|Year : 2021 | Volume
| Issue : 2 | Page : 56-61
Surfing over masked distress: Internet addiction and psychological well-being among a population of medical students
Lateef Olutoyin Oluwole, Adetunji Obadeji, Mobolaji Usman Dada
Department of Psychiatry, College of Medicine, Ekiti State University, Ado-Ekiti, Nigeria
|Date of Submission||26-Nov-2020|
|Date of Decision||18-Jan-2021|
|Date of Acceptance||01-Feb-2021|
|Date of Web Publication||28-May-2021|
Lateef Olutoyin Oluwole
Department of Psychiatry, College of Medicine, Ekiti State University, Ado Ekiti
Source of Support: None, Conflict of Interest: None
Introduction: The Internet has become an integral part of our lives and tool for social interaction and communication and it is becoming worrisome; Internet use among students is assuming a dimension of profound preoccupation over other activities of daily living. Internet addiction (IA) may raise risk for sleep problem, and contribute to the development of some psychiatric disorders and worsening mental health. The aim of this study was to study the interrelationship between IA and psychological well-being of medical students. Methods: This cross-sectional study was carried out at the Ekiti State University College of Medicine among both preclinical and clinical medical students. The study population was the entire medical students. A total of 129 study participants (86 clinical and 43 preclinical students) were purposively enrolled, 83 males and 46 females. Data were collected from the students using a questionnaire that comprised four components: (i) Warwick–Edinburgh Mental Well-Being Scale, (ii) Young IA Test (YIAT), (iii) World Health Organization Alcohol Use Disorders Identification Test, and (iv) Insomnia Severity Index. Results: About half (51.9%) of the students who engaged the Internet dwelled on social media. Moreover, the least reason for using the Internet was for their academic assignments. Twenty-two (17.1%) of the participants scored below the minimum score for addiction on YIAT. This study revealed a statistically insignificant negative correlation between the pairs of IA score and mental well-being (r = −121, P = 0.198) and alcohol use and mental well-being (r = −0.10, P = 0.279). There existed a statistically significant positive correlation between IA and insomnia (r = 0.320, P = 0.000) and IA and alcohol use (r = 0.428, P = 0.000). There was an insignificant positive relationship between alcohol use and insomnia (r = 0.072, P = 0.414). Conclusion: IA and its associated problems among students would require earnest intervention to curb problematic use in order to attain good mental well-being.
Keywords: Alcohol, Internet addiction, medical students, Nigeria, psychological well-being, sleep
|How to cite this article:|
Oluwole LO, Obadeji A, Dada MU. Surfing over masked distress: Internet addiction and psychological well-being among a population of medical students. Asian J Soc Health Behav 2021;4:56-61
|How to cite this URL:|
Oluwole LO, Obadeji A, Dada MU. Surfing over masked distress: Internet addiction and psychological well-being among a population of medical students. Asian J Soc Health Behav [serial online] 2021 [cited 2021 Jul 27];4:56-61. Available from: http://www.healthandbehavior.com/text.asp?2021/4/2/56/317109
| Introduction|| |
The phenomenon of Internet use has experienced a great surge in the last decade and a further rise in its use has continued. The Internet has, progressively, become an integral part of our lives and tool for social interaction and communication. In spite of the enormous benefit of the Internet, it is, however, becoming worrisome that Internet use among the youth is assuming a dimension of profound preoccupation over other activities of daily living. The Internet, in earnest, has enhanced access to knowledge globally. For teacher and the student, the Internet has made both teaching and learning quite easy.
No doubt, undergraduate students are heavier users of the Internet than the general population. An earlier study had observed that youths have a higher level of attachment to their electronic devices which they often use to access the Internet. Browsing the Internet, though not an intended negative influence, the attitude and time channeled into this activity may depict the youth as addicts. More so, heavy Internet use has been associated with potentially detrimental side effects. Serious health problems such as impaired mental health and insufficient sleep have been associated with Internet addiction (IA) among adolescents. The study had found the influence of IA on sleep disturbances, and insomnia among heavy Internet users, and this may directly contribute to the development of some psychiatric disorders and worsening mental health.
It is desirable for students, using internet, to strike a balance in time spent online for academic and non-academic purpose; studies have shown significant differences in the time spent using internet among student in different field of study. Medical students are exposed to long and intensive academic years and are, more often than not, under stress and may suffer from sleep and other health problem. Medical students are known to read and peruse, through day and night, the Internet for academic material that may be pertinent to their course of study. This, it is believed, may predispose them to becoming addicted to the Internet when they fail to control their use of the Internet.
