|Year : 2016 | Volume
| Issue : 1 | Page : 56-63
Medical undergraduates and pathological internet use: Interplay of stressful life events and resilience
Amrita Chakraborti, Prasenjit Ray, Mehboob U Islam, Asim Kumar Mallick
Department of Psychiatry, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
|Date of Web Publication||13-Jan-2016|
Dr. Amrita Chakraborti
B 5/4, ECTP 3, Kasba Golpark, Kolkata - 700 107, West Bengal
Background: Being in the age of technological advancement, the human mind is under constant risk of being engulfed by social media leading to pathological internet use. Cyberworld serves as a buffer under stress by means of satisfying various needs of an individual in the form of entertainment, access to information, gaining recognition and maintaining relationships. Conversely, the morbid preoccupation of the internet was found to be averted by positive coping resilience and sense of self-efficacy under stressful condition.
Objectives: To observe the pattern of internet use in medical students and to explore any possible relationship of internet use with stressful life event and resilience level.
Materials and Methods: The study sample was drawn from medical undergraduates using semistructured questionnaire consisting of demographic profile, details of various aspects of internet use, internet addiction test questionnaire (IAT), resilience scale and student stress scale (SSS).
Results: Almost all of the participants (n = 98) used the internet and social media. Mean age of the sample was 20.41 (±1.64) years, 64.3% were male and 35.7% female. On IAT, 80.6% students were moderate users, and 19.4% were problem users. IAT negatively correlated with resilience (r = −0.272, P = 0.007), whereas positively correlated with SSS total score (r = 0.330, P = 0.001) and total number of stressful life events (r = 0.335, P = 0.001). 30.6% of the students stated that a major life event had influenced their internet usage. In the linear regression model, life event appeared as a significant predictor of IAT score.
Conclusion: Medical students acknowledge the role of the internet in surviving the enormous stress level brought on by various life events. At the same time, stressful life events could predict IA.
Keywords: Life events, medical students, internet use, resilience
|How to cite this article:|
Chakraborti A, Ray P, Islam MU, Mallick AK. Medical undergraduates and pathological internet use: Interplay of stressful life events and resilience. J Health Spec 2016;4:56-63
|How to cite this URL:|
Chakraborti A, Ray P, Islam MU, Mallick AK. Medical undergraduates and pathological internet use: Interplay of stressful life events and resilience. J Health Spec [serial online] 2016 [cited 2018 Nov 15];4:56-63. Available from: http://www.thejhs.org/text.asp?2016/4/1/56/173835
| Introduction|| |
Backed by recent research and emerging scientific knowledge, the concept of 'addiction' has moved beyond the prototypical substance use to include behavioural addictions encompassing the maladaptive use of sex, the internet, video games, etc.
It is interesting to observe how a media like internet, which revolutionised human communication process and deservingly established itself as the changing face of evolution, is also being discovered to have the potential to harm the vulnerable. Social networking phenomenon, moving one step forward, has redefined human interaction and knowledge sharing, especially for paradoxically 'unsocialised' individuals by discarding the need for traditional interactive processes.
Whereas the various motives for internet use include entertainment, information, gaining recognition and maintaining relationships, pathological internet use has been associated with social networking and online chatting, identified across the countries.,,, Comfort of anonymity, nullification of need for non-verbal communication and ease of approach characterises online communication, which facilitate social enhancement in extroverts and social compensation in introverts.,,, Together, these needs might be summarised under the sole objective of social capital gaining, which may either be bonding type (stronger variety providing emotional support) or bridging type (loose, providing communication between different networks). Significantly strong relationship between college students' Facebook usage and their bridging social capital has been found in research. Apart from the intrinsic motive, a far more evident external factor may be the advent of technological advancement resulting in wide and personalised access of internet through mobile handsets. A study on Nigerian university students has demonstrated how easy availability and access naturally brought an increase in social network activities.
Internet use has a complex relationship with stress. On one hand, stress has a positive correlation with internet addiction (IA). The fact that adult addicts have higher stress than non-addicts indicates that they avoid real conflicts and problems instead of solving them. On the other hand, it is well recognised that mental and physical impact of stressful life events is buffered by the social support it provides by different means, either offline or online. Various options meant for mood management provided by cyberworld is also responsible for its increased consumption under stressful condition.
The possibility of an individual trait in the process of development of IA is evident in the observation that firstly, in spite of many people using the internet, not more than a few become addicted to it. Secondly, the resiliency factor in adolescents who were more self-reliant, counted on their intrinsic resources under unfavourable situations, protecting them from becoming dependent on internet were evident in research. Indirectly, resilience helps preserving self-integration whereas behavioural addiction may be seen as a consequence of identity confusion at the stage of 'self-pursuasion'. Thus, resilience is believed to have a negative predictive effect on pathological internet use.
