Indian Journal of Psychiatric Nursing

ORIGINAL ARTICLE
Year
: 2020  |  Volume : 17  |  Issue : 1  |  Page : 39--50

Prevalence of problematic internet use and internet usage pattern among adolescents


Preeti Mathew1, K Raman2,  
1 Saveetha Institute of Medical Science and Technology University, Chennai, Tamil Nadu, India
2 Department of Psychiatry, Saveetha Medical College, Chennai, Tamil Nadu, India

Correspondence Address:
Ms. Preeti Mathew
Assoc. Prof, Research Department, SIMATS, Thandalam, Chennai
India

Abstract

Background: There has been a rapid rise in the use and ease of access to the Internet worldwide, including South-East Asian countries like India. Problematic Internet use (PIU) has become a global phenomenon that causes a serious problem to the affected individual leading to impairment in psychological well-being. Aim: The present study is aimed to assess and compare the prevalence of PIU and the pattern of Internet usage in North and South India. Setting: The study was conducted in Private and Private Aided Schools of two states of North and South India. Methods: The study with a cross-sectional comparative design was conducted for a period of 1 month among 900 students. The participants were selected using nonprobability, convenient sampling technique. The samples who met the inclusive criteria were provided with a self-administered questionnaire after obtaining written consent from their parents and assent from the students. Results: The prevalence of PIU was found to be 1.16% among adolescents of North India and 4.40% in adolescents from South India. A significant difference (χ2-1.111, P- 0.000) was found for PIU of the adolescent from two regions were compared.Conclusion: PIU was found in most of the students in both states. Hence, its important to identify the activities which are the key factors that may influence PIU among adolescents, and it should be put under control using effective measures.



How to cite this article:
Mathew P, Raman K. Prevalence of problematic internet use and internet usage pattern among adolescents.Indian J Psy Nsg 2020;17:39-50


How to cite this URL:
Mathew P, Raman K. Prevalence of problematic internet use and internet usage pattern among adolescents. Indian J Psy Nsg [serial online] 2020 [cited 2020 Nov 24 ];17:39-50
Available from: https://www.ijpn.in/text.asp?2020/17/1/39/291621


Full Text



 Introduction



The Internet has become one of the major necessities of life in almost all countries. Being a rich source of information, and containing entertainment facilities for all age groups, as well as its easy access, are among major reasons of increasing use of the World Wide Web. Despite various advantages of this technology, in the case of being misused, it can be dangerous and lead to Internet addiction (IA).1 This issue is so important that pathological Internet use or IA has been considered as one of the epidemics of the 21st century. It seems that by inventing portable mini-computers and cell phones connecting to the Internet, the problem is undergoing rapid spread, particularly among the youth.[1],[2],[3],[4],[5]

According to a report published on June 30, 2014, the world's Internet user base was around 3 billion, in which approximately 1.4 billion users are from Asia. The higher IA, i.e., 45.7% is from Asian countries (Indians are the highest users in Asia).[6] With over 560 million internet users, India is the second-largest online market in the world, ranked only behind China. By 2021, there will be over 600 million internet users in India. Despite the large base of Internet users, only 17% of the Indian population could access the Internet in 2015. Even then, this was a consistent increase when compared to the previous few years, when the internet penetration rate stood at approximately 10%.[7]

Healthy internet use is the use of the Internet for an expressed purpose in a reasonable amount of time without cognitive or behavioral discomfort, whereas problematic internet use (PIU) or IA is a psychiatric condition that involves maladaptive thoughts and pathological behavior. Now, it is difficult to estimate how widespread this PIU in adolescents is. Internet-related behavior is often described as IA, IA disorder, Internet pathological use, or Internet dependency or PIU[6] The prevalence of IA varies from 1.5% to 25% in different populations.[8],[9],[10],[11] Surveys have shown a prevalence of 0.3%–0.7% in the general population.[12] A recent study reported a prevalence of 0.7% among Indian adolescents.[13] The major symptoms of PIU include: obsession with the Internet, withdrawal symptoms – restless or irritability including a feeling of anger, tension, depression when the computer is inaccessible, repeated unsuccessful effort to control, cut back or stop Internet and so on. Although people in all segments of the society use the Internet, especially adolescents, are the most frequent users and thus more vulnerable to IA.[7],[8],[9],[10],[11],[12],[13],[14],[15]