Some other studies reported on the complex nature of the relationship between sleep disturbances and level of IA. Studies from China, Korea, and Turkey, among other countries, have also reported the association and consequential effect of IA on quality of sleep., Sleep problem may raise risk for, and even directly contribute to, the development of some psychiatric disorders and worsening mental health.
Studies have shown evidence of poor psychological well-being and problematic Internet use, particularly among young users who find it difficult to manage multiple roles and demand of their time. Psychological well-being of university students is regarded as an important research field and thus is of serious global concern. A study reported psychological distress in 24.2% among a group of 835 Nigerian undergraduates. A Taiwanese study also reported issues of psychological well-being such as low-self-esteem, lower self-image, and less social interaction in adolescents suffering from IA. A study revealed that there was a significant effect of IA on academic performance and mental health of students/adolescents. Other studies have shown that IA is associated with some psychiatric disorders such as anxiety disorder, personality disorder, bipolar disorder, social phobia, attention-deficit hyperactivity disorder, and depression in young adults, as well as many other psychological disorders.
The trio of IA, sleep deprivation, and mental well-being are, no doubt, related. Several studies have documented the adverse effect of IA among adolescent lack of adequate sleep;,, however, the study had reported an association between normal sleep quality and lower level of mental health. Amid this contrast, our study aimed to explore the association between IAs, mental well-being, and sleep problem among medical students in a Nigerian university.
| Methods|| |
This cross-sectional study was carried out at the Ekiti State University College of Medicine among both preclinical and clinical medical students. The study population was the entire medical students. Participants were randomly selected after they had given informed verbal and written consent. A total of 129 study participants (86 clinical and 43 preclinical students) were purposively enrolled, 83 males and 46 females.
The data were collected from the students using a questionnaire that comprised two sections. The first section collected data on the sociodemographic variables of the students. The second section included four components: (i) Warwick–Edinburgh Mental Well-Being Scale (WEMWBS), (ii) Young IA Test (YIAT), (iii) World Health Organization Alcohol Use Disorders Identification Test (WHO AUDIT), and (iv) Insomnia Severity Index (ISI).
WEMWBS is a valid and reliable tool for measuring mental well-being. It has been demonstrated to have strong internal consistency and high Cronbach's alpha of 0.87. YIAT is a widely used instrument for screening and measuring of the level of IA on a five-point Likert scale. The WHO AUDIT was used for screening excessive drinking among the participants. ISI, known to have excellent internal consistency, was used to measure the participants' perception of symptoms of insomnia. The questionnaire has a set of responses scored 0-4 on Likert scale for WHO AUDIT and ISI; and scored 0-5 for WEMWBS and YIAT. The score ranges for each of the scales used in this study are as below:
- YIAT: 0–30 (normal), 31–49 (mild), 50–79 (moderate), and 80–100 (severe)
- WHO AUDIT: 0 (no alcohol use), >4 (positive in men), and >3 (positive in women). The higher the AUDIT score, the more likely it indicates problematic drinking
- WEMWBS: The minimum scale score is 14 and the maximum is 70
- ISI: 0–7 (no clinically significant insomnia), 8–14 (subthreshold insomnia), 15–21 (clinical insomnia/moderate severity), and 22–28 (Clinical insomnia severe).
After data gathering using the questionnaire, scores for each of the participants on the WEMWBS, IAS, WHO AUDIT, and ISI component of the questionnaire were calculated. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0. Armonk, NY: IBM Corp. Descriptive statistics were done. Furthermore, an independent t-test was used to compare participants on the various scales based on some demographic characteristics. Spearman correlation was used to explore the relationship between continuous variables.
Ethical clearance was sought and obtained from the Ekiti State University Teaching Hospital Ethics and Research Committee. Informed consent was also obtained from the study participants, and they were assured of confidentiality in respect of the information they filled in the questionnaire.
| Results|| |
Shapiro-Wilk's tests, virtual inspection of their histograms, and normal Q-Q plots of this study sample characteristics showed that the scores on each of three (YIAT, WEMWBS, and ISI) scales were approximately normally distributed for both males and females. The distribution is fairly less approximate normally distributed for the WHO AUDIT scale a skewness of 3.872 (standard error [SE] = 0.269) and kurtosis of 19.768 (SE = 0.532) for males and a skewness of 4.596 (SE = 0.354) and kurtosis of 24.772 (SE = 0.695) for females.
Of the 129 student participants in the study, 83 (64.3%) were male and the rest were female. The mean age of the participants was 24.4 (±2.78) years, and they were between the age range of 20 and 35 years. Majority of the students (96.9%) were single and (87.6%) accommodated in the school hostel. [Table 1] shows the sociodemographic features of the participants.
