socio-demographic data and Internet Addiction, our study revealed that no association was found between Internet Addiction andthe Age and Gender of study participants. Similar findings have been reported from other studies [6-9]. An Iranian study done by Ba tool Gholamian et al. [10] showed a higher prevalence among females, and Carli et al. [11] found a higher prevalence among males, which wasnot in accordance toour study findings. The reason for the equal prevalence of Internet Addiction in male and female subjects may be attributed to the inexpensive availability of technology, the Internet’s accessibility, and individual variances in gender and age. Around 36.3% of the study participants were found to have an internet addiction, which shows a high prevalence rate. Similar prevalence rates were found in a study conducted by Arslaan Javeed et al. [12] was 52.4%. Whereas the study by Muhammad Alamgir Khan et al. [13] and Miano Xin et al. [14] found 16.7% and 26.5%were addicted to the internet, respectively. The reason for this variation may be attributed to many factors like regional differences and mobile devices like smartphones and tablets have become cheaper and easier to get. This has made them more popular. Additionally, consequences of the recent pandemic leading to more online classes, social isolation, and uncertainty may be linked to the high prevalence. According to this study's findings, there is a considerable correlation between internet addiction and anxiety. This indicates that Internet-addicted individuals exhibited considerable anxiety. Shawi et al. [15], Bernardi et al. [16], and Farah Younes et al. [17] reached the same conclusion about this topic based in their research. As the student progresses from the first to the final year of college, the prevalence of Internet addiction decreased a similar finding noted in other study Gamal et al. [18]. Other research revealed that higher grades correlate with a higher prevalence, which contradicted the present study [19]. This link may be a result of stress, the new CBME curriculum, being away from home, and a change in the environment during the first half of the programme, but the lower prevalence in the last years may be a result of cognitive maturation. After completing their senior year, they become interns, a stress-free position that affords them more opportunities to use technology.

CONCLUSION

Internet addiction is common among medical students and is associated with anxiety.

LIMITATIONS OF THE STUDY

The current study is a Online form-based study. The different categories of Internet Addiction were not explored in detail. Results cannot be generalized to the general population.

FUNDING

Nil

AUTHORS CONTRIBUTIONS

Author Mandla Mounika contributed conceptual design, performed the work, and wrote the first draft of the manuscript. Authors Garugu Balaji and Shashanka Vunnam collected the literature and collected data. Vaidyanath Gottumukkula guided the work and corrected the manuscript.

CONFLICTS OF INTERESTS

The authors declared no conflicts of interest.

REFERENCES

  1. Bhattacharjee B. Internet adoption in India. Kantar Icube. 2020;2021:1-23.

  2. Shaw M, Black DW. Internet addiction: definition, assessment, epidemiology and clinical management. CNS Drugs. 2008;22(5):353-65. doi: 10.2165/00023210-200822050-00001, PMID 18399706.

  3. Young KS. Internet addiction: the emergence of a new clinical disorder. Cyber Psychol Behav. 1998;1(3):237-44. doi: 10.1089/cpb.1998.1.237.

  4. Dunstan DA, Scott N. Norms for Zung’s self-rating anxiety scale. BMC Psychiatry. 2020 Feb 28;20(1):90. doi: 10.1186/s12888-019-2427-6, PMID 32111187, PMCID PMC7048044.

  5. Christakis DA. Internet addiction: a 21st century epidemic? BMC Med. 2010 Oct 18;8:61. doi: 10.1186/1741-7015-8-61, PMID 20955578, PMCID PMC2972229.

  6. Weinstein A, Curtiss Feder L, Rosenberg KP, Dannon P. Internet addiction disorder. Behav Addict. 2014:99-117.

  7. Tsitsika A, Janikian M, Schoen makers TM, Tzavela EC, Olafsson K, Wojcik S. Internet addictive behaviour in adolescence: A cross-sectional study in seven European countries. Cyber PsychoBehav Soc Netw. 2014;17:528–35.

  8. Park S, Hong KE, Park EJ, Ha KS, Yoo HJ. The association between problematic internet use and depression, suicidal ideation and bipolar disorder symptoms in Korean adolescents. Aust NZJ Psychiatry. 2013;47(2):153-9. doi: 10.1177/0004867412463613, PMID 23047959.

  9. Ni X, Yan H, Chen S, Liu Z. Factors influencing internet addiction in a sample of freshmen university students in China. Cyberpsychol Behav. 2009;12(3):327-30. doi: 10.1089/cpb.2008.0321, PMID 19445631.

  10. Gholamian B, Shahnazi H, Hassanzadeh A. The prevalence of internet addiction and its association with depression, anxiety, and stress, among high-school students. Int J Pediatr. 2017;5(4):4763-70.

  11. Carli V, Durkee T, Wasserman D, Hadlaczky G, Despalins R, Kramarz E. The association between pathological internet use and comorbid psychopathology: a systematic review. Psychopathology. 2013;46(1):1-13. doi: 10.1159/000337971, PMID 22854219.

  12. Javaeed A, Zafar MB, Iqbal M, Ghauri SK. Correlation between Internet addiction, depression, anxiety and stress among undergraduate medical students in Azad Kashmir. Pak J Med Sci. 2019;35(2):506-9. doi: 10.12669/pjms.35.2.169, PMID 31086541.

  13. Khan MA. Effect of Internet addiction on academic performance of medical students. J Islamic Int Med Coll. 2016 Jun 1;11(2):1-7.

  14. Xin M, Xing J, Pengfei W, Houru L, Mengcheng W, Hong Z. Online activities, the prevalence of internet addiction and risk factors related to family and school among adolescents in China. Addict Behav Rep. 2018 Jun;7:14-8. doi: 10.1016/j.abrep.2017.10.003, PMID 29450251.

  15. Al Shawi AF, Hameed AK, Shalal AI, Abd Kareem SS, Majeed MA, Humidy ST. Internet addiction and its relationship to gender, depression and anxiety among medical students in Anbar Governorate-West of Iraq. Int Q Community Health Educ. 2021:272684X20985708. doi: 10.1177/0272684X20985708. PMID 33402000.

  16. Bernardi S, Pallanti S. Internet addiction: a descriptive clinical study focusing on comorbidities and dissociative symptoms. Compr Psychiatry. 2009;50(6):510-6. doi: 10.1016/j.comppsych.2008.11.011, PMID 19840588.

  17. Younes F, Halawi G, Jabbour H, El Osta N, Karam L, Hajj A. Internet addiction and relationships with insomnia, anxiety, depression, stress and self-esteem in university students: A cross-sectional designed study. Plos One. 2016;11(9):e0161126. doi: 10.1371/journal.pone.0161126, PMID 27618306.

  18. Al-Gamal E, Alzayyat A, Ahmad MM. Prevalence of internet addiction and its association with psychological distress and coping strategies among university students in Jordan. Perspect Psychiatr Care. 2016;52(1):49-61. doi: 10.1111/ppc.12102, PMID 25639746.

  19. Kawabe K, Horiuchi F, Ochi M, Oka Y, Ueno S. Internet addiction: prevalence and relation with mental states in adolescents. Psychiatry Clin Neurosci. 2016;70(9):405-12. doi: 10.1111/pcn.12402, PMID 27178110.