Associations between internet addiction, grit, perceived stress and academic performance in medical students

INTRODUCTION

All medical students have to deal with vast curriculum and have lesser liberty of excess leisure time. Procurement of skill and knowledge with rigorous training is crucial in medical education. Any distraction or procrastination can make the matters difficult. One such parameter is internet use. The internet usage can be beneficial for information seeking or remote learning, however, many a times, a person tends to get distracted and end up spending more time compulsively on other websites. Many internet users are on social media platforms like Instagram, WhatsApp or Facebook and YouTube etc. with high usage most of the time.¹ Our study is aimed at analyzing the association of the internet addiction with perceptive stress and grit, their relation with each other and how it impacts academic performance in medical students. Internet addiction (IA) is the term used for excessive, compulsive and obsessive use of internet. It causes an individual to experience a sense of entertainment. Though it has not been classified as an addiction by the diagnostic and statistical manual of mental disorders, fifth edition or DSM-5 due to insufficient evidence, it appears to show many of the features of an addictive disorder. Internet usage seems to release dopamine in brain reward centers similar to other addictions.^2,3

A person, once introduced to the internet tends to spend increasing time on it in expense social engagement causing lesser offline social interactions. Internet addiction may also include online gambling addiction, cybersex addiction, video game addiction and social media addiction.⁴ IA has been shown to be negatively correlated with mental health in medical students which affect their perceived stress levels and finally their academic performance.⁵ Excessive online engagement may decrease overall wellbeing by affecting the sleep pattern and exacerbating social isolation.

Perceived stress

The magnitude to which a person perceives events in their life as stressful, unexpected, and uncontrollable is known as perceived stress.^6,7 Higher perceived stress has been correlated to more incidence of depressive symptoms with neural changes in left superior frontal gyrus.⁸ Perceived stress is an individual’s impression of life’s events as highly overwhelming. It can lead to developing a physiological stress response. The major source of stress in medical students is academic.⁹ High grade of stress can lead to academic decline by affecting the cognition in terms of retention, recall and reproducing during an assessment.

Grit

Grit is a trait which gives the ability of a person to pursue and work tirelessly towards long term goals and enduring any difficulties which might come in the way. It indicates the passion courage resilience and conscientiousness towards a person’s goals.¹⁰ It is something which hold a trainee from dropping out of the course. It is a noncognitive character driving us to persevere against the odds to reach our goal or finish the task. Grit is one of those characters, which, along with self-confidence, self-discipline, hope and optimism keeps the student going to achieve academic and professional success. The goal focused optimistic personality also gives protection against suicidal tendencies.¹¹

To determine the prevalence of internet addiction in the medical students. To determine the level of grit and perceived stress in 1st year medical students. To study the correlation between Grit, internet addiction and perceived stress. To analyses the association between the level of perceived stress, grit and internet addiction with academic performance.

METHODS

Study place

A cross-sectional study was done in medical students of 1st year, in their 2nd semester of Dr VRK Women’s Medical College, Teaching Hospital and Research Centre.

Study duration

The study period was from May 2023 to October 2023.

Sample size

There were 100 female students who participated in the study. Convenience sampling size of 100 was taken due to admission of 100 students each year. The participants were informed and explained about the study and its future advantages and signed consent was taken.

Inclusion criteria

The inclusion criteria where the participant should be student of 1st year medicine.

Exclusion criteria

The exclusion criteria compromised of students with diagnosed mental disorder and those who did not give consent. They were asked to self-administer the questionnaires on internet addiction, perceived stress and grit.

Their academic performance was analyzed from the common internal assessment exam done in the college. 94 students had attended the internal assessment done in 1st week of May 2023 in the subject of Physiology.

Research tools

Internet addiction test

Internet addiction test by Kimberly Young (1996) was used to find out the prevalence of internet addiction.¹² It consists of 20 questions with Likert score of 1-5. The maximum score is 100. Higher scores show increasing usage.

Score between 31–49 is taken as mild with average use, 50-79 as moderate internet addiction and 80-100 as severe internet addiction.¹³ Moderate internet addiction may experience some impact of increased usage but severe addiction has shown significant problems in their daily life due to high internet use. It shows high degree of internal reliability of 0.92.^14,15

Perceived stress scale

Perceived stress scale devised by Sheldon Cohen was used to check the level of perceived stress.⁶ It is 10 item questionnaire covering feelings and thoughts experienced in the last one month. A score between 0-13 is taken as low stress, 14-26 as moderate stress and 27-40 as high stress. It has good reliability with Cronbach’s alpha of >0.7.⁸

GRIT scale

GRIT scale given by Angela Duckworth has 10 questions enquiring about passion and perseverance.¹⁰ The sum of the Likert scores is divided by 10 to get final score for interpretation. The maximum score is 5. The higher the score the higher the grit.

