Journal of Addictive Behaviors,Therapy & RehabilitationISSN: 2324-9005

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Research Article, J Addict Behav Ther Rehabil Vol: 3 Issue: 3

Internet Addiction and Psychopathological Symptoms in Greek University Students

Evmorfia Koukia1*, Polyxeni Mangoulia2 and Eirini Alexiou3
1Psychiatric Nursing, Faculty of Nursing, University of Athens, Greece
2Evangelismos Hospital, Athens, Greece
3Department of Psychiatry, Sahlgrenska University Hospital, Göteborg University, Sweden
Corresponding author : Evmorfia Koukia
Assist. Professor in Psychiatric Nursing, Faculty of Nursing, University of Athens, Zografou Community Mental Health Center 42 Davaki-Pindou Str, Zografou 157-73 Athens, Greece
Tel: 0030210 7481174/ 0030 6932006001; Fax: 0030210 7718320
E-mail: [email protected] nurs.uoa.gr
Received: June 04, 2014 Accepted: August 06, 2014 Published: August 08, 2014
Citation: Koukia E, Mangoulia P, Alexiou E (2014) Internet Addiction and Psychopathological Symptoms in Greek University Students. J Addict Behav Ther Rehabil 3:3. doi:10.4172/2324-9005.1000125

Abstract

Internet Addiction and Psychopathological Symptoms in Greek University Students

This study aimed to investigate the impact of Internet addiction on psychiatric symptoms among Greek university undergraduate students. The study was conducted among 1324 students. Participants completed a sociodemographic questionnaire, Internet Addiction Test and Symptom Checklist-90-Revision (SCL-90-R). Questionnaires were provided online. T-test and Logistic Regression Analysis were used to compare psychiatric symptoms between Internet addicted and non-addicted students. The prevalence of Internet addiction among Greek students is 4.5% and at risk population 66.1%. There were significant differences between the means of psychiatric symptoms in SCL-90-R subscales among addicted and non-addicted subjects. Depression and anxiety appeared to have the most consistent correlation with Internet addiction. Additionally, obsessive-compulsive symptoms, hostility/aggression, time in the Internet and quarrel with parents associated with Internet addiction.

Keywords: Internet addiction, students, university, psychopathology

Keywords

Internet addiction; Students; University; Psychopathology

Introduction

SInternet has become an easy and immediate way for youths to communicate, representing at the same time, an educational and recreational activity as well. Anonymity, a sense of security and distortion concerning behavioral responsibility, all enhance Internet addiction [1]. Internet addiction, pathological Internet use and problematic internet use, are the terms used to describe a possible addiction that may have a negative impact on emotional well-being, social function, daily life activities and academic/professional status. Internet addiction has been previously related to depression, anxiety, ADHD, obsessive-compulsive symptoms, hostility and aggression [2,3].
Internet addiction disorder (IAD) has been excessively studied and has been included in section III as “Internet gaming disorder” in the DSM-V (http://www.dsm5.org). Meanwhile a variety of assessment tools has been developed and various researches proposed diagnostic criteria and treatments [4-7].
Davis’s (2001) cognitive–behavioral model of Pathological Internet Use distinguishes between specific and generalized pathological Internet use. It has been hypothesized that two distinctive forms of Internet addiction exist [8]. Generalized Internet addiction refers to the problematic use of the Internet, covering a broad range of Internet-related activities, while specific forms of Internet addiction target the problematic use of distinct online activities such as excessive online video gaming or chat rooms [9].
Many studies suggest that there is a possible causal relationship between internet addiction and negative health consequences, academic or job failure, family and social disruption [3,10]. Additionally, it has been associated with substance abuse disorder and attention deficit hyperactivity disorder (ADHD) [11-13]. Additionally, social anxiety and depression are perceived as possible risk factors for problematic Internet use. This hypothesis has been confirmed by a number of studies [14,15].
Many studies examined the association between psychiatric symptoms and Internet addiction in adolescents. They found that Internet addiction is associated with psychological and psychiatric symptoms such as depression, anxiety and low self-esteem [9,16,17]. Additionally, several studies have shown links between internet use and personality traits. They have found that loneliness, shyness, loss of control and low self-esteem was associated with Internet addiction [18-20].
A number of studies explored Internet addiction among students particularly in medical universities [21,22]. Few of them have focused on Internet addiction and psychiatric problems in students of various universities [10,13]. College students are considered to be a rather vulnerable group concerning Internet addiction. Students may have unlimited time to play, a continuous access to the Internet and no parental control. Internet use was associated with depressive symptoms, anxiety, phobias and low self-esteem. Studies also showed the negative impact on students’ academic accomplishments [23-25].
In Greece, at this point, there is no study focusing on the impact of Internet use on psychiatric symptoms in undergraduate university students. Siomos et al. [26] have focused on adolescents between 12 to 18 years old and have found that 11% of them fulfill the criteria for Internet addiction. The majority of studies concerning Internet addiction in adolescents were associated with parental practices, parental bonding and academic achievements [26-28] Only two studies by Frangos et al., in 2010 [30] and 2011 [31] investigated problematic Internet use among Greek university students and found that 11.6% of students had internet addiction and 34.7% presented problematic Internet use.

