|INVITED ORIGINAL ARTICLE
|Year : 2021 | Volume
| Issue : 3 | Page : 269-274
Problematic internet use and its association with psychological stress among adolescents
Nitin Anand1, Manoj Kumar Sharma1, P Marimuthu2
1 Department of Clinical Psychology, Service for Healthy Use of Technology Clinic, Dr. MV Govindaswamy Centre, National Institute of Mental Health and Neuro Sciences, An Institute of National Importance, Bengaluru, Karnataka, India
2 Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, Karnataka, India
|Date of Submission||27-Jul-2021|
|Date of Decision||12-Sep-2021|
|Date of Acceptance||13-Sep-2021|
|Date of Web Publication||30-Sep-2021|
Dr. Manoj Kumar Sharma
Department of Clinical Psychology, Service for Healthy Use of Technology Clinic, Dr. MV Govindaswamy Centre, National Institute of Mental Health and Neuro Sciences, An Institute of National Importance, Hosur Road, Bengaluru - 560 029, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Problematic use of the Internet and psychological stress are interrelated in many ways. The psychological stress originating from Internet usage can create an unfavorable impact on adolescents. These impacts vary from academic progress to competence, career goals, and nonacademic intellectual involvement, hindering skill development. Thus, there is a need to evaluate problematic Internet usage among adolescents. Aim and Objectives: This study was set up to examine Internet usage behaviors, problematic Internet use (PIU), and its association with psychological stress among adolescents from India. Materials and Methods: Six hundred and eighty-two adolescents aged between 15 and 18 years, studying at high school and senior secondary level from institutes primarily situated in South India, participated in the study. The patterns of Internet usage and sociodemographic data were collected through online and sociodemographic forms. Along with this, the Internet Addiction Test (IAT) was employed to assess PIU, and symptoms of psychological distress were evaluated with the Kessler Psychological Distress Scale (K10). Results: Among the total sample of 682 (N), 36.6% (N = 248) of adolescents met criterion on IAT for mild Internet addiction/PIU, 31.96% (N = 218) for moderate Internet addiction/PIU, and 2.93% (N = 20) for severe Internet addiction/PIU. PIU was higher among adolescents who accessed the Internet several times a day and had experienced psychological stress. In addition, stepwise regression analysis indicated that adolescents experiencing psychological stress were at higher risk for engaging in PIU, and stress also predicted engagement in PIU. Conclusions: PIU was present among a substantial proportion of adolescents, which might hinder their academic performance and progress over some time and can impact their psychological health adversely. These adolescents are likely to benefit from the early identification of PIU, which can facilitate the timely implementation of psychotherapeutic intervention strategies for PIU in school settings.
Keywords: Adolescents, Internet addiction, problematic Internet use, psychological stress, school students
|How to cite this article:|
Anand N, Sharma MK, Marimuthu P. Problematic internet use and its association with psychological stress among adolescents. Indian J Soc Psychiatry 2021;37:269-74
|How to cite this URL:|
Anand N, Sharma MK, Marimuthu P. Problematic internet use and its association with psychological stress among adolescents. Indian J Soc Psychiatry [serial online] 2021 [cited 2022 Sep 30];37:269-74. Available from: https://www.indjsp.org/text.asp?2021/37/3/269/327285
| Introduction|| |
Problematic Internet use (PIU) is a rapidly emerging phenomenon among adolescents and young adults,, and is one of the most critical challenges which has emerged from Internet usage. It has the potential to harm many aspects of adolescent life., The prevalence of PIU is known to range from 1.5% to 24.2% among adolescents, which is notably high and can impact the adolescent's academic life and nonacademic pursuits.
The growth of the Internet primarily occurred to make communication quicker, easier, and productive both at individual and societal levels. The Internet is a fundamental tool for communication, exchange of information, socialization, and entertainment needs. Young adults and adolescents use the Internet more than anyone else as they are born in the post-Internet era. Moreover, the Internet has become an effective medium for exchanging ideas and initiating social connections with strangers. It also aids free expressions of thoughts, acts as a gateway to access prohibited content, provides its users with the opportunity to be involved in unique gaming formats, and facilitates numerous other functions. The fact that this process takes place relatively in an individual's privacy might draw toward deviating aspects within the Internet space.,
The use of the Internet in an appropriate manner can serve many needs and be beneficial to adolescents' academic and extracurricular development. On the contrary, the unregulated usage or PIU can be highly devastating to adolescents, hindering their progress and holistic development. Over time, the boundaries between functional and dysfunctional Internet usage have blurred as its use has increased exponentially in every aspect of an individual's life. The Internet has become an inevitable medium that is linked directly or indirectly to work, academics, general learning, daily living tasks, and recreational activities of any individual.
