Description of internet addiction among Chilean medical students: a cross-sectional study

Revealing the Intellectual Structure and Evolution of Digital Addiction Research: An Integrated Bibliometric and Science Mapping Approach

The current study uses "digital addiction" as an umbrella term to refer to addiction to the Internet, social media, smartphones, digital devices, video games, or similar digital technologies. The study aims to investigate the scientific landscape of the digital addiction research field through combining bibliometric and science mapping analysis and to facilitate insight into the development and evolution of this knowledge base. Data for the analysis were extracted from the Scopus database, which covers a wide range of journal articles, with 429 articles addressing digital addiction included in the analysis. The science mapping analysis was performed over three consecutive time periods using SciMAT software to observe the thematic evolution. The results indicated that addictive behavior was the most significant theme across the three time periods. Cross-sectional studies addressing the risk factors or outcomes of addiction among adults and different sexes were prevalent during the first period (1997-2012), while interest moved to the addictive behavior of adolescents and students during the second period (2013-2017). Research during the third period (2018-2022) was driven by smartphone and social media addiction, and resilience as a preventive factor garnered more research interest than previously studied risk factors, which may indicate a perspective change by researchers. Implications are suggested for future investigations of digital addiction.

Internet Addiction among Brazilian Students: Prevalence and Association with Emotional Problems

The objective of this study was to evaluate the prevalence of Internet addiction (I.A.) among students and its association with emotional problems. A total of 2,214 students (M = 21.9; SD = 1.86) from all Brazilian regions responded to an online questionnaire and were classified according to the IAT instrument score in NRU= No-risk Users, LRU= Low-risk Users, and RHU= Risk and High-risk Users. DASS-21 measured emotional problems, and the data were analyzed using descriptive and inferential statistics. It was observed that 12.5% were classified as URAR and presented higher levels of depression (p< 0.001), anxiety (p< 0.001), and stress (p< 0.001). The main predictors for I.A. were depression (aOR = 3.2), anxiety (aOR = 2.5), and stress (aOR = 2.6). These results confirm an association between DI and emotional problems, as indicated in the literature.

Internet Addiction among Undergraduate Medical Students of a Medical College: A Descriptive Cross-sectional Study

Introduction

Internet addiction denotes the compulsive use of the internet which affects physical, mental, social, psychological and academic aspects of life of an individual. Very few studies among medical students in regard to internet addiction have been conducted. Our study aimed to determine the prevalence of internet addiction among undergraduate medical students of a medical college.

Methods

This is a descriptive cross-sectional study conducted in a medical college from September to December, 2021 after obtaining ethical clearance from the Institutional Review Committee (Registration number: 442). The study was conducted among 229 medical students using convenience sampling technique. Internet addiction test questionnaire was used for collecting data. Data were entered in Google Spreadsheet and analysed with Microsoft Excel 2016. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data.

Results

The prevalence of internet addiction among 229 undergraduate students was found to be 121 (52.84%) (43.95-61.73 at 95% Confidence Interval). Out of them, mild and moderate internet addiction accounted for 90 (74.38%) and 31 (25.62%) respectively.

Conclusions

The prevalence of internet addiction in this study was higher in comparison to the other studies conducted in similar settings.

Keywords

internet addiction; medical students; Nepal; prevalence.

How Have Researchers Acknowledged and Controlled for Academic Work Activity When Measuring Medical Students' Internet Addiction? A Systematic Literature Review

Internationally, medical students' Internet Addiction (IA) is widely studied. As medical students use the Internet extensively for work, we asked how researchers control for work-related Internet activity, and the extent to which this influences interpretations of "addiction" rates. A search of PubMed, CINAHL, Web of Science, Scopus, and Google Scholar was conducted on the search phrase of "medical students" and "internet addiction" in March 2020. In total, 98 studies met our criteria, 88 (90%) used Young's Internet Addiction Test, and the studies' IA rates ranged widely. Little note was taken of work-related activity, and, when discussed, had little to no impact on the interpretation of Internet "addiction". Studies seldom accounted for work-related activities, researcher bias appears to influence their position, "usage" appears conflated with "addiction", and correlations between "addiction" and negative behaviours are frequently confused with one-way causation. In spite of IA's not being officially recognised, few researchers questioned its validity. While IA may exist among medical students, its measurement is flawed; given the use of the Internet as a crucial medical education tool, there is the risk that conscientious students will be labelled "addicted", and poor academic performance may be attributed to this "addiction".

