Extended Abstract
Introduction
Internet addiction, also described as pathological Internet use, is characterized by an inability to control Internet usage, ultimately culminating in psychological, social, or occupational problems. International epidemiological studies have demonstrated that Internet addiction is a public health concern, with a prevalence of 8% to 13% among university students and 1.4% to 9.17% among adolescents. Individuals with Internet addiction often present with a range of psychological symptoms, such as depression, attention-deficit/hyperactivity disorder (ADHD) symptoms, social isolation, and low self-esteem. Furthermore, they may exhibit a wide array of problematic behaviors, including impulsivity, sensation-seeking feelings and behaviors, and high levels of aggression. The Internet can provide various opportunities for entertainment and connection with social networks. However, the prevalence of Internet addiction is increasing, particularly among individuals who engage in extensive Internet use for work, entertainment, and social networking.
Given the association of psychiatric disorders and personality traits with Internet addiction, the excessive Internet use in the post-coronavirus disease 2019 (COVID-19) era, and the lack of sufficient research on the relationship between these disorders and Internet addiction among medical students, this study was conducted to determine the prevalence of Internet addiction among medical students at Golestan University of Medical Sciences and its association with psychiatric disorders.
Methods
This descriptive-analytical study was conducted on 189 medical students (73 males and 116 females) at Golestan University of Medical Sciences in 2021.
The tools used in the study consisted of Young’s Internet Addiction Test (IAT) and the Minnesota Multiphasic Personality Inventory-2 (MMPI-2) short form.
The IAT, developed by Dr. Kimberly Young, contains 20 items designed to assess the degree of individuals’ dependence on using the Internet or computer. The response scale for this questionnaire is a five-point Likert scale. The obtained score is the total score of the questionnaire, ranging from 20 to 100. The higher this score, the higher the individual’s Internet addiction, and vice versa. Scores from 20 to 49 indicate the absence of Internet addiction, scores from 50 to 79 indicate being at risk of Internet addiction, and scores from 80 to 100 indicate severe Internet addiction.
The MMPI-2, an objective and self-report tool, is one of the most important and valid questionnaires developed using the external criterion method. It is utilized by professionals for assessing psychopathology and personality traits in both clinical and non-clinical populations. This test comprises 11 standardized scales, 3 of which pertain to validity scales, including Lie (L), Infrequency (F), and Correction (K), and the other 8 relate to clinical scales, including Hypochondriasis (Hs), Depression (D), Hysteria (Hy), Psychopathic Deviate (Pd), Paranoia (Pa), Mania (Ma), Psychasthenia (Pt), and Schizophrenia (Sc).
The scoring of this questionnaire is carried out in two categories of scales. The first category includes validity scales that are scored and interpreted before the clinical scales. Validity scales include cases in which the individual has lied in response to some of the questions or has adopted defensive postures. Clinical scales address the individual’s personality traits in various dimensions, including scales for Hypochondriasis (Hs), Depression (D), Hysteria (Hy), Psychopathic Deviate (Pd), Paranoia (Pa), Mania (Ma), Psychasthenia (Pt), and Schizophrenia (Sc).
The Hypochondriasis (Hs) scale refers to characteristics related to an individual’s hypochondria concerns. The Depression (D) scale indicates the individual’s score regarding level of depression. The Hysteria (Hy) scale indicates a tendency toward attention-seeking and histrionic reactions. The Psychopathic Deviate (Pd) scale reflects the subject’s antisocial reactions. The Paranoia (Pa) scale measures an individual’s level of trust or distrust toward others. The Psychasthenia (Pt) scale refers to an individual’s psychological fatigue and weakness. The Schizophrenia (Sc) scale examines the presence of psychotic symptoms. Finally, the Mania (Ma) scale measures symptoms that are the opposite of depression. Based on cutoff points for each domain, an individual is classified as normal, having a moderate disorder, or having a severe disorder.
Results
According to the results, 136 (71.95%) individuals did not have Internet addiction, 50 (26.45%) individuals were at risk of Internet addiction, and 3 (1.58%) individuals had Internet addiction. Less than 4% of students exhibited a high severity of psychiatric disorders, and 9.5% to 19.6% of students had moderate levels of various psychiatric disorders. Except for the Hypochondriasis (Hs) domain, other domains exhibited a positive and significant correlation with Internet addiction and. The strongest correlation was found between Psychasthenia (Pt) and Internet addiction (r=0.423, P<0.001).
The results of the correlation between the subjects’ scores of Young’s questionnaire and the MMPI-2 revealed that Depression (D), Psychopathic Deviate (Pd), Paranoia (Pa), Mania (Ma), Psychasthenia (Pt), and Schizophrenia (Sc) had significant correlations with the MMPI-2.
The correlation results between the scores of Young’s questionnaire and MMPI-2 based on gender demonstrated that in male students, Psychopathic Deviate (Pd), Paranoia (Pa), Mania (Ma), Psychasthenia (Pt), and Schizophrenia (Sc) had statistically significant and positive correlations with Internet addiction (P<0.05). In female students, such a significant relationship was observed not only for the mentioned cases but also for depression (P<0.05).
The correlation results between the scores of Young’s questionnaire and MMPI-2 based on ethnicity revealed that the highest correlation between these scores was among Fars students, and the lowest correlation was found among Turkmen students. Accordingly, in Fars students, except for hypochondria symptoms, Internet addiction was found to have a significant and positive correlation with other psychiatric disorders, including Depression (D), Hysteria (Hy), Psychopathic Deviate (Pd), Paranoia (Pa), Mania (Ma), Psychasthenia (Pt), and Schizophrenia (Sc). In Turkmen students, only Paranoia (Pa) symptoms were correlated with Internet addiction, and in students of other ethnicities, Psychopathic Deviate (Pd), Psychasthenia (Pt), and Schizophrenia (Sc) symptoms exhibited positive and significant correlations with Internet addiction.
With increasing academic years, the relationship between the severity of psychiatric disorders and Internet addiction decreased so that in students admitted to the university before the 2015 academic year, no relationship was found between the severity of psychiatric disorders and Internet addiction.
Conclusion
Internet addiction among medical students was found to be at a low level. However, over 25% of students were identified as being at risk of Internet addiction, while more than 75% of students fell within the normal range concerning psychological symptoms, and severe psychological symptoms were observed in less than 4% of students.
Ethical Statement
The study was approved by the Ethics Committee of Golestan University of Medical Sciences (IR.GOUMS.REC.1400.197).
Funding
This article has been extracted from the dissertation of Fatemeh Sadat Samsam Shariat to obtain the degree of Doctor of Medicine from Golestan University of Medical Sciences.
Conflicts of Interest
No conflict of interest.
Acknowledgement
The authors would like to thank the esteemed Vice-Chancellor for Research and Technology of the University for their support, as well as to the staff of the Psychiatry Department of 5th Azar Educational and Therapeutic Center in Gorgan for their sincere cooperation in conducting the study.
Key message: The prevalence of Internet addiction among medical students was shown to be at a low level, and the severity of psychiatric disorders increased with higher levels of Internet addiction.