Relationship between internet addiction and depression among young adults in Dhaka, Bangladesh

The primary aim of this study was to examine associations between problematic Internet use, depression and sleep disturbance, and explore whether there were differential effects of problematic Internet use and depression on sleep disturbance. A total of 1772 adolescents who participated in the Shantou Adolescent Mental Health Survey were recruited in 2012 in Shantou, China. The Chinese version of the Internet Addiction Test (IAT) was used to evaluate the prevalence and severity of Internet addiction. The Chinese version of the Pittsburgh Sleep Quality Index (PSQI), a 10-item version of the Center for Epidemiologic Studies Depression Scale (CESD-10), and other socio-demographic measures were also completed. Multiple regression analysis was used to test the mediating effect of problematic Internet use and depression on sleep disturbance. Among the participants, 17.2% of adolescents met the criteria for problematic Internet use, 40.0% were also classified as suffering from sleep disturbance, and 54.4% of students had depressive symptoms. Problematic Internet use was significantly associated with depressive symptoms and sleep disturbance. The correlation between depressive symptoms and sleep disturbance was highly significant. Both problematic Internet use (β = 0.014; Sobel test Z = 12.7, p < 0.001) and depression (β = 0.232; Sobel test Z = 3.39, p < 0.001) had partially mediating effects on sleep disturbance and depression was of greater importance for sleep disturbance than problematic Internet use. There is a high prevalence of problematic Internet use, depression and sleep disturbance among high school students in southern China, and problematic Internet use and depressive symptoms are strongly associated with sleep disturbance. This study provides evidence that problematic Internet use and depression have partially mediating effects on sleep disturbance. These results are important for clinicians and policy makers with useful information for prevention and intervention efforts.

Internet addiction has become a serious behavioral health problem in Asia. However, there are no up-to-date country comparisons. The Asian Adolescent Risk Behavior Survey (AARBS) screens and compares the prevalence of Internet behaviors and addiction in adolescents in six Asian countries. A total of 5,366 adolescents aged 12-18 years were recruited from six Asian countries: China, Hong Kong, Japan, South Korea, Malaysia, and the Philippines. Participants completed a structured questionnaire on their Internet use in the 2012-2013 school year. Internet addiction was assessed using the Internet Addiction Test (IAT) and the Revised Chen Internet Addiction Scale (CIAS-R). The variations in Internet behaviors and addiction across countries were examined. The overall prevalence of smartphone ownership is 62%, ranging from 41% in China to 84% in South Korea. Moreover, participation in online gaming ranges from 11% in China to 39% in Japan. Hong Kong has the highest number of adolescents reporting daily or above Internet use (68%). Internet addiction is highest in the Philippines, according to both the IAT (5%) and the CIAS-R (21%). Internet addictive behavior is common among adolescents in Asian countries. Problematic Internet use is prevalent and characterized by risky cyberbehaviors.