However, excessive Internet use has also become a significant mental health concern among students. Several studies globally, and numerous anecdotal media reports, suggest possible links between overuse of the Internet by adolescents and young adults and negative health consequences such as depression, attention deficit hyperactivity disorder, excessive daytime sleepiness, problematic alcohol use, or injury. Excessive Internet use has also been associated with negative academic consequences, such as missed classes, lower grades, and academic dismissal.[16]

As mentioned earlier, Internet use has become widespread in India, particularly among the youth, and it is important to study the extent and pattern of Internet usage among adolescents with easy access to Internet. There is also a need to focus on emerging adults who are students to promote safe and healthy Internet use behaviors across the life span. Further, adolescents form a particularly vulnerable group to develop PIU due to several psychological and environmental factors associated with school life.[17]

Considering the enormous use of Internet among adolescents, it is important to analyze the prevalence and pattern of internet use among adolescents. Besides using Internet for information, education, they are a vulnerable group on account of the time they spend on the Internet. The aim of the present survey was to estimate the prevalence of IA, understand the pattern of internet use, and to determine the association between PIU and internet usage pattern among adolescents from North and Southern parts of India, as the researcher feels there will be a considerable difference in the prevalence and pattern of usage between two areas.

Objectives of the study

To assess the prevalence of PIU among adolescents in the two regionsTo assess and compare the level of PIU among adolescents studying in selected schools of North and South IndiaTo assess and compare the internet usage pattern among adolescents studying in selected schools of North and South IndiaTo find out the association between levels of PIU, Internet usage pattern, and selected demographic variable adolescents studying in selected schools of North and South India.

Hypotheses

H1: There is a significant difference between PIU of adolescents between North and South IndiaH2: There is a significant difference between Internet usage pattern of adolescents between North and South IndiaH3a: There is a significant association of PIU with selected sociodemographic variables in North IndiaH3b: There is a significant association of PIU and with selected socio-demographic variables in South IndiaH4a: There is a significant association of PIU with and Internet usage pattern of adolescentsin North IndiaH4b: There is a significant association of PIU with and Internet usage pattern of adolescentsin South India.

 Methods



Samples

Adolescents studying in the 9th and 11th standard studying in Private and Private Aided Schools in two states of North and South India were the participants of the present study. Passive information and consent forms were sent to parents/guardians. After obtaining consent form from Parents and Adolescents, both the parents and adolescents were recruited as subjects. The subjects were assured the confidentiality and anonymity, and they were made fully aware about their right to participate and withdraw from the study.

Inclusion and exclusion criteria

The students were recruited according to prespecified inclusion and exclusion criteria.

Inclusion criteria specified that students who had mild to severe PIU, from grades 9th and 11th in secondary and higher secondary schools studying in Private and Government undertaking and willing to participate in this study, and whose parents signed the informed consent form were eligible for this studyExclusion criteria were withdrawal from the study for any reason, failure to participate in the program for >2 weeks, and suffering from any condition that impaired communication, such as physical illness or comorbid psychiatric illness and who attended intervention program.

Research design and approach

The research design used for the present study was a descriptive comparative cross-sectional survey design.