Aim

The aim of the study was:
1. To determine the inverse association between psychiatric symptoms and Internet addiction in Greek students from the four universities in greater Athens area.
2. To point out possible predictive factors of addiction such as the number of hours spent online, the days spent on Internet use during a student’s life, the age of computer use initiation, parents’ knowledge and possible quarrels with parents due to Internet use.

Materials and Methods

Participants and data collection
This was a voluntary Internet survey. Participants were undergraduate students in the 4 universities of Athens greater area (National & Kapodistrian University of Athens, Athens University of Economics and Business, Agricultural University of Athens, National Technical University of Athens). Self-administered questionnaire was used in this study. The Ethical Committee of National and Kapodistrian University of Athens Faculty of Nursing approved the study protocol.
The questionnaires were provided online for a 3-month time schedule. The study was explained in detail in the front Internet page and permission was requested as a prerequisite to continue to next pages. Survey respondents were able to see for themselves if they have an addiction or not (the results of Internet Addiction Test were provided to participants), as compensation.
We have also integrated a question at the beginning of the survey concerning substance abuse in order to exclude these students, from the final analysis. Students had to answer the following question: “Did you have any abuse problem concerning alcohol or drug, or a relative diagnosis by a doctor, during the last 12 months?”
Additionally, we have asked students to report their activities engaged on the Internet, such as searching for studying resources or spending leisure time (chat rooms, online video games, online shopping). Previous study has shown that time spent online on leisure activities was a significant predictor for a high Internet addiction score [32].
We have advertised the webpage of the survey in the official university students’ web pages after personal contact of the main author with university presidents. The nature of the research ensures anonymity and confidentiality. Participants had to answer each question to gain access to the following one and to receive a response concerning Internet addiction at the end of the survey. The use of a secure Internet program provided assurance that each student could have responded once in the questionnaires.
Instruments
The first part of the survey consisted of a self-administered list of questions assessing sociodemographic data and characteristics of computer use. Students had to respond to the following questions: “how many hours per day have you spent online during your student life?”, “How many days per week have you spent online during your student life?”, “At what age have you begun to use Internet”, “do your parents know about your Internet use?”, “do you have quarrels with your parents concerning Internet addiction?”
There was also a specific question at the beginning of the questionnaire concerning substance use in an attempt to exclude students with active substance addiction disorder. “Have you ever used or been treated for substance use during your student life?”
Internet Addiction Test: Internet Addiction Test (IAT Young 1998) is a 20-item scale that measures the presence and the severity of Internet dependency. In the present study, we used a Greek version of IAT. IAT was translated by the main author after a license from Young and standardized to the Greek population, which had a Cronbach’s alpha reliability of 0.876, and the p-value of test-retest was 0.72. Users are divided into minimal (scores 20-39), moderate (scores 40-59) and excessive (scores 60-100) [33].
Symptoms Checklist 90: revised is a multidimensional selfreport symptom inventory developed by Derogatis et al. designed to measure psychopathology by quantifying nine dimensions: somatization, obsession-compulsion, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychotism. Additionally, there are three global indices of distress, the General Severity Index (GSI), representing the extent or depth of the present psychiatric disturbance, the Positive Symptom Total (PST), representing the number of questions rated above 1 point and the Positive Symptom Distress Index (PSDI), representing the intensity of the symptoms. Higher scores on the SCL-90, indicate greater psychological distress. The SCL-90 was proven to hold excellent testretest reliability, internal consistency and concurrent validity [34].