"A person who never made a mistake never tried anything new." -Albert Einstein THE BEGINNING In 1995, when the New York based psychiatrist Dr. Ivan Goldberg posted a sincere-looking but satirical note on the online psychiatric bulletin board PsyCom.net (no longer available now) taking a dig at the rigid diagnostic criteria of the newly released 4th edition of the Diagnostic and Statistical Manual (DSM-IV) of the American Psychiatric Association (APA) by "creating" a fictitious disorder called Internet addiction disorder (IAD) and cooking up its "diagnostic criteria" as per DSM style for substance dependence, little did he know that he had opened the proverbial Pandora's box.[1] He and his bulletin board were flooded with people narrating their tales of woe of "remaining caught in the Net" and seeking help for their condition. This was one condition he did not intend to create (he himself did not believe that there could be a true "addiction" to Internet but rather excessive or pathological use), but there it was whatever name you gave it! In 1995, a clinical psychology student Ms Kimberly Young, then in Rochester, USA, got interested in the psychological factors behind computer use and independently conceived of "addictive use of the Internet" as a pathological condition.[2] It is interesting to hear of this story from the author herself 20 years later: "Internet addiction began as a pet project in a young researcher's one bedroom apartment in Rochester, New York. I was that young researcher. It was in 1995, and a friend of mine's husband was seemingly addicted to AOL Chat Rooms spending 40, 50, and 60 h online at a time when it was still $2.95/h to dial into the Internet. Not only did they suffer financial burdens but also their marriage ended in divorce when he met women in online chat rooms."[3] The rest, as they say, is history, with her first illustrative case report published in 1996 having been cited 755 times, and her first definitive research article titled, "Internet addiction: Emergence of a new clinical disorder," published in 1998, having been cited a phenomenal 3144 times as on December 15, 2015![4] In 1995, a clinical psychologist Mark Griffiths, working at Nottingham Trent University, Nottingham, UK, who had been interested in research on gambling, computer use, and use of various machines or technology by humans in general for a few years at that time, published an article named, "Technological addictions."[5] The next year, in 1996, he published on Internet addiction, conceptualized by him as a subset of the broader term technology addiction.[6] This was the beginning, 20 years ago. As the freelance writer Michael OReilly, reporting in Canadian Medical Association Journal in 1996, (who, himself, interestingly, declared that "he may be at risk for developing IAD") titled his article as "Internet addiction: A new disorder enters the medical lexicon," where he mentioned Young's still unpublished research on Internet addiction.[7] Truly, a PubMed search on "Internet addiction" pegs this short report as the very first article included in PubMed on the topic. THE ACCOLADES… Now, in 2015/6, as on December 15, 2015, there are 1561 articles cited in PubMed on "Internet addiction." What is more interesting is a look at the acceleration rate of publication. While there were only three articles in 1996, there were 32 in 2005, 275 in 2014, and 296 (and still counting) in 2015! Thus, while the growth rate of publications was not hugely impressive in the first decade of its life, Internet addiction is now a robust young adult in its postteen year with a sizeable growth spurt in its second decade. Not many "new" terms can boast of such growth in just 20 years in the PubMed! As an aside, it is to be noted that the term "Internet addiction" has many competing contenders; some of the important ones are pathological Internet use, problematic Internet use (PIU), compulsive Internet use, Internet use disorder (IUD), and pathological use of electronic media among others. Pathological Internet use or PIU is often a favored term these days, but we have stuck to the original term because it is still very popular certainly with the social media but also in medical/psychological scientific research, and especially because we wanted to place this editorial in a historical perspective. Hence, what kinds of articles are being published on Internet addiction over the past decade or so? This is no place (and space) for a comprehensive review on the topic. Suffice it to say that, in addition to individual research articles from America, Europe, Asia, and Oceania, there are now a number of published narrative and even a few systematic reviews on almost every aspect of Internet addiction, including its concept and historical perspective,[89] diagnostic criteria,[10] epidemiology,[11] psychosocial and neuropsychological aspects,[1213] neurobiological aspects,[1314151617] and management, both pharmacological and nonpharmacological.[1819] It appears that the issue is, at least partly, resolved, and that we have sufficient power in our knowledge base to conceptualize, detect, diagnose, characterize, treat, and prognosticate something called Internet addiction. Twenty years … and we are quite there. Well, not quite, yet. …AND THE BRICKBATS The first jolt came from APA in their widely publicized 5th edition of the DSM (DSM-5) published in May 2013.[20] Although the much-awaited and much-hyped category of "behavioral addictions" was indeed kept in its re-formulated category, "Substance-related and addictive disorders," the sole diagnostic category kept in its final version under behavioral addictions was gambling disorder, which was a slightly tweaked version of the earlier pathological gambling, shifting its parental home from impulse control disorders of DSM-IV (there is no broad category of impulse control disorders any more in DSM-5) to addictive disorders in DSM-5. Despite early speculations and expectations, Internet addiction did not find a home under behavioral addictions. Instead, and almost as a consolation prize, one particular subtype of Internet addiction, called Internet Gaming Disorder, has been entertained in the DSM-5, but only as a tentative "Condition for Further Study" that "requires further research before they might be considered formal disorders," in its Section III called Emerging Measures and Models. The second jolt, and the one more important from an international perspective including India, comes from the forthcoming 11th revision of the International Classification of Diseases (ICD-11) by the World Health Organization (WHO). A recent article from the WHO Working Group on Classification of Obsessive-Compulsive and Related Disorders, while deliberating on this area as a "key controversy," concluded that, "based on the limited, current data, it would therefore seem premature to include it in the ICD-11."[21] Consequent to this stand, the very recently released Beta Draft of the entire ICD-11 (where Mental and Behavioral Disorders is coded as 07) sticks to its previous model of separate groups for "disorders due to substance use" (which has, by definition, no mention of any behavioral addictions but only substance use related disorders), and "impulse control disorders," which continues to house pathological gambling but has also added "compulsive sexual behavior disorder," a contender for the behavioral addictions, under impulse control disorders. Internet addiction, in any of its avatars, is nowhere in sight.