Findings on the relationship between Internet addiction and psychological symptoms in Brazilian adults

This study evaluated the prevalence of Internet addiction (IA) and its association with negative psychological symptoms in Brazilian adults. A network analysis was conducted to estimate specific variables and their expected influence on IA. In this cross-sectional study, 15,476 adults (M_age  = 37.5, SD = 9.59) completed an open web-based survey. Three questionnaires were used: the Internet Addiction Test (IAT), Depression Anxiety and Stress Scale (DASS-21) and Satisfaction With Life Scale (SWLS). Based on IAT scores, participants were classified as No-Risk user (NRU), Low-Risk user (LRU) or High-Risk user (HRU). We observed that 4.8% of the participants were classified in the HRU group. In addition, their risk for severe symptoms of depression was 10 times higher and, for anxiety, seven times higher than that in the NRU group (p < .001). Time spent using smartphones was also significantly higher in the HRU group (M_hours  = 5.1, p < .001). The main factors associated with IA were depression, gender and anxiety, but the variable "having children" was the most influential in the IA network. These findings suggest that psychiatric symptoms are the main factors associated with IA among the adult population.

Associations of personality traits with internet addiction in Chinese medical students: the mediating role of attention-deficit/hyperactivity disorder symptoms

BACKGROUND

Internet addiction (IA) has emerged as a public health concern, particularly among adolescents and young adults. However, few studies have been conducted in medical students. This multi-center study aimed to investigate the prevalence of IA in Chinese medical students, to examine the associations of big five personality traits with IA in the population, and to explore the possible mediating role of attention-deficit/hyperactivity disorder (ADHD) symptoms in the relationship.

METHODS

Self-reported questionnaires, including Internet Addiction Test (IAT), Big Five Inventory (BFI), Adult ADHD Self-Report Scale-V1.1 (ASRS-V1.1) Screener, and socio-demographic section were distributed to clinical students at 3 medical schools in China. A total of 1264 students became the final subjects.

RESULTS

The overall prevalence of IA among Chinese medical students was 44.7% (IAT > 30), and 9.2% of the students demonstrated moderate or severe IA (IAT ≥ 50). After adjustment for covariates, while conscientiousness and agreeableness were negatively associated with IA, neuroticism was positively associated with it. ADHD symptoms mediated the associations of conscientiousness, agreeableness and neuroticism with IA.

CONCLUSION

The prevalence of IA among Chinese medical students is high. Both personality traits and ADHD symptoms should be considered when tailored intervention strategies are designed to prevent and reduce IA in medical students.

Problematic internet use and its correlates among resident doctors of a tertiary care hospital of North India: A cross-sectional study

BACKGROUND

Problematic Internet use/ Internet addiction (IA) has gained the attention of mental health professionals recently and studies have found that medical professionals are not immune to IA with prevalence rate ranging from 2.8 to 8%. Few studies from India have also reported high rates of IA among medical students. The term 'Problematic internet use' is being increasing used nowadays in place of IA as it signifies a better terminology than the word 'addiction' per se. However, there is lack of information among resident doctors.

AIM

To evaluate the prevalence of problematic Internet use and its association with depressive symptoms, perceived stress, and health care outcomes among resident doctors working in a government funded tertiary care Institute.

MATERIALS & METHODS

An online e-mail survey was carried out among medical professionals (a total of 1721 doctors) in a tertiary care hospital located in Chandigarh, India out of whom 376 responded. The residents doctors were the postgraduate trainees (MBBS) and those residents who have complete post-graduation and working as senior residents/registrar (MBBS, MD/MS). They were in the age group ranging from 24 to 39 years. The survey included Young's Internet addiction test (IAT), Patient Health Questionnaire-9 (PHQ-9), Cohen's Perceived Stress Scale, Maslach Burnout Inventory and a self designed questionnaire to assess the health care related outcomes.

