A cross-sectional study to assess internet addiction among medical undergraduate students of government medical college in Agra, India

INTRODUCTION

Addiction is a chronic brain disorder characterized by compulsive engagement in rewarding stimuli despite adverse consequences.^1-4 Addiction does not mean only of substance abuse (chemical) but it also includes behavioral addiction like internet addiction, gambling shopping, food addiction etc. Internet user population world-wide has increased from 360 million in December 2000 to 4.8 billion in June 2020. The internet can foster various addictions including addiction to game-playing, pornography, auction sites, social networking sites and surfing of web.⁵ Internet addiction may also be called compulsive internet use, problematic internet use (PIU), internet dependence.⁶ Internet addiction disorder is characterized by pre-occupation with internet, need to spend long periods online, repeated attempts to reduce internet use, time management problems, environment distress, deception regarding time spent online, and mood modification through internet use.⁷ As adolescents (12-19 years) and emerging adults (20-29 years) access the internet more than any other age groups and undertake a higher risk of overuse of the internet, the problem of Internet addiction (IA) disorder is most relevant to young people.⁸

Some researchers and mental health practitioners see excessive Internet use as a symptom of another disorder such as anxiety, social phobia or depression rather than a separate entity.⁹ The increase in penetration of high-speed internet coupled with affordability of computer devices in India over the last few years has led to emergence of IA as reported by some recent studies.^10,11 Risk of Internet addiction has increased this year (2020) may be due to Coronavirus disease 2019 (COVID-19) pandemic, where most of time people are restricted to their homes in order to avoid social gathering, thus relying on social media applications to be in touch with fellow peoples, moreover work from home as well as online learning practices increases their exposure time to screen and internet.^12,13

With this background, a study was conducted to assess internet addiction among medical undergraduate students of Government Medical College in Agra, India

METHODS

After obtaining the Institutional Ethical Committee clearance, this online survey based cross sectional study was done among medical undergraduate students of S. N. Medical College, Agra. We disseminated the e-questionnaire using Whatsapp^TM through the aid of class representatives that helped us to contact and deliver the survey to the entire students of all the four professional years. This online survey was carried out from September 13th, 2020 to September 21st, 2020 among a total 600 medical undergraduate students in the college and out of which only 488 students participated in the study.

A semi-structured, pre-validated, self-administered e-questionnaire has three parts. First part includes relevant demographic information along with their academic year. Second part contains questions regarding internet usage patterns viz. years since started using internet, screen time per day (hours), hours of internet usage time per day (hours), most common type of internet connection used, most commonly device used for accessing internet, most common location for internet access. Last part consists of Young Internet addiction test (IAT) questionnaire developed by Dr. Kimberly Young. It is a 20-item questionnaire that measures the presence and severity of internet dependency. Cronbach’s alpha for internal consistency has been reported as 0.0889.¹⁴ It has been validated in various countries and has been used in some studies in India.^15-17 The responses are based on a 5-point Likert scale. The severity of internet addiction is evaluated in the following manner: scores of 0-30 as no, 31-49 mild, 50-79 moderate, and 80-100 severe impairment. Data was entered in a computer-based spreadsheet and data collected was further analyzed by Statistical package for social sciences (SPSS) version 21. chi-square test was applied for testing the association of internet addiction with demographic variables and variables related to internet usage patterns.

RESULTS

A total of 600 medical undergraduate students were approached through Whatsapp to complete the self-administered, pre-validated e-questionnaire out of which 488 students had filled up the e-questionnaire, giving response rate of 81.33%. The mean (± Standard deviation (SD)) age of population was 22.27±1.59 years with 48.36% males and 51.64% females. Around half (47.54%) were staying away from home i.e., in hostel or paying guest accommodation or rented flats etc. Proportion of students in combined 1st and 2^nd prof and in final prof part 1^st and 2nd year were 47.55% and 52.45% respectively.

The prevalence of internet addiction was 61.5% (300/488). The level of internet addiction was mild among 41% (200/488), moderate among 19.7% (96/488) and 4 (0.8%) participants had severe addiction. While 38.5 % (188/488) of the participants were completely free from internet addiction (Table 1).

67.80% of male students had IA at the time of interview while 55.55% of female students had internet addiction and observed differences were found to be statistically significant (χ²=7.7106; p=0.005). Among, students having monthly family income ≤50,000, 57.69% of them had internet addiction while among those having monthly family income greater than 50,000, 65.78% had internet addiction and results were found to be statistically significant (χ²=7.650; p=0.005). It was also found that 50.84% of combined 1st and 2nd professional year students had internet addiction while 71.42% of final year part 1st and 2nd year students had internet addiction, the observed differences were highly significant (χ²=21.796; p≤0.00001) (Table 2).