[22] This is certainly a big disappointment for the advocates and champions of behavioral addictions, technological addictions, including Internet addictions. Let alone classifying it as an addictive disorder, ICD-11 Beta Draft refuses to recognize Internet addiction as a disorder in the first place! Why is it so? And, what can be done? To our mind, there is a hierarchical series of questions that need to be answered to get a grasp on the issue. Each successive question builds on its predecessor, assuming that the question hierarchically one step above is answered in the affirmative. THE FOUR CARDINAL QUESTIONS The first and foremost question: Is Internet addiction better conceptualized as a "disorder" or as a continuum of normal behavior (after all, Internet use is an essential part of everyday life of a vast proportion of people worldwide, and steadily increasing – we all are Internet "dependent" in much the same way we are dependent on so many basic things in life)? Although heavily debated already, the simple answer to this question can be borrowed from ICD-11 Working Group: "Where there is a continuum between normal and pathological behavior, associated impairment may become a key determinant of whether or not behavior is disordered. An additional important consideration, from a public health perspective, is whether efficacious treatments are available."[21] As abundantly documented in the literature over the past 20 years, excessive, uncontrolled, and inflexible Internet use behavior can indeed lead to severe functional impairment in some persons. Further, consider the definition of a mental and behavioral disorder as espoused in the Beta Draft of ICD-11: "Mental and behavioral disorders are recognizable and clinically significant behavioral or psychological syndromes that are associated with distress or interference with personal functions."[22] Many (but not all) cases of Internet addiction would satisfy this definition. As in many other psychiatric disorders, there would be a large "gray area," but that only proves that there is indeed a "white" ("normal") and a "black" (pathological or disordered) area as well. From a public health perspective, this is an important question because of its policy implications. There is also some evidence that at least nonpharmacological interventions (especially cognitive behavioral therapy for Internet addiction) can be useful though much more research is needed. And that would only be feasible, once we initially and tentatively agree that indeed there can be a disorder for which we are seeking a treatment! The second important question we ask is, assuming that some cases of these excessive, uncontrolled, and inflexible Internet use behavior indeed is a mental and behavioral disorder: Is this pattern of behavior an addictive disorder? There are actually three sublevels of criticism or question in this: How can there be an addiction to something which is not as tangible a thing as drugs? Why is it not better explained by simply as a manifestation of other underlying disorders such as depression, anxiety, or social phobia? Why is it not better conceived as, say, an impulse control disorder (as done for pathological gambling or the new category of compulsive sexual behavior disorder), or an obsessive-compulsive spectrum disorder? As to the response to the first sublevel of this question/critique, our take is: Epistemologically, "addiction" to psychoactive substances was a later development in history. The Latin root of the word "addiction" – addicere – simply meant "to adjudge, sentence, doom, assign, confiscate, or – importantly – enslave."[23] Thus, "addicted" would simply mean "being sentenced, doomed, or enslaved." The object of this transitive verb could be theoretically anything, from drugs to playing poker. On a neurobiological note, it is the brain learning or memory of a rewarding experience that is the basis of dopaminergic-based positive reinforcement which defines the early stages of addiction, rather than which specific stimulus (whether cocaine or social networking online) triggered that experience.[24] Once continued for a while, this early mechanism paves the way for a delayed-onset recruitment of nondopaminergic anti-reward mechanisms that provides negative reinforcement for a particular behavior which perpetuates that behavior in a compulsive manner.[24] Finally, at a behavioral level, addiction (as opposed to pharmacological dependence on a substance) is always with regard to a core behavior. Even in case of substances, what characterizes substance dependence is the pathological pattern of "use" of the substance (please note: Use refers to a particular behavior). For example, take the definition of alcohol dependence as in the ICD-11 Beta Draft: "Alcohol dependence is a disorder of the regulation of alcohol use, arising from repeated or continuous use of alcohol. Characteristic features are a strong drive to use alcohol, impaired ability to control its use, and giving increasing priority to alcohol use over other activities. Often individuals develop tolerance and experience withdrawal symptoms when cutting down or stopping, or use alcohol to prevent or alleviate withdrawal symptoms. Use of alcohol increasingly becomes a central focus of the person's life and relegates other interests, activities, and responsibilities to the periphery. Continuation of alcohol use despite adverse consequences is a common feature."[22] Now, let us do a little fun experiment. Try substituting the word "alcohol" with "Internet" in this definition and see what comes out of it! The second level of this second question/criticism is partly true. There is a documented large comorbidity between the putative behavioral addictions (including Internet addiction) and other psychiatric disorders, particularly depressive and anxiety and bipolar disorders.[25] However, that is true for many psychiatric disorders and certainly true for substance use disorders in general. The fact that alcohol dependence is heavily comorbid with depression does not make the former identical with the latter! If at all, such a pattern lends credence to the similarity of these behavioral disorders with addictive disorders.[26] Of course, Internet addiction should not be diagnosed if such behavior is exclusively contained within the boundaries of a bipolar, depressive, or anxiety episode and spontaneously resolves after the resolution of such conditions. Coming to the third level, the very nature of these behavioral disorders, we land in a debate that goes to the very heart of concept and nosology of psychiatric disorders. Substance use disorders too, from time to time, have been conceptualized as impulse control disorders, obsessive spectrum disorders, compulsive spectrum disorders, or combinations of these.