Sampling technique and sample size calculation

Four hundred and fifty patients each were recruited from 12 schools from two states of North and South India using a convenient sampling technique. Sample size for the two zones was estimated based on the equation n = Z1−α/2p (1−p)/d2where Z1−α/2= 1.96 when α = 0.05, p = expected prevalence = 0.60 (obtained from the pilot study done among 100 subjects in relation to assess the effectiveness of Nurse-led multi intervention on Psychosocial Variable and Academic Performance), d = expected allowable error in p, i.e., 0.05, then n = 369 + 20% attrition rate = 369 + 74 = 444. Thus, 450 patients each were recruited in both the zones.

Measures

Tool 1

Tool Consists of Researcher developed sociodemographic pro forma and Internet usage pattern

Sociodemographic pro forma: to assess sociodemographic characteristics of the study participants. Sociodemographic pro forma was used to collect demographic characteristics of study participantsand it consisted of 11 items related to age, gender, religion, Grade, type of school, residency, socioeconomic status, no of siblings, type of family, relationship with parents, parenting styleInternet usage pattern: aimed to obtain information pertaining to Internet usage. It consists of 11 items: beginning age, source of internet access, place of Internet access, purpose of Internet use, mostly used website, privacy, log in status, money spend, time of the day when Internet is accessed, average duration of access: daily and weekly.

Tool 2

PIU Questionnaire is a self-report, 18-item survey constructed by Zsolt Demetrovics, Beatrix Szeredi, and Sándor RózsaD (2008) to establish a valid and reliable instrument to identify the components of PIU and to measure the problems associated with excessive Internet usage. Permission to use the tool from the author was obtained. The tool consists of 18 items with three domains: obsession, neglect, and control disorder. The overall Scoring for PIU was: 18–90, scoring for No PIU was ≥18, for 18–36 Mild PIU, 36–54 for Moderate PIU, and a score of 55–90 for severe Internet use.[18]

Data collection procedure

The Institutional Ethics committee of Saveetha Institute of Medical Science and Technology University, (002/02/2019/IEC/XXX) approved the study. Permission letter to conduct the study was obtained from the Administrators of the 12 Schools of two respected states before the conduct of the study. Data were collected for f 4 months, from March to July 2019. In the initial phase of the study, after receiving formal permission from the administrative departments of respective Principal, Parent Teacher Association for data collection, the researcher approached the parents for getting the consent from them as the subjects were minor after explaining the purpose of study, assent was also obtained from the subject, and the parents and subjects were ensured that participation in the study was voluntary. Confidentiality and anonymity were also assured to both. The subjects who met the inclusion criteria were recruited as the sample for the present study, using a convenient sampling technique. The researcher approached the subjects directly during their class hours, preferably during free periods or Zero periods. Self-administered questionnaire: Sociodemographic data sheet, Internet usage pattern, and PIU questionnaire were distributed to the students with the help of class teachers. The subjects were requested to fill in the questionnaire and were asked to raise their hands to clarify doubts if any. Doubts, if any arose, were cleared at the middle of the session as well as at the end. The subjects took approximately 30–40 min to complete the questionnaire. After completion, the questionnaire was collected. Data were entered in the excel, and analysis was done using IBS SPSS statistics ver 16.

Plan for data analysis

Based on the objectives and hypothesis of the study the following steps will be taken to analyze the data: Assessment of PIU will be analyzed using descriptive statistics: mean, frequency, percentage, standard deviation. Association between PIU, Internet usage pattern and sociodemographic variables will be calculated using inferential statistics: Chi-square or Fisher test 0.05 level of significance. Comparison of PIU and internet usage pattern was also calculated using Chi-square.

