Prevalence of Internet Addiction, Poor Sleep Quality, and Depressive Symptoms Among Medical Students: A Cross-Sectional Study

Exploring the relationship between depressive symptoms, problematic smartphone use, and cumulative risk factors in nursing students: A cross sectional study

BACKGROUND

No single risk factor is decisive in shaping an individual's healthy development. This study aimed to analyze the relationship between depressive symptoms and a cumulative risk index comprising individual, family, and social variables among nursing students.

METHODS

We enrolled 1716 Chinese nursing students from three universities in a paperless survey that assessed a range of individual, family, and social risk factors associated with depressive symptoms. Multiple risk analysis was conducted to create a composite risk score for each individual. A test for trend was employed to assess the relationship between the multiple risk classification and depressive symptoms individually. Additionally, a 2-step cluster analysis and χ2 tests were used to examine the relationship between the different clusters and the level of depressive symptoms.

RESULTS

The mean scores of depressive symptoms increased significantly as the number of risk factors increased, regardless of their combination. As the number of risk factors increased, the proportion of nursing students in the normal group decreased, while the proportion in the group with depressive symptoms of varying severity tended to increase (P < 0.001). A high-risk cluster characterized by poor sleep quality combined with problematic smartphone use was associated with higher levels of depressive symptoms (P < 0.001).

CONCLUSION

Based on these findings that cumulative exposure to multiple risk factors is more harmful than cumulative exposure to fewer risk factors, then interventions that isolate only one risk factor are less likely to be effective than those that are multifaceted.

Validation of the Amharic version of Internet Addiction Test-20: a cross-sectional study

Background

Internet Addiction is defined as excessive internet use or poorly controlled preoccupations, impulses, or behaviors related to computer use and internet access that cause impairment or suffering. It had devastating effect on people lives, families, productivity, academic performance and rarely engaging in criminal acts like alcohol use, drug addiction, or compulsive gambling. This study aimed to investigate the psychometric properties of the Amharic version of Internet Addiction Test-20 among Addis Ababa University, College of Health Sciences medical students, Addis Ababa, Ethiopia.

Methods

A cross sectional study was carried out among 410 medical students using a convenience sampling method after stratifying them based on their year level. SPSS Version 23 was used to do Pearson's correlation coefficient to determine the convergent validity of Amharic version of IAT. We computed correlation coefficient between the aggregate scores of IAT-20 and the scores for depressive symptoms, problematic substance use, and other characteristics of participants which was assessed using Patient health questionnaire-9 (PHQ-9), Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and questionnaire developed to assess demographic and internet use related characteristics, respectively. AMOS 23 software was used to conduct confirmatory factor analysis (CFA) to evaluate the construct validity of Amharic version of IAT. Test-retest reliability was also determined with 2 weeks interval (n = 51).

Results

The data confirmed a two-factor structure. Normed Fit Index (NFI) = 0.89, Tucker Lewis Index (TLI) = 0.91 and Comparative Fit Index (CFI) = 0.92, Root Mean Square Error Approximation (RMSEA) = 0.07, and Standardized Root Mean Residual (SRMR) =0.05 indicated a good fit model structure. There was moderate positive correlation between the aggregate scores of IAT-20 and PHQ-9 scores (r = 0.55, p < 0.00), but weak positive correlation between IAT-20 and ASSIST scores (r = 0.14, p < 0.00). IAT-20 was also found to have good internal consistency (Cronbach's alpha = 0.89 for each factor). The test-retest reliability was also good for all items (Intra Class Correlation Coefficient (ICC) > 0.30) except item 16.

Conclusion

We found that the IAT-20 is psychometrically sound and a simple screening test for Internet Addiction. However, it is important to acknowledge that further studies are necessary to replicate these findings on diverse population.

Prevalence of internet addiction and its relationship with insomnia, depression, anxiety, and stress among medical students of a tertiary care medical institute of Eastern India

Background

Internet has become an integral part of our daily lives but as the use of internet is increasing, it is important to be aware of the prevalence, context, and impact of its addiction on sleep and the presence of anxiety, depression, and stress in our lives.

Aim

To assess the prevalence of internet addiction and its association with insomnia, depression, anxiety, and stress among medical students in a tertiary care medical institute in Eastern India.

