Internet Addiction and Its Relationship with Depression and Academic Performance: A Cross-Sectional Study at a Medical School in Pakistan
Background: Excessive Internet use may induce depression, influence relationships, and decrease academic performance. There is scarce information about Internet addiction in Pakistan. This study aimed to determine prevalence of Internet addiction and its relationship with depression and academic performance.
Methods: A study based on a self-administered survey was carried out at a medical school in Peshawar, Pakistan. Participants were medical students (MBBS) and a non-randomized convenience sampling technique was utilized for data collection. We collected demographic information, last professional exam score, Internet addiction, and depression scores using the Young’s Internet Addiction Test (YIAT) and the Beck’s Depression Inventory (BDI), respectively. The analysis included binomial 95% confidence intervals (95% CI) estimations and linear and logistic regressions to assess variables relations.
Results: We analyzed responses from 231 participants (380 students approached and 250 responded: response rate=65.79%, 19 excluded), 64.07% were male and the age average was 21±2 years. Profound and slight addiction to the Internet was found in 9.09% (95%CI=5.71-13.56) and 41.99% (95%CI=35.55-48.64) of students, respectively. Frequency of depression (mild-severe) was 59.74% (95%CI=53.11-66.12). Levels of Internet addiction and depression were found associated after adjusting by sex and age (β=0.27, R2=0.03, p-value=0.009). Internet addiction (OR=0.54, 95%CI=0.2-1.49, p-value=0.23) and depression (OR=0.62, 95%CI=0.36-1.09, p-value=0.10) were not significantly associated with low grades after adjusting by sex and age.
Conclusion: More than half of the students are having excessive Internet usage which could result in despondency and academic performance deterioration. Internet addiction should be considered an emerging challenge and appropriate mitigation measures should be taken opportunely.
Shaw M, Black DW. Internet addiction: Definition, assessment, epidemiology and clinical management. CNS Drugs. 2008; 22(5):353–365.
Yang SY, Fu SH, Chen KL, Hsieh PL, Lin. Relationships between depression, health-related behaviors, and internet addiction in female junior college students. PLoS One 2019 Aug; 14(8): e0220784.
Meerkerk GJ, Van Den Eijnden RJ, Vermulst AA, Garretsen HF. The Compulsive Internet Use Scale (CIUS): some psychometric properties. Cyberpsychol Behav. 2009 Feb;12(1):1-6.
Davis R.A. A cognitive-behavioral model of pathological Internet use. Comput. Hum. Behav, 2001 Mar; 17(2):187-195.
Cash H, Rae CD, Steel AH, Winkler A. Internet Addiction: A Brief Summary of Research and Practice. Curr Psychiatry Rev. 2012 Nov;8(4):292-298.
Chaudhari B, Menon P, Saldanha D, Tewari A, Bhattacharya L. Internet addiction and its determinants among medical students. Ind Psychiatry J. 2015 Jul-Dec;24(2):158-162.
Young KS. Internet addiction: The emergence of a new clinical disorder. Cyberpsychology Behav. 1998 Jan; 1(3):237–244.
Kuss DJ, Lopez-Fernandez O. Internet addiction and problematic Internet use: A systematic review of clinical research. World J Psychiatry. 2016 Mar;6(1):143-176.
Kumar M, Mondal A. A study on Internet addiction and its relation to psychopathology and self-esteem among college students. Ind Psychiatry J 2018; 27(1):61-66.
Winkler A, Dörsing B, Rief W, Shen Y, Glombiewski JA. Treatment of Internet addiction disorder: Clin psychol rev. 2013 Jan;33(2):317-329.
Samaha AA, Fawaz M, El Yahfoufi N, Gebbawi M, Abdallah H, Baydoun SA, Ghaddar A, Eid AH. Assessing the Psychometric Properties of the Internet Addiction Test (IAT) Among Lebanese College Students. Front Public Health. 2018 Dec 17;6:365.
Demetrovics Z, Király O, Koronczai B, Griffiths MD, Nagygyörgy K, Elekes Z, Tamás D, Kun B, Kökönyei G, Urbán R. Psychometric Properties of the Problematic Internet Use Questionnaire Short-Form (PIUQ-SF-6) in a Nationally Representative Sample of Adolescents. PLoS One. 2016 Aug 9;11(8):e0159409.
Kimberly S. Young, Eric Griffin-shelley, Al Cooper, James O'mara & Jennifer Buchanan. Online infidelity: A new dimension in couple relationships with implications for evaluation and treatment. Sex Addict Compulsivity 2000; 7: 59–74.