[27] Impulsivity in decision making and behavior, obsession-like repeated preoccupation, and a compulsion-like quality in repeated use of substances, all are important components of the process of addiction, but addiction as a gestalt has characteristics beyond each of these individual phenomena; otherwise, all substance use disorders would have been consumed under any of these too. Thus, we take on this matter at the moment (admittedly incomplete and one that will require a lot more research to settle) is that pathological or PIU, after a certain threshold of severity and functional impairment, can be conceptualized as an addictive disorder. However, we suggest that the name of the condition be changed to "Internet Use Disorder (IUD)." This term retains the three cardinal characteristics:First, it is a disorder; second, it is concerned with a particular core behavior of using the Internet as a medium (for whatever purpose); and third, Internet) the target "object" (in a metaphorical sense, not as a substance but as a vehicle or medium) of use. The third question, assuming that the two above have been answered, is: If PIU is indeed best conceptualized as an addictive disorder (i.e. IUD, as a behavioral addiction), what is the person addicted to? Is it the Internet as a medium, any of the many actions using the software applications of the Internet (e.g., online gambling, gaming, social networking, relating, watching a particular content such as pornography or scientific literature search, buying, etc.), or to a particular gadget of technology that hosts the Internet (e.g., smartphones, tablets, laptop, or desktop computers)? Many authors now contend that there are two distinct forms of IUD – one specific (where the addictive behavior is predominantly focused on a particular application of the Internet) and another generalized (where there is no such focus).[928] Some researchers even have theorized about the different psychological and neurobiological pathways of these two subtypes.[13] In this regard, we would reiterate that it is the pathological use of the Internet that is the main concern at hand, not what specific purpose it is used for. Much more commonly, users of the Internet (both "normal" and "pathological") use it for a narrow set of specific purposes. Indeed, normal users use the Internet for much more varied purposes, while pathological users tend to narrow down their focus on specific activities (gaming, gambling, sex, chat, buying, etc.) to the exclusion of others. This is reminiscent of the "narrowing of repertoire" characteristic originally espoused for a "dependence syndrome" by Edwards and Gross.[29] Only a handful of persons with IUD do not have any predominant focus; however, even in them, an apparently aimless surfing of the Internet itself is an activity which, however, "useless" in the value-laden sense it may be, is actually a use of the Internet! Thus, the conceptualization of IUD obviates the question of whether one is addicted to the Internet as a source for gratifying other needs or addicted to the Internet as a medium (or to a gadget that hosts that medium), so long as the use of the Internet is the object of the addictive behavior. This view suggests that there is one IUD, with varied subtypes or specifiers based on the specific applications or even lack of any specific one (which may be thought of as "not otherwise specified" in the standard nosological tradition). The fourth question, assuming that we conceptualize IUD as a unifying concept with varied "subtypes" based on specific applications of the Internet, is: How to diagnose such a condition? There is a plethora of screening and diagnostic instruments (21 instruments as mentioned in reference 11) based upon the authors' own theoretical understanding of the issue. Unfortunately, these instruments often provide very different estimates of Internet addiction or PIU, ranging from <1% to 27%.[11] Of course, sample nature and sample selection also play a significant role in explaining such wide intervals. However, coupled with such heterogeneous instruments, such figures undermine the confidence in the concept and diagnosability of the condition. The answer to this question has to build on at least partial resolution of the above questions. INDIAN SCENE: A SKETCHY VIEW There is a trickle of Indian research in this area. Although the first published article was published more than a decade ago,[30] not many published articles are available in peer-reviewed journals. It is beyond the scope and space of this article to critically review all these, but two characteristics are commonly seen:First, often the samples are self-selected or convenience samples, likely to be drawn from accessible college students; second, an almost exclusive use of Young's Internet Addiction Test. It is interesting to note that two Indian studies compared the prevalence of Internet addiction by using two different diagnostic questionnaires from different constructs of Internet addiction. One study compared questions derived from ICD-10 substance dependence criteria with Young's questionnaire;[31] another recent one compared a more conservative and validated diagnostic criteria set with the latter.[32] Both the studies found a wide disparity between prevalence figures for Internet addiction as estimated by different instruments. The prevalence figures varied widely, from 1.2% to more than 50%! This demonstrates the important point raised in the fourth question above. Why is this issue important for India? India is a country with rapidly increasing Internet connectivity. Starting from August 14, 1995, when Videsh Sanchar Nigam Limited first launched India's first full Internet service for public access,[33] interestingly, again 20 years later as of September 2015, there were 350 million active Internet users, fuelled by the rapid spread of smartphones and other In by India is to become the second the and second only to this and growth even a conservative of just prevalence of PIU, IUD, or Internet addiction, by whatever name it is will the number of pathological Internet users to This is a number to Thus, there is a clinical and public health perspective to the question of IUD, which are mentioned as the in this in mind, the recently published of on and Emerging an of the Indian Psychiatric by the Section on Substance Use Disorders, an entire on behavioral Some may contend that it is a mistake to clinical on that nosological at nosological A In a series article in the Indian Journal of and titled as "Internet addiction disorder: or into sufficient research might over time at it a the Internet to the of many but "Internet addiction" as of now more questions than can be a decade with and an scientific literature in hand, we are in with the second but no longer with the There are people out there who are because of their use of the Internet. need and at least some of can be There is evidence to suggest that Internet addiction (or what we to IUD, in with substance use disorders of DSM-5) can no longer be considered a there are still many questions to be answered, and it is the nature of to answer a few questions while agree that we need to the use of the term as opposed to its scientific use, and to estimates of the condition by use of instruments of This is to the concern of or of any behavior with or as a medical disorder. the same time, however, this concern our and to diagnose and for who are indeed in need of it would be the out with the In this there is to be some this way or that way before we can the between and is we need to of the to Einstein in the There is new that we are – each one of the questions above has been and with often upon the perspective. The on these will require a series of What we to do was to the key questions in a hierarchical the and make our stand, however, or it may be, with the that we would to be The purpose is to further in this important to some of a and to ask the question that the

