Elsevier

Journal of Affective Disorders

Volume 298, Part A, 1 February 2022, Pages 126-133
Journal of Affective Disorders

Research paper
Prevalence, correlates, and network analysis of Internet addiction symptoms among Chinese pregnant and postpartum women

https://doi.org/10.1016/j.jad.2021.10.092Get rights and content

Highlights

  • Around 30.19% Chinese women reported Internet addiction during or after pregnancy.

  • Women with previous adverse pregnancy experiences and physical comorbidities had a higher likelihood of developing Internet addiction.

  • Internet Addiction Test item 16 (request an extension for longer time spent online) was the most central symptom in the analyses, and also the strongest bridging symptom linking the Internet addiction and quality of life communities.

  • Internet addiction was significantly associated with poor QOL in physical health, psychological health, social relationship, and environmental health domains.

Abstract

Objective

Excessive Internet use is a common health problem globally. This study aimed to assess the prevalence, correlates, and network structure of Internet addiction symptoms (Internet addiction hereafter) among Chinese pregnant and postpartum women.

Methods

This was a multicenter cross-sectional study using Internet Addiction Test (IAT) and the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) to evaluate Internet addiction and quality of life (QOL), respectively. Univariate analyses, multivariate logistic regression analyses, and network analyses were performed.

Results

Of a total of 1,060 women who completed the study, 320 (30.19%, 95% CI=27.42%-32.96%) women reported Internet addiction during or after pregnancy. Women with previous adverse pregnancy experiences (OR=1.831, P=0.001) and physical comorbidities (OR=1.724, P=0.004) had a higher likelihood of developing Internet addiction. Internet addiction was significantly associated with poor QOL in all domains. Network analyses revealed that IAT item 16 (request an extension for longer time spent online) was the most central symptom in the analyses, and also one of the strongest bridging symptoms linking the Internet addiction and QOL communities.

Limitations

This was a cross-sectional study, all study findings were based on self-reported data, and possible recall bias and selection bias may exist.

Conclusion

Internet addiction is common among Chinese pregnant and postpartum women, and is significantly associated with lower QOL. Effective strategies, especially focusing on central symptoms, are needed to reduce the impact of Internet addiction and improve QOL in pregnant and postpartum women.

Introduction

Internet addiction, which is defined as ‘an inability to control Internet use, or a maladaptive pattern of Internet use, usually time-consuming, that results in clinically significant impairment or distress’ (Laconi et al., 2014; Young, 2004), typically occurs in adolescents and younger adults. In the past decade, with the common use of Internet across most age groups (Durkee et al., 2012) for information, entertainment and social interaction purposes (The Lancet, 2018), excessive / problematic Internet use and Internet addiction have increased. There is presently much attention on their negative physical and psychosocial consequences (Andreetta et al., 2020; Mamun et al., 2020; Stavropoulos et al., 2021), such as asthenopia (Huang et al., 2005), carpal tunnel syndrome (Duan et al., 2013; Middleton and Anakwe, 2014), psychosomatic symptoms (Cao et al., 2011), negative interpersonal relationships (Milani et al., 2009), personality deviations (Huang et al., 2005), reduced quality of life (QOL) (Ferrara et al., 2017; Van Den et al., 2018), and increased risk of insomnia, cognitive decline, depression, and even suicidal ideation (Huang et al., 2020; Karimy et al., 2020; Lu et al., 2018; Wang et al., 2019).

With the growing research interest in Internet addiction, more than 40 instruments on Internet addiction have been developed (Laconi et al., 2014). However, to date no consensus has been reached on the gold standard for measuring Internet addiction (Laconi et al., 2014). Of the currently available tools on Internet addiction, the Internet Addiction Test (IAT) with 20 items (Young, 1996) is most frequently used. The associated factors of Internet addiction have been widely studied, with commonly reported factors including older age, personality traits, substance abuse, social anxiety, and urban residence (Li et al., 2018; Zajac et al., 2017). For example, individuals having poor relationships with friends or family (Milani et al., 2009) and those with limited parental care were at higher risk of developing Internet addiction (Yen et al., 2007). Internet addiction is also associated with psychiatric comorbidities such as anxiety, depression, and attention deficit and hyperactivity disorder (ADHD) (Ho et al., 2014).

Compared with other subpopulations, pregnant and postpartum women have an increased risk of developing excessive Internet use and Internet addiction, probably due to longer hours being at home (i.e., on maternity leave) and less outdoor and physical activities owing to restricted mobility. Additionally, psychiatric comorbidities (i.e. anxiety, and depression) are common in pregnant and postpartum women (Kazemi and Dadkhah, 2020; Lagadec et al., 2018), which could also increase the likelihood of Internet addiction among this population.

In order to develop effective interventions and allocate health resources to prevent the negative health outcomes of Internet addiction, it is important to understand the prevalence and associated factors of Internet addiction among different populations. As most research on Internet addiction have focused on children and adolescents (Li et al., 2018; Zhang et al., 2018), there is a paucity of studies of Internet use behaviors among other subpopulations such as perinatal women. Further, the epidemiology of Internet addiction is substantially influenced by sociocultural and economic factors, which can result in variations across countries. Currently, no studies on the prevalence and correlates of Internet addiction in perinatal women in China have been published. Although one study (Huang et al., 2018) found that smartphone addiction was significantly associated with depression among women in early pregnancy, such findings could not be generalized to Internet addiction.