Though a number of studies have been conducted to explore the relation between internet use, stress and resilience, literature on Indian population, especially medical personnel, is scant until date.
In this background, the current study was undertaken to observe the pattern of internet use in medical students, and to explore possible relationship of internet use with stressful life event and resilience level.
| Materials and Methods|| |
Study sample consisted of undergraduates of a medical college in West Bengal (a state in East India), representing both genders.
The study design was approved by the Ethical Committee of the concerned Medical College.
Semistructured questionnaire: Consisting of demographic profile and details of internet use
Before constructing the questionnaire for data collection, information was gathered in informal meetings with students regarding their access to internet, various aspects of internet usage, and motives and expectations related to online activities. Keeping in mind the popular responses, items were incorporated in the questionnaire with multiple choice questions. Open ended questions were included to enhance active participation.
Internet addiction test questionnaire (by Kimberly Young, 1999)
It is a 20 - item scale measuring addictive use of internet and extent of its impact on persons thought and behaviour measuring on a 5 - point Likert scale., A total score of 20 - 49 indicates an average user, 50 - 69 for an user facing frequent problems due to internet use and scores of 80 - 100 indicating significant problems due to internet use.
Resilience scale (by Wagnild and Young, 1987)
Consists of 25 items, measures a person's adaptive capacity under stressful conditions on a 7 point Likert scale., Items cover areas of personal competence and acceptance of self and life. The instrument showed very good internal consistency in our study.
Student stress scale (by Insel and Roth, 1991)
Consists of 31 items, each representing a life event a subject encountered within the duration of a semester. Each event is given a score indicating the amount of adjustments to be made in life as a result of the change. A score more than 300 indicates serious health risk.
Collection of data
Students were approached in batches and the semistructured questionnaire was handed over to willing students, individually, after prior briefing and obtaining written informed consent. Reliability of IA test (IAT) and resilience scale (RS) was tested in the study population.
Descriptive statistics were used to analyse sociodemographic variables and data regarding various aspects of internet use, applying Chi-square and Student's t-test for categorical and continuous variables, respectively. Pearson's method for bivariate analysis was applied to find out the relationship between concerned variables (IAT, RS, student stress scale [SSS] score, number of stressful events). Variables that are found to have significant correlation were introduced into hierarchical linear regression model. Analysis was carried out in SPSS: Statistical Package for Social Sciences, 16th version, for Windows, SPSS Inc. 233 South Wacker Drive, 11th Floor Chicago, IL 60606-6412, significance taken at 5% level.
| Results|| |
IAT and RS were found to be reliable in the study population (Cronbach's alpha 0.90 and 0.91, respectively). Factor extraction using principal component analysis with varimax rotation was used. This resulted in a 5 factor model but elaboration on factor analysis willfully excluded to concentrate on findings congruent to study objectives only.
The questionnaire was distributed among 150 students out of which 106 responded. Of these, eight questionnaires were rejected because of incomplete data. Thus, total sample size was 98. All of them, except for one person, responded that they use internet.
Mean age of the participants was 20.41 (±1.64) years, most were male (64.3%) while 35.7% were female. Most of the students were single (66.3%), rest of them were in a relationship and 1% was married. About one in every five participants was using substance, most common being tobacco (7.1%) and alcohol (4.1%), followed by others. The most widely used device to access internet was reported to be a mobile or a tablet (54.1%). Majority of the participants (39.8%) were spending between 1 and 3 h/day for using internet, evening and night being the preferred time for net usage (51%). Various purposes of using internet were pointed out by the participants, social networking (76.5%) and academic activity and research (74.5%) being the more common ones [Figure 1].