Materials and Methods

A descriptive cross-sectional questionnaire-based study with a purposive sampling method was conducted among 420 undergraduate medical students of different professional years. Out of 420 medical students, 413 students who gave consent and returned complete performa were taken in the study using a semi-structured performa for sociodemographic details, Young's Internet Addiction Test, Insomnia Severity Index, and Depression Anxiety Stress Scale.

Results

We found 31.2% of students had internet addiction, 24.2% had clinical insomnia, 58.1% had stress, 68.8% had anxiety, and 64.6% had depression. Potential internet addiction was significantly related to average screen time, insomnia, stress, anxiety, and depression.

Conclusions

Internet addiction is prevalent among medical students affecting sleep, anxiety, depression, and stress, which needs urgent preventive strategies.

Perfect people, happier lives? When the quest for perfection compromises happiness: the roles played by substance use and internet addiction

Building on the Conservation of Resources Theory and the Stress-Coping Model, the present study explored the relationship between perfectionism (rigid, self-critical, narcissistic) and subjective happiness among youth. In this relationship, we also examined the mediating roles of substance use (i.e., drinking and smoking) and Internet addiction symptoms. Our sample comprised 431 Romanian university students aged 18-25 (M = 20.50, SD = 1.58), and most of them were females (79.81%, self-reported gender). Participants completed self-reported anonymous scales through a web-based survey at the beginning of 2023. Correlation analysis results indicated that all forms of perfectionism were associated with Internet addiction symptoms. Self-critical and narcissistic perfectionism and drinking, smoking, and Internet addiction symptoms were negatively associated with subjective happiness. Path analysis suggested that health-risk behaviors completely mediated the effect of perfectionism on subjective happiness. High levels of perfectionism were associated with high levels of health-risk behaviors, and high levels of addictive behaviors were associated with low levels of subjective happiness. We discuss the present findings considering their practical use regarding students' subjective happiness.

Internet addiction and nomophobia among medical undergraduates of a tertiary care teaching institute in Patna, Eastern India

BACKGROUND

Excess use of the internet and gadgets for learning, gaming, and socialization has resulted in addictive behavior and nomophobia, especially among college-going students. Thus, this study was designed to find out the proportion and predictors of internet addiction and nomophobia among medical undergraduates.

MATERIALS AND METHODS

This cross-sectional study conducted on 367 medical undergraduates of a teaching hospital was carried out using a standard tool: the Internet Addiction Test Short Form for screening internet addiction and the Nomophobia Questionnaire for nomophobia. Results were tabulated and multivariable binomial logistic regression analysis was performed to find out the predictors of internet addiction and nomophobia.

RESULTS

A total of 116 (31.6%, 95% CI: 27%-36.5%) students were addicted to the internet and 247 (67.3%, 95% CI: 62.3%-71.9%) were screened to have moderate-to-severe nomophobia. The age of the student (adjusted odds ratio (AOR): 0.83 [0.69-0.99]), male gender (AOR: 2.24 [1.33-3.79]), screen time (AOR: 1.24 [1.14-1.34]), checking the phone first in the morning (AOR: 1.98 [1.107-3.54]), non-leisure time usage of phone (AOR: 2.07 [1.25-3.4]), and altered reading habit (AOR: 2.51 [1.26-5.01]) were independent predictors of internet addiction. Increased screen time (AOR: 1.103 [1.016-1.23]), checking the phone first in the morning after waking up (AOR: 1.68 [1.05-2.81]), altered academic performance (AOR: 1.99 [1.079-3.68]), and presence of internet addiction (AOR: 8.17 [3.56-18.76]) were independent predictors of moderate-to-severe nomophobia among medical students.

CONCLUSION

One and two out of every three medical students were found to have internet addiction and moderate-to-severe nomophobia, respectively. Increased screen time, altered academic performance, and the presence of internet addiction were independent predictors of moderate-to-severe nomophobia.

The Worldwide Prevalence of Sleep Problems Among Medical Students by Problem, Country, and COVID-19 Status: a Systematic Review, Meta-analysis, and Meta-regression of 109 Studies Involving 59427 Participants

Abstract

Purpose of Review

Several studies have found that medical students have a significant prevalence of sleep issues, such as poor sleep quality, excessive daytime sleepiness, and inadequate sleep duration. The purpose of this review is to carefully evaluate the current research on sleep problems among medical students and, as a result, estimate the prevalence of these disturbances. The EMBASE, PsychINFO, PubMed/MEDLINE, ScienceDirect, Scopus, and Web of Science and retrieved article reference lists were rigorously searched and rated for quality. Random effects meta-analysis was performed to compute estimates.

