|Year : 2020 | Volume
| Issue : 4 | Page : 289-295
Social media disorder among Indian undergraduate medical students and its association with depression: An institution-based mixed-method study
Rajib Saha, Manisha Sarkar
Department of Community Medicine, Bankura Sammilani Medical College, Bankura, West Bengal, India
|Date of Submission||12-Mar-2020|
|Date of Acceptance||18-Apr-2020|
|Date of Web Publication||31-Dec-2020|
Dr. Manisha Sarkar
Jagatpur, Near Jagatpur High School, Gouranga Nagar, North 24 Parganas, Kolkata - 700 159, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Social media disorder (SMD) is the current entity in this decade that leads to different screen-related health problems. Despite of tremendous academic pressure, how social media affects the future doctors, is yet unknown. Aims: The aim is to determine the prevalence of SMD among the undergraduate medical students of a tertiary care hospital in West Bengal and to determine its predictors. Settings and Design: A cross sectional analytical mixed-method study was conducted at a tertiary care center of Bankura. Methodology: During April–June 2019, 216 undergraduate medical students were selected through two-stage sampling method. Data were collected using semi-structured questionnaire, 9-item SMD scale, and Beck's Depression Inventory Scale. Statistical Analysis Used: Data were analyzed using SPSS (version 16) initially through bivariate analysis using Chi-square test and later logistic regression was used to determine the actual predictor(s). Results: The prevalence of SMD was found to be 11.6%. All of the students were found to be social media users and among them the prevalence of screen-related sleep disturbance, headache, eye problem, musculoskeletal problems, and overweight or obesity was 35.6%, 36.1%, 28.7%, 31.5%, and 50.9%, respectively. However, no significant relationship was obtained between SMD and above health problems. Through logistic regression model, it was found that the students with depression were 6.7 times more prone to develop SMD. Conclusions: Depression being a risk-factor for SMD needs to be addressed as priority by providing appropriate counseling and/or professional consultation.
Keywords: Addiction, depression, medical students, screen related health problem, social media disorder
|How to cite this article:|
Saha R, Sarkar M. Social media disorder among Indian undergraduate medical students and its association with depression: An institution-based mixed-method study. Indian J Soc Psychiatry 2020;36:289-95
|How to cite this URL:|
Saha R, Sarkar M. Social media disorder among Indian undergraduate medical students and its association with depression: An institution-based mixed-method study. Indian J Soc Psychiatry [serial online] 2020 [cited 2021 Jan 18];36:289-95. Available from: https://www.indjsp.org/text.asp?2020/36/4/289/305949
| Introduction|| |
Social media are various ways of electronic communication through which users share information, ideas, personal messages, and other content with others. Social media has somehow become a necessary evil now a day. The inseparable bond of humans with the use of social media has overtaken interpersonal relationships. As on January 2019, globally 3.48 billion people were active social media users (approximately 45% of the world population), while in India 310 million people (approximately 23% of the Indian population) were active social media users.,
Social media overuse may waste lot of productive time and may cause problems related to daily functioning, completion of tasks, relationships, and/or psychological status. The perceived need to be online on social media may result in compulsive use of social media, which in extreme cases may result in symptoms and consequences traditionally associated with substance-related addictions.
Social media disorder (SMD) is a proposed diagnosis related to the overuse of social media, similar to internet addiction particularly internet gaming disorder and other forms of digital media overuse., Gaming disorder has been already included in International Classification of Diseases-11. Although the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) recognizes Internet gaming disorder as a tentative disorder in the appendix of the manual American Psychiatric Association 2013, SMD still has no status in the DSM-5. While the exclusion of SMD from the DSM-5 may give the impression that SMD is not a legitimate mental disorder, there is a growing body of evidence suggesting otherwise. Time has come to consider it as a psychological disorder. According to the study done by O'Keeffe et al., it was found that excessive use of social media led to increase in internet addiction, decline of face-to-face interaction, cyber bullying, and sleep deprivation. Al-Menayes found that spending time online in social media websites and lack of sleep due to late night internet use led to low academic performance. Whang et al. found that social media addicts had a higher degree of loneliness and depression compared to nonaddicts.