Most of the participants (83.7%) reported using social networking sites. On responding to an open question regarding their motive for using social networking sites, majority (70.4%) said it was to maintain contact with their old friends. For others, it was to make new friends (58.2%), exhibiting their creativity (22.4%), getting update about events (3.1%), to escape loneliness (3.1%), for gaming (2%), for the purpose of flirting (1%), and because they thought it was a means of low cost connectivity (1%). Those who used social networking primarily to make new friends, identified various advantages of online friendship like 'to have idea about different cultures', 'sharing being easier with unknown persons', 'capacity to access many persons at the same time', 'lack of likeminded people in their own surrounding'. Many of these responders cited multiple advantages. Although there were very few (17.3%) who did not log on to social network sites, there were many who responded with disadvantages of social networking. Reasons for not preferring social network were 'missing spontaneity of face-to-face conversation', 'online communication being often deceitful' and 'intimacy was not possible online', and also that 'one couldn't hang around with online friends'. However, 42.9% of respondents admitted they would go on meeting an online friend. Reasons shown by those willing to meet their online friend were 'to know the person better'(42.9%), 'to make the experience more interesting', 'to share interest in real life', because they 'loved blind dating' and just to use 'a way of spending money'. However, many did not wish to meet their friends-made-online for they preferred 'online friends for online interaction only', the likelihood of 'faking identity', and as they thought it was a 'waste of time'.
Mean score on SSS was 258.29 (±169.59), while most frequent responses were change in sleeping habits (62.2%), change in eating habits (55.1%), change in social activities (51%) and increased workload at school (50%). A good number of the students (30.6%) pointed out that a major life event had influenced their internet use, although the rest did not think so. Some of these events, identified by them, were leaving home, falling in love and break up [Figure 2]. A good number of the students (86.7%) said internet helped them cope with stress in different ways, such as providing better means of communication (32.7%), helping to forget tension (27.6%), fulfilling demands of entertainment (10.2%), providing option of shopping (8.2%) and helping to seek advice (8.2%). Most of them (93.9%) were satisfied with their current internet use, although a few (6.1%) wished if they could increase their internet use (e.g. by availing faster connectivity).
|Figure 2: Major life events in preceding/following six months of the responders' in whom internet usage was supposedly influenced by those|
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On IAT, most of the students (80.6%) had scores between 20 and 49 or that of a moderate user, 17 (17.3%) had scores of 50 - 69 indicating a problem user, while two persons (2.0%) scored more than 70 indicating severe IA. For the convenience of analysis, the sample was divided into moderate users with IAT sore <50 (80.6%) and problem users with IAT score >50 (19.4%). Though the moderate and problem user groups did not differ significantly in most of the personal attributes or aspects related to internet use, significant difference (P < 0.05) did exist in status of internet usage, major life event affecting internet use and satisfaction with internet use [Table 1] and [Table 2]. Problem users have been increasing their internet use significantly (P = 0.003) and their internet use was more likely getting affected by major life events (P = 0.006), in comparison to the moderate users. Problem users were found to be less satisfied with their internet use (P = 0.029) than the moderate users.
|Table 1: Comparison of personal attributes and internet use profile between moderate user and problem user|
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|Table 2: Comparison of demographic profile between moderate user and problem user|
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Problem users scored higher in SSS (P = 0.026) and in total number of stressful events (P = 0.031) in past/following 6 months in comparison to moderate user group. The mean total resilience score was lower in problem users than the moderate users, though this difference was not found to be statistically significant [Table 3]. Although gender as a variable did not distinguish problem users from average users, males showed significantly higher scores on IAT (P = 0.003). They also reported higher number of stressful events in their lives.
|Table 3: Internet use, stress and resilience between moderate and problem users|
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On Pearson's correlation IAT negatively correlated with RS (r = −0.272, P = 0.007), positively correlated with SSS total score (r = 0.330, P = 0.001) and total number of stressful events (r = 0.335, P = 0.001) [Table 4]. Based on current findings, the various parameters were put into a hierarchical linear regression model. Introduction of SSS score, number of stressful events and resiliency score did not seem to increase the predictive power on IAT score (in the presence of all control variables) in the 2nd and 3rd model but introduction of 'major life event affecting internet use' in the 4th model resulted in significant r2 change [Table 5]. However, all regression models are statistically significant (good model fit).
| Discussion|| |
Regarding the psychometric properties of IAT, 5 factor model which was obtained by principal component analysis differed from previous authors studying on different population.,
The fact that except for one participant everyone used internet indicates that internet is an integral part of an MBBS student's life. Mobile set being the preferred device points that introduction of net-friendly mobile sets aided the freedom of internet access anytime and any place they liked, thereby enhancing consumption by the student consumers. According to Griffith's availability hypothesis increased access and opportunity naturally increases the number of people who engage in such activities. As observed by Alabi in the Sub-Sahara Africa, advent of global system of mobile communication that made internet reachable to many university undergraduates through mobile phones helped them becoming Facebook users. As noted by Ferland, internet is capable of creating and maintaining various types of social capital. Others have outlined such benefits to include emotional support, useful information, or functional assistance. The pattern of internet use and the motives behind it, as evident from the current study, reflects those observations. Internet appeared to serve a variety of purposes of the participants, among which primary were academic purposes and social networking. Shopping, gaming, cyber-sex/anonymous chatting, entertainment too had their share, supporting findings of previous study on high school students by Yadav et al. Though, lower involvement in online creative activities and in cyber games stood in contrast with that study, reason might have been the different maturity level of the study sample.