Network analysis is a novel data-driven approach that provides a visual depiction of the complex associations among individual symptoms (Beard et al., 2016). It allows identification of highly central symptoms (defined as nodes) and symptom-symptom interactions (defined as edges), and produces spatially ordered networks in which key nodes are located at the center of the network and nodes with fewer connections at the periphery (Mullarkey et al., 2019). Analyzing Internet addiction symptoms from the perspective of network analysis allows better understanding of which symptoms might be particularly central to the experience of Internet addiction (Borsboom, 2017). Furthermore, identifying central nodes and the relevant influential edges may be helpful to develop effective treatment and improve health outcomes (Hofmann et al., 2016).

In this study we examined the prevalence, correlates, and network structure of Internet addiction symptoms (Internet addiction hereafter), and also explored the association of Internet addiction and QOL in Chinese pregnant and postpartum women. According to previous findings (Ferrara et al., 2017; Van Den Eijnden et al., 2018) we hypothesized that certain clinical variables, such as pregnancy stage, and physical comorbidities, would be significantly associated with internet addiction. We also hypothesized that Internet addiction would negatively influence pregnant and postnatal women's QOL.

Section snippets

Study settings, inclusion, and exclusion criteria

This cross-sectional, multicenter study was conducted from February to October 2019. A consecutive sampling method was adopted to recruit participants from eight hospitals located in 8 provinces in China including Beijing, Xinjiang, Sichuan, Liaoning, Guangdong, Qinghai, Hubei, and Jiangsu. Women who met the following criteria were included: 1) adults (aged 18 years or above); 2) fluent in Mandarin or Cantonese, 3) being in the perinatal period (from the start of pregnancy to 1 week after

Participant characteristics

Overall, 1,140 women were invited to take part in this study, and finally, 1,060 met the study entry criteria and completed the assessment, giving a participation rate of 92.98%. The mean age of the women was 29.4 years (SD=4.2). Most of the participants lived in urban areas (n=897, 84.6%), had education at college level or above (n=712, 67.2%), were currently employed (n=655, 61.8), and had their first pregnancy/birth (n=608, 57.4%). Majority of the women did not report adverse pregnancy

Discussion

To the best of our knowledge, this was the first study that examined the prevalence, correlates, and network structure of Internet addiction, and its association with QOL in pregnant and postpartum women. In this study, we found that a total of 320 (30.19%; 95% CI=27.42%-32.96%) pregnant and postpartum women reported Internet addiction. No similar studies in pregnant and postpartum women were conducted, therefore direct comparisons could not be made. When compared to findings in other

Funding source

The study was supported by the National Science and Technology Major Project for investigational new drug (2018ZX09201-014), the Beijing Municipal Science & Technology Commission (no. Z181100001518005), and the University of Macau (MYRG2019-00066-FHS).

Ethical approval and consent to participate

This study was approved by the Clinical Research Ethics Committee of the Peking Union Medical College Hospital and all participating hospitals (Ref No: S-K1273). All participants provided informed consent form.

Authors’ contribution

Study design: HXB, and YTX. Data collection, analysis and interpretation: PHW, XHL, LNG, WXL, YX, YLX, FJL, XJX, and HHW. Drafting of the manuscript: YY, DYZ, YLL, and MZ. Critical revision of the manuscript: TC, and CHN. Approval of the final version for publication: all co-authors.

Consent for publication

Not applicable.

Code availability

Not applicable.

Declaration Competing of Interest

The authors declare that they have no competing interests.

Acknowledgements

None.

References (51)

  • M. Belvederi Murri et al.

    The symptom network structure of depressive symptoms in late-life: results from a European population study

    Mol. Psychiatry

    (2020)
  • D. Borsboom

    A network theory of mental disorders

    World Psychiatry

    (2017)
  • H. Cao et al.

    Problematic Internet use in Chinese adolescents and its relation to psychosomatic symptoms and life satisfaction

    BMC Public Health

    (2011)
  • J. Chen et al.

    Extended Bayesian information criteria for model selection with large model spaces

    Biometrika

    (2008)
  • X.H. Duan et al.

    Analysis of current situation of computer use and related health problems of medical students (in Chinese)

    Chin. J. Sch. Health

    (2013)
  • T. Durkee et al.

    Prevalence of pathological Internet use among adolescents in Europe: demographic and social factors

    Addiction

    (2012)
  • S. Epskamp et al.

    Estimating psychological networks and their accuracy: a tutorial paper

    Behav. Res. Methods

    (2018)
  • S. Epskamp et al.

    qgraph: network visualizations of relationships in psychometric data

    J. Stat. Softw.

    (2012)
  • F. Evcili

    A study on the relationship between internet use, anxiety levels, and quality of life of Turkish pregnant women

    Perspect. Psychiatr. Care

    (2019)
  • J.Q. Fang et al.

    Reliability and validity for Chinese version of WHO quality of life scale (in Chinese)

    Chin. Mental Health J.

    (1999)
  • P. Ferrara et al.

    Internet addiction: starting the debate on health and well-being of children overexposed to digital media

    J. Pediatr.

    (2017)
  • J. Friedman et al.

    Sparse inverse covariance estimation with the graphical lasso

    Biostatistics

    (2008)
  • A. Harper et al.

    Development of the World Health Organization WHOQOL-BREF quality of life assessment

    Psychol. Med.

    (1998)
  • R.C. Ho et al.

    The association between Internet addiction and psychiatric co-morbidity: a meta-analysis

    BMC Psychiatry

    (2014)
  • S.G. Hofmann et al.

    A complex network perspective on clinical science

    Perspect. Psychol. Sci.

    (2016)
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