INTERNET ADDICTION OR PSYCHOPATHOLOGY IN DISGUISE? RESULTS FROM A SURVEY OF COLLEGE-AGED INTERNET USERS

Aboujaoude's review of problematic Internet use is a timely contribution to the literature on a poorly understood behaviour that has apparently caught the attention of the media more than that of mental health professionals. And, while psychiatrists and clinical psychologists seem to be sceptical about many aspects of the problematic Internet use, concern in the community about the adverse effects of the Internet use seems to be growing exponentially. This revolves mainly around two issues. The first is the impact of violent video games and other violent online content; the second is what has increasingly been referred to as "Internet addiction". The focus of this commentary will be on the latter issue. The problem starts with terminology, as the appropriate name for the condition or behaviour often labelled "Internet addiction" is not clear. Progress in this area can hardly be made without first reaching a consensus as to what terms to use. "Internet addiction" is a troublesome term, not only because of its pejorative connotations, but also because there is no evidence that this is really an addictive disorder, i.e., that it is characterized by the hallmarks of substance addiction such as tolerance and withdrawal. If adopted without sufficient evidence, "Internet addiction" will clearly be an arbitrary term. It is appropriate to be cautious and retain more descriptive and "neutral" terms, such as problematic (or problem) Internet use. Other terms have also been proposed, e.g., "pathological use of electronic media" 1, but "Internet addiction" still seems to dominate the literature and professional jargon. The terminological rigour should go hand in hand with conceptual clarity. A part of the reason for the ongoing struggle with terminology is the lack of clarity about the key features of problematic Internet use. Several features have been proposed, but many of them seem to overlap and boil down to the basic two characteristics. The first pertains to the aspects of Internet use, described as excessive or compulsive, along with preoccupation with and loss of control over the Internet use. The second refers to various adverse consequences of spending too much time on the Internet, such as neglecting social activities, relationships, health and work or school duties, and altering sleep and eating habits in a detrimental way. Further research is needed to ascertain more precisely to what extent these features characterize problematic Internet use. Problematic Internet use appears to be too heterogeneous as a concept. It has been suggested that it consists of at least three subtypes: excessive gaming, problematic sexual behaviour, and e-mail/text messaging 2. The Internet may also be used excessively and with negative consequences to gamble, shop, or chat. These different purposes of using the Internet may be associated with different patterns of use, different underlying psychopathology, and different adverse consequences. It may then be inappropriate to lump together all the instances of problematic Internet use and perhaps more useful to consider online gambling as a manifestation of pathological gambling, Internet-related problematic sexual behaviour as a feature of a sexual or some other disorder, and so on. In accordance with this approach, we have formulated and tested preliminary criteria for problem video game use 3, but these require further study. "New" disorders or patterns of behaviour may be no more than alternative expression of various psychopathological entities. Accordingly, it has been debated whether addictive disorders, including problematic Internet use, represent primary conditions in their own right or whether they can be better understood as a manifestation of some underlying psychopathology or poor coping, that is, a "secondary addiction" 4,5. Various mental and other disorders often co-occur with problematic Internet use, which suggests that in many cases the latter may be conceived of as being related to the former. The co-occurring conditions and corresponding dimensions of psychopathology include depressive and bipolar disorders, anxiety disorders (especially social anxiety disorder, generalized anxiety disorder, and obsessive-compulsive disorder), sleep disturbance, substance use disorders, impulse control disorders, attention deficit and hyperactivity disorder, personality disorders and traits (especially borderline, narcissistic, antisocial, and avoidant), and psychotic disorders. Several issues should be addressed when elucidating whether and when problematic Internet use is primary or secondary. First, prospective studies need to ascertain the sequence in the development of problematic Internet use and psychiatric disorders. Second, it is important to understand to what extent the relationship between problematic Internet use and the associated psychopathology is specific. Finally, treatment of individuals with problematic Internet use crucially depends on whether an underlying condition accounts for problematic Internet use, as that condition should then be targeted by treatment. There have been calls to conceptualize problematic Internet use as a mental disorder, include it in the DSM-V, and classify it as a "compulsive-impulsive spectrum disorder" 2. However, doing so seems premature in view of the following: a) it is not yet clear whether and how problematic Internet use can be distinguished from a pattern of behaviour usually labelled by others as undesirable or disturbed; b) the boundary between normal and problematic Internet use has not been established; c) it remains to be ascertained whether problematic Internet use possesses conceptual validity, including distinct presentation and sociodemographic and neurobiological correlates, internal homogeneity, and sufficient longitudinal stability with distinct course, prognosis, and response to treatment. Not endowing problematic Internet use with the status of a mental disorder would prevent its psychiatric reification at the time when so little is known about it, while fostering an open-minded attitude towards further research.