RESULTS

On IAT, 142 residents (37.8%) scored <20 i.e., normal users and 203 residents (54%) had mild addiction. Only 31 residents (8.24%) had moderate addiction category, none of the residents had severe IA (score>80). Those with IA reported higher level of depressive symptoms, perceived stress and burnout. There was positive association between ever use of alcohol and watching pornography (as a part of recreational activities) with IA. Significantly higher proportion of those with IA, reported having faced physical abuse and verbal abuse in the hands of the patients/caregivers.

CONCLUSIONS

The present study suggests that about 8.24% of resident doctors have Problematic internet use/IA. Problematic internet use/IA is associated with presence of higher level of depressive symptoms, perceived stress and burn out. Further, Problematic internet use/IA is also associated with higher likelihood of facing violence in the hands of patients and their caregivers.

Internet use behaviors, internet addiction and psychological distress among medical college students: A multi centre study from South India

BACKGROUND

Internet Addiction (IA) among medical students and its association with psychological distress can impact their academic progress and long term career goals. IA would also indirectly impact community of health care professionals and the society. Thus, there is a need to investigate the IA among medical students.

OBJECTIVES

This study was a first such attempt to explore internet use behavior's, IA, among a large group of medical students across multiple centers and its association with psychological distress primarily depression.

METHODS & MATERIALS

1763 medical students aged 18 to 21 years, pursuing Bachelor of Medicine; Bachelor of Surgery (MBBS) from three south Indian cities of Bangalore, Mangalore and Trissur participated in the study. The socio-educational and internet use behaviors data sheet was used to gather demographic information and patterns of internet use, IA Test (IAT) was utilized to assess IA and Self-Report Questionnaire (SRQ-20) assessed psychological distress primarily depression.

RESULTS

Among the total N = 1763, 27% of medical students met criterion for mild addictive internet use, 10.4% for moderate addictive internet use, and 0.8% for severe addiction to internet. IA was higher among medical students who were male, staying in rented accommodations, accessed internet several times a day, spent more than 3 h per day on internet and had psychological distress. Age, gender, duration of use, time spent per day, frequency of internet use and psychological distress (depression) predicted IA.

CONCLUSIONS

A substantial proportion of medical students have IA which can be detrimental for their medical education progress and long term career goals. Early identification and management of IA and psychological distress among medical students is crucial.

Internet Use Patterns, Internet Addiction, and Psychological Distress Among Engineering University Students: A Study from India

BACKGROUND

Internet addiction (IA) among university engineering students and its association with psychological distress can impact their educational progress, academic competence, and long-term career goals. Thus, there is a need to investigate the IA among engineering students.

OBJECTIVES

This study was a first such attempt to explore internet use behaviors, IA, among a large group of engineering students from India, and its association with psychological distress primarily depressive symptoms.

METHODS

One thousand eighty six engineering students aged 18-21 years pursuing bachelors in engineering from the south Indian city of Mangalore participated in the study. The socio-educational and internet use behaviors data sheet was used to gather demographic information and patterns of internet use, Internet Addiction Test (IAT) was utilized to assess IA, and Self-Report Questionnaire (SRQ-20) assessed psychological distress primarily depressive symptoms.

RESULTS

Among the total N = 1086, 27.1% of engineering students met criterion for mild addictive internet use, 9.7% for moderate addictive internet use, and 0.4% for severe addiction to internet. IA was higher among engineering students who were male, staying in rented accommodations, accessed internet several times a day, spent more than 3 h per day on internet, and had psychological distress. Gender, duration of use, time spent per day, frequency of internet use, and psychological distress (depressive symptoms) predicted IA.

CONCLUSIONS

A substantial proportion of engineering students have IA which can be detrimental for their educational progress in university studies and long-term career goals. Early identification and management of IA and psychological distress among engineering students is crucial.

