Int J Environ Res Public Health. 2018 Dec 14;15(12). pii: E2861. doi: 10.3390/ijerph15122861.
Hsieh KY1,2, Hsiao RC3,4, Yang YH5,6, Liu TL7,8, Yen CF9,10.
Abstract
The aim of the study was to determine the predictive effects of sex, age, depression, and problematic behaviors on the incidence and remission of internet addiction (IA) in college students over a one-year follow-up. A total of 500 college students (262 women and 238 men) were recruited. The predictive effects of sex, age, severity of depression, self-harm/suicidal behaviors, eating problems, risk-taking behaviors, substance use, aggression, and uncontrollable sexual encounters on the incidence and remission of IA over a one-year follow-up were examined. The one-year incidence and remission rates for IA were 7.5% and 46.4%, respectively. Severity of depression, self-harm and suicidal behaviors, and uncontrollable sexual encounters at the initial investigation predicted the incidence of IA in a univariate analysis, whereas only severity of depression predicted the incidence of IA in a multivariable logistic regression (p = 0.015, odds ratio = 1.105, 95% confidence intervals: 1.021⁻1.196). A relatively young age predicted the remission of IA. Depression and young age predicted the incidence and remission, respectively, of IA in college students in the one-year follow-up.
KEYWORDS: depression; incidence; internet addiction; predictor; problematic behavior; remission
PMID: 30558175
4. Discussion
The results of this study revealed that depression and age predicted the incidence and remission of IA, respectively, whereas problematic behaviors did not predict changes in IA in the college students during the study period. Cross-sectional studies found a significant association between depression and IA in college students [44,45]. Temperament profiles that include high harm avoidance, low self-directedness, low cooperativeness, and high self-transcendence partially account for the association between depression and IA [46]. The present study further supported the predictive role of depression for the incidence of IA. As a modifiable factor, depression should be detected early and treated to improve the mental health and prevent the incidence of IA among college students. Helping individuals with depression manage their emotional difficulties is a pertinent strategy for preventing IA [27,28].
A higher proportion of college students who developed IA in the study period had self-harm behaviors, suicidality, and uncontrollable sexual encounters at baseline than those who did not develop IA. A systematic review also found that individuals with IA are more likely to have non-suicidal self-injurious behavior and suicidality than those without IA [47]. However, the predictive effects of self-harm, suicidality, and uncontrollable sexual encounters for the incidence of IA were nonsignificant in a multivariate multiple regression analysis after the effect of depression was considered simultaneously. This result indicates that the association of self-harm, suicidality, and uncontrollable sexual encounters with the incidence of IA is mainly accounted for by depression.
The present study found that young age predicted a greater likelihood of remission of IA in the college students. A relatively young age may indicate a relatively short duration of IA, which may increase the possibility of remission of IA. Research found age differences in internet activities; for example, young age was associated with problematic online shopping [48,49]. Whether various internet activities account for young age being a predictor for the remission of IA warrants further study.
Although research found a sex difference in IA [50,51], the present study did not support the predictive effect of sex on the incidence or remission of IA in the college students. Previous studies found that the preference of online activities differs by sex. Women tend to use social media excessively and engage in online shopping, whereas men tend to view online pornography and engage in gambling [52,53]. Further study is warranted to examine the role of sex in predicting changes in involvement in other internet activities and not only in IA. Moreover, whether sex may have various effects on the incidence and remission of IA in various age groups warrants further study.
Contrary to the hypothesis, the present study did not find significant predictive effects of eating problems, risk-taking behaviors, substance abuse, and aggression for the incidence of IA among the college students. The college students with aggression at baseline were more likely to have IA, whereas aggression did not predict the incidence of IA in the follow-up. A study found that the individuals of addiction-prone phenotypes for substance-use disorder are also sensitive to other reinforcers [54]. Research also found that alcohol use, smoking, and drug use are prevalent among individuals with IA [19,20]. Although it is reasonable to hypothesize that substance use can predict the incidence of IA, the results of the present study did not support this. Moreover, there was no significant difference in IA between the college students with and without substance abuse at baseline. Whether the association between problematic behaviors and IA exists for specific demographic or socioeconomic characteristics warrants further study.
The present study found that the remission rate of IA was 46.4% during the one-year study period. The remission rates of IA in previous studies varied because of various definitions of IA and research designs. A two-year follow-up study found that the remission rate of pathological online gaming was 16% in Dutch adolescents [32]. A one-year follow-up study found that the remission rate of online video game addiction was 50% among adolescents in Netherlands [55]. The results of the present and previous studies indicate that, like other behavioral addictions [30], IA may have the characteristic of provisionality during the period of adolescence and emerging adulthood.
Our study had several limitations. Firstly, the participants were recruited using an advertisement on BBS targeting college students. Those who did not visit BBS might not have had a chance to join this study. Secondly, the data were drawn from self-reported questionnaires, which may have resulted in shared method variance. We did not obtain side information from others to evidence participants’ levels of IA and depression and the occurrence of problematic behaviors. Thirdly, there may be factors that predict the incidence and remission of IA that were not examined in the present study. For example, the predicting effects of participants’ psychiatric diagnoses, the content of the internet activity, expectation of internet use, and peer relationship warrant further study. Finally, the rate of IA at initial assessment was 17.3%, which was comparable to the result of a previous study on college students in Taiwan [41]. However, the number of participants with remission of IA was pretty small, which may limit the statistical significance of the outcome data.
To the best of our knowledge, the present study is one of the first to examine the predictive effects of sex, age, depression, and problematic behaviors simultaneously for the incidence and remission of IA in college students. The results of the present study warrant further study to replicate. Moreover, problematic behaviors mainly occur during adolescence. The relationship between problematic behaviors and internet addiction among secondary school students warrants further study.
5. Conclusions
On the basis of our study, we propose that an early survey of depression in college students is pertinent for reducing the incidence of IA. Older college students with IA are at risk of persisting IA in the subsequent year and should be the target of intervention for IA.
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