When choosing a topic for my selective component, I wanted to choose a topic that both interested me on my clinical rotations and was clinically relevant in today’s society. On my psychiatric rotation, the only interaction with the pediatric psychiatric unit was just observation while passing by but I couldn’t help but wonder, what was their reason for being there? What environmental factors caused these patient’s to have these psychiatric disorders?
This topic is important since psychiatric disorders are so prevalent in today’s society and seem to be increasing throughout the years. In addition to the increase in psychiatric disorders, there is also a noticeable increase in technology throughout the years. Smartphones with instant internet access, social media, live streaming, etc. all are very useful in our daily lives, but is there a point when use of technology become detrimental to those who use them?
With the increase in school shootings, suicides and overall teen mental illness, I wanted to look further on whether or not internet addiction could be contributing to those trends. The clinical question that I chose to review was “Does internet addiction have a relationship/association with adolescent psychiatric disorders?”
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The two citations that I researched were on Touro University Nevada’s PubMed database searching “internet addiction” and “psychiatric disorders” in the search bar. These articles are titled “[p]revalence and patterns of psychiatric disorders in referred adolescents with Internet addiction” and “[c]omorbidity of psychiatric disorders with Internet addiction in a clinical sample: The effect of personality, defense style and psychopathology”.
I chose the first article because of how the study directly correlates the relationship of internet addiction and psychiatric disorders. In this study, 60 participants (45 male, 15 female) ranging from age 10-18 at the Child and Adolescent Psychiatry Department at Istanbul Medicine University were brought in for sampling.
The inclusion criteria for the participants were age, problematic behavior or internet use, Young’s Internet Addiction Scale (YIAS) score ≥80 which in short is a twenty question Likert score questionnaire that ranks internet addiction on scale from 20-100 with higher scores indicating greater risk of addiction, IQ ≥70 and informed consent to participate in the study. All the participants had access to a computer or some type of internet connection at home. The study found that these participants spent a mean of 53.7 hours per week, the average YIAS score was 85 and all participants had one DSM‐IV Axis I diagnosis. In addition to one psychiatric diagnosis, 88% had two or more and 65% had three or more diagnosis.
The percentages of diagnosis were behavioral disorder at 86.7%, anxiety disorder, at 71.7%, mood disorder at 38.3%, substance use disorder at 6.7%, ADHD at 83.3%, social phobia at 35% and major depression disorder at 30%. Some of the limitations found when reviewing this study was the small sample size and potential bias created from the study. I found that the statistics could be skewed by a small sample size of 60 and inclusion criteria that ultimately shows referral bias towards the picking the participants.
Referral bias can be seen by picking participants that are already in a psychiatric facility vs taking every child as a whole population which skews that results showing higher percentage of internet addiction users having a comorbid psychiatric disease. Even with factoring in the limitations, this study found that there were high rates of psychiatric disorders in adolescents with internet addiction. I believe, due to the increasing prevalence that instant internet access with smartphones and computers has on society, clinicians in any field, not just clinicians managing psychiatric disorders, should consider the effects internet addiction has on adolescents and educate them and parents on potential comorbid conditions correlated with high internet usage.
The second article I chose further researches comorbidities with psychiatric disorders from a sample of college students who are in treatment of internet addiction disorder as well as trying to better understand any underlying causes of internet addiction disorder. This article makes a point that there are three possibilities of internet addiction and psychiatric disorders; either that an individual with a pre-existing psychiatric diagnosis develops internet addiction, or that an individual clinically diagnosed with internet addiction develops psychiatric symptomatology as a result of the adverse effects that internet addiction causes to the sufferer, or finally that a person with a pre-existing psychological vulnerability (e.g. a personality disorder) develops internet addicition when exposed to adverse life events [2].
The clinical sample of 39 males and 11 females in college who sought treatment of internet addiction were measured on the basis of a demographics questionnaire, questions on online activities, the Online Cognitions Scale (OCS), the Defense Style Questionnaire (DSQ), the Zuckermann–Kuhlman Personality Questionnaire (ZKPQ) and the Symptom Checklist (SCL-90) questionnaire.
To describe the study in short, the study concluded that half of the sample (25/50) presented with comorbidity of another Axis I disorder and 38% (19/50) with a concurrent Axis II personality disorder. Of the sample size, 51.85% of Axis I disorders were reported by students prior to onset of their internet addiction disorder, while 33.3% reported their disorders where after the onset of internet addiction disorder. Limitations with this study, again, pertains to the small sample size of the study and as well as self-report questionnaires. With the small samples size, the overall general population is not accurately addressed.
Limitations with the self-report questionnaires, are that some of the participants might not be completely honest on when they were diagnosed with psychiatric disorders, the extent of their psychiatric disorders, behavioral questionnaires or the overall usage of the internet. Nonetheless, the results of this study show that regardless of whether comorbid psychiatric disorders start prior or after the internet addiction, there is a relationship between the two and clinicians should not rule out further evaluating a patient’s internet usage when assessing their psychiatric disorders or vice versa.
In conclusion, these two studies show that there is a relationship of internet addiction with comorbid psychiatric disorders. Although after reviewing these studies and numerous other studies not presented in the paper, I found that not enough statistical validity has been presented to this topic to make a reliable conclusion for evidence based medicine.
Even without the statistically significant data presented from these studies, I found this topic interesting enough and prevalent enough to discuss with other colleagues on if there is a correlation between the two and if changes to psychiatric diagnosis questionnaires should start to include questions on internet addiction or time spent on the internet. With the increasing prevalence of instant internet access and the rise in psychiatric disorders, I would like to see more studies dive into this topic to see if we can prevent psychiatric disorders by limiting the amount of time spent on the internet.