Some adolescents can limit their Internet usage, whereas others lose control over their usage patterns. The inappropriate and excessive use of the Internet has been termed as compulsive Internet use, PIU, pathological Internet use, and Internet addiction. The present study would use the term PIU, which can be understood as “use of the Internet that creates psychological, social, school, and work difficulties in an individual's life.” Evidence-based studies have shown that unfavorable developmental outcomes such as depression, social isolation, and unproductive use of time are caused by PIU among children and adolescents., There are substantial studies on PIU; however, there is no established understanding of the various pathways leading to PIU among adolescents., This emergent problem among adolescents acquires a crucial status, as establishing the determinants of PIU is the first step toward planning prevention and intervention programs. In the current study, we hypothesized that environmental stressors need to be considered a potential PIU determinant.
An adolescent endures numerous significant biological, psychological, social changes and overcomes complex challenges from parents, family, peers, and school authorities. The pathways for PIU are likely to emerge from these environmental stressors., The literature suggests that stress is an emerging factor that correlates with PIU among adolescents. In addition, accumulative life stressors in an adolescent's life exponentially enhance the risk for PIU., Adolescents who experience stressors consistently and have poor coping mechanisms to resolve them are likely to engage in PIU. The Internet helps them to escape from stress and provides them with a subjective experience of transitory stress. Gradually, the use of the Internet becomes excessive, uncontrollable, and leads to negative consequences such as academic decline and conflicts with parents and peers. The emergence of PIU is also seen as a result of this excessive usage. The PIU itself can create an experience of loneliness and social isolation. Subsequently, it takes away opportunities like that of learning from peers to resolving stressors.
The research evidence suggests that the existence of stress and PIU are likely to be responsible for the sustenance of each other, and among them, the question of principal mental illness is debatable. The objective of the present study is to investigate the existence and magnitude of stress and PIU and its mutual relationship among adolescents. The research findings explored by the present study can be of value to a broad group of health professionals, including psychiatrists, psychologists, psychosocial counselors, and mental health professionals in school and primary health settings, to comprehend the existence of this emerging phenomenon and the reciprocal relationship between stress and PIU.
| Materials and Methods|| |
The study adopts a cross-sectional design. A total of 700 students pursuing higher school studies aged between 15 and 18 years, with the mean age being 16.2 ± 1.10 years (mean age ± standard deviation [SD]) studying in varied subject streams at recognized educational institutes, participated in the study. All these adolescents were competent enough to read, write, and comprehend English. Out of 700 adolescents, 682 provided their informed assent, and their parents gave informed consent for these adolescents to participate in this online-based study. The adolescents were chosen as a sample for the study as PIU behaviors can have long-standing consequences on academic progress and a higher likelihood of global impact on their progress in professional courses. Ethical approval was received from the institute ethics committee before the initiation of the study.
The researchers prepared the demographic form to collect information about sociodemographic data and factors pertaining to Internet usage such as access to an active Internet connection, duration, frequency, devices used, the experience of craving for Internet use, and other such variables.
Internet Addiction Test
Internet Addiction Test (IAT) is a 5-point Likert scale with twenty self-report items designed to assess the IA's severity. The individual item scores were collated to obtain a full scale for each individual in the range of 20–100. The norm criterion of the scale indicates mild, moderate, or severe categories of IA which was utilized to interpret the total scores. Psychometric properties indicate well to moderate internal consistency (alpha coefficients – 0.54–0.82). The content, convergent validity, internal consistency (ά =0.88), and test–retest reliability (r = 0.82) of IAT appear to be statistically acceptable.
Kessler Psychological Distress Scale (K10)
The K10 scale is a brief screening tool to measure generalized psychological distress. The scale consists of 10 items, and each scored on a 5-point Likert scale and with the total scores ranging from 10 (no distress) to 50 (severe distress). It is a suitable instrument for screening the general population, and it has an acceptable internal consistency (Cronbach's alpha: ά =0.93).
