Abstract: Internet Addiction Disorder. Are Medical Students using Internet wisely? Objective: The objective of this study was to assess the frequency of Internet addiction disorder among medical students. Material and methods: Study Design: Cross sectional study Place and Duration of Study: Allama Iqbal Medical College based study that included medical students from five medical colleges in Lahore, King Edward medical university, Fatima Jinnah, Services institute of medical sciences and FMH College of Medicine and Dentistry, from January 2014 to May 2014. Methodology: Out of 6,204 medical students currently enrolled in the stated medical colleges, 364 medical students were selected by stratified random sampling, with 95% confidence interval, 5 margin of error and.30 assumed proportion of Internet addiction. Students were given Internet addiction questionnaire devised by Dr. Young. Data was entered and analyzed in SPSS ver.21.0 using descriptive statistics (percentage) and analytic statistics (Chi-square test). Frequency tabulation was done for the presence and absence of Internet addiction syndrome on basis of scoring. RESULTS: 364 medical students were assessed for Internet addiction syndrome through Internet addiction questionnaire. Among them 76.1% were online user with complete control (score 20-49) 20.9 % had frequent problem due to Internet usage (score 50-69) and 3% were those in which Internet was causing significant problems in other words who had Internet Addiction disorder (score 70-100). Among gender, in males 71.9% were online user with complete control (score 20-49). In females 77.6% were online user with complete control (score 20-49). 25.7 % had frequent problem due to Internet usage (score 50-69). CONCLUSION: Internet usage causing significant problem is very less among medical students but considerable proportion of medical students have frequent problem due to Internet usage. Medical students living in hostel have more frequent problems due to Internet than day scholars. Key words: Addiction, Internet, Internet addiction syndrome. INTRODUCTION: Internet addiction disorder is an interdisciplinary phenomenon and it has been studied from different viewpoints in terms of various sciences such as medicine, computer, sociology, law, ethics, and psychology. Studies have determined the association of psychiatric symptoms with Internet addiction while controlling for the effects of age, gender, marital status, and educational levels. It is hypothesized, that high levels of Internet addiction are associated with psychiatric symptoms and are specially correlated with obsessive-compulsive disorder symptoms. 1 Research on Internet addiction originated in the US by Dr. Kimberly Young. In 1996, she presented the first paper on the topic at the American Psychological Association s annual conference held in Toronto entitled, Internet Addiction: The Emergence of a New Disorder. 2 Since then, studies have documented Internet addiction in a growing number of countries such as Italy, Iran, Germany, and the Czech Republic. Reports also indicate that Internet addiction has become a serious public health concern in China, Korea, and Taiwan. Treatment centers have emerged across the US and abroad. It is difficult to estimate how widespread the problem is. In Pakistan, many physicians are yet unaware of it and are unable to treat it. Until and unless there isn t any survey done here.surveys in the United States and Europe have indicated prevalence of between 1.5% and 8.2%, with varying diagnostic methods between countries. 3 In a study conducted by a team from Stanford University s School of Medicine estimates that nearly one in eight Americans suffer from at least one sign of problematic Internet use. 4 There are wide range of prevalence of internet addiction from 0.3% to 38%. 19 Internet addiction will now be included in the appendix in the upcoming revision of the DSM- V.1Since the craving people have to use the Internet unrestrained is a fairly new concept that has been brought to public attention just recently there has not been much research done in the field to date. And it is still a very debatable question whether it exists or not. Some say that the Internet is addictive to the point where it controls one s life, others say http://www.ijmshc.com Page 1
that it is not the same as getting high or drunk to an extreme. Nevertheless the Internet is affecting the people who use it extensively whether it is to be called addictive or not. 5,6 The rationale of this study is that in a developing country this issue has never been high lightened and there is excessive use of Internet among students especially undergraduates. This study will probe into frequency and characteristics of Internet addiction disorder among medical students. Objectives: The objective of this study is to assess the frequency of Internet addiction Disorder among medical students. Operational definitions: Internet addiction disorder: Internet addiction disorder was diagnosed on the Axis I Scale of the DSM through Internet Addiction Diagnostic Questionnaire (IADQ), containing 20 questions measured on lickerts scale from 1 (Rarely) to 5 (always), with minimum score of 20 to maximum score of 100. If score is >70 subject is labeled as a diagnosed case of Internet Addiction disorder. 1. 20 49 points: An average on-line user. 2. 