Elsevier

Comprehensive Psychiatry

Volume 72, January 2017, Pages 114-120
Comprehensive Psychiatry

Exploring depression, self-esteem and verbal fluency with different degrees of internet addiction among Chinese college students

https://doi.org/10.1016/j.comppsych.2016.10.006Get rights and content

Abstract

Background

The aims of this study were to explore depression, self-esteem and verbal fluency functions among normal internet users, mild internet addictions and severe internet addictions.

Methods

The survey sample consisted of 316 college students, and their internet addiction symptoms, depression and self-esteem symptoms were assessed using the Revised Chen Internet Addiction Scale (CIAS-R), Zung Self-Rating Depression Scale (ZSDS), Rosenberg Self-Esteem Scale (RSES), respectively. From this sample, 16 students with non-addictions, 19 students with mild internet addiction (sub-MIA) and 15 students with severe internet addiction (sub-SIA) were recruited and subjected to the classical verbal fluency tests, including the semantic and phonemic fluency task.

Results

The results indicated that severe internet addiction in the survey sample showed the highest tendency towards depressive symptoms and lowest self-esteem scores, and sub-SIA showed poor performance on the semantic fluency task.

Conclusion

In conclusion, severe internet addiction was significantly associated with depression, low self-esteem and semantic verbal fluency problems.

Introduction

With the exponentially increased usage of internet technologies in our lives and the easy access of internet, overuse of the internet, particularly in teens and young adults, has become a concern in recent years. The researchers used different terms to describe this compulsive behavior when referred to an overuse of the internet, such as internet addiction [1], [2], compulsive internet use [3], problematic internet use [4], and pathological internet use [5]. This study prefers the term ‘internet addiction’, which refers to an individual's inability to control his or her own internet use and leads to functional impairments of daily activities [6], [7], [8], bearing many similarities to other types of behavioral addictions and substance abuse [9], [10], [11], [12].

Several studies have examined internet addicted users' daily behaviors and their psychological characteristics. Internet addicted users often showed poor academic performance, avoided face-to-face communication, and so forth [13], [14]. Numerous research findings have revealed that psychopathological factors, such as depression, and personality factors, such as low self-esteem, were related to the internet addicted behaviors [15], [16]. However, it is not clear whether the existing psychological or personality factors were the causes for internet addiction, or it is the other way around. A meta-analysis of recent literatures reported that depression is one of the most co-morbid disorders with internet addiction [17]. Low self-esteem, as a principal component of depression, is described as the individual's negative attitude towards themselves [18]. A previous study found that adolescents with lower self-esteem were more easily addicted to the Internet [19]. Internet addicted users often considered the internet as a ‘haven’, a place where they can gain more social support and ease pain from their daily lives. However, these individuals often became even lonelier and more depressed, rather than more socially connected and happier [19], [20], and often showed more deterioration in daily communication skills or speech, and other executive functions.

Studies of internet addition often utilized survey or self-report questionnaires to assess the participants' addictions levels [1], [3], [21]. However, mild internet addiction, which was regarded as those users possibly or intermittently addicted to the internet (a possible or intermittent use), may have different psychological characteristics (i.e. depression and self-esteem) compared with severely internet addicted users. Therefore, it is important to utilize both traditional diagnosis instruments (e.g. questionnaires) and major quantitative measurement of internet addition (e.g. time spent online) to better differentiate normal internet users, mild and severe internet additions, and to quantitatively compare the differences in the psychological characteristics (i.e. depression and self-esteem) among the different internet users.

In addition to depression and self-esteem, our study also focused on cognitive dysfunction of internet addiction. Over the years, extensive research has demonstrated deficits in executive functioning, such as non-verbal working memory, inhibition and decision-making tasks, in internet addiction and its coexisting psychiatric disorders (e.g. pathological gambling, problematic alcohol use and attention-deficit/hyperactivity disorder) [22], [23], [24]. Verbal fluency was also commonly used to evaluate cognitive functioning in psychiatry disorders with impaired attention capacity, such as pathological gambling, alcoholism, Parkinson's disease and attention-deficit/hyperactivity disorder. Verbal fluency is an important cognitive function that facilitates information retrieval from memory and usually defined as the number of words produced within a restricted category and limited duration [25]. Assessments of verbal fluency are based on two common parameters: semantic and phonemic fluency. In general, phonemic fluency has been thought to be associated with frontal-lobe functioning and is assessed by asking the examinee to generate words beginning with a single given letter. Semantic fluency has been thought to be associated with temporal-lobe functioning and is tested by asking the examinee to generate semantic category exemplar [26], [27]. Many internet users reported that they had fewer opportunities to write by hand and had forgotten how to write words when picking up a pen. Interestingly, an early study showed that patients with depression produced fewer words on the semantic fluency test than controls, but performed normally on the phonemic fluency test [28]. Taking into account that depression is one of the most commonly coexisting psychiatric disorders with internet addiction [17], it is reasonable to hypothesize that internet addicted users may also have impaired verbal fluency function, either directly due to internet addiction, or influenced by depression.

Taken together, our study addresses several key issues regarding internet addition. First, we try to better differentiate normal internet users, mild and severe internet additions by using both the scores of a traditional diagnosis questionnaire of internet addiction and a major quantitative parameter, the time spent online per day. Time spent online per day was proven to be a well-validated indicator for differentiating normal everyday users from mild and severe internet addictions [29], [30], [31]. Several studies have shown 3–6 h per day was the time cutoff for diagnosing internet addicted individuals [30], [32], [33], [34], [35]. Second, we used two standard scales to quantify the depression and self-esteem levels and to provide post hoc statistical analyses among normal internet users, and individuals with mild or severe internet additions. Third, we applied the classical verbal fluency tests to determine if three different groups of Internet users perform differently in verbal fluency and if the internet addition-associated impairments are semantic or phonemic. Finally, we focus on college students who usually have considerable freedom to spend a large amount of time online and their significant increase of internet use in college is worrisome [36].

Section snippets

Participants

Based on the report that internet addicted students often showed poor academic performances [13], [14], we selected a university, whose admission criteria are lower than other schools located in Wuhan city, as the source population of participants recruited in our study. After obtaining the approval from the university, trained research assistants visited 8 randomly-selected classes and explained the purpose of the study to the students. 320 students agreed to participate and filled out a set

Demographic characteristic and questionnaires scores in the survey sample

The proportions and means of the demographic information for this survey sample (n = 316) are shown in Table 1. There were no significant differences in age and gender composition among MIA, SIA and their non-addicted counterparts. With respect to the scope of the internet usage, the most often used internet service type was social network sites (86.7%), followed by entertainment (85.8%), download or retrieval of information (74.1%), retrieval of information related to education (50.3%) and

Discussion

The current study showed that 30.1% of college students had mild Internet addiction. This observed prevalence was similar to that reported in previous studies in that intermittent internet addiction was possibly encountered in 30.3%–30.5% of Korean adolescents [29], [44]. In this study, 88.4% (n = 84) of MIA reported that they have used social network sites more than other four internet activities; however, 90.6% (n = 48) of SIA reported more use of entertainment categories than that of the social

Acknowledgment

We thank PhD Yanli Zhang-James for providing language help. This study was supported by The National Natural Science Foundation of China Youth Science Fund Project (31300865).

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