Internet addiction detection rate among college students in the People's Republic of China: a meta-analysis

BACKGROUND

With the development of economy and technology, the Internet is becoming more and more popular. Internet addiction has gradually become a serious issue in public health worldwide. The number of Internet users in China has reached 731 million, with an estimated 24 million adolescents determined as having Internet addiction. In this meta-analysis, we attempted to estimate the prevalence of Internet addiction among College Students in the People's Republic of China in order to improve the mental health level of college students and provide evidence for the prevention of Internet addiction.

METHODS

Eligible articles about the prevalence of Internet addiction among college students in China published between 2006 and 2017 were retrieved from online Chinese periodicals, the full-text databases of Wan Fang, VIP, and the Chinese National Knowledge Infrastructure, as well as PubMed. Stata 11.0 was used to perform the analyses.

RESULTS

A total of 26 papers were included in the analyses. The overall sample size was 38,245, with 4573 diagnosed with Internet addiction. The pooled detection rate of Internet addiction was 11% (95% confidence interval [CI] 9-13%) among college students in China. The detection rate was higher in male students (16%) than female students (8%). The Internet addiction detection rate was 11% (95% CI 8-14%) in southern areas, 11% (95% CI 7-14%) in northern areas, 13% (95% CI 8-18%) in eastern areas and 9% (95% CI 8-11%) in the mid-western areas. According to different scales, the Internet addiction detection rate was 11% (95% CI 8-15%) using the Young scale and 9% (95% CI 6-11%) using the Chen scale respectively. Cumulative meta analysis showed that the detection rate had a slight upward trend and gradually stabilized in the last 3 years.

CONCLUSION

The pooled Internet addiction detection rate of Chinese college students in out study was 11%, which is higher than in some other countries and strongly demonstrates a worrisome situation. Effective measures should be taken to prevent further Internet addiction and improve the current situation.

Internet Gaming Disorder in Adolescents: Personality, Psychopathology and Evaluation of a Psychological Intervention Combined With Parent Psychoeducation

Internet Gaming Disorder is an increasingly prevalent disorder, which can have severe consequences in affected young people and in their families. There is an urgent need to improve existing treatment programs; these are currently hampered by the lack of research in this area. It is necessary to more carefully define the symptomatic, psychosocial and personality characterization of these patients and the interaction between treatment and relevant variables. The objectives of this study were three: (1) to analyze the symptomatic and personality profiles of young patients with Internet Gaming Disorder in comparison with healthy controls; (2) to analyze the effectiveness of a cognitive behavioral treatment on reducing symptomatology; and (3) to compare the results of that treatment with or without the addition of a psychoeducational group offered to the parents. The final sample consisted of 30 patients consecutively admitted to a specialized mental health unit in Spain, and 30 healthy controls. The experimental group received individual cognitive-behavioral therapy. The experimental group was divided into two subgroups (N = 15), depending on the addition or not of a psychoeducational group for their parents (consecutively admitted). Scores on the Millon Adolescent Personality Inventory (MACI), the Symptom Checklist-Revised (SCL-90-R), the State-Trait Anxiety Index (STAI), and other clinical and psychopathological measures were recorded. The patients were re-assessed post treatment (except for the MACI questionnaire). Compared with healthy controls, patients did not differ in symptomatology at baseline, but scored significantly higher in the personality scales: Introversive and Inhibited, and in the expressed concerns scales: Identity Confusion, Self-Devaluation, and Peer Insecurity and scored significantly lower in the Histrionic and Egotistic scale. In the experimental group, pre-post changes differed statistically on SCL-90-R scales Hostility, Psychoticism, and Global Severity Index and on the diagnostic criteria for Internet Gaming Disorder, regardless of the addition of a psychoeducational group for parents. Pre-post changes did not differ between experimental subgroups. However, the subgroup without psychoeducation for parents presented statistically higher drop-out rates during treatment. The results of this study are based on a sample of patients seeking treatment related to problems with online gaming, therefore, they may be of value for similar patients.

Prevalence, associated factors and impact of loneliness and interpersonal problems on internet addiction: A study in Chiang Mai medical students

INTRODUCTION

Internet addiction is common among medical students, and the prevalence is higher than the general population. Identifying and creating solutions for this problem is important. The aim of this study was to examine the prevalence and associated factors, particularly loneliness and interpersonal problems among Chiang Mai medical students.