A lot of studies on social media use have been conducted in India with only a few studies in West Bengal. Most of them have been conducted either on school or preuniversity students, through face-to-face self-administered questionnaire or have been conducted on youths through online surveys.,,,,, SMD can have far greater impacts on college students than school students. More so, online surveys have fewer responses and have their own limitations due to one's busy schedule. Furthermore, studies have been done across the country and worldwide on internet addiction disorder among different population groups including the medical students., However, despite exhaustive search, no study was found in our country among the undergraduate medical students regarding the extent of SMD particularly for nonacademic purposes or nonjob-related purposes. With this background, the current study was undertaken among the undergraduate medical students of Bankura Sammilani Medical College with an aim to study the pattern of social media use, the factors predisposing to SMD and its probable screen-related effects on their physical and mental health and academic performance. The study may help to understand the threats to social media over use and measure the overall burden of the SMD among the undergraduate medical students, who are the future doctors and who have extreme academic pressure. This may in turn create awareness regarding the impacts of SMD, before the entire population is gripped in the flame of social media overuse.
| Materials and Methods|| |
An institution-based cross-sectional, mixed method study was conducted among the undergraduate medical students of a tertiary care center at West Bengal from April to June, 2019 using both quantitative (analytical study) and qualitative methods (thematic analysis). Students who were not willing to participate in the study, having a history of preexisting musculoskeletal disorder due to other pathological reasons (such as fracture and tumor) and having a history of preexisting eye diseases due to other pathological reasons (such as infections, glaucoma, tumor, and retinal pathology) were excluded. Out of existing 600 MBBS students, the required sample was obtained using two-stage sampling method. Initially the required sample size was calculated to be 96, using the formula n = Z2(pq)/d2 (where, P is the prevalence of SMD = 50% [as there were no available data on SMD prevalence], q = 1 − p, d or absolute precision = 10%). As two-stage sampling method was used for sampling, above calculated sample size was multiplied by design effect of 2 and the sample size was obtained as 192. Considering 10% nonresponse rate 213 sample size was calculated. In the first stage of sampling, all the four batches of MBBS students were included in the study and in the second stage, from each batch 54 eligible students were selected by simple random sampling technique using random number table. Thus, the study was ultimately conducted among 216 MBBS students. After taking informed consent and maintaining the anonymity, data were collected using self-administered predesigned, pretested, semi-structured validated questionnaire along with validated 9-item SMD scale and Beck's Depression Inventory Scale. Weighing machine and stadiometer were used for computing body mass index (BMI) following standard techniques by the authors. Asian criteria of BMI were used for categorizing students based on their BMI. Subjects who had used social media for at least 2 months in the past for nonacademic or nonjob-related purposes were considered as social media users. A person who responded to 5 or more items as “yes” in the 9-item SMD scale was considered to be having SMD. Data were entered into Microsoft Excel and analyzed using the Statistical Package for the Social Sciences version 16.0 (IBM Corp, Armonk, NY, USA). Bivariate analysis (Chi-square test or Fisher's exact test as per applicability) was performed to assess the association between SMD and different independent variables. Factor(s) which was/were found statistically significant in bivariate analysis, was/were considered for logistic regression to reveal the ultimate predictor variable(s).
Before conducting the study, permission was obtained from the Institutional Ethics Committee.
| Results|| |
At the time of data collection 2nd, 4th, 6th and 8th semester's MBBS batch was existing in the institution. Among all the participating students, 60.6% were male, 83.3% were Hindu, 65.3% were unreserved, 78.2% were belonging to nuclear family, and 66.2% students were belonging to upper class socio-economic status based on Modified BG Prasad scale, March 2019., According to their responses toward Beck's Depression Inventory Scale, 29.2% were found to be depressed (Beck Depression Inventory [BDI] scale score-ranged between 17 and 63, mean ± standard deviation was 23.6 ± 3.8). Among them 78.9% were found as borderline clinical depression (17–20) and 21.1% were found to be having moderate depression (21–30). The socio-personal profile according to the presence or absence of SMD has been shown in [Table 1].
|Table 1: Distribution of undergraduate medical students according to their sociopersonal profile and the presence of social media disorder (n=216)|
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The pattern of social media use among the study population is shown in [Table 2] and [Figure 1]. All of the students in the current study were found to be social media users. Most (89.2%) of the study subjects used android phones to avail social media applications. Others used desktop/laptops or tablets to use social media. Among them 99.1% of the students were using WhatsApp, 88.4% were using Facebook, 36.6% were Instagram users, 24.9% were using different video chat apps, and 5.1% were using different dating apps. Among the social media users, 99%, 76.9%, 71.4%, and 75% were found to be daily users of WhatsApp, Facebook, Dating apps and other social media sites, respectively. After analyzing the score of SMD scale, it was found that 11.6% of the subjects had SMD. Although the median values of total time spent on social media were same (i.e., 3 h) for both social media addicted students and social media nonaddicted students, however there was wide variation in duration of time spent on social media by half of the students with SMD. Similar observation was observed for Facebook app also. In case of WhatsApp, among the students with SMD, both median and interquartile range of time spent was found higher as compared to students without SMD. There was a weak positive correlation (r = 0.234) between the duration of social media use and severity of SMD score. Moreover, it was statistically significant too (P = 0.001).
|Table 2: Distribution of undergraduate medical students based on the type of social media use and presence of social media disorder (n=216)|
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|Figure 1: Box plot showing comparison of time spent daily (hours) on different social media sites among social media addicted and social media non addicted students|
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Majority of the students (82.6%) preferred social media use for entertainment. Maximum students (84.2%) were connected with friends through social media. About one-third students preferred social media communication over face-to-face communication.