 Results



[Table 1] shows frequency and percentage distribution of sociodemographic characteristics of adolescents with PIU in North and South parts of India. 54.70% of the subjects were in the age group of 13–14 years and 45.30% of the subjects were in the age group of 15–17 years From North India, 43.80% were males and 56.20% were females and the highest were 53.30% were males in South India. Religion wise 42% were Hindus, 35.10% were Muslims, and 29.90% were Christians in North India and in South 37.60% were Christians, 31.60% were Hindus, and 30.90% were Muslims. In both the regions, 54.70% of adolescents were from the 9th grade and 45.30% from 11th grade. In North India 53.10% of the adolescents belonged to Urban Area, whereas in South India, highest number of adolescents (55.60%) were from Rural Area. In both the regions, the highest subjects of adolescents hailed from the Nuclear family (North India-59.10%, South India-53.60%). Highest number of adolescents in both areas belonged to the income group of Rs. 30,000 and above (North India: 29. 80% and South India 29.60%) followed by 52% in the income group of Rs. 5000–20,000 in North and 50% in the income group of Rs. 10,000 to Rs. 30,000 in South. About 53.50% of adolescents in both the area had one sibling each. Almost 78% of subjects in both the region had a good relationship with the family members. Most of the subjects (approximately 69%) in both the groups felt their parents had a democratic style of parenting.{Table 1}

[Table 2] shows the frequency and percentage-wise distribution of Internet usage Pattern in North and South India. Highest 34.44% of adolescents in North India and 38.67% of adolescents in South India started using the Internet at the age of 12–14 years, and 31.56% adolescents from North India and 38.67% from South India started using Internet at the age of 10–12 years approximately >80% of adolescents in both the areas reported no cravings for Internet and they accessed Internet at home. The common device used by the majority to access Internet in both areas (77.11% in North and 81.78% in South India) were smartphones, respectively. In South India, majority (82.80%) accessed Internet for academic purpose, whereas in North India, only 33.33% of adolescents used it for academic purpose. Approximately 50% of adolescents from North India reported medium privacy at home while accessing the Internet, whereas in South India, like number of adolescents reported low privacy. Similar no adolescents (approximately 50%) in both the areas preferred to be online in the evening time. Approximately 80% of the adolescents from North India used Internet for less than hour to 2 h/day, with 50% of them accessing Internet for 7 h/week. However, 73.11% of adolescents from South India accessed Internet up to 4 h a day, with approximately 50% of them accessing for 14–28 h per week. Most of the adolescents spend between Rs. 100-300/-(85.8%) in South India and 45-8% in North India [Figure 1]. The commonly used website was YouTube by South Indian Adolescents (52.67%), whereas North Indian Students commonly accessed google (37.33%) and Yahoo (31.33%) [Figure 2].{Table 2}{Figure 1}{Figure 2}

Of the 450 adolescents from North Zone, majority (56.20%) had mild PIU, 41.10% reported moderate PIU and miniscule 1.60% had severe PIU and 1.10% had no PIU. The overall mean score percentage was 51.68 ± 10.17 and prevalence was found to be 1.60%. Nevertheless, in Southern India, the overall prevalence reported was 4.40% and the level of PIU ranged from mild to severe, with 1.80% adolescents reporting no PIU. Most of the adolescents (71.80%) reported moderate PIU with 22% having mild and 4.40% having severe PIU and the overall mean score was 57.12 ± 12.56 [Table 3] and [Table 4].{Table 3}{Table 4}

Chi-square was used to test the difference between PIU in North and South India, and a significant difference between the two was reported (χ2-1.111, P - 0.000). Hence the research hypothesis H1: There is a significant difference between PIU of adolescents between North and South India is accepted [Table 5].{Table 5}

On comparing the adolescents from Northern and Southern part of India based on their Internet usage pattern a significant difference was reported for the device used (Fisher's exact test - 3.142, P - 0.47), purpose of Internet used (χ2-2.74, P - 0.000), mostly used website (χ2-1.605, P - 0.000), privacy (χ2-3.733, P - 0.000) and login status (Fisher's exact test -

1.111, P - 0.000), money spend on Internet (χ2-1.612, P - 0.000), average duration of access per day (χ2-1.118 and P - 0.000) and average duration of access per week (χ2-2.954, P - 0.000) [Table 6].{Table 6}

