Document Type : Original Article
Authors
ICMR‑Regional Medical Research Centre, Bhubaneswar, Odisha, India
Abstract
BACKGROUND: COVID‑19 initiated in December 2019 in Wuhan, China, and over a period of
time, the infection outspread across the world in a rapid pace. To protect the people and to further
limit the spread of infection, lockdown was declared in most parts of the world including India.
As all people were forced to stay indoors during this pandemic, internet was the only source of
entertainment whose overuse has side effects on anxiety and sleep quality. This study is aimed to
know the impact of Internet addiction during COVID‑19 on anxiety and sleep quality among college
students of Bhubaneswar city.
MATERIALS AND METHODS: This was a web‑based cross‑sectional, questionnaire study. It
administered 475 students from six colleges. The students were assessed by a proforma containing
demographic details, patterns of internet use, Youngs Internet Addiction Test, Generalised Anxiety
disorder score, and the Pittsburgh Sleep Quality Index. Statistical analysis was done using SPSS
version 21.0 using Chi‑square test and Wilcoxon signed‑rank test.
RESULTS: The mean age of the study group was 18.81 ± 1.189. Out of 475 students, 60.6% were
female and 39.4% were male. 23.6% and 13.4% of recruited students had severe internet addiction
and anxiety disorder, respectively. The mean global PSQI score in the study was 6.356 ± 1.88.
About 84.6% of the students had poor global sleep quality score. All components of sleep quality
were significantly associated (P = 0.000) with different degrees of internet addiction except sleep
duration (P = 0.589) and efficiency (P = 0.767).
CONCLUSION: Females were highly addicted than males. The study findings specified that students’
excessive internet usage leads to anxiety, and affects mental health. Monitoring and controlling
students’ internet addiction through informative sessions on how to use the Internet adequately is
useful.
Keywords
1. Elhai JD, Yang H, McKay D, Asmundson GJ. COVID-19 anxiety
symptoms associated with problematic smartphone use severity
in Chinese adults. J Affect Disord 2020;274:576-82.
2. Huang Y, Zhao N. Generalized anxiety disorder, depressive
symptoms and sleep quality during COVID-19 outbreak in
China: A web-based cross-sectional survey. Psychiatry Res
2020;288:112954.
3. Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study
of knowledge, attitude, anxiety & perceived mental healthcare
need in Indian population during COVID-19 pandemic. Asian J
Psychiatr 2020;51:102083.
4. Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive
muscle relaxation on anxiety and sleep quality in patients with
COVID-19. Complement Ther Clin Pract 2020;39:101132.
5. Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social
support on sleep quality of medical staff treating patients with
coronavirus disease 2019 (COVID-19) in January and February
2020 in China. Med Sci Monit 2020;26:e923549.
6. Stojanov J, Malobabic M, Stanojevic G, Stevic M, Milosevic V,
Stojanov A. Quality of sleep and health-related quality of
life among health care professionals treating patients with
coronavirus disease-19. Int J Soc Psychiatry 2021;67:175-81.
7. Coronavirus Disease 2019 (COVID-19). Available from: https://
www.cdc.gov/coronavirus/2019-ncov/cdcresponse/aboutCOVID-19.html. [Last accessed on 2020 Nov 01].
8. World Health Organization Declares COVID-19 A ‘Pandemic.’
Here’s What That Means. Available from: https://time.
com/5791661/who-coronavirus-pandemic-declaration/. [Last
accessed on 2020 Nov 01].
9. Odisha Reports First Positive Coronavirus Case, Man Returned
from Italy. Available from: https://www.indiatoday.in/india/
story/odisha-coronavirus-positive -case-1655 901-2020-0316. [Last accessed on 2020 Nov 01].
10. Verma S, Mishra A. Depression, anxiety, and stress and sociodemographic correlates among general Indian public during
COVID-19. Int J Soc Psychiatry 2020;66:756-62.
11. Modi Orders 3-Week Total Lockdown for All 1.3 Billion Indians.
Available from: https://www.nytimes.com/2020/03/24/
world/asia/india-coronavirus-lockdown.html. [Last accessed
on 2020 Nov 01].
12. Taking Cues from Odisha, Punjab Extends Lockdown Till
1 May. Available from: https://www.livemint.com/news/
india/taking-cues-from-odisha-punjab-extends-lockdown-till1-may-11586520697517.html. [Last accessed on 2020 Nov 01].
13. Lee SA. Coronavirus anxiety scale: A brief mental health screener
for COVID-19 related anxiety. Death Stud 2020;44:393-401.