Recent Findings

The current meta-analysis revealed an alarming estimated pooled prevalence of poor sleep quality (K = 95, N = 54894) of 55.64% [95%CI 51.45%; 59.74%]. A total of 33.32% [95%CI 26.52%; 40.91%] of the students (K = 28, N = 10122) experienced excessive sleepiness during the day. The average sleep duration for medical students (K = 35, N = 18052) is only 6.5 h per night [95%CI 6.24; 6.64], which suggests that at least 30% of them get less sleep than the recommended 7-9 h per night.

Summary

Sleep issues are common among medical students, making them a genuine problem. Future research should focus on prevention and intervention initiatives aimed at these groups.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40675-023-00258-5.

Associations Between Problematic Internet Use and Mental Health Outcomes of Students: A Meta-analytic Review

The increasing prevalence of problematic internet use has heightened concerns about its adverse impact on internet users' mental health. Despite reviews investigating the associations between problematic internet use and mental health outcomes, there is a lack of understanding of various aspects of students' mental health. This study aimed to bridge this gap by providing a more comprehensive overall picture of this issue through a quantitative synthesis based on three-level random-effects meta-analytic models. In total, 223 studies with a cumulative total of 498,167 participants and 512 effect sizes were included in this synthesis. The results showed that problematic internet use was moderately and positively associated with depressive symptoms, anxiety, loneliness, and other mental health outcomes, and negatively related to subjective well-being. Moderator analyses revealed that several study features (i.e., school grade, region, measure of problematic internet use, publication year, and gender) could explain the variations in the findings across individual studies. These research results provide solid evidence for the link between problematic internet use and different mental health outcomes and have implications for future research and interventions on students' problematic internet use.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40894-022-00201-9.

Mental problems and risk factors for depression among medical students during the COVID-19 pandemic: A cross-sectional study

Prevalence of depression is high among medical students and several mental problems are identified as risk factors. Coronavirus disease 2019 (COVID-19) pandemic causes difficulties that could adversely affect mental health. However, data concerning prevalence of mental problems, and whether or not these problems remain risk factors for depression during the COVID-19 pandemic in medical students are scarce. To investigate the prevalence of depression, social media addiction, game addiction, sleep quality, eating disorder risk, and perceived stress among Thai medical students, risk factors for depression were investigated. Online surveys via our faculty's learning portals were advertized to medical students who engaged online learning and 224 respondents provided complete data. Study-related medical students' data were collected using the Patient Health Questionnaire-9 for depression, the Social-Media Addiction Screening Scale for social media addiction, the Game Addiction Screening Test for game addiction, the Pittsburgh Sleep Quality Index for sleep quality, the Eating Attitudes Test for eating disorder risk, and the Perceived Stress Scale for perceived stress. Depression was reported in 35.7% of medical students, social-media addiction in 22.3%, game addiction in 4.5%, eating disorder risk in 4.9%, poor sleep quality in 80.8%, and moderate-to-high perceived stress in 71.4%. The independent predictors of depression were lower grade point average, social media addiction, and moderate-to-high perceived stress. A high prevalence of depression, stress, and poor sleep was found among medical students during the COVID-19 pandemic. Medical students who are stressed, have lower grades, and/or who are addicted to social media warrant depression screening.

Investigating Internet Addiction and Sleep Quality Correlation Among Students of Isfahan University of Medical Sciences in 2021

Background: The quality of sleep plays an important role in physical development, as well as maintaining physical and mental health. Approximately 20% of Iranian students suffer from Internet addiction, and 56% suffer from insomnia. Objectives: This study aimed to investigate the relevance of Internet addiction and sleep quality among Isfahan University of medical sciences students. Methods: This cross-sectional study was conducted as a questionnaire at the Medical Sciences University of Isfahan. The collected data had three components: (1) Demographic information, (2) sleep quality with the Pittsburgh Sleep Quality Index (PSQI), and (3) amount of internet use with a questionnaire of 20 Internet Addiction Tests (IAT). Logistic regression was used to find any association between Internet Addiction and Sleep quality. Results: A total of 562 female and male students participated in the study, with a mean age of 21.41 ± 1.87. Internet users with moderate and mild addiction had poorer sleep quality than those with normal and severe Internet addiction. Logistic regression analysis showed an association between Internet addiction scores and sleep quality (OR = 1.035: 1.02, 1.04, P < 0.001). In addition, poor sleep quality was also predicted by the subgroups "excessive internet use" and "anticipation". Conclusions: The relationship between internet addiction and sleep quality was significantly negative. Universities and all educational institutions can use it to control the effects of Internet abuse and the quality of sleep of students.