The participants were approached over the Internet for participating in the study. Approval was obtained from the Institutional Research and Ethics Committee. The study was conducted from July 2020 to December 2020. The web-based questionnaire to assess the problematic use of the Internet and psychological stress was distributed on social media networks such as WhatsApp, and other platforms to obtain the most heterogeneous sample possible. The participants who gave their assent for participation were requested to approach their parents to seek their informed consent for study participation. The participants' parents indicated their informed consent by checking on the box indicating acceptance (yes) for participating in the study.
Once the informed consent was obtained, the study participants were offered the online-based research survey. The 682 participants who indicated their willingness and whose informed consent was obtained were included in the study. These participants then completed assessment tools in an online format which included a sociodemographic details form, IAT, and the Kessler Psychological Distress Scale (K10). Each of the participants had to spend around 30–45 min to complete these self-report assessment tools. The online data collection for the research study lasted for 4 weeks. The incomplete responses were excluded from the analysis for understanding the association between psychological stress and PIU.
The study data were analyzed by using version 19 of SPSS (Statistics for Windows, published by the IBM Corporation, Armonk, New York, United States). Chi-square was used to evaluate the categorical variables. Measures of central tendency and Spearman's correlation analysis were used for ascertaining associations across variables. Multiple stepwise regression analysis was used to identify the significant predictors of IA. Internet addiction was taken as a dependent variable, while stress was included as a predictor or independent variable. The linearity was assessed by analysis of variance. The significant value for the study results has been set at P ≤ 0.05.
| Results|| |
The primary use of the Internet by adolescents was to access social networking sites (N = 344), social media applications (N = 401), and online gaming (N = 129). Gender was not found to be significantly associated with the addictive use of the Internet.
[Table 1] shows that the study sample comprised 682 adolescents, of which 495 (72.60%) were female and 187 (26.80%) were male. The study sample ranged from 15 to 18 years, with the mean age being 16.2 ± 1.10 (mean age ± SD). In addition, out of 682 adolescents, nearly an equal number of participants were in both the age groups of 15–16 years (52.7%) and 17–18 years (47.5%).
[Table 2] shows that 36.6% (N = 248) of adolescents met the criteria of IAT for mild Internet addiction, 31.96% (N = 218) for moderate Internet addiction, and 2.93% (N = 20) for severe Internet addiction.
[Table 3] indicates that 18.47% (N = 126) experienced mild levels of stress, 29.17% (N = 199) experienced moderate levels of stress, and around 26.39% (N = 180) had experienced severe psychological stress.
[Table 4] indicates that adolescents experiencing psychological stress (odds ratio = 1.45; P ≤ 0.001) were at higher risk for engaging in PIU. A positive correlation was found between psychological stress and IA (r =0.451; P ≤ 0.001). These findings suggest that adolescents who have attained higher K10 scores were more likely to engage in problematic or addictive Internet use.
| Discussion|| |
The adolescents engaging in severely addictive/PIU were 2.93%, and those engaging in moderate IA were 31.96% as per the criteria offered by IAT. The findings of the present study (31.96% – moderate PIU) are similar to prevalence rates of moderate PIU reported from other countries, which ranged from 21.2% in Greek adolescents to 24.2% in China and 32.9% among adolescents in Nepal. In addition, the prevalence rates of severe PIU in adolescents in the current study (2.93%) are in a lower range in comparison to the other studies which indicated a prevalence of 11.8% of severe PIU in another study from India, 37.6% in China, 22.5% in Hong Kong, 11% in Greece, and 1.5% in Nepal. The present study suggests that the prevalence of total PIU inclusive of mild, moderate, and severe PIU was 71.49% among adolescents. The likely factors for the difference in prevalence reported across studies could be the impact of variations in sample sizes, assessment instruments utilized, different adolescent populations, and study assessment of timeline.
The study findings on regression and correlation analysis indicate that the adolescent students who were comparatively in the older range were at higher risk for indulging in PIU. The final years of school education correspond to lesser parental control than middle and higher school education years. In addition, these late adolescent years also provide increased opportunities for self-expression, use of self-control, and coping strategies to manage newer forms of emerging stressors. In this context, adolescents who lack control over self-initiated behaviors in the case of reduced parental monitoring are understandably at higher risk for PIU.
Our study indicated that PIU behaviors were not significantly higher among either male or female adolescents. However, in most studies, the male population was confirmed to be at higher risk for engaging in PIU. In addition to this, observations of recent Indian studies reveal similar results.,, Studies conducted in China and Greece also reveal coherent gender differences and PIU findings. The male gender appears to be more vulnerable due to socialization practices and behavioral changes in most cultural contexts. Thus, there is a higher involvement of males in Internet-based conversations, online gaming, virtual sex, and pornography which increases the probability of engaging in addictive use of the Internet.