14. Liu CH, Stevens C, Conrad RC, Hahm HC. Evidence for elevated
psychiatric distress, poor sleep, and quality of life concerns
during the COVID-19 pandemic among U.S. young adults with
suspected and reported psychiatric diagnoses. Psychiatry Res
2020;292:113345.
15. Shi L, Lu ZA, Que JY, Huang XL, Liu L, Ran MS, et al. Prevalence
of and risk factors associated with mental health symptoms among
the general population in China during the coronavirus disease
2019 pandemic. JAMA Netw Open 2020;3:e2014053.
16. Jain A, Sharma R, Gaur KL, Yadav N, Sharma P, Sharma N, et al.
Study of internet addiction and its association with depression
and insomnia in university students. J Family Med Prim Care
2020;9:1700-6.
17. Kolaib AM, Alhazmi AH, Kulaib MM. Prevalence of internet
addiction and its associated factors among medical students
at Taiba University, Saudi Arabia. J Family Med Prim Care
2020;9:4797-800.
18. Younes F, Halawi G, Jabbour H, El Osta N, Karam L, Hajj A,
et al. Internet addiction and relationships with insomnia, anxiety,
depression, stress and self-esteem in university students: A crosssectional designed study. PLoS One 2016;11:e0161126.
19. Kumar S, Singh S, Singh K, Rajkumar S, Balhara YP. Prevalence
and pattern of problematic internet use among engineering
students from different colleges in India. Indian J Psychiatry
2019;61:578-83.
20. Nagori N, Vasava K, Vala A, RatnaniI. Association of sleep quality
and internet addiction among the medical students. Int J Res Med
Sci 2019;7:2703-7.
21. Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, et al. Mental health
problems and social media exposure during COVID-19 outbreak.
PLoS One 2020;15:e0231924.
22. Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college
students in China. Psychiatry Res 2020;287:112934.
23. Son C, Hegde S, Smith A, Wang X, Sasangohar F. Effects of
COVID-19 on college students’ mental health in the United States:
Interview survey study. J Med Internet Res 2020;22:e21279.
24. Young KS. Internet addiction: The emergence of a new clinical
disorder. Cyber Psychol Behav 1998;3:237-44.
25. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for
assessing generalized anxiety disorder: The GAD-7. Arch Intern
Med 2006;166:1092-7.
26. Carpenter JS, Andrykowski MA. Psychometric evaluation of the
Pittsburgh Sleep Quality Index. J Psychosom Res 1998;45:5-13.
27. Available from: https://www.stoeltingco.com/media/wysiwyg/
IAT_web_sample.pdf/. [Last accessed on 2021 Mar 07].
28. Fernández-Villa T, Molina AJ, García-Martín M, Llorca J,
Delgado-Rodríguez M, Martín V. Validation and psychometric
analysis of the internet addiction test in Spanish among college
students. BMC Public Health 2015;15:953.
29. Famodu OA, Barr ML, Holásková I, Zhou W, Morrell JS,
Colby SE, Olfert MD. Shortening of the Pittsburgh Sleep Quality
Index Survey Using Factor Analysis. Sleep Disord. 2018 Apr
12;2018:9643937.
30. Saleem SM. Modified Kuppuswamy socioeconomic scale updated
for the year 2020. Indian J Forensic Community Med 2020;7:1-3.
31. Durkee T, Kaess M, Carli V, Parzer P, Wasserman C, Floderus B,
et al. Prevalence of pathological internet use among adolescents
in Europe: Demographic and social factors. Addiction
2012;107:2210-22.
32. Goel D, Subramanyam A, Kamath R. A study on the prevalence
of internet addiction and its association with psychopathology
in Indian adolescents. Indian J Psychiatry 2013;55:140-3.
33. Veisani Y, Jalilian Z, Mohamadian F. Relationship between
internet addiction and mental health in adolescents. J Educ Health
Promot 2020;9:303.
34. Lin PH, Lee YC, Chen KL, Hsieh PL, Yang SY, Lin YL. The
relationship between sleep quality and internet addiction among
female college students. Front Neurosci 2019;13:599.
35. Morahan-Martin J, Schumacher P. Loneliness and social uses of
the internet. Comput Hum Behav 2003;19:659-71.
36. Karimi N, Saadat-Gharin S, Tol A, Sadeghi R, Yaseri M,
Mohebbi B. A problem-based learning health literacy intervention
program on improving health-promoting behaviors among girl
students. J Educ Health Promot 2019;8:251.
37. Kuss DJ, Griffiths MD, Karila L, Billieux J. Internet addiction:
A systematic review of epidemiological research for the last
decade. Curr Pharm Des 2014;20:4026-52.
