VIENNA — Excessive Internet use, particularly excessive use of video streaming, social networking, and instant messaging, may be associated with severe mental health problems in younger people, results of a Canadian survey indicate.
The prevalence of symptoms of depression and anxiety, as well as poorer executive functioning, was significantly increased in students who met diagnostic criteria for Internet addiction, revealed researchers at the 29th European College of Neuropsychopharmacology (ECNP) Congress.
"This leads us to a couple of questions: firstly, are we grossly underestimating the prevalence of internet addiction? And, secondly, are these other mental health issues a cause or consequence of this excessive reliance on the Internet?" said lead researcher Michael Van Ameringen, MD, FRCPC, Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Canada.
"This may have practical medical implications. If you are trying to treat someone for an addiction when, in fact, they are anxious or depressed, then you may be going down the wrong route. We need to understand this more, so we need a bigger sample, drawn from a wider, more varied population," he added.
Cause or Effect?
To examine problematic Internet use, the team administered a battery of questionnaires on Internet usage, impulsiveness, symptoms of depression and anxiety, and executive function to undergraduate students at McMaster University.
The assessments included the Dimensions of Problematic Internet Use (DPIU), which is a scale based on DSM-5 addiction criteria that examines nine dimensions of Internet use: entertainment and video streaming, social media, gaming, messaging, dating apps, gambling, sexual content, online shopping, and information seeking.
The assessments were completed by 254 students (mean age, 18.5 years), of whom 74.5% were female. Criteria for Internet addiction, as determined on the basis of scores on the Internet Addiction Tool (IAT), the were met by 12.5% of participants; 42% met the addiction criteria on the DPIU.
The dimensions of Internet use most commonly reported as being difficult to control were video streaming (55.8% of participants), social networking (47.9%), and instant messaging (28.5%).
Individuals who screened positive for Internet addition on the IAT spent significantly more of their nonessential leisure time on the Internet than those who were not addicted (P < .001). A similar pattern was seen for those who screened positive on the DPIU, although the difference was not so marked (P < .05).
Those who screened positive on the IAT and on the DPIU for Internet addiction had significantly higher levels of functional impairment, depression and anxiety symptoms, executive function impairment, and attention problems than those who did not. They were also significantly more likely to have symptoms of attention-deficit/hyperactivity disorder (ADHD) (P < .001 in all cases).
The team also found that participants who screened positive for Internet addiction were more likely to have difficulties controlling instant messaging usage than those who screened negative (P = .01). No other differences were noted.
It is not possible to determine from the current results whether problematic Internet use is associated with preexisting psychopathologies or is causing a novel set of mental health problems.
"We don't know, because it's a cross-sectional thing. So it could be that for people who are depressive or anxious, it's a way of coping with that; they're spending all this time on the Internet and just can't get away from it," Dr Van Ameringen told Medscape Medical News.
"It could be people who have just very poor control. That's suggested by some of the ADHD symptoms and some of the impulsive symptoms that some the people with ADHD have. They're easily distracted, and [the Internet is] constant stimulation," he added.
It is also not clear whether there is something inherently problematic in the temptation to instantly reply to messages, which is a central feature of modern social networking.
Dr Van Ameringen said this phenomenon may be "only problematic for some people.
"I'm not sure that you're checking your mobile phone every 4 seconds, as soon as it beeps. If your phone beeps right now, you're not stopping this interview because of that. You see young people when there's a professor speaking to them, and when their phone beeps, they will pull it out. There's just no kind of control. They have to see that message that's on their phone," he said.
Jan Buitelaar, MD, from Radboud University Nijmegen Medical Center, the Netherlands, who is also a member of the ECNP Child and Adolescent Disorders Treatment Scientific Advisory Panel, agreed, saying that excessive Internet use "is an understudied problem."
He noted that it "may disguise mild or severe psychopathology," adding that "excessive use of the Internet may be strongly linked to compulsive behavior and addiction." Dr Buitelaar pointed out that "further study is needed in larger populations."
Although the notion of Internet addiction is controversial, the IAT, which is the gold-standard assessment tool, was developed in 1998, before the widespread adoption of smartphones and broadband Internet connections.
"We were concerned that the IAT questionnaire may not have been picking up on problematic modern Internet use or showing up false positives for people who were simply using the Internet, rather than being overreliant on it," said Dr Van Ameringen.
The study received no funding. The authors and Dr Van Ameringen have disclosed no relevant financial relationships.
29th European College of Neuropsychopharmacology (ECNP) Congress. Abstract P.6.e.002. Presented September 18, 2016.
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Cite this: Youth Internet Addiction Linked to Serious Mental Health Issues - Medscape - Sep 20, 2016.