Background: Technology has a high influence on our lifestyle. This has a significant bearing on both the physical and mental health of an individual. Young adults spend a significant amount of time on the Internet. Studies have demonstrated that this overindulgence can be problematic. Internet addiction has an adverse effect on academic and occupational outcomes of Young people. Objectives: The objective of this study was to determine the prevalence of internet addiction among young adults in Kenya. Method: A cross-sectional quantitative study was carried out on young adults from one college in rural setting and one in urban setting. Two questionnaires were administered to the young adults. One was sociodemographic questionnaire and the second one was the Young’s Internet Addiction Test. Results: The overall prevalence of internet addiction was (81.5%). On analysis of the extent of severity of Internet use among young adults, it was found that majority of the young adults were moderate internet addicts (45.6%) followed by mild internet addicts (31.2%), normal internet users (18.5%) and severe internet addicts (4.2%). It was found that reported online activities significantly affect the levels of Internet use among young adults. Association was found between internet addiction and online betting, middle income and parental education as well as the course being taken in the college. Conclusion: Internet addiction both in rural and urban areas in Kenya is high and there is a need to start addressing the problem.

Background: The high rate at which online technologies are becoming part of normal operations has heightened the anxieties over Problematic Internet Use (PIU), especially in young adults. PIU has been attributed to impaired self-regulatory ability, distorted reward sensitivity, and adverse psychological consequences. According to neurobehavioral perspective, the differences in sensation seeking and self-efficacy could impact the susceptibility to PIU by the mechanisms of reward sensitivity, impulse modulation, and executive control. Although these constructs are increasingly gaining interest, their combined relationship with PIU is not well studied, particularly in Indian socio-cultural setting. Purpose: The current research aimed to investigate the interrelations between problematic internet use, sensation seeking and self efficacy among young adults with the intention of establishing psychologically based correlates applicable to neuro behavioral explanations of PIU. Methods: It took the form of a correlational research design that entailed a sample of 60 undergraduate and postgraduate students aged 18-25 years. The participants were provided with self-report measures, such as the General Self-Efficacy Scale (GSE), Zuckerman Sensation Seeking Scale (SSS), and Problematic and Risky Internet Use Screening Scale (PRIUSS18) that are standardized and self-report. The product-moment correlation test conducted by Pearson was used to evaluate relations between the variables of the study. Results: The results of the analysis showed that there was a large negative correlation between sensation seeking and problematic internet use (r = -.344, p &lt;. 01), which means that the higher the sensation-seeking behavior, the lower the PIU. Problematic internet use had a negative relationship with self-efficacy (r = -.092) and sensation seeking (r = -.273, p &lt;.05) developed a significant negative relationship with self-efficacy. These results are in contrast to what has been widely reported about sensation seeking as a direct risk factor to PIU. Conclusion: The findings indicate that sensation seeking and self-efficacy play different roles in problematic internet use among the young adults. A neurobehavioral viewpoint indicates that self-efficacy can manifest executive regulation mechanisms that counter maladaptive digital usage and sensation-seeking requirements can be more favourably achieved when offline. The paper has provided initial psychological indicators that can also inform potential neurocognitive and translational studies of problematic internet use.

