|Year : 2020 | Volume
| Issue : 1 | Page : 70-75
Unraveling the net of self-esteem, stress, and coping skills in the era of internet addiction
Amey Y Angane, Kranti S Kadam, Geetanjali S Ghorpade, Vishnu B Unnithan
Departments of Psychiatry, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra, India
|Date of Submission||21-Nov-2019|
|Date of Decision||03-Feb-2020|
|Date of Acceptance||20-Feb-2020|
|Date of Web Publication||30-May-2020|
Dr. Amey Y Angane
Department of Psychiatry, Seth G.S. Medical College and K.E.M. Hospital, Mumbai, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Internet is one of the most popular forms of media, but heavy use may result in negative effects like decreased self-esteem. New and unexpected life changes in medical students cause increased perception of stress leading to internet addiction as a way of coping. The purpose of this study was to assess the prevalence of internet addiction in medical students, to assess the level of perceived stress and self-esteem in them, and to obtain the correlation between internet addiction with perceived stress as well as self-esteem. Various coping strategies implemented by students using internet were found. Methodology: A cross-sectional study with 200 students recruited by stratified random sample technique was undertaken. After taking informed consent, participants were assessed on Young's internet Addiction Test (YIAT-20), Rosenberg's Self-Esteem Scale, Cohen's Perceived Stress Scale-10, and Brief COPE Scale. Two groups were made using YIAT-20, those having internet addiction and those without, the two being compared. Results and Discussion: Mean age of medical students was 19.16 years (±1.45). Meantime of internet usage was 107.15 min (±67.99) per student per day. The prevalence of internet addiction was 18%. The group of students that had internet addiction showed high perceived stress (P = 0.001) and low self-esteem (P < 0.0001). Internet use had a positive correlation with perceived stress (r = 0.2866) and a negative correlation with self-esteem (r = −0.2918). Students with internet addiction used more emotion-based coping skills rather than task-oriented coping skills (P = 0.0032). Conclusions and Implications: Medical students having internet addiction were found to have higher levels of perceived stress, lower levels of self-esteem and predominantly emotion-based coping skills when compared to students having average internet use who have task-oriented coping skills.
Keywords: Coping skills, internet addiction, medical students, perceived stress, self-esteem
|How to cite this article:|
Angane AY, Kadam KS, Ghorpade GS, Unnithan VB. Unraveling the net of self-esteem, stress, and coping skills in the era of internet addiction. Ann Indian Psychiatry 2020;4:70-5
|How to cite this URL:|
Angane AY, Kadam KS, Ghorpade GS, Unnithan VB. Unraveling the net of self-esteem, stress, and coping skills in the era of internet addiction. Ann Indian Psychiatry [serial online] 2020 [cited 2020 Jul 12];4:70-5. Available from: http://www.anip.co.in/text.asp?2020/4/1/70/285516
| Introduction|| |
Internet has become one of the most popular forms of media, but heavy use of the internet results in many negative effects. Young has defined problematic internet-using behavior as “internet addiction.” Internet addiction is defined as any online-related, compulsive behavior which interferes with normal living and causes severe stress on family, friends, loved ones, and one's work environment. No single behavioral pattern defines internet addiction. These behaviors include: compulsive use of the internet, a preoccupation with being online, lying or hiding the extent or nature of your online behavior, and an inability to control or curb your online behavior.
Adolescence can be a particularly vulnerable period in terms of life changes and stress. Students' reactions to these difficult experiences can vary widely, ranging from stress, depression, anxiety and even suicidal ideation. One explanation for the variation in reactions to stressful life events is the different approaches to coping. Researchers, following the lead of Lazarus and Folkman, have frequently grouped coping strategies into three categories, problem focused (e.g., engaging in behaviors to address a problem), active-emotional (e.g., venting), and avoidant-emotional (e.g., denial). Problem-focused coping is often considered the more adaptive approach because, in contrast to emotion-focused coping, it emphasizes action; action targeted toward change. Relatively little current research exists on the role that the internet may play in the coping and coping approaches used by college students.
According to problem behavior theory, use of alcohol, smoking, and illicit substance use have been grouped as problem behaviors of adolescents, which have the same psycho-social proneness. Internet addiction, which emerged as a behavior problem in adolescents after the internet developed, has not been included or comprehensively compared to previously defined problem behaviors. If internet addiction is new problem behavior, treatment interventions should be developed in comprehensive programs for this problem behavior.