A crucial factor that increases the risk of PIU is the amount of time an individual spends on the Internet. It could be compound time over a week or time spent daily. The current study findings suggest that adolescents who had higher levels of PIU were engaging in more than 5 h of Internet use per day in nonacademic Internet activities (P ≤ 0.001). The study also indicated that the time spent on the Internet per day and higher frequency of Internet access over a day were variables predicting PIU.
The increase in the duration of Internet usage has been found to be associated with the increase in the risk of severity levels of IA/PIU, and the same has been consistently suggested by research evidence from many studies. Adolescents who use primarily smartphones and tablets are likely to experience higher levels of PIU as these devices offer mobility and easier accessibility to the Internet. Such technological convenience appears to strengthen the addictive or PIU behaviors.
The present study also outlines that adolescents who had higher IA/PIU scores were using the Internet for more than 4 years. Globally, the time duration required for the emergence of IA/PIU since its initial use by a user cannot be considered the only variable in isolation that creates a pathway for the development of PIU. Given the rapid developments in digital technology and its accessibility, the time duration may steadily reduce in the future, if not at this moment. Such beliefs are strengthened with a colossal shift in the Indian telecommunication sector, where the Internet is getting cheaper.
The potential risk of PIU increases with psychological stress, which appears to be a significant contributing factor in enhancing the risk of development of PIU. The regression analysis indicated that psychological stress in adolescents predicted PIU or enhanced the risk of engaging in PIU behaviors. The correlations observed between psychological stress and PIU in the current study are similar to other studies., The transition period of senior secondary education or Grade XI in the school poses a set of distinct academic and nonacademic challenges.
Nevertheless, this varies for students according to their chosen academic streams such as science or arts. This transition requires them to adapt to new situations, where they will be compelled to find solutions to the new environment's problems while finding a balance between personal care and social relationships, managing food, sleep, health, and forging new interpersonal relationships. Adolescents who lack the skills to adapt to these newer requirements find themselves vulnerable and can experience helplessness, loneliness, psychological stress, and sadness during this phase of transition.
Under these circumstances, some adolescents experiencing psychological stress may view the Internet as a tool for a coping mechanism that establishes new interpersonal relationships while also satisfying their entertainment needs. However, the risk for PIU increases with excessive nonproductive usage of the Internet, which can cause psychological stress. Adolescents who are predisposed to develop psychological stress or are experiencing stress are likely to engage in addictive use of the Internet., This experience of stress is likely to push them to use the Internet in its many forms to escape temporarily from unpleasant emotional states, including psychological stress. On the other hand, the adolescent starts skipping available offline opportunities and diverts themselves from in-person social interactions, social get-togethers, family interactions, and extracurricular events to gradually isolating oneself and predisposing oneself toward experiencing stress.
| Conclusions|| |
PIU appears to be an ever-growing and significant mental health condition among adolescent students. IA/PIU and psychological stress were positively correlated, and stress is a variable that predicts PIU. Adolescents must hence be screened at school settings or mental health settings for PIU and psychological stress as there is a significant possibility that they coexist and can intensify each other. Programs for early intervention can be offered to adolescents if the health care efforts are directed toward early identification and suitable referrals of psychological care in specialized centers. Research also suggests that a majority of adolescents and young adults who knew about PIU and its detrimental effects have made attempts on their own to reduce Internet dependence. Hence, awareness generation initiatives about PIU and its associated risk factors on school-going adolescents are an appreciable step in healthy Internet engagements.
Financial support and sponsorship
This study was financially supported by the Department of Health Research, Indian Council of Medical Research, New Delhi, India.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Leung L. Stressful life events, motives for Internet use, and social support among digital kids. Cyberpsychol Behav 2007;10:204-14.
Hongli L, Li L. The relationship of coping styles and pathological internet use of middle school students. Acta Psychol Sin 2005;37:87-91.
Anand N, Jain PA, Prabhu S, Thomas C, Bhat A, Prathyusha PV, et al.
Prevalence of excessive internet use and its association with psychological distress among university students in South India. Ind Psychiatry J 2018;27:131-40.
] [Full text]
Greenfield P, Yan Z. Children, adolescents, and the internet: A new field of inquiry in developmental psychology. Dev Psychol 2006;42:391-4.
