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|Year : 2018
: 60 | Issue : 3 | Page
|Use of social networking site and mental disorders among medical students in Kolkata, West Bengal
Lisa Barman1, Dipta Kanti Mukhopadhyay1, Gautam Kumar Bandyopadhyay2
1 Department of Community Medicine, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
2 Department of Psychiatry, College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
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|Date of Web Publication||16-Oct-2018|
| Abstract|| |
Background: Use of social networking sites (SNS) and prevalence of anxiety and depression among the young population is on the rise.
Objectives: The aim of this study is to assess the pattern of use of SNS and the prevalence of anxiety and depression among medical students as well as to examine the relation, if any, between the use of SNS and anxiety and depression.
Methods: A cross-sectional study was conducted among 200 undergraduate students of a medical college in Kolkata, West Bengal during 2017. Information on individual characteristics and use of SNS of medical students were collected using a structured questionnaire. Anxiety and depression were measured using State-Trait Anxiety Inventory (STAI) and becks depression inventory (BDI). Prevalence was expressed in percentage and association was examined with Mann–Whitney U-test.
Results: More than 90% of students use more than one SNS or instant messaging system. One-third remained active in SNSs all through the day and around 80% for ≥4 h. Use of SNSs during odd hours was reported by 55% participants, and 23.5% expressed their inability to spend a day without SNSs. Nearly 24% reported depression and 68.5% had state anxiety. STAI and BDI scores were significantly (P < 0.05) higher among students who used SNSs for 4 h or more, used it during odd hours or stated inability to spend a day without SNSs than their counterparts.
Conclusion: The use of SNS by medical students was pervasive. More use of SNSs and dependence on it were associated with anxiety and depression.
Keywords: Anxiety, depression, medical students, social networking sites
|How to cite this article:|
Barman L, Mukhopadhyay DK, Bandyopadhyay GK. Use of social networking site and mental disorders among medical students in Kolkata, West Bengal. Indian J Psychiatry 2018;60:340-5
| Introduction|| |
Social networking sites (SNS) can be defined as “a group of Internet-based applications that allow the creation and exchange of user-generated content.” For the past decade, there is a huge change in the field of communication because of the rapid development of social networking. It has an enormous effect on how people interact with each other, sometimes being the first line of communication. In research in 2015, it was noted that adolescents are avid users of SNS, with approximately 71% of them using more than one online sites and Facebook was the most (41%) widely used SNS. It can be really assumed how much important these sites are in our daily lives from more than one billion active users of Facebook.
SNS acts as a two-edged sword. They are used for academic excellence. On the other hand, the excessive use of online SNS can cause addiction and dependence, sleep disturbance, and depression. Recent research documented an association between online social networking and mental health. As the popularity of SNS is surging among the today's young generation, any proposed psychiatric conditions associated with it can pose serious public health issue may be a global cyber-epidemic. The most alarming thing is most of the users do not realize the negative impact of social media as they are already addicted to it.
The medical profession is also joining the parade and attracted substantial interest among educators and institutions. A recent meta-analysis suggests that 75% of medical students were regularly using SNS including the compulsive/compensatory use of social networking and India is no exception to that.,,
It is already established that the level of the stress among medical students is much higher and this stress affects the lives of the medical students-their academic performance, physical health as well as their psychological health. As a result of that depression and anxiety are not very uncommon in medical students.,,
Empirical evidence regarding the magnitude of use of SNS and its association with the mental health status of medical students are scarce in India. On the backdrop of these situations, the present study was conducted to assess the pattern of use of SNSs, the prevalence of anxiety and depression and their interrelation among undergraduate medical students in a Medical College in Kolkata, West Bengal.
| Materials and Methods|| |
Study design, setting, and duration
A cross-sectional descriptive epidemiological study was conducted among the undergraduate medical students who enrolled in the college from 2012 to 2016 academic sessions in a Medical College in Kolkata, West Bengal having a capacity of 100 students per year during the period of June–August 2017.