Over two-thirds of the students spent more than 2 h per day using the Internet. More than half (51.9%) of the students cited surfing the social media as most preferred reason for use of the internet. Moreover, the least reason indicated for Internet use was academic assignments. Forty-six (35%) of the participants admitted that they had tried cutting down on time spent on engaging the Internet. Twenty-two (17.1%) of the participants scored below the minimum score for addiction on YIAT. [Table 2] further depicts the gender-based pattern of Internet use by the participants. The mean score on YIAT was 32.56 (±15.94) with a range of 74. There was no statistically significant difference in the mean scores on IA Young's scale for male and female participants.
|Table 2: Demographic characteristics by internet addiction, Warwick-Edinburgh Mental Well-Being Scale, Alcohol Use Disorders Identification Test, and Insomnia Severity Index|
Click here to view
The mean score of the participants on the WEMWBS was 52.94 (±7.68), and the scores ranged between 27 and 70. About a tenth, 12 (9.3%) of the participants, scored above the mean score + standard deviation.
This reflects the participants' level of risk related to alcohol. The mean score of participants' WHO AUDIT total score was 1.23 (±2.66) and range of the total score was 20. Six (4.7%) of the participants had a total score of 8 and above indicating hazardous/harmful use on the WHO AUDIT scale.
The participants' mean total score on ISI was 4.33 (±4.05) with a total score ranging between 0 and 19. About 80% of the participant reported no clinically significant sleep problem (score: 0–7) and the rest had subthreshold/moderate severity sleep problem (score: 8–21).
Relationship between continuous variables
This study revealed statistically insignificant negative correlation between the pairs of IA score and mental well-being (r = −121, P = 0.198) and alcohol use and mental well-being (r = −0.10, P = 0.279). There existed a statistically significant positive correlation between IA and insomnia (r = 0.320, P = 0.000) and IA and alcohol use (r = 0.428, P = 0.000). There was an insignificant positive relationship between alcohol use and insomnia (r = 0.072, P = 0.414).
Sociodemographic variables and mean scores on Insomnia Severity Index, Young Internet Addiction Test, Warwick–Edinburgh Mental Well-Being Scale, and Alcohol Use Disorders Identification Test
The younger age group (20–27 years) had a statistically lower score, though not significant, on YIAT (P = 0.061) and alcohol use (P = 0.0.136) scales compared to the older age group (28–35 years). There was also no statistically significant difference in the scores of both age groups on the mental well-being (P = 0.627) and ISI (P = 0.285) scales. There was no statistically significant difference between male and female participants' score on IA, mental well-being, and alcohol use.
However, male and female participants had significantly different scores on the ISI with females scoring higher than malesas shown in [Figure 1]. (P = 0.000). Participants' place of abode did not contribute significantly in respect of their scores on IA (P = 0.223), mental well-being (P = 0.165), and severity of insomnia (P = 0.799), whereas participants who resided at home had a significantly higher score on alcohol use than those who resided within the school hostel (P = 0.038). There existed no statistically significant difference between the preclinical and clinical students on each of the four scales measured; the clinical students had higher mean scores than the preclinical students on YIAT and AUDIT, while the preclinical students had higher mean scores on WEMWBS and ISI.
| Discussion|| |
This study has revealed the rate of addiction to Internet use among a cross section of medical students in a budding medical school, Southwest Nigeria. More than eight out ten (82.9%) of the students in this study qualified to be described as having (mild to moderate) IA, as evaluated by YIAT. This rate is far higher than a pooled prevalence of 32.2% reported by a 2018 meta-analysis of studies that used similar test tool on IA. However, the high prevalence found in this study could compare with the IA rate found in a population of medical students in another African study. It is worthy of note that the rate was also higher among male participants than their female counterparts. The prevalence in this study is higher than a prevalence of 59.2% observed among a students' population in an earlier Nigerian study. The higher prevalence may be due to some factors such as timing of this study, further increase in accessibility enhanced by cheaper mobile data plans, and progressive increase in the number of mobile apps. The finding in this study with regard to the different age groups was in contrast to reports by some other studies; the older age group in this study has a higher prevalence of problematic Internet use. Similar to some earlier studies, both genders were not significantly different in their IA scores. However, more studies had reported higher IA scores in males. We believe that the varying prevalence rates may be attributed to different test tools and other sampled population variables.
The purpose for the use of the Internet among students is greatly diverse. In spite of generally perceived notion of enormous academic workload in medical school, majority of the participants in this study, ironically, engaged the Internet for social media use. The purpose least cited by participants in this study was academic use. This contrasts with findings by some other studies done in similar and nonsimilar environments as this present study., The finding in this regard by this study may require further in-depth causative factors for the observed preference in the use of the Internet. However, experience of boredom, among the study group, of having spent longer years than expected in medical school might be responsible; boredom has been one of the common factors known to trigger intensive Internet use among problematic Internet use behavior.