Statistical analysis

Statistical analysis was done with Statistical package for social sciences 20 (SPSS-20). Descriptive statistics, correlational studies and regression analysis was done to find the association between internet addiction levels, perceived stress, grit and academic performance.

RESULTS

Analysis of the results obtained from the internet addiction test, perceived stress scale and grit scale and the academic performance was done. Descriptive statistics showing the mean age of participants, mean Grit score, mean internet addiction score and mean perceived stress score is shown below (Table 1). The prevalence of internet addiction in medical students was as high as 90% which includes 20% with moderate internet addiction and 70% mild internet addiction and 10% showing no internet addiction. None showed severe internet addiction. The perceived stress score showed 10% with low stress, 59% moderate stress and 31% scored high stress. On analysis by Pearson’s bivariate correlation the level of perceived stress was positively correlated with the grade of internet addiction showing statistical significance at p<0.05 (Table 2). Grit scores had negative correlation with internet addiction scores having significance at p<0.05 level (Table 3). The mean academic score was observed to decrease with increasing grade of internet addiction. The mean academic score was higher for moderate stress compared to low and high perceived stress as shown in (Table 4). Linear regression analysis showed significant positive effect of grit on academic performance at p<0.05.

*Correlation; *p=0.034 which shows correlation is statistically significant.

*Correlation; *p=0.013 which correlation is statistically significant

DISCUSSION

Our study showed 70% of mild and 20% moderate IA which is higher compared to similar study done in India in 2015 reporting 51.42% mild, and 7.45% moderate.¹⁶ This effect might probably be due to increased and easy availability of high-speed internet and smart phones. A metanalysis reported 30.1% of internet addiction among medical students.¹⁷ Pearson’s correlation study between the grade of internet addiction showed moderate positive correlation with level of perceptive stress at significance of p<0.05 similar to recent systematic review by Melca et al and other studies.^18,19 Pearsons’s correlation showed significant negative correlation between grit and internet addiction. This shows that students having higher grit are less likely to have internet addiction.

The main objective of a student or a teacher is to get academic excellence. Many factors might facilitate or hinder attainment of high grades. In our study we found that academic performance is under considerable effect of internet addiction, grit and perceptive stress. Our study has shown that grit scores have significant positive correlation with academic performance at p=0.03. Students with more grit tend to perform better in medical studies including clinical subjects.^20,21 The grit scale by Duckworth takes into consideration the passion towards attaining long term goals and maintaining the motivation and dedication to work towards it in spite of any hurdles and drawbacks.¹⁰

Therefore, its scores are a marker of resilience, unending optimism, self-confidence and focus on the task. Low grit is shown to have risk of mental disorders and higher perceived stress.^22-24 Encouraging optimism and an attitude towards continuous progress can increase gri.²⁵ Internet addiction had a negative impact on academic performance showing declining score with increasing internet addiction grade similar to Nath et al and Haroon et al.^26,27 In terms of perceptive stress, participants with moderate stress levels were having higher academic score than those with low or high perceptive stress. This is most probably due to optimum stress levels delivering better performance as aptly shown by Yerkes Dodson law which analyzes pressure and performance to state that “Performance increases with physiological or mental arousal, but only up to a point”.²⁸

The study has limitations like a larger sample size and inclusion of both the genders would have yielded better insight to the study.

CONCLUSION

The medical field is an ever-growing area with new research and information added frequently with newer topics constantly being added to the medical curriculum. As a result, the syllabus has become very vast. For the procurement of sufficient skills and knowledge, students should be taught to remove distractors and increase facilitators of learning. Internet addiction or high stress can create hurdles in the attainment of these goals. Grit in recent times has come out as a significant facilitator for determination towards learning. Our study clearly shows academic performance is better with lesser internet usage, more grit and optimal stress levels. Steps should be taken to make students aware of the magnitude of ill effects of excessive internet usage for purposes other than for learning, on their academic goals. They should be educated about the detrimental effect of internet addiction on perceived stress and grit which can hinder achievement of scholastic excellence. More research should be done to understand the complexities of these factors affecting the academic performance and appropriate measures should be formulated to counteract their effects.

Funding: No funding sources

Conflict of interest: None declared

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

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