38. Iravani MR, Rajabi M, Abbasi MG, Jannesari H. A social work
study on impact of gender, marital status and employment status
on internet addiction. Manage Sci Lett 2013;3:1019-24.
39. Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C,
et al. A Nationwide survey of psychological distress among Italian
people during the COVID-19 pandemic: Immediate psychological
responses and associated factors. Int J Environ Res Public Health
2020;17:3165.
40. Bhandari PM, Neupane D, Rijal S, Thapa K, Mishra SR,
Poudyal AK. Sleep quality, internet addiction and depressive
symptoms among undergraduate students in Nepal. BMC
Psychiatry 2017;17:106.
41. Lebni JY, Toghroli R, Abbas J, NeJhaddadgar N, Salahshoor MR,
Mansourian M, et al. A study of internet addiction and its effects
on mental health: A study based on Iranian University Students.
J Educ Health Promot 2020;9:205.
42. Siste K, Hanafi E, Sen LT, Christian H, Adrian, Siswidiani LP, et al.
The impact of physical distancing and associated factors towards
internet addiction among adults in Indonesia during COVID-19
pandemic: A nationwide web-based study. Front Psychiatry
2020;11:580977.
43. Griffiths MD, van Rooij AJ, Kardefelt-Winther D, Starcevic V,
Király O, Pallesen S, et al. Working towards an international
consensus on criteria for assessing internet gaming disorder:
A critical commentary on Petry et al. (2014). Addiction
2016;111:167-75.
44. Anand N, Jain PA, Prabhu S, Thomas C, Bhat A, Prathyusha PV,
et al. Internet use patterns, internet addiction, and psychological
distress among engineering university students: A study from
India. Indian J Psychol Med 2018;40:458-67.
45. Montag C, Bey K, Sha P, Li M, Chen YF, Liu WY, et al. Is it
meaningful to distinguish between generalized and specific
Internet addiction? Evidence from a cross-cultural study from
Germany, Sweden, Taiwan and China. Asia Pac Psychiatry
2015;7:20-6.
46. Available from: https://pib.gov.in/PressReleasePage.
aspx?PRID=1650669. [Last accessed on 2021 Feb 01].
47. Gualano MR, Lo Moro G, Voglino G, Bert F, Siliquini R. Effects
of COVID-19 lockdown on mental health and sleep disturbances
in Italy. Int J Environ Res Public Health 2020;17:4779.
48. Tavernier R, Willoughby T. Sleep problems: Predictor or outcome
of media use among emerging adults at university? J Sleep Res
2014;23:389-96.
49. Kumari RK, Jain KJ, Nath B. Sleep quality assessment among
college students using Pittsburgh Sleep Quality Index in a
municipal corporation area of Uttarakhand, India. Ceylon Med J
2020;65:86-94.
50. Peach HD, Gaultney JF, Ruggiero AR. Direct and indirect
associations of sleep knowledge and attitudes with objective and
subjective sleep duration and quality via sleep hygiene. J Prim
Prev 2018;39:555-70.
symptoms associated with problematic smartphone use severity
in Chinese adults. J Affect Disord 2020;274:576-82.
2. Huang Y, Zhao N. Generalized anxiety disorder, depressive
symptoms and sleep quality during COVID-19 outbreak in
China: A web-based cross-sectional survey. Psychiatry Res
2020;288:112954.
3. Roy D, Tripathy S, Kar SK, Sharma N, Verma SK, Kaushal V. Study
of knowledge, attitude, anxiety & perceived mental healthcare
need in Indian population during COVID-19 pandemic. Asian J
Psychiatr 2020;51:102083.
4. Liu K, Chen Y, Wu D, Lin R, Wang Z, Pan L. Effects of progressive
muscle relaxation on anxiety and sleep quality in patients with
COVID-19. Complement Ther Clin Pract 2020;39:101132.
5. Xiao H, Zhang Y, Kong D, Li S, Yang N. The effects of social
support on sleep quality of medical staff treating patients with
coronavirus disease 2019 (COVID-19) in January and February
2020 in China. Med Sci Monit 2020;26:e923549.
6. Stojanov J, Malobabic M, Stanojevic G, Stevic M, Milosevic V,
Stojanov A. Quality of sleep and health-related quality of
life among health care professionals treating patients with
coronavirus disease-19. Int J Soc Psychiatry 2021;67:175-81.
7. Coronavirus Disease 2019 (COVID-19). Available from: https://
www.cdc.gov/coronavirus/2019-ncov/cdcresponse/aboutCOVID-19.html. [Last accessed on 2020 Nov 01].