MATERIALS AND METHODS

Of 324 first to sixth year medical students, 56.8% comprised females with a mean age of 20.88 (SD 1.8). All completed questionnaires related to the objectives and activities of internet use, the Young Internet Addiction Test, the UCLA loneliness scale, and the Interpersonal Problems Inventory were employed to identify internet addiction.

RESULTS

In all, 36.7% of the subjects exhibited internet addiction, mostly at mild level. Amount of time used daily, loneliness and interpersonal problems were strong predictors (beta = 0.441, p < 0.05, beta = 0.219, p < 0.001 and beta = 0.203 p < 0.001, respectively), whereas age and sex were not. All objectives of using internet contributed to the variance of internet addiction score. For internet activities, only non-academic or studying contributed. The final model accounted for 42.8% of total variance of the internet addiction score.

CONCLUSION

Even though most addiction was at a mild level, careful strategies should be applied to better understand the situation. Along with a screening for potential internet addiction among medical students, attention should be paid to identifying those who experience loneliness and interpersonal problems, because both are strong predictors that can be improved by a variety of appropriate intervention.

Prevalence of excessive internet use and its association with psychological distress among university students in South India

BACKGROUND

Excessive internet use, psychological distress, and its inter-relationship among university students can impact their academic progress, scholastic competence, career goals, and extracurricular interests. Thus, a need exists to evaluate the addictive internet use among university students.

OBJECTIVES

This study was set up to examine the internet use behaviors, internet addiction (IA), and its association with psychological distress primarily depression among a large group of university students from South India.

METHODS

Totally 2776 university students aged 18-21 years; pursuing undergraduate studies from a recognized university in South India participated in the study. The patterns of internet use and socioeducational data were collected through the internet use behaviors and demographic data sheet, IA test (IAT) was utilized to assess IA and psychological distress primarily depressive symptoms were evaluated with Self-Report Questionnaire-20.

RESULTS

Among the total n = 2776, 29.9% (n = 831) of university students met criterion on IAT for mild IA, 16.4% (n = 455) for moderate addictive use, and 0.5% (n = 13) for severe IA. IA was higher among university students who were male, staying in rented accommodations, accessed internet several times a day, spent more than 3 h per day on the Internet and had psychological distress. Male gender, duration of use, time spent per day, frequency of internet use, and psychological distress (depressive symptoms) predicted IA.

CONCLUSIONS

IA was present among a substantial proportion of university students which can inhibit their academic progress and impact their psychological health. Early identification of risk factors of IA can facilitate the effective prevention and timely initiation of treatment strategies for IA and psychological distress among university students.

Internet Addiction of Young Greek Adults: Psychological Aspects and Information Privacy

The main goal of this study is to examine the Internet addiction status of Greek young adults, aged from 18 to 25, using Young's Internet Addiction Test (IAT) and self-administered questionnaires. In addition this paper assesses the psychological traits of addicted persons per addiction category, using the big five factor model tool to study the user's personality and analyze the components that lead a person to become Internet addicted. Furthermore, we found an association between addicted people and the five factors from the Big Five Factor Model; i.e., extraversion, agreeableness, conscientiousness, neuroticism, openness to experience. Moreover, this paper discusses information privacy awareness issues related to Internet Addiction treatment.

Internet Addiction among Junior Doctors: A Cross-sectional Study

BACKGROUND

The number of Internet users in India crossed 205 million in October 2013. Excessive internet use has been attributed to socio-occupational dysfunction, and this study is targeting the junior doctors on whom not many studies have been done till date.

OBJECTIVE

The objective of this study was to analyze the proportion of junior doctors with internet addiction and whether there is any relation between increased internet use and psychological distress, assessed using General Health Questionnaire (GHQ).

MATERIALS AND METHODS

One hundred postgraduate students and house surgeons were requested to fill out the specially prepared pro forma, Internet Addiction Test Questionnaire and GHQ, and the data were analyzed. P < 0.05 was considered statistically significant.

RESULTS

Among the 100 study participants, 13% were found to have moderate addiction and none were in severe addiction range. Internet addiction was more common among those from urban areas (P = 0.011). A significant association was found between GHQ score and internet addiction test score (P = 0.031).