[Table 7] and [Table 8] show the Chi-square and fishers exact test to find the association between PIU and selected sociodemographic variable in North and South India. There was no significant association found between PIU and selected demographic variables in North India. Hence the research hypothesis H3a(There is a significant association of PIU with selected sociodemographic variables in North India.) is rejected, and Null hypothesis is accepted. However, a significant association was seen between PIU and selected demographic variables of adolescents in South India, where a significant association was reported for No of sibling (χ2-22.499, P - 0.01), relationship with family (χ2-21.783, P - 0.01). Hence, the research hypothesis, H3b: There is a significant association of PIU and of adolescents with selected sociodemographic variables in South India is accepted.{Table 7}{Table 8}

[Table 9] and [Table 10] show the Chi-square and fishers exact test to find the association between PIU and Internet usage pattern in North and South India. A significant association was reported between PIU and internet usage pattern for craving (Fisher's exact test - 5.411, P - 0.568), place of internet access (Fisher exact test - 0.094, P - 1.000), purpose of Internet used (Fisher's exact test - 7.454, P - 0.24) preferred time of the day (χ2-4.091, P - 0.664) among adolescents from North India. However, a significant association was seen for PIU and money spend for internet use (χ2-5.709, P - 1.88), average duration of access per day (χ2-12.818, P - 0.46) and average duration of access per week (χ2-1.633, P - 0.000).{Table 9}{Table 10}

 Discussion



This study describes the Prevalence of PIU among adolescents in different parts of India. The prevalence was found to be 1.60% in North India and 4.40% among adolescents in South India. The prevalence of PIU found in this study was less in accordance with the overall prevalence of IA (representing moderate and severe addiction) was 19.85%, with most studies that have assessed IA using Young's IAT.[14] The level of PIU in the two regions ranged from mild to severe PIU and a significant difference was observed between the two zones (P < 0.001). Mild PIU was seen more for adolescents in North zone (56.20%) when compared to South (22%). However, moderate (71.80%) and severe PIU (4.4%) were more in South students when compared to North students. Similar findings were reported in a study by Anand et al. were among the total n = 1086, 27.1% of students were mild addictive internet users, 9.7% moderate addictive internet users, and 0.4% for a severe addiction to Internet.[19]

The adolescent in both the group was in the age group of 13–17 years and the mean age was 14.75 (standard deviation [SD] - 1.71). Gender-wise North zone had more females and south had more males. In both the zones, the higher no of students were Hindus (North – 42%, South - 31.60%), majority from the 9th grade (54.70% in both the groups). High number of Adolescents was from Nuclear family with majority in higher income group of Rs. 30,000 and above. 53.50% of them in both groups had one sibling each. Majority (77.80% in North and 77.30% respectively). Parents in both the group had democratic style of parenting (68% in North and 69.60%). More or less similar findings were reported in the study by Sharma KD, Gupta ID, Gunjan, Sharma V where age range was 14–19 years with a mean of 15.78 ± 0.8413. Males (57.75%) predominated over females (42.42%), respectively. 51.42% belonged to 11th standard and 48.57% belonged to 12th standard. The monthly income was Rs. 32,049, for 28.57% students. 63.85% of students were from the Nuclear family.[19] In another study by Arthanari et al., 72.7% students were in the age group of 14–16 years and 17–19 years age group. The proportion of males and females were more or less similar. 49% of students were in 9th and 10th standard and 51% in the 11th and 12th standard.[20] No significant association was found on associating PIU with age, gender, religion, grade, types of family, place of residency, SE status and No of siblings in North India but a significant association was reported for level of PIU and number of siblings and relationship with family in south India. Similar findings were reported by Kayastha et al. in their study.[21]