50 69 points: Experiencing occasional or frequent problems because of the Internet. 3. 70 100 points: Causing significant problems in your life i.e. sufferers of Internet addiction disorder. Methodology: A Cross sectional Allama Iqbal Medical College based study that included medical students from five medical colleges in Lahore was conducted among 364 calculated from winpepi with 95% confidence interval, 5 margin of error and.38 assumed proportion of internet addiction through stratified random sampling. 19 Students were given anonymously Internet addiction questionnaire devised by Dr. Young. Data was analyzed in SPSS ver.21.0. Frequency tabulation was done for the presence and absence of Internet addiction syndrome on basis of scoring. Cross tabulation was done with gender and residential status. Chi-square test was used to assess any statistical significance between gender, residential status and Internet addiction disorder with p <.05 as statistical significance. RESULTS: 364 medical students with age range 18 27 years and mean ages 20.8 S.D+1.787 were assessed for Internet addiction syndrome through Internet addiction questionnaire. 26.4% were males and 73.6% were females. 55.5% were boarder and 44.5% were day scholar.(graph no: 1).Among them 76.1% were online user with complete control (score 20-49) 20.9 % had frequent problem due to Internet usage (score 50-69), and among 3.0% Internetas causing significant problem (score (70-100). (Table no: 1). Table no: 1 Internet Addiction Score Internet Addiction Score Frequency Percent Online user with complete control (score 20-49) 277 76.1 Frequent Problem due to internet usage (score 50-69) 76 20.9 Internet is causing significant problem (score 70-100) 11 3.0 Total 364 100.0 Gender comparison showed that among males 71.9% were online user with complete control (score 20-49) 24.0 % had frequent problem due to Internet usage (score 50-69), and among 4.2% Internet was causing significant problem (score (70-100). In females 77.6% were online user with complete control (score 20-49) 19.8 % had frequent problem due to Internet usage (score 50-69), and among 2.6% Internet was causing significant problem (score (70-100). (P >.05). (Table no 3) http://www.ijmshc.com Page 2
Internet Addiction Score Table no: 3 Internet Addiction Score * Gender of Medical Students Gender and Residential status of Medical Students Male Female Total P value Online user with complete control (score 20-49) 69 208 277 P >.259 Frequent Problem due to internet usuage (score 50-69) Internet is causing significant problem (score 70-100) 71.9% 77.6% 76.1% 23 53 76 P >.387 24.0% 19.8% 20.9% 4 7 11 P >.460 4.2% 2.6% 3.0% Total 96 268 364 P>.481 100.0% 100.0% 100.0% Among current residential status, in boarders 71.3% were online user with complete control (score 20-49) 25.7 % had frequent problem due to Internet usage (score 50-69), and among 3.0% Internet was causing significant problem (score (70-100). In day scholars 82.1% were online user with complete control (score 20-49) 14.8 % had frequent problem due to Internet usage (score 50-69), and among 3.1% Internet was causing significant problem (score (70-100). (Chi-square 6.527, P <.05). (Table no: 4) Internet Addiction Score Online user with complete control (score 20-49) Frequent Problem due to internet usage (score 50-69) Internet is causing significant problem (score 70-100) Table no: 4 Internet Addiction Score * Residential Status Residential Status Boarder Day scholar Total 144 133 277 71.3% 82.1% 76.1% P<.038 52 24 76 25.7% 14.8% 20.9% P<.016 6 5 11 3.0% 3.1% 3.0% P<.011 Total 202 162 364 P<.038 100.0% 100.0% 100.0% DISCUSSON: Given the popularity of the Internet, accurate diagnosis of Internet addiction isoften difficult as its legal use and privacy often mask addictivebehavior. 9 The best method to clinically detect compulsive use of the Internet is tocompare it against criteria for other established addictions. Researchers have likenedinternet addiction to addictive syndromes similar to impulse-control disorders on theaxis I Scale in the DSM 7,8 and utilized various forms of DSM-IV based criteria to defineinternet addiction. Of the all the references in the DSM, Pathological Gambling was viewed as most akin to this phenomenon. As, the Internet AddictionDiagnostic Questionnaire (IADQ) was developed as an initial screening instrumentutilized for diagnosis in academic research and clinical treatment settings. 9,10 In our study we also found out that 76.1% were online user had complete control (score 20-49) over their usage mean they do spent more time on web but they can control their internet usage. 20.9 % had frequent problem due to Internet usage (score 50-69) that is affecting their life and among 3.0% internet.as causing significant problem (score (70-100). Co-morbidity with other psychiatric conditions is also common among addictivedisorders clouding the actual awareness that a client may suffer from a computer-related problem. 10 In many developing countries self-referrals for Internet addiction are becoming more common, oftenthe patients does not present with complaints of computer addiction. The patients initiallypresent with signs of clinical depression, bi-polar disorder, anxiety, or obsessivecompulsivetendencies masking use of internet as their root cause. 10,11 In a study by Kuss et al a total of 3105 adolescents in the Netherlands filled out a questionnaire including the Compulsive Internet Use Scale, results indicate that 3.7% of the sample was classified as potentially being addicted to the Internet. The use of online gaming and social applications (online social networking sites and http://www.ijmshc.com Page 3