Tsitsika A, Critselis E, Kormas G, Filippopoulou A, Tounissidou D, Freskou A, et al.
Internet use and misuse: A multivariate regression analysis of the predictive factors of internet use among Greek adolescents. Eur J Pediatr 2009;168:655-65.
Lievrouw LA, Livingstone S. Handbook of New Media: Social Shaping and Consequences of ICTs. Handbook of New Media: Social Shaping and Consequences of ICTs. London: SAGE Pub; 2018.
Teo TS, Lim VK. Gender differences in internet usage and task preferences. Behav Inf Technol 2000;19:283-95.
Meerkerk GJ, Van Den Eijnden RJ, Vermulst AA, Garretsen HF. The compulsive internet use scale (CIUS): Some psychometric properties. Cyberpsychol Behav 2009;12:1-6.
Caplan SE. Problematic Internet use and psychosocial well-being: Development of a theory-based cognitive-behavioral measurement instrument. Comput Human Behav 2002;18:553-75.
Huang C. Internet addiction: Stability and change. Eur J Psychol Educ 2010;25:345-61.
Beard KW, Wolf EM. Modification in the proposed diagnostic criteria for Internet addiction. Cyberpsychol Behav 2001;4:377-83.
Chou C, Condron L, Belland JC. A review of the research on Internet addiction. Educ Psychol Rev 2005;17:363-88.
Guan SS, Subrahmanyam K. Youth internet use: Risks and opportunities. Curr Opin Psychiatry 2009;22:351-6.
Li H, Wang J, Wang L. A survey on the generalized problematic internet use in Chinese college students and its relations to stressful life events and coping style. Int J Mental Health Addict 2009;7:333-46.
Widyanto L, McMurran M. The psychometric properties of the internet addiction test. Cyberpsychol Behav 2004;7:443-50.
Kessler RC, Andrews G, Colpe LJ, Hiripi E, Mroczek DK, Normand SL, et al.
Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002;32:959-76.
Siomos KE, Dafouli ED, Braimiotis DA, Mouzas OD, Angelopoulos NV. Internet addiction among Greek adolescent students. Cyberpsychol Behav 2008;11:653-7.
Li Y, Zhang X, Lu F, Zhang Q, Wang Y. Internet addiction among elementary and middle school students in China: A nationally representative sample study. Cyberpsychol Behav Soc Netw 2014;17:111-6.
Tenzin K, Dorji T, Choeda T, Wangdi P, Oo MM, Tripathi JP, et al.
Internet addiction among secondary school adolescents: A mixed methods study. JNMA J Nepal Med Assoc 2019;57:344-51.
Yadav P, Banwari G, Parmar C, Maniar R. Internet addiction and its correlates among high school students: A preliminary study from Ahmedabad, India. Asian J Psychiatr 2013;6:500-5.
Yu L, Shek DT. Internet addiction in Hong Kong adolescents: A three-year longitudinal study. J Pediatr Adolesc Gynecol 2013;26:S10-7.
Restrepo A, Scheininger T, Clucas J, Alexander L, Salum GA, Georgiades K, et al.
Problematic internet use in children and adolescents: Associations with psychiatric disorders and impairment. BMC Psychiatry 2020;20:252.
Goel D, Subramanyam A, Kamath R. A study on the prevalence of internet addiction and its association with psychopathology in Indian adolescents. Indian J Psychiatry 2013;55:140-3.
] [Full text]
Balhara YP, Mahapatra A, Sharma P, Bhargava R. Problematic internet use among students in South-East Asia: Current state of evidence. Indian J Public Health 2018;62:197-210.
] [Full text]
Batigun AD, Kılıc N. The relationships between internet addiction, social support, psychological symptoms and some socio-demographical variables. Turk Psikol Derg 2011;26:1-10.
Chen HC, Wang JY, Lin YL, Yang SY. Association of internet addiction with family functionality, depression, self-efficacy and self-esteem among early adolescents. Int J Environ Res Public Health 2020;17:E8820.
Feng Y, Ma Y, Zhong Q. The relationship between adolescents' stress and internet addiction: A mediated-moderation model. Front Psychol 2019;10:2248.
Gong Z, Wang L, Wang H. Perceived stress and internet addiction among Chinese College Students: Mediating effect of procrastination and moderating effect of flow. Front Psychol 2021;12:632461.
[Table 1], [Table 2], [Table 3], [Table 4]