The beginning age of use of internet in both the group was 12-14 years and majority reported no craving of internet. Most of them in both the groups accessed internet at home through smartphones, and both reported medium privacy in terms of parental control and the highest number of users in both the groups had intermittent login status. Both the groups reported evening hours as convenient time to access the internet, accessing daily for 1–2 h on daily basis and the money spent for internet was between Rs. 100–300. Majority in the north zone accessed internet for <7 h on weekly basis whereas in south the adolescents accessed for 14–28 h and also the adolescents from North accessed internet for entertainment purpose like social networking, chatting, playing online games, shopping, downloading media files whereas adolescents from south used it mainly for academic purpose. The common websites surfed were Google in North India and You tube in South India. In a study by Bhatia et al., it was reported that maximum students (60.33%) had started using internet after 12 years of age, with majority (60.33%) accessing the internet for <2 h online per day, 50.66% spending between Rs. 100 and 500/month for internet.[22] According to Prabhakaran et al., mean age of internet use was 11.6 years (SD - 1.73). 63.6% Participants used internet from own devices with 60.6% having smart phone. 27.9% had permanent log in status, 34.5% used for academic purpose and 65.5% for entertainment and majority accessed internet for more than four hours/day.[23] On associating the level of PIU with internet usage pattern a significant difference was reported for average duration of access per day and week in adolescents from South India (P < 0.001), whereas among adolescents in north India significant difference was reported between level of PIU, craving, place, purpose of internet access, preferred time of the day (P < 0.001). In a study by Goel et al., it was seen the purpose of using the Internet was significantly different for addicts. They indulged more in social networking, chatting, and downloading media files (χ2 = 76, P < 0.001). Significantly, most of the addicts used the Internet mostly in the evening and nights as compared to other users who used it in the mornings and afternoons as well (χ2 = 26.4, P = 00019). Interesting findings were noted with respect to the place of accessing Internet. This finding too was statistically significant (χ2 = 144, P < 0.001). In this study, no significant relationship was found between IA and the hours of use per day.[24]

On further associating the PIU with the internet usage pattern between the two groups, a significant difference was observed for the variables: device used, purpose of Internet use, mostly web site, privacy, login status, money spend for internet use, average duration per week (P < 0.001). A significant difference between the prevalence of PIU, level of PIU, and Internet usage pattern among adolescents in North and South India. Thus, the extent and pattern of PIU among adolescents from schools located in the northern and southern parts of India varied. This might be because of the differences between the attributes, personality traits of the study population.

 Conclusion



PIU among the student population has been a focus of attention in recent years, and it has the potential to become one of the significant public health issues soon. PIU among adolescents varied according to the pattern of internet use and based on the region: North or South. This finding of the present study strongly suggests PIU among adolescents in all the states of India as an important public health concern, keeping in mind the substantial amount of existing evidence regarding negative consequences of excessive internet use on the physical, mental, and social well-being of individuals. Hence, measures should be taken to find at-risk students, to promote awareness of PIU, and to educate students to use Internet meaningfully and appropriately. Authorities and Parents should monitor Internet use by adolescents and set limits.

The main strengths of this study are its large sample size and offline survey approach used for the collection of data. Further, the study questionnaires were filled anonymously by the participants, and teachers were kept away from the classrooms during the period of data collection. This was done to encourage the participants to provide more factual and truthful responses without the fear of later consequences. However, this study also has certain limitations that should be kept in mind while interpreting its results. The students were selected from only two states falling in North and South of India, and hence the results cannot be generalized. The information was collected through self-reported questionnaires, and PIU was not confirmed by the use of any other means such as a clinical interview by a trained person. Thus, there is a possibility of a misreporting of actual prevalence rates. Furthermore the responses may have been biased due to discussions among the students.

Acknowledgment

The authors would like to acknowledge the Principal, PTA for granting the permission to conduct the study and young subjects and their Parents who gave consent to adolescents to participate in the study. Mrs Ancy Sebastian for translating the tool into Malayalam. With special mention to Zsolt Demetrovics, Beatrix Szeredi, and Sándor RózsaD for giving permission to use the PIUQ tool for the study and Dr Kalesh Karun in helping with analysis of data.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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