CONCLUSION

The Internet is a double-edged social revolution. Further studies are required to delineate the specific effects on human behavior.

Association between Internet addiction and depression in Thai medical students at Faculty of Medicine, Ramathibodi Hospital

Objective

To study the extent of Internet addiction (IA) and its association with depression in Thai medical students.

Methods

A cross-sectional study was conducted at Faculty of Medicine, Ramathibodi Hospital. Participants were first- to fifth-year medical students who agreed to participate in this study. Demographic characteristics and stress-related factors were derived from self-rated questionnaires. Depression was assessed using the Thai version of Patient Health Questionnaire (PHQ-9). A total score of five or greater derived from the Thai version of Young Diagnostic Questionnaire for Internet Addiction was classified as “possible IA”. Then chi-square test and logistic regression were used to evaluate the associations between possible IA, depression and associated factors.

Results

From 705 participants, 24.4% had possible IA and 28.8% had depression. There was statistically significant association between possible IA and depression (odds ratio (OR) 1.92, 95% confidence interval (CI): 1.34–2.77, P-value <0.001). Logistic regression analysis illustrated that the odds of depression in possible IA group was 1.58 times of the group of normal Internet use (95% CI: 1.04–2.38, P-value = 0.031). Academic problems were found to be a significant predictor of both possible IA and depression.

Conclusion

IA was likely to be a common psychiatric problem among Thai medical students. The research has also shown that possible IA was associated with depression and academic problems. We suggest that surveillance of IA should be considered in medical schools.

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis

IMPORTANCE

Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.

OBJECTIVE

To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.

DATA SOURCES AND STUDY SELECTION

Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.

DATA EXTRACTION AND SYNTHESIS

Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.

MAIN OUTCOMES AND MEASURES

Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.

RESULTS

Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.

CONCLUSIONS AND RELEVANCE

In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.

Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis

Importance

Medical students are at high risk for depression and suicidal ideation. However, the prevalence estimates of these disorders vary between studies.

Objective

To estimate the prevalence of depression, depressive symptoms, and suicidal ideation in medical students.

Data Sources and Study Selection

Systematic search of EMBASE, ERIC, MEDLINE, psycARTICLES, and psycINFO without language restriction for studies on the prevalence of depression, depressive symptoms, or suicidal ideation in medical students published before September 17, 2016. Studies that were published in the peer-reviewed literature and used validated assessment methods were included.

Data Extraction and Synthesis

Information on study characteristics; prevalence of depression or depressive symptoms and suicidal ideation; and whether students who screened positive for depression sought treatment was extracted independently by 3 investigators. Estimates were pooled using random-effects meta-analysis. Differences by study-level characteristics were estimated using stratified meta-analysis and meta-regression.

Main Outcomes and Measures

Point or period prevalence of depression, depressive symptoms, or suicidal ideation as assessed by validated questionnaire or structured interview.

Results

Depression or depressive symptom prevalence data were extracted from 167 cross-sectional studies (n = 116 628) and 16 longitudinal studies (n = 5728) from 43 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of depression or depressive symptoms was 27.2% (37 933/122 356 individuals; 95% CI, 24.7% to 29.9%, I2 = 98.9%). Summary prevalence estimates ranged across assessment modalities from 9.3% to 55.9%. Depressive symptom prevalence remained relatively constant over the period studied (baseline survey year range of 1982-2015; slope, 0.2% increase per year [95% CI, -0.2% to 0.7%]). In the 9 longitudinal studies that assessed depressive symptoms before and during medical school (n = 2432), the median absolute increase in symptoms was 13.5% (range, 0.6% to 35.3%). Prevalence estimates did not significantly differ between studies of only preclinical students and studies of only clinical students (23.7% [95% CI, 19.5% to 28.5%] vs 22.4% [95% CI, 17.6% to 28.2%]; P = .72). The percentage of medical students screening positive for depression who sought psychiatric treatment was 15.7% (110/954 individuals; 95% CI, 10.2% to 23.4%, I2 = 70.1%). Suicidal ideation prevalence data were extracted from 24 cross-sectional studies (n = 21 002) from 15 countries. All but 1 study used self-report instruments. The overall pooled crude prevalence of suicidal ideation was 11.1% (2043/21 002 individuals; 95% CI, 9.0% to 13.7%, I2 = 95.8%). Summary prevalence estimates ranged across assessment modalities from 7.4% to 24.2%.