8. World Health Organization Declares COVID-19 A ‘Pandemic.’
Here’s What That Means. Available from: https://time.
com/5791661/who-coronavirus-pandemic-declaration/. [Last
accessed on 2020 Nov 01].
9. Odisha Reports First Positive Coronavirus Case, Man Returned
from Italy. Available from: https://www.indiatoday.in/india/
story/odisha-coronavirus-positive -case-1655 901-2020-0316. [Last accessed on 2020 Nov 01].
10. Verma S, Mishra A. Depression, anxiety, and stress and sociodemographic correlates among general Indian public during
COVID-19. Int J Soc Psychiatry 2020;66:756-62.
11. Modi Orders 3-Week Total Lockdown for All 1.3 Billion Indians.
Available from: https://www.nytimes.com/2020/03/24/
world/asia/india-coronavirus-lockdown.html. [Last accessed
on 2020 Nov 01].
12. Taking Cues from Odisha, Punjab Extends Lockdown Till
1 May. Available from: https://www.livemint.com/news/
india/taking-cues-from-odisha-punjab-extends-lockdown-till1-may-11586520697517.html. [Last accessed on 2020 Nov 01].
13. Lee SA. Coronavirus anxiety scale: A brief mental health screener
for COVID-19 related anxiety. Death Stud 2020;44:393-401.
14. Liu CH, Stevens C, Conrad RC, Hahm HC. Evidence for elevated
psychiatric distress, poor sleep, and quality of life concerns
during the COVID-19 pandemic among U.S. young adults with
suspected and reported psychiatric diagnoses. Psychiatry Res
2020;292:113345.
15. Shi L, Lu ZA, Que JY, Huang XL, Liu L, Ran MS, et al. Prevalence
of and risk factors associated with mental health symptoms among
the general population in China during the coronavirus disease
2019 pandemic. JAMA Netw Open 2020;3:e2014053.
16. Jain A, Sharma R, Gaur KL, Yadav N, Sharma P, Sharma N, et al.
Study of internet addiction and its association with depression
and insomnia in university students. J Family Med Prim Care
2020;9:1700-6.
17. Kolaib AM, Alhazmi AH, Kulaib MM. Prevalence of internet
addiction and its associated factors among medical students
at Taiba University, Saudi Arabia. J Family Med Prim Care
2020;9:4797-800.
18. Younes F, Halawi G, Jabbour H, El Osta N, Karam L, Hajj A,
et al. Internet addiction and relationships with insomnia, anxiety,
depression, stress and self-esteem in university students: A crosssectional designed study. PLoS One 2016;11:e0161126.
19. Kumar S, Singh S, Singh K, Rajkumar S, Balhara YP. Prevalence
and pattern of problematic internet use among engineering
students from different colleges in India. Indian J Psychiatry
2019;61:578-83.
20. Nagori N, Vasava K, Vala A, RatnaniI. Association of sleep quality
and internet addiction among the medical students. Int J Res Med
Sci 2019;7:2703-7.
21. Gao J, Zheng P, Jia Y, Chen H, Mao Y, Chen S, et al. Mental health
problems and social media exposure during COVID-19 outbreak.
PLoS One 2020;15:e0231924.
22. Cao W, Fang Z, Hou G, Han M, Xu X, Dong J, et al. The psychological impact of the COVID-19 epidemic on college
students in China. Psychiatry Res 2020;287:112934.
23. Son C, Hegde S, Smith A, Wang X, Sasangohar F. Effects of
COVID-19 on college students’ mental health in the United States:
Interview survey study. J Med Internet Res 2020;22:e21279.
24. Young KS. Internet addiction: The emergence of a new clinical
disorder. Cyber Psychol Behav 1998;3:237-44.
25. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for
assessing generalized anxiety disorder: The GAD-7. Arch Intern
Med 2006;166:1092-7.
26. Carpenter JS, Andrykowski MA. Psychometric evaluation of the
Pittsburgh Sleep Quality Index. J Psychosom Res 1998;45:5-13.
27. Available from: https://www.stoeltingco.com/media/wysiwyg/
IAT_web_sample.pdf/. [Last accessed on 2021 Mar 07].
28. Fernández-Villa T, Molina AJ, García-Martín M, Llorca J,
Delgado-Rodríguez M, Martín V. Validation and psychometric
analysis of the internet addiction test in Spanish among college
students. BMC Public Health 2015;15:953.
29. Famodu OA, Barr ML, Holásková I, Zhou W, Morrell JS,
Colby SE, Olfert MD. Shortening of the Pittsburgh Sleep Quality
Index Survey Using Factor Analysis. Sleep Disord. 2018 Apr
12;2018:9643937.