Sample size and sampling technique
The available literature showed that the proportion of medical students using SNS ranged from 67% to 75%., Assuming the proportion of students having one or more accounts of SNSs as 67%, considering the confidence level of 95%, the relative precision of 10%, the final sample size was 189 which were rounded off to 200. As the number of enrolled students is similar in each batch (year-group), 40 students from each batch was selected through simple random sampling from the list of students as per Attendance Register of the College. As the diagnosis of psychiatric diseases and/or psychotropic drugs might alter the use of social media, students with clinically diagnosed psychiatric illness and/or Students under medication for any psychiatric illness were excluded from the study.
The study tool had three different sections:
- Assessment of anxiety-State Trait Anxiety Inventory (STAI)
- Assessment of depression-Becks Depression Inventory (BDI)
- Structured Questionnaire for assessment of the use of SNSs.
The section of a questionnaire for assessing the use of SNS and its effect on daily life was pretested in a similar population and validated with the help of psychiatrists, public health specialists, and sociologists. For assessing the use of SNSs, the participants were asked whether they have any account in any of the SNS and instant messaging software. If yes, they were asked to state how many times in a day, on average, they visited the site (s) in the last 7 days. They were also asked to state the average duration they spent on each visit in the last 7 days. They were also asked whether they wake up early or went to bed late to spend time in SNSs. Their perceived ability to spend a day without SNSs was also enquired. Effect of spending time in SNS on their self-confidence and their satisfaction with use were assessed.
Validated English version of STAI questionnaire and the BDI Scale was applied to the participants to screen anxiety and depression among medical students. Specific cut-off (39/40) for college students as cited in the manual for STAI was used to screen state anxiety among participants. The BDI was used as per guideline to screen depression.
Method of data collection
The study obtained clearance from the Institutional Ethics Committee of the concerned Medical College. After obtaining the written informed consent, the structured questionnaire in English was distributed among the selected students to collect information regarding their sociodemographic characteristics such as age and gender. The pattern of use of SNS and its effect on daily lives were assessed along with screening of depression and anxiety. Consecutive three visits were paid for each batch to include the selected students.
Method of data analysis
The proportion was used to express the use of SNS as well as the prevalence of screener positive depression and state anxiety. Differences in anxiety and depression scores (measured using STAI and BDI) according to the pattern of use of SNS were examined with Mann–Whitney-U (MW-U) test as the scores were considered as ordinal data.
| Results|| |
Characteristics of study subjects
The final analysis was performed with a filled-in questionnaire of 200 medical students enrolled in College of Medicine and Sagore Dutta Hospital, Kamarhati, Kolkata. More than half of the students aged 21–23 years while the mean age (± standard deviation) of the sample was 21.6 (±1.8) years. There was an almost equal representation of male (51.0%) and female students (49.0%).
Use of social networking sites
All the study participants used SNSs, and among them, only 8.0% use one SNS. More than half of students (50.5%) used two SNSs while around two-fifth students (41.5%) used three or more SNSs. “WhatsApp” was the most preferred SNS (97.9%) followed by “Facebook” (91.4%) and “Instagram” (30.5%). Communication with the friends and families was the most common (59.0%) cited reasons for using SNSs followed by entertainment (43.1%) and education and professional activities (31.4%).
As noted in [Table 1], around one-third students (32.5%), SNSs were accessed at least once in an hour, while more than half (53.5%) used it at least 4-hourly in a day. Almost one-tenth students (10.5%) used SNSs 1–3 times a day, rest are an occasional user. Around 80.0% of the students accessed SNSs for at least 4 h a day and 29.0% students remained available in SNSs all through the day. One-fifth study participants (18.0%) often wake up early or went to bed late night to spend time in SNSs and another 37.0% did it for sometimes. Around one-fourth (23.5%) students were either not sure or expressed their inability to spend a day without SNSs. Another 14.0% reported that they could spend a day without SNSs in some particular times.
|Table 1: Distribution of study participants according to use of social networking sites|
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Only 7.0% always definitely felt satisfied with the use of SNSs and slightly more than half (52.5%) were satisfied to some extent. Another 30.5% were not sure and one-tenth was not at all satisfied with the use of SNSs.