Conclusions and Relevance

In this systematic review, the summary estimate of the prevalence of depression or depressive symptoms among medical students was 27.2% and that of suicidal ideation was 11.1%. Further research is needed to identify strategies for preventing and treating these disorders in this population.

Gender Difference in Internet Use and Internet Problems among Quebec High School Students

OBJECTIVES

There are presently no data available concerning Internet addiction (IA) problems among adolescents in Canada and the province of Quebec. The goal of this study is thus to document and compare the influence of gender on Internet use and addiction.

METHOD

The study data were collected from a larger research project on gambling among adolescents. Activities conducted online (applications used and time spent) as well as answers to the Internet Addiction Test (IAT) were collected from 3938 adolescents from grades 9 to 11. The two most often employed cut-off points for the IAT in the literature were documented: (40-69 and 70+) and (50+).

RESULTS

Boys spent significantly more time on the Internet than did girls. A greater proportion of the girls made intense use of social networks, whereas a greater proportion of the boys made intense use of massively multiplayer online role-playing games, online games, and adult sites. The proportion of adolescents with a potential IA problem varied according to the cut-off employed. When the cut-off was set at 70+, 1.3% of the adolescents were considered to have an IA, while 41.7% were seen to be at risk. At a 50+ cut-off, 18% of the adolescents were considered to have a problem. There was no significant difference between the genders concerning the proportion of adolescents considered to be at risk or presenting IA problems. Finally, analysis of the percentile ranks would seem to show that a cut-off of 50+ better describes the category of young people at risk.

CONCLUSIONS

The results of this study make it possible to document Internet use and IA in a large number of Quebec adolescents.

Exploring the association of ego defense mechanisms with problematic internet use in a Pakistani medical school

The present study was designed to analyze association between problematic internet use and use of ego defense mechanisms in medical students. This cross-sectional study was undertaken at CMH Lahore Medical College (CMH LMC) in Lahore, Pakistan from 1st March, 2015 to 30th May, 2015. 522 medical and dental students were included in the study. The questionnaire consisted of three sections: a) demographic characteristics of respondent b) the Defense Style Questionnaire-40 (DSQ-40) and c) the Internet Addiction Test (IAT). All data were analyzed in SPSS v20. Chi square, Independent sample t test and One Way ANOVA were run to analyze association of different variables with scores on IAT. Multiple regression analysis was used to delineate ego defenses as predictors of problematic internet use. A total of 32 (6.1%) students reported severe problems with internet usage. Males had higher scores on IAT i.e had more problematic use of internet. Scores on internet addiction test (IAT) were negatively associated with sublimation and positively associated with projection, denial, autistic fantasy, passive aggression and displacement. There was a high prevalence of problematic use of internet among medical and dental students. It had significant associations with several defense mechanisms.

Treatment of Internet Addiction with Anxiety Disorders: Treatment Protocol and Preliminary Before-After Results Involving Pharmacotherapy and Modified Cognitive Behavioral Therapy

BACKGROUND

The growth of the Internet has led to significant change and has become an integral part of modern life. It has made life easier and provided innumerous benefits; however, excessive use has brought about the potential for addiction, leading to severe impairments in social, academic, financial, psychological, and work domains. Individuals addicted to the Internet usually have comorbid psychiatric disorders. Panic disorder (PD) and generalized anxiety disorder (GAD) are prevalent mental disorders, involving a great deal of damage in the patient's life.

OBJECTIVE

This open trial study describes a treatment protocol among 39 patients with anxiety disorders and Internet addiction (IA) involving pharmacotherapy and modified cognitive behavioral therapy (CBT).