Adolescents, in dire need of mood repair due to college-related problems, appear to seek comfort in the internet where paradoxically people appear to show more care for others' feelings. Relaxing, having fun, showing off their own achievements and enviable personal lives to receive encouragement, impress people, and gain a superior social standing were some of their other aims.
The research that does exist suggests that internet use maybe both a source of stress and also a useful means of coping with stress. Kraut et al. found time spent on the internet to be positively associated with levels of depression and social anxiety and negatively associated with family communication; however, Kraut et al. found that time on the internet was positively associated with communication, social involvement and overall well-being. This type of discrepancy has been indicated in other studies , suggesting the need for a more nuanced approach to examining the relationship between internet use and stress for college students.
Adolescent's use of internet is highly associated with its perception as a coping style and way of a compensation of some deficiencies such as low self-esteem. Various studies exist on this issue and it is concluded that a strong relationship exists between these two variables. Internet allows them to feel better, because it is a mode for which they adopt a different personality and social identity.,
The purpose of this study was to assess the patterns and prevalence of internet addiction in medical college students and whether levels of stress motivate internet use. The study further analyzed how self-esteem played a role in internet addiction and how internet use has become a new coping strategy for adolescents and young adults. It sheds light on how online behavior statistically predicted the level of perceived stress, self-esteem, and traditional coping strategies. It also aimed to find out the difference if present, in the type of coping mechanism used by students found to have internet addiction as opposed to average internet users.
| Methodology|| |
Ethical clearance from the Institutional Ethics Committee was sought for before beginning the study. Approval for the study was obtained from the Institutional Ethics Committee-1 of Seth G.S. Medical College, approval statement numbered IEC (II)/OUT/6/17 dated January 4, 2017. Written informed consent was taken from all participants for consent to participate in the study and for publication of the results obtained after completion of the study. This was a cross-sectional observational study and was conducted among undergraduate students of a medical college in Mumbai.
By applying the stratified random sampling technique, 200 medical undergraduate students studying in first, second, third, and final years of the MBBS course, who were >18 years of age and willing to give informed consent were recruited into the study. Students were administered the questionnaires in the college campus itself.
They were administered:
Semi-structured pro forma
To document the demographic profile, duration of internet usage, the mode of internet usage (desktop, laptop, smartphone, and others) and patterns of use, which included all types of internet sites and android applications.
Young's Internet Addiction Test 20
It is a 20-item questionnaire, answered in a five-point Likert scale. It is freely available in public domain. It recognizes internet addiction and also covers the degree to which their internet use affects their daily routine, social life, productivity, sleeping pattern, and feelings. The minimum score is 20, and the maximum is 100; the higher the score, the greater the problems internet use causes. Those scoring 50 or higher were considered the ones having internet addiction  and two groups were made accordingly,
- Internet addiction
- Average internet users.
Perceived Stress Scale 10
It is one of the more popular tools for measuring psychological stress. It is a self-reported questionnaire that was designed to measure “the degree to which individuals appraise situations in their lives as stressful.” For this study, the Perceived Stress Scale 10 version was used. Total scores range from 20 to 40. Scores of 20 or higher were taken as high perceived stress.
Rosenberg Self Esteem Scale
It is one of the most widely used self-report methods for assessing global self-esteem. The tool consists of 10 items, five of which are positively and five negatively worded. Total scores range from 20 to 40. Scores of 20 or higher were taken as high self-esteem.
Brief COPE Scale
The Brief COPE scale was proposed to assess a broad scope of coping behavior among adults for all conditions, illnesses or nonillnesses. The scale is rated by the four-point Likert scale and comprises 14 dimensions and 28 items (two for every dimension). They are self-distraction, active coping, denial, substance use, use of emotional support, use of instrumental support, behavioral disengagement, venting, positive reframing, planning, humor, acceptance, religion, and self-blame. The higher score in any dimension represents greater coping strategies used by the respondents.
The collected data were tabulated. The frequency distribution of collected demographic data was made. The obtained scores on Young's internet Addiction Test (YIAT-20), PSS 10 and Rosenberg's Self-Esteem Scale (RSES) were then associated with the tabulated demographic data using contingency tables to assess for any significant results using Chi-square test. Pearson's coefficient was also applied to correlate perceived stress and self-esteem with internet addiction. Linear regression models were obtained. Two groups were made using YIAT-20, those having internet addiction and those without, and the association between the coping skills of the two was made. The entire statistical analysis was carried out using GraphPad Prism software (San Diego, CA).
| Results|| |
All the 200 medical undergraduate students recruited by stratified random sampling technique from students studying in the first, second, third, and final years of the MBBS course who were administered the questionnaire returned completed forms. The response rate was 100%.