Symptoms of Nomophobia, Psychological Aspects, Insomnia and Physical Activity: A Cross-Sectional Study of ESports Players in Saudi Arabia

(1) Background: ESports is a new trend of sports, which has gained considerable popularity worldwide. There is a scarcity of evidence that focuses on the lifestyle of ESports players (eSP) particularly on symptoms of nomophobia, level of anxiety, sleep quality, food consumption and physical activity. (2) Objective: to determine the prevalence and relationship between symptoms of nomophobia, psychological aspects, insomnia and physical activity of eSP in Saudi Arabia. (3) Methods: A cross-sectional study was conducted between March and April 2021 using a convenient self-selection adult sample. A total of 893 (216 eSP vs. 677 non-eSP (NeSP)) participants aged over 18 years were included. All participants answered a seven-part validated questionnaire that included: (i) sociodemographic questions; (ii) a symptoms of nomophobia questionnaire; (iii) general anxiety disorder questions, (iv) an insomnia severity index, (v) an Internet addiction scale, (vi) the Yale food addiction scale 2.0 short form and (vii) an international physical activity questionnaire. (4) Results: Among the entire population, the prevalence of moderate to severe nomophobia, anxiety, insomnia, Internet addiction and low physical activity were 29.8%, 13.9%, 63.3%, 27% and 2.8%, respectively. The eSP and NeSP differed significantly in nomophobia scale, anxiety and insomnia values. Compared to NeSP, eSP had a higher level of severe nomophobia p = 0.003, a severe level of anxiety p = 0.025 and symptoms of insomnia p = 0.018. Except for food addiction and physical activity, a positive correlation was identified between symptoms of nomophobia, anxiety and insomnia among eSP. (5) Conclusion: This study reported high prevalence of nomophobia, anxiety and insomnia among eSP compared to NeSP.

Prevalence of internet addiction among college students in the Indian setting: a systematic review and meta-analysis

BACKGROUND

The internet is an integral part of everyone's life. College going adolescents are highly vulnerable to the misuse of the internet.

AIMS

To estimate the pooled prevalence of internet addiction (IA) among college students in India.

METHODS

Literature databases (PubMed, Web of Science, Scopus, EMBASE, PsycINFO and Google Scholar) were searched for studies assessing IA using the Young Internet Addiction Test (Y-IAT) among adolescents from India, published in the English language up to December 2020. We included studies from 2010 to 2020 as this is the marked era of momentum in wireless internet connectivity in India. The methodological quality of each study was scored, and data were extracted from the published reports. Pooled prevalence was estimated using the fixed-effects model. Publication bias was evaluated using Egger's test and visual inspection of the symmetry in funnel plots.

RESULTS

Fifty studies conducted in 19 states of India estimated the prevalence of IA and the overall prevalence of IA as 19.9% (95% CI: 19.3% to 20.5%) and 40.7% (95% CI: 38.7% to 42.8%) based on the Y-IAT cut-off scores of 50 and 40, respectively. The estimated prevalence of severe IA was significantly higher in the Y-IAT cut-off points of 70 than 80 (12.7% (95% CI: 11.2% to 14.3%) vs 4.6% (95% CI: 4.1% to 5.2%)). The sampling method and quality of included studies had a significant effect on the estimation of prevalence in which studies using non-probability sampling and low risk of bias (total quality score ≥7) reported lower prevalence. The overall quality of evidence was rated as 'moderate' based on the Grading of Recommendations Assessment, Development and Evaluation criteria.

CONCLUSIONS

Our nationally representative data suggest that about 20% to 40% of college students in India are at risk for IA. There is a need for further research in the reconsideration of Y-IAT cut-off points among Indian college students.

PROSPERO REGISTRATION NUMBER

CRD42020219511.