[Table 3] represents the probable screen related health impacts and academic performances with respect to the presence or absence of SMD among the undergraduate medical students. Sleep disturbance, headache, eye problems, musculo-skeletal problems, obesity, and poor academic performance are known screen related disorders or impact for students. The prevalence of screen-related sleep disturbance, headache, eye problem, musculoskeletal problems, and overweight or obesity was 35.6%, 36.1%, 28.7%, 31.5%, and 50.9%, respectively. However, in this study, no significant relationships were found between the presence of SMD and above known screen-related health disorder or impact and academic performance as well. In bivariate analysis, only depression was found to be statistically significant associated with SMD. To assess the predicting ability bivariate logistic regression was performed. Dependent variable (SMD) was coded dichotomously 0 and 1 as SMD absent and present accordingly. The logistic regression model was significant, as evident from omnibus Chi-square test (χ2 = 18.547, P = <0.01). The independent variable, i.e., depression could explain between 8.2% and 16.1% variance of the dependent variable, i.e., SMD, as evident from Cox and Snell and Nagelkerke R2. Overall, the model predicts 88.4% of SMD correctly, as calculated in classification table of the logistic regression model. Through the logistic regression model, it was found that the students, who were depressed, were 6.7 times more prone to develop SMD than those who were not depressed as shown in [Table 4].
|Table 3: Distribution of undergraduate medical students according to presence of social media disorder and screen related health impacts and academic performance (n=216)|
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|Table 4: Bivariate logistic regression model: Modelling the association of depression with social media disorder|
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The thematic analysis was used to identify the reasons and pattern of social media use among the study subjects. Questionnaire contained few open-ended questions. As it was anonymous, students expressed their views elaborately. Responses were transcribed as it was written in the questionnaire. All transcripts were read and re-read and constructed themes were coded. Newer data were compared to previous data constantly and label of themes were refined accordingly. Ultimately developed themes were analyzed.
Reasons of social media use
”As it is rural based medical college, have scarce scope of entertainment. Social media brings the world in hand and also find necessary entertainment stuffs here.”
”My thoughts and creativity are getting appraised in the social media platform and it brings a feeling of wellness.”
”As we are living far away from home, social media helps us to maintain long distance relationships. It is not only entertainment for spare time, but a necessary part of my life.”
Connection through social media
”For regular updating from friends, social media is very useful.”
”I use social media mostly for chatting with friends.”
”I can communicate with my family members through video apps. It reduces the distance between home and hostel.”
”It has been possible to maintain long distance relationship since 4 years only through Facebook.”
Preference of face to face communication versus social media communication
”I always face problem asking questions or interacting with people directly whereas, I prefer to approach through social media to easily interact with any people.”
”I always have communication problems with the girls. After entering the social media world, I can talk freely with them through social media.”
”There is lack of space for group chat within the college campus. Social media has solved the problem.”
Pattern of social media use
”I get information regarding the updates, recent news or group meeting from WhatsApp. That's why I have to observe WhatsApp very frequently.”
”Though everybody tells me introvert, but I am very much outspoken in Facebook platform. I use it regularly. I can't stop myself without checking my updates on Facebook every hour.”
”…I keep open WhatsApp and Facebook during my lecture class also. Those apps are more entertaining than boring lectures.”
”…After dinner I usually go to bed and sleep around 3 am……most of the time I do group chat on Facebook at late night.”
”…I have seven social media accounts.I maintain it simultaneously.everybody find me online all time on different social media sites.maximum time I spend in social media sites by observing silently.”
”. I prefer to meet with new peoples on social sites over known friends…”
”.my initiatives on poetry get inspiration from the liking and comments of friends at social media site.”
| Discussion|| |
An observational analytical mixed method study was conducted among the medical students with an overall aim to find the prevalence of SMD among them and to determine its correlates. The prevalence of SMD was found to be 11.6%. All of the students were found to be social media users and among them the prevalence of screen-related sleep disturbance, headache, eye problem, musculoskeletal problems, and overweight or obesity were 35.6%, 36.1%, 28.7%, 31.5%, and 50.9%, respectively. However, no significant relationship was obtained between SMD and above health problems. Through logistic regression model, it was found that the students, who were depressed, were 6.7 times more prone to develop SMD.