Among those respondents who have been using the internet since ≤8 years 56.38% had internet addiction while among those using internet since >8 years 78.57% of respondents had internet addiction and the observed differences were found to be highly statistically significant (χ²=17.939; p=0.000023). Statistically significant association was seen with greater screen time per day (in hours) and internet addiction (χ²=5.734; p=0.0166). Also, highly statistically significant association was seen between greater number of hours of Internet use per day and internet addiction (χ²=68.428; p≤0.0001) (Table 3).

*Statistically significant, #Others included hostel or paying guest accommodation or rented flats etc.

*Statistically significant, ^##others included mobile phone internet, internet dongle, landline broadband, ^$others included classroom, campus, public places and library.

DISCUSSION

In our study among 488 medical undergraduate students, 188 (38.5%) participants had no internet addiction, total prevalence of IA found to be 61.5% where 200 (41.0%) had mild addiction, 96 (19.7%) participants had moderate addiction and 4 (0.8%) participants had severe addiction. In a study conducted by Karthikeyan et al among medical students found prevalence of mild and moderate internet addiction accounting to 63.8% and 20.2% respectively.¹⁸

In a study by Chaudari et al, the prevalence of internet addiction among medical students was found to be 58.8% with mild and moderate IA accounting for 51.42% and 7.45% respectively.⁷ In another study done by Subhaprada prevalence of IA was 52.63% mild and 24.21% moderate while 23.16% students reported free from addiction.¹⁹ In a study conducted in Egypt among 369 medical students, prevalence of IA (moderate and severe) was determined to be 18.88%. Majority (57.77%) confirmed to mild addiction.²⁰ Irrespective of place of study or number of students screened, medical students are vulnerable for internet addiction and mild IA is quite high among them. Higher prevalence of IA in our study might be accounted to the fact that regular classroom teaching has been withheld due to the COVID-19 pandemic. Online learning practices which emerged as an alternative tool as well as the added leisure time has increased their exposure time to screen and internet. Efforts must be taken to increase awareness and prevent the problem of Internet addiction in them. Certain studies have reported prevalence of IA to be different from ours, which can be attributed to the difference in population group studied and variation in cutoffs used for categorizing IA.

We found higher prevalence of IA among male student, many other studies both from India and abroad had showed similar finding.^11,21 Available data from the community and online surveys as well as clinical samples suggest that Internet addiction appears to have a male preponderance.^22-27 Socio-cultural norms might have played a role in gender difference with respect to internet access. It is also suggested that the gender distribution may be explained by the fact that men are more likely to express interest in games, pornography, and gambling activities that have all been associated with problematic internet use.²²

We found no association between age of study participants and IA. Similar findings with respect to age and IA has been reported by certain studies.^15,28,29 We also found higher prevalence of IA among students of higher professional year, another study have reported the same.²⁹ This might be due to reason that they get more freedom as well as more experience to explore internet as they get promoted to next year in course. However, certain studies reported opposite of this, i.e. initial years of study were associated with higher burden of IA.^15,31

In our study, there was no difference in the prevalence of IA between participants who lived at home and those living away from home. Similar finding was observed among college students of Bengaluru, but in a study from Maharashtra, people staying at private accommodations were at higher risk of IA as compared to those staying at home.^15,11 The differences in internet access and socio-cultural differences might have led to this variation.

Higher family income groups have been found to be associated with a higher prevalence of IA in many studies.^32,33 This is consistent to our findings too. This may be due to fact that higher income group had more resources which gave them freedom to access internet in the form of higher spending per month and possessing a high-end internet enabled-devices.

We found statistically significant association between more number of years of internet usage and IA, similar findings were reported in certain other studies.^6,15 We found higher number of hours of internet use and high screen time per day, significantly associated with increased risk of IA. The similar association between duration of internet use and IA has been observed in adolescents from Vadodara and from college students of Mumbai.^34,11 Outside India similar results were reported in several studies as from South east Asia, Europe and Middle east.^10,35-37

We found no association between IA and the type of device/type of internet connection most commonly used for accessing the internet. Another study too have found similar findings.³⁹ However, some authors have reported that owning a smart phone is a significant risk factor for IA.^29,38 Also no association was found between most commonly used location to access internet and IA, similar finding was seen in a study conducted in North India by Gupta et al.³⁹

CONCLUSION

Finding of our study revealed high magnitude of IA among students of medical colleges. IA has psychological, physical, and social impact on student’s life. So, it is necessary to develop strategies for prevention of internet addiction as well as therapeutic interventions, which is vital for promoting healthy and safe use of the Internet. Awareness should be created among the students to improve ability to reduce the occurrence of internet addiction behaviour promoting their healthy growth.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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