The objective of this article is to fully understand Internet addiction, we aimed to compare the attachment styles and psychopathologies associated with problematic Internet use with those related to alcohol use. Through the participation of 141 male participants, the present study assessed problematic Internet and alcohol use, attachment, psychopathology, and demographic data via the use of self-rating questionnaires. We explored the significant predictors among avoidant and anxious attachments, depression, anxiety, and phobia to explain problematic Internet and alcohol use. The results showed that anxious attachment, depression, and anxiety could explain problematic alcohol use. In contrast, both anxious and avoidant attachment as well as depression and phobia explained problematic Internet use. Additionally, depression moderated the effects of avoidant attachment on problematic Internet use. We demonstrated that the interaction of attachment and psychopathology predicts problematic Internet use originating from an earlier stage of life than that associated with problematic alcohol use.

Internet addiction specifies to the extreme use of the internet which sequentially causes problems in relationship, health and professional aspects. The current study attempted to find out the pattern of internet use and internet addiction-related behaviour among the students of private medical colleges in Dhaka City, Bangladesh. A cross-sectional study was executed in three private medical colleges in Dhaka city. A total of 350 medical students were recruited as study participants by employing a simple random sampling technique. Data was collected through a self-administered semi-structured questionnaire on sociodemographic and internet use related activities. Internet addiction-related data were collected by using Young’s Internet Addiction Test (IAT) Scale. The data were analysed using the Statistical Package for Social Science (SPSS version 20). Descriptive and inferential statistics using the Chi-square test was conducted. P-value &lt;0.05 was considered as significant. The findings show that 73.7% of study participants were female and the rest were male, with a mean age of 21.1 years. The percentage of students used the internet more than 10 times per day was 37.4% followed by 5 – 10 times per day which was 35.1% and less than five times per day with 27.4% students. A total of 44.3% students reported that they spent 1 – 3 hours per day for internet usage followed by 37.7% use 4 – 8 hours per day and 18% reported more than 8 hours per day. A total of 43.7% of students mentioned that they used the internet for entertainment, while 40%, 9.7% and 6.6% reported for time passing, social networking, and academic purposes respectively. Overall, 76.9% of students had internet addiction either in any form, 62.6% had moderate internet addiction or problem use, or 14.3% had severe internet addiction. This study concludes that the characteristics of internet use among this population are diverse and the prevalence of internet addiction found to be considerably higher compared to other Asian countries.

Problematic Internet Use (PIU) and Problematic Mobile Phone Use (PMPU) are emerging public health concerns associated with various mental health conditions, including autistic traits. However, PIU and PMPU remain poorly understood, and the role of psychological distress as a contributing factor has not been fully clarified. This study examined frequency and associations of autistic traits, PIU and PMPU, and substance use in adults, accounting for psychological distress. An online cross-sectional survey was conducted among 420 Italian adults aged 18 – 65, to assess autistic traits (Autism Spectrum Quotient, AQ), PIU (Uso e Abuso di Internet-2, UADI-2), PMPU (Mobile Phone Problematic Use Scale for Adults, MPPUS), substance use (Alcohol, Smoking and Substance Involvement Screening Test, ASSIST), and psychological distress (Kessler Psychological Distress Scale, K10). Correlation analyses, MANCOVA and Multivariate Multiple Regression (MMR) were performed to examine associations between variables, controlling for psychological distress. Young adults (18–24 years) showed higher levels of Internet (M = 66.36, SD = 13.56, 95% CI [63.87, 68.85]) and mobile phone use (M = 61.41, SD = 14.25, 95% CI [58.92, 63.9]). Autistic traits correlated positively with both PIU and PMPU, while psychological distress was positively associated with all outcomes, including substance use in younger participants. MANCOVA indicated significant effects of autistic traits and psychological distress on outcomes. MMR showed that higher autistic traits predicted higher PIU and PMPU, while psychological distress additionally predicted substance use. Autistic traits and psychological distress were significantly associated with PIU and PMPU, with psychological distress showing stronger associations. PIU and PMPU may be specifically linked to autistic traits, whereas substance use may be more related to psychological distress, suggesting different pathways. Further efforts should prioritize interventions targeting distress and emotion-regulation skills, particularly among young adults and individuals exhibiting PIU and PMPU.