METHODS

Of the 39 patients, 25 were diagnosed with PD and 14 with GAD, in addition to Internet addiction. At screening, patients responded to the MINI 5.0, Hamilton Anxiety Rating Scale, Hamilton Depression Rating Scale, Clinical Global Impressions Scale, and the Young Internet Addiction Scale. At that time, IA was observed taking into consideration the IAT scale (cutoff score above 50), while anxiety disorders were diagnosed by a psychiatrist. Patients were forwarded for pharmacotherapy and a modified CBT protocol. Psychotherapy was conducted individually, once a week, over a period of 10 weeks, and results suggest that the treatment was effective for anxiety and Internet addiction.

RESULTS

Before treatment, anxiety levels suggested severe anxiety, with an average score of 34.26 (SD 6.13); however, after treatment the mean score was 15.03 (SD 3.88) (P<.001). A significant improvement in mean Internet addiction scores was observed, from 67.67 (SD 7.69) before treatment, showing problematic internet use, to 37.56 (SD 9.32) after treatment (P<.001), indicating medium Internet use. With respect to the relationship between IA and anxiety, the correlation between scores was .724.

CONCLUSIONS

This study is the first research into IA treatment of a Brazilian population. The improvement was remarkable due to the complete engagement of patients in therapy, which contributed to the success of the treatment from a behavioral perspective, and gave patients the confidence to continue to manage Internet use in their lives.

Problematic Internet Use and Its Correlates Among Students from Three Medical Schools Across Three Countries

OBJECTIVE

The authors aimed to assess and compare problematic internet use among medical students enrolled in a graduate degree course in one school each from Croatia, India, and Nigeria and to assess correlates of problematic use among these students.

METHODS

The questionnaire included a sociodemographic profile of participants and Young's Internet Addiction Test.

RESULTS

The final analysis included 842 subjects. Overall, 38.7 and 10.5 % of respondents scored in the mild and moderate categories. Only a small fraction (0.5 %) of students scored in the severe category. Being male and spending more time on the internet were correlated with problematic internet use. Moreover, a significantly higher proportion of participants who scored above the cutoff used the Internet for browsing, social networking, chatting, gaming, shopping, and viewing pornography. However, there was no difference between the two groups with regard to using the internet for e-mailing or academic activities.

CONCLUSIONS

It is important to address problematic internet use among medical students. The correlates can help identify those at increased risk.

Internet addiction in Greek medical students: an online survey

OBJECTIVE

The authors investigated the prevalence of Internet addiction (IA) in undergraduate medical students to identify possible associations with sociodemographics and Internet habits.

METHODS

All students at the Aristotle University of Thessaloniki School of Medicine, Greece, were invited to complete the online Internet Addiction Test (IAT) along with sociodemographics and preferences on Internet activities.

RESULTS

The authors received 585 responses after three reminders (23.5 % response rate). Mild IA was found in 24.5 %, moderate in 5.4 %, and severe in 0.2 %. In multivariable analysis, the odds to develop IA were increased with visits in Internet cafes (Odds Ratio [OR] 3.49, 95 % Confidence Interval [CI]: 1.45, 8.46), the use of Facebook (OR 2.43, 95 % CI: 1.35, 4.38), Twitter (OR 2.45, 95 % CI: 1.37, 4.39), and online games (OR 1.95, 95 % CI: 1.29, 2.94). Using e-mails seemed to be protective against IA (OR 0.59, 95 % CI: 0.37, 0.94).

CONCLUSION

This is the first IA prevalence study in a European medical school. Early-detection systems and other ways to help students with pathological behaviors should be developed.

The relationship between personality, defense styles, internet addiction disorder, and psychopathology in college students

The purpose of this study is to assess any underlying links between personality, defense styles, Internet addiction disorder (IAD), and psychopathology in a college student sample. This is a cross-sectional study of fourth-year Greek Medical students who responded in a comprehensive test battery, which included validated questionnaires on IAD, personality traits, patterns of psychological defense styles, and psychopathology symptoms. A path model that was tested using Partial Least Squares (PLS) methodology showed that the defense styles employed by the students and certain personality traits (Impulsivity, Sensation Seeking, Neuroticism/Anxiety, and Aggression-Hostility) contributed to the prediction of variability in IAD, with IAD in turn predicting variability in overt psychopathology.