Daneback K, Mansson SA, Ross MW. Technological advancements and internet sexuality: Does private access to the internet influence online sexual behavior? Cyberpsychology, Behav Soc Netw 2012 Aug; 15(8): 386–390.
Davis, R. A. “A cognitive-behavioral model of pathological Internet use.” Comput. Hum. Behav. 2001 Mar; 17(2):187-195.
Kim SH, Baik SH, Park CS, Kim SJ, Choi SW, Kim SE. Reduced striatal dopamine D2 receptors in people with Internet addiction. Neuroreport. 2011 Jun;22(8):407-411.
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 May; 55(2): 140–143.
Diagnostic and Statistical Manual of Mental Disorders (DSM-5), Fifth edition. 2013. https://www.psychiatry.org/patients-families/depression/what-is-depression (accessed 21 October 2020).
Henriksen IO, Ranøyen I, Indredavik MS, Stenseng F. The role of self-esteem in the development of psychiatric problems: a three-year prospective study in a clinical sample of adolescents. Child Adolesc Psychiatry Ment Health. 2017 Dec 29;11:68.
Ha JH, Kim SY, Bae SC, Bae S, Kim H, Sim M, Lyoo IK, Cho SC. Depression and Internet addiction in adolescents. Psychopathology. 2007;40(6):424-30.
Internet users in the world 2020 | Statista, https://www.statista.com/statistics/617136/digital-population-worldwide/ (accessed 27 November 2020)
Sharma A, Sahu R, Kasar P, Sharma R. Internet addiction among professional courses students: A study from central India. Int J Med Sci Public Health. 2014; 3(9): 1069-1073.
Zhang MWB, Lim RBC, Lee C, Ho RCM. Prevalence of Internet Addiction in Medical Students: a Meta-analysis. Acad Psychiatry. 2018 Feb;42(1):88-93.
Research Ethics Review Committee, https://www.who.int/groups/research-ethics-review-committee/guidelines-on-submitting-research-proposals-for-ethics-review/templates-for-informed-consent-forms (accessed 5 December 2020)
Wang YP, Gorenstein C. Psychometric properties of the Beck Depression Inventory-II: a comprehensive review. Braz J Psychiatry. 2013 Oct-Dec;35(4):416-31.
Rabadi L, Ajlouni M, Masannat S, Bataineh S, Batarseh G, Yessin A, Haddad K, Nazer MK, Hmoud S, Rabadi G. The Relationship between Depression and Internet Addiction among University Students in Jordan. J Addict Res Ther 2017; 08: 1–8.
Chakraborty K, Basu D, Vijaya Kumar KG. Internet addiction: Consensus, controversies, and the way ahead. East Asian Arch Psychiatry. 2010 Sep; 20(3):123–132.
Haroon MZ, Zeb Z, Javed Z, Awan Z, Aftab Z, Talat W. Internet Addiction In Medical Students. J Ayub Med Coll Abbottabad. 2018 Oct-Dec;30(Suppl 1)(4):S659-S663.
Kumar S, Kumar A, Badiyani B, Singh SK, Gupta A, Ismail MB. Relationship of internet addiction with depression and academic performance in Indian dental students. Clujul Med. 2018 Jul;91(3):300-306.
Taha MH, Shehzad K, Alamro AS, Wadi M. Internet Use and Addiction Among Medical Students in Qassim University, Saudi Arabia. Sultan Qaboos Univ Med J. 2019 May;19(2):e142-e147.
Xin M, Xing J, Pengfei W, Houru L, Mengcheng W, Hong Z. Online activities, prevalence of Internet addiction and risk factors related to family and school among adolescents in China. Addict Behav Rep. 2017 Oct 19;7:14-18.
Cheng C, Li AY. Internet addiction prevalence and quality of (real) life: a meta-analysis of 31 nations across seven world regions. Cyberpsychol Behav Soc Netw. 2014 Dec;17(12):755-60.
Aghakhani N, Sharif Nia H, Eghtedar S, Rahbar N, Jasemi M, Mesgar Zadeh M. Prevalence of depression among students of urmia university of medical sciences. Iran J Psychiatry Behav Sci. 2011 Fall;5(2):131-5.
Ediz, B., Ozcakir, A., & Bilgel, N. Depression and anxiety among medical students: Examining scores of the beck depression and anxiety inventory and the depression anxiety and stress scale with student characteristics. Cogent Psychology, 2017 4(1): 1283829.
Mak KK, Jeong J, Lee HK, Lee K. Mediating Effect of Internet Addiction on the Association between Resilience and Depression among Korean University Students: A Structural Equation Modeling Approach. Psychiatry Investig. 2018 Oct;15(10):962-969.