In the study, the mean age of the population was 19.27 (±1.45) years with the minimum age being 18 years and maximum being 24 years. One hundred and two males and 98 females participated in the study. Ninety-four percent of students used smartphones, whereas the rest used desktops and laptops. The mean time of internet usage per student per day was 107.15 ± 68 min [Table 1].
Students spent 47% time on the internet for chatting, 28% time using social networking sites, 12.5% time viewing online videos, 7.5% time reading online books, 4% time gaming, and the rest 1% time was used for online shopping and other activities [Figure 1]a.
|Figure 1: (a) Horizontal bar graph showing different patterns of internet use, (b) linear regression graph showing correlation between internet addiction and perceived stress, (c) linear regression graph showing correlation between internet addiction and self-esteem, (d) graphical analysis of coping skills of average internet users, (e) graphical analysis of coping skills of internet addicts|
Click here to view
The average score on YIAT-20 was 35.6 (standard deviation 16.06), RSES was 20.95 (standard deviation 5.01), and Cohen's Perceived Stress Scale was 18.42 (standard deviation 6.01).
The prevalence of internet addiction was 18%.
Internet addiction and perceived stress had a strong association (P = 0.001) [Table 2] and a positive correlation (r = 0.2866) [Figure 1]b. Internet addiction and self-esteem had a strong association (P < 0.0001) [Table 3] and negative correlation (r = −0.2198) [Figure 1]c. A strong association was found between internet addiction and emotion-based coping skills (P = 0.0032) [Table 4].
Students with average internet use resorted to more task-oriented coping skills (active coping, instrumental support, and planning) [Figure 1]d as opposed to students with internet addiction used more of emotion-based coping skills (positive reframing, emotional support, humor, venting) [Figure 1]e.
The association between prevalence of internet addiction with the sociodemographic variables of gender and mode of internet usage (PC or mobile) was found to be statistically insignificant.
| Discussion|| |
An almost equal number of males (51%) and females (49%) participated. Other studies on internet addiction in medical students by Malviya et al. (67.4%) and Nath et al. (60.6%) had male predominance and Chaudhari et al. (56.7%) had female predominance. Maximum students (94%) used smartphones as a major means for accessing the internet as opposed to desktops and laptops (6%) which was keeping in touch with the studies done by Nath et al. and Chaudhari et al. This showed that smartphones provided individual with an opportunity to have easy and continuous access to internet which lead to excess and unintended use of internet. Furthermore, the meantime of internet usage per student per day was around 1 h and 47 min which itself was very high. This showed that internet has definitely become one of the most important human needs as it caters various requirements in a quick and comprehensive way with a touch of a button. In fact, the 2011 Cisco Connected World Technology Report  indicated that roughly 80% of college students perceive the internet to be “close to” or “as vital” as air, water, food, and shelter.
The study showed that the prevalence of internet addiction was 18%. This finding was almost in keeping with the prevalence of 15.2% as reported by Paul et al. in a study among college students from South India and 23% in Malviya et al. in the college of Central India. Sharma et al. reported 7.4% prevalence of internet addiction in professional college students in India which was on the lower side. Nath et al. reported that 46.8% of respondents were at increased risk for addiction which was quite high. In studies done abroad, a study on Turkish college students showed the prevalence of internet addiction to be 9.7%, while in a study among Iranian medical students, the prevalence was 10.8%.
Patterns of internet use showed a trend toward internet being used more for socializing and means of communication. It was seen that the students spent maximum time on the internet for chatting which included WhatsApp, Hike, Skype, Snapchat, Telegram, Hangout etc., followed by social networking sites which included Facebook, Twitter, Pinterest, and Instagram. This higher use of internet for social media and interactions was in keeping with findings by Nath et al. This also showed that the internet has also become a source of fulfilling emotional and social needs. Adolescents and young adults were using internet as a tool for emotional gratification and entertainment rather than for academic needs. They also used internet as a means to develop intimate relationships to decrease stress.