Advances in technology have introduced new challenges and issues for policymakers and researchers. There is some debate in the literature whether the Internet, Facebook, and online gaming addictions may be true addiction disorders or are all manifestations of a more general information technology addiction. The purpose of this study is to explore gender differences in problematic Internet and Facebook use and online gaming, and the independence of these phenomena. The study sample comprised 500 college students, who completed a sociodemographic questionnaire, the Internet Addiction Test, Bergen Facebook Addiction Scale, and Online Gaming Scale. Males had more problems related to online gaming, and more problematic Internet and Facebook use. A bifactor model with one general and three specific factors - problematic online gaming, problematic Internet use and problematic Facebook use - obtained the best fit to the data. However, the specific variance explained by the factors of problematic Internet and Facebook use was low, but high in the case of problematic online gaming. Therefore, problematic online gaming seems to have more distinctive characteristics than the other two types of behavioural addictions.

The 21st-century problem of Internet addiction is increasing globally, but especially among university students. Not surprisingly, then, problematic Internet use is associated with university students' academic procrastination. Because studies are scarce in Mexico and Spain has one of the highest rates of Internet addiction in Europe, this paper (i) analyzed the presence and degree of Internet addiction among university students in Mexico and Spain, (ii) determined potential sociodemographic factors influencing Internet addiction, and (iii) established the type of correlation between Internet addiction and academic procrastination. The cross-sectional study design used an online questionnaire to measure problematic Internet use and academic procrastination through convenience sampling at one university in Mexico and one in Spain. The questionnaire contained three sections: participants' sociodemographic data, the Internet Addiction Test, and the Academic Procrastination Scale. The final sample comprised 758 university students, 387 from Mexico, and 371 from Spain, aged from 18 to 35 (M = 20.08, SD = 3.16). Results revealed similar prevalence rates of problematic and daily Internet use for leisure, potentially influencing Internet addiction in all three models (i.e., Mexico, Spain, and Total). Additionally, significant positive correlation was revealed between problematic Internet use and academic procrastination (p < .001). Finally, findings showed relevant data on Internet addiction's prevalence in Mexican and Spanish university contexts, along with its influential sociodemographic factors.

Internet addiction (IA) prevalence has been found to increase along with rising internet use, with young adults being more susceptible than anybody else. Internet addiction can be described as an impulse control disorder characterized by excessive or poorly controlled preoccupations, urges, or behaviours regarding computer use and internet access that lead to impairment or distress. Various studies reported internet addiction to be positively correlated with stress, anxiety, and depressive symptoms. Among these studies, some found that depressive symptoms predicted internet addiction or were at risk of engaging in internet addiction. The majority of studies on internet addiction and its link to depression, anxiety, and stress among Indian young adults have been conducted on students studying medicine, dentistry, nursing, or engineering, with very few studies done on young adults enrolled in other courses offered in India. Therefore, the current study's objective is to assess the relationship between young adults' internet addiction and their levels of stress, anxiety, and depression. Convenience sampling was used to select 150 participants (63 males and 87 women) between the ages of 18 to 25 for this cross-sectional study. Internet Addiction Test (IAT), Depression, Anxiety, Stress Scale-21 (DASS-21) was administered online through Google forms to assess internet addiction and depression, anxiety, and stress respectively. To see the gender difference on the above variables”t” test and correlation coefficient was used for assessing the relationship among the variables significant gender differences was found on Internet Addiction for the study and IA was found strongly related with Stress, Depression and Anxiety of the Participants.

Problematic internet use and its correlates among resident doctors of a tertiary care hospital of North India: A cross-sectional study.

Introduction• Use of Internet is increasing day by day• Rising concern for pathological compulsive internet use and addiction especially amongst the adolescentsObjectives• 1. To estimate prevalence of Internet Addiction among adolescents aged 10-19 years• 2. To determine the correlates of Internet AddictionMethods• Cross sectional study conducted on 1325 adolescents in a cantonment in Western Maharashtra.• Young’s Internet Addiction test was used, which has 20 items and is scored 0-5 for each item• Participants with score of 70 and above were diagnosed as having Internet Addiction.Results• The mean age 13.99 years• 57.4% of the participants being males.• 70.8%: normal use of internet• 26.7%: possible internet addiction.• The prevalence of Internet Addiction: 2.5%.• Factors associated with Internet addiction:• male sex• access to internet in bedroom• feeling loneliness at home.• Reasons for initiation of internet use were• gaming,• staying connected with friends and• social media.Conclusion• Internet addiction was found to be more common in adolescent males as compared to females.