Ahmad Bhat S, Hussain Kawa M. A Study of Internet Addiction and Depression among University Students. Int J Behav Res Psychol 2015 Jun;3(4) 105–108.
Davis NM. Depression in children and adolescents. J Sch Nurs 2005 Dec; 21(6):311–317.
Morrison CM, Gore H. The relationship between excessive internet use and depression: A questionnaire-based study of 1,319 young people and adults. Psychopathology 2010; 43(2): 121–126.
Seki T, Hamazaki K, Natori T, et al. Relationship between internet addiction and depression among Japanese university students. J Affect Disord 2019 Sep; 256: 668–672.
Kuladee S, Boonvisudhi T. Association between Internet addiction and depression in medical students, faculty of medicine in Thailand. Eur Psychiatry 2017 Apr; 41: S310–S310.
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 Mar-Apr;35(2):506-509.
Sachitra V. Internet Addiction, Academic Performance and University Students. International Knowledge Press. 2015 Jun; 3(4):179-186.
Hassan Rahnaward Ghulami, Mohd Rashid Ab Hamid, Mohd Reza Ibrahim. Relationship between Internet addictions and academic performance among Afghan universities students. Int J Innov Res Sci Stud. 2018 Dec; 1(4):63–72.
Javaeed A, Jeelani R, Gulab S, Ghauri SK. Relationship between internet addiction and academic performance of undergraduate medical students of Azad Kashmir. Pak J Med Sci. 2020 Jan-Feb;36(2):229-233.
Ma HK. Internet addiction and antisocial internet behavior of adolescents. ScientificWorldJournal 2011 Nov; 11: 2187–2196.
Christakis DA. Internet addiction: A 21st century epidemic? BMC Med. 2010 Oct; 8(1):61.
Copyright (c) 2020 Farrukh Ansar, Waqar Ali, Adil Zareef, Noman Masud, Sawarul Zahab, Huma Iftikhar
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- The Author retains copyright in the Work, where the term “Work” shall include all digital objects that may result in subsequent electronic publication or distribution.
- Upon acceptance of the Work, the author shall grant to the Publisher the right of first publication of the Work.
- The Author shall grant to the Publisher and its agents the nonexclusive perpetual right and license to publish, archive, and make accessible the Work in whole or in part in all forms of media now or hereafter known under a Creative Commons Attribution 4.0 International License or its equivalent, which, for the avoidance of doubt, allows others to copy, distribute, and transmit the Work under the following conditions:
- Attribution—other users must attribute the Work in the manner specified by the author as indicated on the journal Web site; with the understanding that the above condition can be waived with permission from the Author and that where the Work or any of its elements is in the public domain under applicable law, that status is in no way affected by the license.
- The Author is able to enter into separate, additional contractual arrangements for the nonexclusive distribution of the journal's published version of the Work (e.g., post it to an institutional repository or publish it in a book), as long as there is provided in the document an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post online a prepublication manuscript (but not the Publisher’s final formatted PDF version of the Work) in institutional repositories or on their Websites prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work. Any such posting made before acceptance and publication of the Work shall be updated upon publication to include a reference to the Publisher-assigned DOI (Digital Object Identifier) and a link to the online abstract for the final published Work in the Journal.
- Upon Publisher’s request, the Author agrees to furnish promptly to Publisher, at the Author’s own expense, written evidence of the permissions, licenses, and consents for use of third-party material included within the Work, except as determined by Publisher to be covered by the principles of Fair Use.
- The Author represents and warrants that:
- the Work is the Author’s original work;
- the Author has not transferred, and will not transfer, exclusive rights in the Work to any third party;
- the Work is not pending review or under consideration by another publisher;
- the Work has not previously been published;
- the Work contains no misrepresentation or infringement of the Work or property of other authors or third parties; and
- the Work contains no libel, invasion of privacy, or other unlawful matter.
- The Author agrees to indemnify and hold Publisher harmless from the Author’s breach of the representations and warranties contained in Paragraph 6 above, as well as any claim or proceeding relating to Publisher’s use and publication of any content contained in the Work, including third-party content.
Enforcement of copyright
The IJMS takes the protection of copyright very seriously.
If the IJMS discovers that you have used its copyright materials in contravention of the license above, the IJMS may bring legal proceedings against you seeking reparation and an injunction to stop you using those materials. You could also be ordered to pay legal costs.
If you become aware of any use of the IJMS' copyright materials that contravenes or may contravene the license above, please report this by email to firstname.lastname@example.org
If you become aware of any material on the website that you believe infringes your or any other person's copyright, please report this by email to email@example.com