In this study, it was found that all of the study participants were social media users. This was similar to the findings of Barman et al. where also all of the study participants used social networking sites. The prevalence of SMD among the undergraduate medical students was found to be 11.6% in the current study. As there were no previous such studies related to SMD among the undergraduate medical students, the comparisons with other studies could not be done. However, in a study among the preuniversity nonmedical, college students at Bengaluru, the prevalence of SMD was found to be 36.9% among users. The differences could be because of the differences in the scale used for detecting SMD or could be because of huge study burden and subsequent less free time for social media among medicos as compared to nonmedicos, that needs further exploration. The problem is that despite of such vast curriculum and huge study burden, still approximately more than one tenth of the undergraduate medical students are already addicted to social media which may have long term health or academic impacts. In the current study, it was revealed that nearly all of the MBBS students were using WhatsApp and 88.4% of them were using Facebook. Almost all of the WhatsApp users were daily users while three fourth of the Facebook users were daily users. This was similar to the study findings of Shettigar et al. conducted at Mysore Medical College and Research Institute, India, where 91.36% students were using WhatsApp. Similarly, Lahiry et al. in their study found that 83% of the students were using Facebook. Masoud et al. found that more than half of the users (55.6%) spent (1–4) h daily and one-fourth (26.2%) of students spent (5–8) h daily. In this study, it was found that majority of the students (82.6%) preferred social media use for entertainment, maximum students (84.2%) used social media to connect with friends and about one-third students preferred social media communication over face-to-face communication. This was consistent with the findings of Begum et al. who found that the main purpose of using the social media among the undergraduate medical students was for chatting (51.3%) and to communicate with others (26.0%). Drago also reported that 46% of respondents communicated with friends or family more frequently through technology than in person. The current study found that students who were depressed were 6.7 times more prone to develop SMD and this finding was consisted with the findings of Barman et al. who also concluded that more use of social networking sites and dependence on it were associated with anxiety and depression. Pantic et al. also found out in his study that online social networking is related to depression. Social media users may have long-term health impact. In this study, it was found that the prevalence of screen-related sleep disturbance, headache, eye problem, musculoskeletal problems, and overweight or obesity was 35.6%, 36.1%, 28.7%, 31.5%, and 50.9%, respectively, among the social media users. In this study, there was no significant relationships between SMD and above known screen-related health disorders and academic performance as well. Similarly, Ramesh Masthi et al. found that the most common health problem identified due to social media use were strain on eyes (38.4%), anger (25.5%), and sleep disturbance (26.1%). In another study conducted by Jha et al., it was found that burning eyes (21%), disturbed sleep (19%), headache (16%), and neck and back pain (12.2% together) were the most common adverse health effects reported by the Facebook users. Khajeheian et al. revealed that highest BMI in the high school was observed for children who mostly or always ate unhealthy food, use social media 2–3 h/day or more and have no physical activity or only once per week. Lahiry et al. revealed that 60.87% of participants felt that their academic performance was influenced in a positive way, while the rest (39.13%) believed to the contrary. However, Daffalla and Dimetry concluded that the prevalence of negative effect of using the social networks on academic performance is high. These differences could be explained by the fact that in the later study academic performance were assessed by subjective perceptions, however, in the current study, the marks obtained by the student in their last examination were considered as an indicator for academic performance or maybe the impacts might develop in future after long-term social media use which further emphasizes on the need to conduct longitudinal studies.
Implications of the study
Social media is being used extensively today by all age groups, but it should be used judiciously. Though SMD has not been considered as a separate entity under DSM V, yet the authors have found statistically significant association between SMD and depression. It is alarming for this generation. If this issue is not being highlighted immediately, increasing burden of psychological disorders will further increase the menace of SMD silently that may further affect mental health and worse scenarios might have to be faced in future.
This study provides the baseline data regarding the burden of SMD among the medical students as no such study have been conducted previously.
SMD is itself a psychological disorder. It may have wide spectrum of impact on student's psychology and it may also manifest with other psychological disorders. Here, the authors explored only depression, other psychological issues such as anxiety and obsessive–compulsive disorder could not be explored and may be explored in future studies using better study designs.
| Conclusion|| |
All of the respondents were social media user. Approximately one-tenth had SMD. One-third students were experiencing screen-related sleep disturbances, screen-related migraine/headache, and screen-related musculoskeletal disorders while one-fourth were suffering from screen related eye problems. About one-third students perceived depression. Students, who were depressed, were 6.7 times more prone to develop SMD than those who were not depressed.
Social media should be used judiciously. One should be aware of SMD, its consequences and should take necessary steps toward addressing it. Depression being a risk factor for SMD needs to be addressed as priority by providing appropriate counseling and/or professional consultation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]