Twitter) increased the risk for Internet addiction, whereas extraversion and conscientiousness appeared as protective factors in high frequency online gamers. The findings support the inclusion of Internet addiction in the DSM-V. Vulnerability and resilience appear as significant aspects that require consideration in further studies 12,13. In our study 3.0% Internet as causing significant problem (score (70-100) and 76.1% were online user with complete control (score 20-49) but 20.9 % had frequent problem due to Internet usage (score 50-69). Other research also stresses the fact that the Internet addiction disorder is not a uni-dimensional but a multidimensional construct. Various facets of Internet use must be differentiated because of their differential predictors, mechanisms and consequences. 14-15 Online activities which, if done in person, would normally be considered troublesome, such as compulsive gambling, or shopping, are sometimes called net compulsions. 16,17 In another study of 267 college students was surveyed to examine Internet dependency and academic performance. Survey data indicate that playfulness significantly predicts Internet dependency (ΔR 2 = 19%). Playfulness is also significantly related to students grade point average (p<.001), as well as Internet use for social purposes (p<.022), and its impacts are fully mediated by Internet dependency. 18 In our study we found 25.7 % had frequent problem due to internet usage (score 50-69), 14.8 % had frequent problem due to internet usage (score 50-69). (P<.05) and might be affecting their grades in professionals. Internet addiction has been linked to a handful of risk factors including anxiety, family problems, drug abuse, personality disorders and other related aspects. 20 The problem is worldwide and needs to be dealt with at an adequate scholarly level. CONCLUSION: The conclusion of our study is that Internet usage causing significant problem is very less among medical students but considerable proportion of medical students have frequent problem due to Internet usage. Medical students living in hostel has more frequent problems due to Internet than day scholars REFERENCES: 1. Weinstein A,Feder LC, Rosenberg KP. Internet Addiction Disorder: Overview and Controversies. Behr Add 2014. 99-117. 2. Young K. The relationship between depression and internet addiction. Cyberpsych & Beh. 1999; 1: 25 28. 3. Caplan, SE. High A.. "Beyond excessive use: The interaction between cognitive and behavioral symptoms of problematic internet use". Comm Res Rep 2006; 23 (4): 265 4. Young, K. The research and controversy surrounding internet addiction. Cyber Psychology and Behavior. Springer Int J Ment Health Addict 2006; 2: 381 383. 5. Meerkerk JG, Van Den EijndenJM Vermulst AA, Garretsen HFL. CyberPsychology & Behavior. 2009, 12(1): 1-6. 6. Young, K.. Understanding online gaming addiction and treatment issues for adolescents. Amn Jour Fam Ther. 2009; 37 (5): 355--356. 7. Echeburua E, de Corral P.Addiction to new technologies and to online social networking in young people: A new challenge. Adicciones 2010;22: 91-95. 8. Beard, K. W., & Wolf, E. M. (2001). Modification in the proposed diagnostic criteria for Internet addiction. Cyberpsych & Beh. 2001; 4: 377-383. 9. Warden NL, Phillips JG, James RP. Internet Addiction. Psychiatry, Psych & Law. 2004; 11:2-8 10. Shapira NA, Lessig, MC, Goldsmith TD, Szabo ST, Lazoritz M, Gold MS,Stein D J. Problematic Internet use: Proposed classification and diagnostic criteria. Dep & Anx. 2003; 17: 207-216. 11. Davis RA. A cognitive behavioral model of pathological Internet use. Computers in Human Behavior.2001; 17: 187-195. 12. KussDJ,Vanrooij AJ, Shorer GW, Griffiths MD, Mheen D. Internet addiction in adolescents: Prevalence and risk factors Int Joul Ment Hlth & Addn 2013; 29(5): 1987-96. 13. Young, K.S. Caught in the Net: How to recognize the signs of Internet addiction and a winning strategy for recovery. New York, NY: John Wiley & Sons. 1998. 14. Sang-Ming WL, LeeS,Chang G. Internet Over-Users' Psychological Profiles: A Behavior Sampling Analysis on Internet Addiction, Cyberpsych & Beh. 2003;6 (2): 143-150. 15. Shapiro NA, GoldsmithTD, Keck PE, KhoslaUM, McElroySL. Psychiatric evaluation of individuals with problematic Internet use. Jour Aff Disd. 2000; 57:267-272. 16. Widyanto L, McMurren M... The psychometric properties of the Internet addiction test. Cyberpsych & Beh. 2012; 7(4):445-453. 17. Kandell, J. J. Internet addiction on campus: The vulnerability of college students. Cyberpsych & Beh. 1998; 1:11-17 18. Jia R. Computer playfulness, Internet dependency and their relationships with online activity types and student academic performance. Jour Beh Add 2012, Vol. 1, No. 2: 74-77. 19. Chakraborty K, Basu D, Vijaya Kumar KG. Internet addiction: consensus, controversies, and the way ahead. East Asian Arch Psych. 2010;20(3):123-32. http://www.ijmshc.com Page 4
20. Aviv W, Laura CF, K Rosenberg and Pinhas Dannon, Chp 5 - IAD: Overview and Controversies, In Behavioral Addi, edited by Kenneth Paul Rosenberg and Laura Curtiss Feder, Academic Press, San Diego, 2014, Pages 99-117 http://www.ijmshc.com Page 5