Internet addiction and perceived stress had a strong association (P = 0.001) and a positive correlation [Table 5]. These findings were keeping in with findings of the study done by SanghviandRai. This also suggests that higher levels of stress motivated internet use either to relieve stress or as a means of avoiding stressful situations. Adolescent and young adults turn to internet during stressful times not only because it caters to a variety of needs and gives unlimited options for entertainment but also due to its easy availability and accessibility. However, this may result in spending hours on internet leading to further increase in stress and thus, a vicious cycle.
|Table 5: Correlation of internet use with levels of perceived stress and self-esteem|
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Internet addiction and self-esteem had a strong association (P < 0.0001) and negative correlation [Table 5]. It concluded that lower self-esteem motivates more internet use. This was keeping in with findings of the study done by Shaw and Gant. Thus, students having low self-esteem turn toward internet for appreciation from others and boosting self-confidence.
A strong association was found between internet addiction and emotion-based coping skills (P = 0.0032) concluding the fact that due to maladaptive coping skills students turn more to internet to decrease the stress levels. Students with average internet use resorted to more task-oriented coping skills [Table 6]. In contrast, students with internet addiction used more of emotion-based coping skills. Thus, internet had become a place for venting out stress and frustration and seeking emotional support. Students should be taught alternative task-oriented coping strategies that focus more on dealing with the problems that would reduce stress levels and would reduce pathological use of internet.
The study is different from previous studies as participants were not recruited through WhatsApp messages or mail. Such recruitment methods result in sampling bias, which has been a major limitation of several previous studies as high internet users who are more likely to be interested in the results would subsequently enrol for the study. Thus, the main strength of this study is the offline mode used for the collection of data. The questionnaires were administered to all the medical students on the campus itself. Further, while the study questionnaires were being filled by the participants, parents, and lecturers were kept away to encourage the participants to answer truthfully, without regrets and the worry of subsequent repercussions.
This study was done in a single medical institute and from a metropolitan city and thus the result obtained cannot be generalized nationally. Since the study was a cross-sectional study, no causal relationships could be established. There may have been a response and recall bias while answering the internet addiction scale. Previous exposure to internet and the student's own personality governed by his upbringing, expectations from and need for internet usage may all contribute to actual usage being slightly different from that reported. Furthermore, since all the questionnaires were self-reported, individual factors such as upcoming exams, family relations, various stressors, and personal goals may all result in variation of scores in the self-esteem and perceived stress levels even in otherwise similar situations.
The study emphasizes need for longitudinal studies on a large scale taking into account other variables that could overcome all the above limitations and provide strategic direction for psychiatrists to combat this menace. Further studies at various other centers, and in multiple cultural settings carried out with multisectoral coordination across the country can chart out the further roadmap in this field for the student community at large. Studying psychopathology in students with internet addiction is a future recommendation.
| Conclusions and Implications|| |
In this study, the prevalence of internet addiction in students was found to be 18%, which was definitely a noticeable finding encouraging us to look into the problem of internet addiction in a grave manner. The mean time of internet usage was found to be 107.15 (±68) min/day which is nearly about 1 h and 47 min showing that definitely internet has now become like a basic human need. Majority of the population used smartphones as their major source of internet use as opposed to desktops and laptops due to its easy availability and accessibility leading to further rise in internet addiction. Students spent more time on internet for chatting and social networking purpose on the contrary to using it for academic purpose pointing out the new trend of adolescent and young adults toward building intimate relationships through internet. The study concluded an association between internet addiction and perceived stress and with a positive correlation between the two suggesting that higher levels of stress motivate internet use. The study also concluded a strong association between internet addiction and self-esteem with a negative correlation between the two suggesting that lower levels of self-esteem motivate internet use. The study also concluded a strong association between internet addiction and emotion-based coping skills leading us to the conclusion that faulty coping skills also lead to higher internet use leading to its addiction.
It is an open secret that the internet is now becoming like a basic human need. If internet addiction is a new problem behavior, treatment interventions should be developed in comprehensive programs for this problem behavior which currently seems limited. Measures to create awareness among college going students or maybe even at school-going age is necessary for early identification and to prevent internet addiction as it might cause academic decline. Furthermore, adolescents and young adults seem to be using internet as one of the means of dealing with stress. However, using internet seems to be a faulty way of coping leading to further increase in stress and a vicious cycle. Communication between parents and children should increase so it becomes a better way of dealing with stress. Measures to improve self-esteem by healthy means should also be emphasized. Psycho-education of parents regarding gravity of the problem of internet addiction is also the need of the hour. Furthermore, correcting maladaptive coping techniques might definitely help to reduce the problem of internet addiction.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]