The participants, at the time of the study in 2019, had spent between 2 and 4 years longer in the university.
In spite of the literature suggesting a heterogeneous result in the interdependence between alcohol use and IA, results from majority of studies support a link between IA and alcohol consumption. Psychoactive substance use, such as alcohol use, among medical students is not novel. In a study that included medical students, among other nonmedical students as participants, medical students ranked higher in the use of alcohol. This study, however, revealed a low rate of alcohol use among participants when compared with that obtained among Nigerian university students in general. Notwithstanding the low rate of alcohol use among the study participants, the significant positive correlation observed between IAs was among the participants who resided outside the school hostel. This subgroup of participants tends to live a more permissive life outside the school environment in the form of self-indulgence. Albeit alcohol may be means of coping with stress, the low rate found in this study could be due to nonpermissive environment for alcohol use. However, social desirability response may account for the low rate in the case of the preclinical students who lived in environment predominantly populated by other (nonmedical) students outside the university environment.
Medical students are not immune to psychological instability. While the prevalence of psychiatric disorders was said to be high among medical students in a Nigerian study, the participants in this study had only one out of ten been psychologically distressed. This is lower than a prevalence of 24.2% and 30.9% reported among population of Nigerian and Saudi university students, respectively., The lower rate, rather an irony, of psychological distress observed among the participants in this study, however, could not explain the reality of the unexpectedly longer training period the participants had spent in medical school as a result of delay in accrediting the school by the regulatory body for medical education in Nigeria. There is a possibility that the use of Internet as well as alcohol may have served as means of coping with stressful circumstances.
There is no doubt problem of excessive Internet use can lead to health (sleep) problems for reason of unhealthy preoccupation with Internet use, particularly during late hours at night. The proportion, about 20%, of participants in this study who had sub-threshold to moderate severity sleep problem is low compared to a range 27% to 40% reported by earlier studies within and outside Nigeria. [30,31] Evidences concerning the relationships between IA and sleep problems, IA and mental well-being, have been inconsistent. This study, however, has established a significant positive correlation coefficient between IA and insomnia. Similarly, some other studies had reported a significant association between the use of smartphones (often used for browsing the Internet) and sleep problems among individual smartphone users., The ready comfortability of smartphone use even while lying in bed to surf the Internet has been recognized as a contributory factor in attendant sleep problem that may result from prolonged use of smartphones.
This study, however, was limited by its small population size and thus would not allow the outcome to be generalized. Some of the responses to the questionnaires, by the respondents, might be influenced by effect of social desirability effect.
| Conclusion|| |
This study has brought to the fore contemporary issues germane to students' well-being. Besides IA, our study also looked at the collateral issues, of sleep and mental well-being, that may be associated with problematic use of the Internet among medical students. IA and its associated problems are real among college students and would require earnest intervention from school authority with a view to curb problematic use. Students should be encouraged to harness their interest in Internet use that will promote and sustain good mental well-being.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Tran BX, Huong LT, Hinh ND, Nguyen LH, Le BN, Nong VM, et al
. A study on the influence of internet addiction and online interpersonal influences on health-related quality of life in young Vietnamese. BMC Public Health 2017;17:138.
Quadri GO, Abomoge SO. A survey of reading and internet use habits among undergraduate students in selected university libraries in Nigeria. Information Knowledge Management 2013;3:38-46.
Ezemenaka E. The usage and impact of internet enabled phones on academic concentration among students of tertiary institutions: A study of University of Ibadan, Nigeria. Int J Educ Dev Using Inf Commun Technol 2013;9:162-73.
Kawabe K, Horiuchi F, Ochi M, Oka Y, Ueno S. Internet addiction: Prevalence and relation with mental states in adolescents. Psychiatry Clin Neurosci 2016;70:405-12.
Ayub AF, Hamid WH, Nawawi MH. Use of internet for academic purposes among students in Malaysian institutions of higher education. Turk Online J Educ Technol 2014;13:232-41.
Azad MC, Fraser K, Rumana N, Abdullah AF, Shahana N, Hanly PJ, et al
. Sleep disturbances among medical students: A global perspective. J Clin Sleep Med 2015;11:69-74.
Cheung LM, Wong WS. The effects of insomnia and internet addiction on depression in Hong Kong Chinese adolescents: An exploratory cross-sectional analysis. J Sleep Res 2011;20:311-7.
