Media use and Internet addiction in adult depression: A case-control study

Highlights

• The extend of Internet addiction was compared between a group of depressive patients and healthy controls.

• Results demonstrated a high prevalence of Internet addiction in depressive patients.

• Low age and male sex were significantly predictors for Internet addiction in depressive patients.

Abstract

The present case-control study explored tendencies of Internet addiction in a group of depressive patients compared with a control group of healthy persons. Standardized questionnaires were used to assess the extent of Internet addiction (ISS), depression symptoms (BDI), impulsivity (BIS) and global psychological stress (SCL-90R). Depressive patients with and without Internet addiction were compared regarding depression severity and psychological stress. In addition, predictors of Internet addiction in depressive patients were investigated. The results presented significantly higher tendencies for Internet addiction in the group of depressive patients. The prevalence of Internet addiction in this group was considerably high (36%). In addition, depressive patients with Internet addiction showed consistently but insignificantly higher symptom severity and psychological stress compared with patients without Internet addiction. Both groups of depressive patients were significantly higher burdened with depressive symptoms and psychological stress than the healthy controls. Low age and male sex were particularly important predictors of Internet addiction in the group of depressive patients. The results are in accordance with previously published findings in other fields of addiction disorders. Co-occurrence of depression and Internet addiction should be noted and considered in psychiatric treatment.

Introduction

Depression, as a global public health burden, is defined as a cluster of specific symptoms with a large and diverse range of impairment (Chapman & Perry, 2008). The main symptoms include depressed mood, loss of interest and enjoyment in usual activities, and reduced energy (APA, 2013). The decreased activity can lead to a deficit of physical movement that is related to increased media use, screen time, and depressive mood as well (Feng et al., 2014, Hamer and Stamatakis, 2014).

Research findings about the interactions between media, especially Internet use, and depression are still heterogeneous (Center on Media and Child Health, 2014). While Internet use might become a dysfunctional way of escaping unsolved problems, there is also some evidence that Internet use may be a way to cope with depressive feelings (Carpentier et al., 2008, Morgan and Cotton, 2003, Romer et al., 2013). So far, most studies investigating the relation between depression and media use focused on cohorts of healthy adolescents and young adults (Liu et al., 2015, Lucas et al., 2011). There is some evidence that high levels of Internet use might increase depressive symptoms (Kraut et al., 2002, Kraut et al., 1998 &; Romer et al., 2013), while other studies found no association between Internet use and psychological burden like depressive symptoms or general well-being (Gross, 2004, Jelenchick et al., 2013).

There is an ongoing discussion whether excessive Internet use and depression are independent comorbidities, or depressive disorders do predict Internet addiction (Ko, Yen, Yen, Chen, & Chen, 2012). However, in the field of alcohol and gambling addiction there is evidence from prospective longitudinal studies that addiction is associated with higher risk for the onset of a first depressive episode (Afifi et al., 2016, Bellos et al., 2016). So conversely, addiction itself might be even a risk factor for the occurrence of depression. Further, high individual's impulsivity is known to increase the vulnerability to both substance addictive disorders (Stevens et al., 2014) and pathological Internet use (Cao, Su, Liu, & Gao, 2007). Pathological Internet users have shown comparably higher impulsivity compared with alcohol-addicted patients (te Wildt et al., 2012).

With all advances in media technology, screen time (e.g. watching television, using the Internet, and playing video games) becomes a central component of our daily lives.

As a result, there is a lively scientific discussion about potential side effects of escalated media usage (Young, 1999, te Wildt et al., 2010). Internet addiction and especially online gaming addiction become more and more relevant in many parts of the world. A multinational analysis including 89.281 participants from 31 nations across seven world regions (Cheng & Li, 2014) showed a global prevalence of Internet addiction of 6.0% (95% CI 5.1–6.9). The highest prevalence was reported in the Middle East (10.9%, 95% CI 5.4–16.3) and Asia (7.1%, 95%CI 5.3–8.9). The lowest prevalence rate was 2.6% (95% CI 1.0–4.1), assessed in Northern and Western Europe. The prevalence of Internet addiction in Germany was estimated to approximate 1% for 14–64years old persons, and 4% for 14–16years old persons (Bischof, Bischof, Meyer, John, & Rumpf, 2013, pp. 1–9). When treating patients with Internet addiction, depression is one of the most common psychiatric comorbidities, followed by anxiety disorders and ADHD (Carli et al., 2013, Ko et al., 2012). Clinical research in this new field of medicine is steadily growing. Internet Gaming Disorder is currently identified in section III of the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a condition warranting more clinical research and experience before it might be considered for inclusion in the main section as a formal disorder (Ko, 2014).

There is only little knowledge about the media use and Internet addiction of adult patients suffering from depression. It remains a need for further studies to describe the function of media use in adult depression. Our objective was to investigate the prevalence of Internet addiction in a group of adult depressive patients. Furthermore, depressive patients' specific characteristics in media use should be examined. The corresponding research questions (RQ) were the following:

RQ 1

Do depressive patients show higher tendencies of Internet addiction compared with healthy controls? In addition, what is the prevalence of Internet addiction in adult depressive patients?

RQ 2

Are those depressive patients, who show an Internet addiction, even more severely burdened with depressive symptoms and psychological stress?

RQ 3

Are there predictors for Internet addiction in the group of adult depressive patients?