Data Analysis

The data were analyzed using the Statistical Package for Social Sciences (SPSS) version 16.0. Descriptive statistics were used for sociodemographic characteristics and computer use characteristics. T test was used to determine the association between Internet addiction and psychiatric symptoms. Logistic regression analysis was used to determine factors affecting Internet addiction. For our analysis we dichotomized users to “non-Internet addicted” versus “Internet addicted (at risk and Internet addicted)”.

Results

Demographics and users characteristics
One thousand three hundred and twenty four students participated in the study. Sixty-six students were excluded by their own indication that they have used a substance (alcohol or drug or had an official substance abuse diagnosis) during the past 12 months. Greek university undergraduate students seem to use Internet more than any other group, a finding compatible to previous study [13].
The mean ages of males and females were found to be 21.68 (± 2.82) and 20.82 (± 2.39) respectively, a not statistically significant difference. Students were unmarried and were undergraduates. There was not any statistically significant difference between various universities and technological schools.
The vast majority of the students reported that they use Internet for pleasure: activities in social networks and online gaming.
Focusing on users’ characteristics and Internet activities there were no differences between males and females concerning age of computer use initiation, frequency of Internet use per day in hours and frequency of Internet use per week in days (Table 1).
Table 1: Users characteristics and internet activities.
Internet addiction is defined as Internet addiction (yes) plus at-risk Internet use. The frequency of Internet addiction was 1.4% for males and 0.8% for females (IAT score: 60-100). The frequency of at-risk Internet addiction was 16.4% for males and 16.6% for females (IAT score 40-59). The frequency of Internet addiction in the total sample (1324) was 35.2% (2.2% internet addiction and 33.0% at risk) (Table 2).
Table 2: Gender percentages among internet addicted users, moderate addicted users and non addictive users (n=1324).
The gender differences for Internet addiction were not statistically significant.
T–test results between SCL-90 and internet addiction
The comparison of scores in all dimensions and the three global indices on SCL-90 between students with and without Internet addiction, demonstrated that students with Internet addiction had higher scores in all dimensions. Psychiatric symptoms such as somatization, obsession-compulsion, sensitivity, depression, anxiety, hostility, psychoticism and paranoid ideation were associated with Internet addiction (Table 3).
Table 3: T test results of psychiatric symptoms with internet addiction.
Logistic regression analysis results
The association between Internet characteristics, the 10 dimensions of the SCL-90 and Internet addiction examined, was performed using logistic regression analysis.
The results indicated that students with Internet addiction played more hours per day, had more quarrels with their parents, had higher level of somatization, obsession-compulsion, interpersonal sensitivity and phobic anxiety (Table 4).
Table 4: Logistic Regression Analysis Results: IATSCORE.