Khayat MA, Qari MH, Almutairi BS, Hassan SB, Rambo MZ, Alrogi MJ, et al
. Sleep quality and internet addiction level among university students. Egypt J Hosp Med 2018;73:7042-7.
Canan F, Yildirim O, Sinani G, Ozturk O, Ustunel TY, Ataoglu A. Internet addiction and sleep disturbance symptoms among Turkish high school students. Sleep Biol Rhythms 2013;11:210-3.
Alimoradi Z, Lin CY, Broström A, Bülow PH, Bajalan Z, Griffiths MD, et al
. Internet addiction and sleep problems: A systematic review and meta-analysis. Sleep Med Rev 2019;47:51-61.
Dutta O, Chye SY. Internet use and psychological wellbeing: A study of international students in Singapore. J Int Stud 2017;7:825-40.
Macaskill A. The mental health of university students in the United Kingdom. Br J Guid Counc 2013;41:426-41.
Nduanya CU, Okwaraji FE, Onyebueke GC, Obiechina IK. A cross sectional study on internet addiction, locus of control and psychological distress in a sample of Nigerian undergraduates. J Med Res 2018;4:146-50.
Ko CH, Yen JY, Yen CF, Lin HC, Yang MJ. Factors predictive for incidence and remission of internet addiction in young adolescents: A prospective study. Cyberpsychol Behav 2007;10:545-51.
Singh N, Barmola KC. Internet addiction, mental health and academic performance of school students/adolescent. Int J Indian Psychol 2015;2:98-108.
Orsal O, Orsal O, Unsal A, Ozalp SS. Evaluation of internet addiction and depression among university students. Procedia Soc Behav Sci 2013;82:445-54.
Choi K, Son H, Park M, Han J, Kim K, Lee B, et al
. Internet overuse and excessive daytime sleepiness in adolescents. Psychiatry Clin Neurosci 2009;63:455-62.
Ekinci Ö, Çelik T, Savaş N, Toros F. Association between internet use and sleep problems in adolescents. Noro Psikiyatr Ars 2014;51:122-8.
Zhai K, Gao X, Wang G. The role of sleep quality in the psychological well-being of final year undergraduate students in China. Int J Environ Res Public Health 2018;15:2881.
Zhang MW, Lim RB, Lee C, Ho RC. Prevalence of internet addiction in medical students: A meta-analysis. Acad Psychiatry 2018;42:88-93.
Ali R, Mohammed N, Aly H. Internet addiction among medical students of Sohag University, Egypt. J Egypt Public Health Assoc 2017;92:86-95.
Okwaraji FE, Aguwa EN, Onyebueke GC, Shiweobi-Eze C. Assessment of internet addiction and depression in a sample of Nigerian university undergraduates. Int Neuropsyc Dis J 2015;4:114-22.
Upadhayay N, Guragain S. Internet use and its addiction level in medical students. Adv Med Educ Pract 2017;8:641-7.
Ogedebe PM. Internet usage and students' academic performance in Nigeria tertiary institutions: A case study of university of Maiduguri. Acad Res Int 2012;2:334.
Wang WC. Exploring the relationship among free-time management, leisure boredom, and internet addiction in undergraduates in Taiwan. Psychol Rep 2019;122:1651-65.
Ajayi AI, Owolabi EO, Olajire OO. Alcohol use among Nigerian university students: Prevalence, correlates and frequency of use. BMC Public Health 2019;19:752.
Hakami RM. Prevalence of psychological distress among undergraduate students at Jazan University: A cross-sectional study. Saudi J Med Med Sci 2018;6:82-8.
] [Full text]
Haque M, Rahman NA, Majumder MA, Haque SZ, Kamal ZM, Islam Z, et al
. Internet use and addiction among medical students of Universiti Sultan Zainal Abidin, Malaysia. Psychol Res Behav Manag 2016;9:297-307.
Vignau J, Bailly D, Duhamel A, Vervaecke P, Beuscart R, Collinet C. Epidemiologic study of sleep quality and troubles in French secondary school adolescents. J Adolesc Health 1997;21:343-50.
Bailly D, Bailly-Lambin I, Querleu D, Beuscart R, Collinet C. Sleep in adolescents and its disorders. A survey in schools. Encephale 2004;30:352-9.
Moattari M, Moattari F, Kaka G, Kouchesfahani HM, Sadraie SH, Naghdi M. Smartphone addiction, sleep quality and mechanism. Int J Cogn Behav 2017;1:1-7.
Xie X, Dong Y, Wang J. Sleep quality as a mediator of problematic smartphone use and clinical health symptoms. J Behav Addict 2018;7:466-72.
[Table 1], [Table 2]