30. Saleem SM. Modified Kuppuswamy socioeconomic scale updated
for the year 2020. Indian J Forensic Community Med 2020;7:1-3.
31. Durkee T, Kaess M, Carli V, Parzer P, Wasserman C, Floderus B,
et al. Prevalence of pathological internet use among adolescents
in Europe: Demographic and social factors. Addiction
2012;107:2210-22.
32. Goel D, Subramanyam A, Kamath R. A study on the prevalence
of internet addiction and its association with psychopathology
in Indian adolescents. Indian J Psychiatry 2013;55:140-3.
33. Veisani Y, Jalilian Z, Mohamadian F. Relationship between
internet addiction and mental health in adolescents. J Educ Health
Promot 2020;9:303.
34. Lin PH, Lee YC, Chen KL, Hsieh PL, Yang SY, Lin YL. The
relationship between sleep quality and internet addiction among
female college students. Front Neurosci 2019;13:599.
35. Morahan-Martin J, Schumacher P. Loneliness and social uses of
the internet. Comput Hum Behav 2003;19:659-71.
36. Karimi N, Saadat-Gharin S, Tol A, Sadeghi R, Yaseri M,
Mohebbi B. A problem-based learning health literacy intervention
program on improving health-promoting behaviors among girl
students. J Educ Health Promot 2019;8:251.
37. Kuss DJ, Griffiths MD, Karila L, Billieux J. Internet addiction:
A systematic review of epidemiological research for the last
decade. Curr Pharm Des 2014;20:4026-52.
38. Iravani MR, Rajabi M, Abbasi MG, Jannesari H. A social work
study on impact of gender, marital status and employment status
on internet addiction. Manage Sci Lett 2013;3:1019-24.
39. Mazza C, Ricci E, Biondi S, Colasanti M, Ferracuti S, Napoli C,
et al. A Nationwide survey of psychological distress among Italian
people during the COVID-19 pandemic: Immediate psychological
responses and associated factors. Int J Environ Res Public Health
2020;17:3165.
40. Bhandari PM, Neupane D, Rijal S, Thapa K, Mishra SR,
Poudyal AK. Sleep quality, internet addiction and depressive
symptoms among undergraduate students in Nepal. BMC
Psychiatry 2017;17:106.
41. Lebni JY, Toghroli R, Abbas J, NeJhaddadgar N, Salahshoor MR,
Mansourian M, et al. A study of internet addiction and its effects
on mental health: A study based on Iranian University Students.
J Educ Health Promot 2020;9:205.
42. Siste K, Hanafi E, Sen LT, Christian H, Adrian, Siswidiani LP, et al.
The impact of physical distancing and associated factors towards
internet addiction among adults in Indonesia during COVID-19
pandemic: A nationwide web-based study. Front Psychiatry
2020;11:580977.
43. Griffiths MD, van Rooij AJ, Kardefelt-Winther D, Starcevic V,
Király O, Pallesen S, et al. Working towards an international
consensus on criteria for assessing internet gaming disorder:
A critical commentary on Petry et al. (2014). Addiction
2016;111:167-75.
44. Anand N, Jain PA, Prabhu S, Thomas C, Bhat A, Prathyusha PV,
et al. Internet use patterns, internet addiction, and psychological
distress among engineering university students: A study from
India. Indian J Psychol Med 2018;40:458-67.
45. Montag C, Bey K, Sha P, Li M, Chen YF, Liu WY, et al. Is it
meaningful to distinguish between generalized and specific
Internet addiction? Evidence from a cross-cultural study from
Germany, Sweden, Taiwan and China. Asia Pac Psychiatry
2015;7:20-6.
46. Available from: https://pib.gov.in/PressReleasePage.
aspx?PRID=1650669. [Last accessed on 2021 Feb 01].
47. Gualano MR, Lo Moro G, Voglino G, Bert F, Siliquini R. Effects
of COVID-19 lockdown on mental health and sleep disturbances
in Italy. Int J Environ Res Public Health 2020;17:4779.
48. Tavernier R, Willoughby T. Sleep problems: Predictor or outcome
of media use among emerging adults at university? J Sleep Res
2014;23:389-96.
49. Kumari RK, Jain KJ, Nath B. Sleep quality assessment among
college students using Pittsburgh Sleep Quality Index in a
municipal corporation area of Uttarakhand, India. Ceylon Med J
2020;65:86-94.
50. Peach HD, Gaultney JF, Ruggiero AR. Direct and indirect
associations of sleep knowledge and attitudes with objective and
subjective sleep duration and quality via sleep hygiene. J Prim
Prev 2018;39:555-70.
)