Discussion

This was the first study in Greek undergraduate university students, exploring the association between Internet addiction and psychiatric symptoms. Accurate estimates of the prevalence of Internet addiction in Greek students are lacking. The sampling method gave the opportunity to gather information from the main three universities of the capital (Athens). The procedure for selecting the sample has allowed the generalization of the results to the entirety of the college population.
In the beginning of the questionnaires, it was attempted to differentiate students with and without substance abuse disorder. Previous studies have shown that individuals with substance use are more likely to exhibit Internet addiction [35,36].
Of the 1390 students that visited the online website, the 1324 were reported as not having a substance abuse. Sixty-six students were excluded by their own indication that they have used a substance (alcohol or drug or had an official substance abuse diagnosis) during the past 12 months. Therefore, one thousand three hundred and twenty four respondents were included in the data analysis.
In this study there was no statistically significant gender difference concerning Internet addiction, which is a contradictory finding to previous studies. Some studies showed that males are in more danger to be addicted to Internet gaming than females [11,27]. This difference might be a reflection of the cultural observation made in the last decade, that female Greek students have augmented significantly their Internet use.
The IAT test, based in a systemic review concerning Internet use, has been identified as the only validated instrument used in a study that reported prevalence rates [6]. The prevalence of Internet addiction was 4.5% (2.8% for male and 1.7% for female) a finding compatible to previous studies in college students [17,20]. On the other hand, a number of studies reported a higher percentage of Internet addicted youths [37,38].
It is of note that 32.5% of males and 33.6% of females are at risk for Internet addiction. Whether these students will actually develop an addiction, is difficult to be predicted. Nevertheless, the continuous exposure to Internet and a possible susceptibility to addictive behaviors may represent a possible danger. Previous studies have found similar results concerning moderate Internet addiction [22,26].
The results of the study show that students of both genders with Internet addiction have higher psychiatric symptoms in all 10 dimensions than those without. In this study, Internet addiction affected psychiatric symptoms by controlling gender. This finding is consistent with previous studies [3,37]. Alavi et al., had also examined the association between psychiatric symptoms and Internet addiction using the SCL-90 scale. The results of the study had shown that there was a strong association between psychiatric symptoms and Internet addiction [2]. Students reported the presence of psychiatric problems such as anxiety, depression and psychotism. Many studies reported that excessive use of Internet was correlated with psychiatric problems like depression and anxiety [23,27]. The association of depression, suicidal ideation and Internet addiction, is well-documented in previous studies especially in adolescents [9,38]. A number of studies demonstrate the presence of both major depressive disorder and dysthymic disorder as well, to Internet addicts [21].
In this study paranoid ideation was associated with Internet addiction, which is a contradictory result to previous studies [2,4]. However, whether paranoid ideation preexists and predisposes Internet addiction in online activity, has not been validated and needs further analysis and clinical assessment. There are few studies reporting an association between Internet addiction and other psychiatric disorders as shown in the review of the literature made by Ko et al. [28].
Hostility is also associated with Internet addiction even though there is a lack of information concerning whether this behavior is expressed in everyday life. The fact that there were no sex differences concerning hostility, in contrary to previous study [11], is a rather surprising result that needs further exploration.
Logistic regression analysis showed that somatization, obsession-compulsion, interpersonal sensitivity and phobic anxiety were associated with Internet addiction. The association between obsessive-compulsive disorder and Internet addiction supports previous findings [39]. Sensitivity, somatization and phobic anxiety was associated with Internet addiction as well. These findings are consistent with other studies [29,39]. In an article by Ko et al., the majority of surveys conveyed the association between pathological Internet use and depression, anxiety, obsessive-compulsive symptoms and hostility/aggression [25].
ReferencesResults have also shown that the longer the hours of Internet use, the higher the vulnerability to Internet addiction becomes and as a consequence, higher scores of psychiatric symptoms are measured. These results are compatible to previous studies [15,40]. In this study, we have tried to determine the association of Internet addiction with factors referring to the relationship with the students’ parents, concerning Internet use. The analysis has shown that Internet use is associated with quarrels with parents. These results have to be considered with skepticism when we try to investigate the effectiveness of parental practices of security on Internet addiction [26]. Parents have to exercise security practices to protect their children and to prevent the perpetration of online victimization and addiction as shown by Floros et al. [14]
In this study, it was tried to demonstrate the effect of Internet addiction in psychiatric symptoms. Causal relationship between psychiatric and psychological problems and Internet addiction needs to be further analyzed in order to determine whether Internet use causes psychiatric problems or exacerbates symptoms that already exist. Studies have shown that adolescents with depressive symptoms and social anxiety symptoms are more vulnerable to Internet addiction [41,42]. This result highlights the need for more clinical studies focusing on psychiatric or psychological symptoms, based on psychiatric interview diagnosis [43].

Conclusion

This was the first study addressing Internet use to undergraduate university students that has used a validated instrument of Internet addiction, examining the association of Internet addiction and psychiatric symptoms. Internet addicted individuals showed depression, anxiety and hostility. Internet addiction was also associated with somatization, obsession-compulsion, interpersonal sensitivity and phobic anxiety. The high percentages of at-risk population raise a number of concerns about the use of Internet and the possible factors that may contribute to addiction. This situation underlines the need for the development of preventive measures and for the substantiation of an ongoing assessment of students’ population.

Limitations

The study did not manage to clarify the causal relationship between Internet addiction and psychiatric symptoms. Internet addiction may precipitate psychiatric symptoms or psychiatric symptoms may lead to Internet addiction. Another limitation of this study is that the procedure for selecting the sample through Internet, did not allow us to identify the psychiatric medical record of each student. Thus psychiatric symptoms may preexist any Internet addiction and may create a vulnerability to addiction. Previous researches have mentioned that college students who are vulnerable to substance abuse may be also vulnerable to Internet addiction. In our study, it was rather difficult to explore the truthfulness of students’ replay to the question of substance abuse. We had to rely on their personal confirmation at the beginning of the study. The study did not allow us to differentiate the essential use of the Internet from its recreational use.

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