The sole criterion considered to measure IA in this study was the score in IAT. Unlike previous studies, male gender did not appear as a risk factor for problematic internet use,,,, although scores on IAT found to be significantly higher, in males indicating greater online involvement.,, However, duration of internet use did not emerge as a significant variable, demarcating problem users from average users [Table 1] on the contrary to the finding by Yadav et al. It might be explained by the difference in speed in individual internet use. Besides, since internet use is not free of cost, it might have played some modifying role in duration of use. The classification of moderate users and problem users was based on IAT score (>50 indicating problem users). Previous studies by Yadav et al. and Stavropoulos et al. using the same threshold level supports our study for defining IA., Moreover, problem users differed significantly from moderate users in a number of variables [Table 1].
Social network and internet use
Use of social network was another almost universal response by students. Among the various purposes for internet use, as pointed out by the participants, social networking came as the primary online activity with 76.5% reporting in its favour. All the five motives of using social media, as identified by Nyland et al., i.e., meeting new people, entertainment, maintaining relationships, social events and media creation, were also seen in our sample with higher preference to maintaining relationship ('meet old friends') rather than making new friends. Social networking for entertainment was indicated by responses like 'to escape boredom/loneliness (3.1%) and gaming (2%). As almost 43% of students saying yes to 'will you go on meeting an online friend' and again 43% among them justified by showing reason 'to know the person better' indicate they are the group using bonding social capital as classified by Putnam, whereas bridging social capital was indicated by reasons for the same mentioned as 'to spice up the interaction', 'blind dating', 'to use a means of spending'. This also reflects the need for online interaction being social enhancement in extroverts and social compensation in introverts. Advantages of online communication as pointed out by responders highlighted features of comfort of anonymity, nullification of need for non-verbal communication and ease of approach as mentioned by earlier authors.,,, However, the most common response in this regard, 'to have idea about different cultures' is congruent with curiosity and pleasure of sharing, as suggested by another researcher.
Interestingly, in spite of the popularity of social networking sites as evident by the responses, around 30% subjects pointed out their view against online communication, pointing out lack of spontaneity and deceitfulness being common. This observation however did not appear to have discouraging influence on internet use.
Stress, resilience and internet use
Internet appeared as a new generation weapon of combating stress as majority came out with responses about 'How internet use helps you to cope'. According to many it 'keeps busy, helps forget tension' and 'provides better avenue for communication' thereby aiding positive distraction and social support seeking as a means of coping. According to Leung, stressful life events are significantly associated with the consumption of the internet for mood management (such as entertainment and information) and social compensation (such as gaining recognition and maintaining relationships) motives.
Evident from regression model was the importance of major life event in predicting IA [Table 4]. Leaving home, falling in love and break up were the most reported ones. Item pertaining to these events also received frequent responses in SSS. For e.g., 'change in sleeping habits', 'change in eating habits', 'change in social activities', all of which can be observed in someone who was getting accustomed to hostel life after joining MBBS course, can be related to 'leaving home'.
Higher total score on SSS and more number of stressful events represented problem users which set them apart from average users. Since this was a cross-sectional study, it was refrained from concluding on causal relation. However, based on the perception of participants and existing literature, some comments could be made on certain associations observed in the study. Internet as a 'stress buffering tool' being widely recognised by study participants in self-reported questionnaire reflect their perception. On the other hand, statistical analysis of the data obtained clearly indicated stressful life event, both as a distinguishing variable between problem user and average users [Table 1] and a predictor of IA [Table 5]. Hence is our assumption that on occurrence of a stressful life event, internet consumption rises which might lead to pathological use in vulnerable lacking effective resilience [Table 4]. Resilient adolescents may have more positive perception of and more intrinsic resources to effectively deal with unfavourable situations, thus less likely be lost in the virtual realm of internet.
From the current study, it appears that internet use and social networking are common among MBBS students, with problem use and addiction being comparable with other parts of the country. Medical students acknowledge the role of internet in facing the enormous stress level brought upon them by the various life events. Stressful life event emerges as a significant predictor of IA. Problem arising from internet overuse seems not due to negative implications of its stimuli, but because of the difficulties in controlling the impetus. The role of resilience to preserve this thin line of control can be understood through the users' insight into their own behaviour.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]