Prevalence of depression and anxiety
As per score obtained in Beck's Depression Inventory (BDI), one-fifth of the study participants had mild-to-moderate depression and another 4.0% had severe depression.
According to the score obtained in State and Trait Anxiety Inventory-State (STAI-S), 59.0% had moderate anxiety, and 9.5% had severe anxiety at the time of assessment.
Association of use of SNSs with depression and anxiety [Table 2] and [Table 3]
|Table 2: Association between use of social networking sites and becks depression inventory score|
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|Table 3: Association between use of social networking sites and State Trait Anxiety Inventory -S score|
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The BDI score and STAI-S score were higher among students who used more than three SNS than those who used <3, but the differences were not statistically significant for BDI (MW-U = 4313.0; P = 0.178) or STAI-S (MW-U = 4578.5; P = 0.492).
Significant differences in BDI score (MW-U = 1764.5; P = 0.023) and STAI-S (MW-U = 1715.0; P = 0.015) score between students who used SNS four times or more per day and those who used <4 times a day were statistically significant.
Similarly, students who used SNS for 4 h or more per day scored significantly higher in BDI (MW-U = 1831.5; P = 0.042) and STAI-S (MW-U = 1811.0; P = 0.035) than those who used SNS for less duration.
Students who wake up early or go to bed late at night to spend time in SNS were more likely to have a higher score in BDI (MW-U = 3636.0; P = 0.001) and STAI-S (MW-U = 3785.0; P = 0.004) scales than those who do not.
Students who were sure that they could spend a day without SNS were more likely to score lower in BDI (MW-U = 2390.0; P < 0.001) and STAI-S (MW-U = 2372.5; P < 0.001) than those who apprehended difficulties in doing so.
| Discussion|| |
While the communication facilities of social media have transformed the lives of young adults across the globe in a positive way, it might also affect the development and wellbeing of young people adversely. Debates are encircling around the question that whether the use of SNS and instant messaging are causative factors for mental disorders or it is the increased case ascertainment and greater societal concern which leads to increase reporting of mental disorders among adolescents and youth.
Use of social networking sites
Because of the emerging use of SNSs, face-to-screen interaction is much more than face-to-face interaction. That may lead to depression and loneliness, anxiety perceiving people around doing better jobs, or may help in depressed persons with social withdrawal to connect, take tips, joining online help groups.
Use of SNS was universal among the undergraduate medical students in the present study with more than two-fifths of them using three or more social media. Among the different platforms, WhatsApp emerges to be the most popular, followed by Facebook with >90.0% of the study participants using these, corroborating earlier research in India. Although the percentages of respondents using Facebook and WhatsApp were found to be higher than some previous researches,, figures similar to our study has been reported among adolescents in US, medical students in India, Australia, and UK.
Regarding use frequency, this study showed that the medical students were avid users of SNS with around one-third of the students accessing SNSs at least once in an hour and nearly 60.0% used it at least once in a day. Duration wise, around 80.0% students reported to use SNSs for > 4 h while one-third of the participants remain logged in throughout the whole day. This suggests heavy and frequent use among the participants, which is relatable to the previous study conducted by Goel et al. and Hall et al.,
One of the interesting findings was that around 18% of the study subjects often wake up early or went to bed late night to spend more time in SNS. Another 38% did it for sometimes, making around 56% odd time users of SNS found in our study-which corroborates similar findings from Madaiah et al. Although the reported proportion of participants who expressed their inability to spend a day without SNSs in the referred study was almost three times higher than that of the present study.
Kraut et al. showed that SNSs helped youth to satisfy with larger network and larger estimated audiences, the level of satisfaction attained by the participants in this study was mixed. Strikingly, around one-third of participants reported that they perceived positive effect on using SNSs on their self-confidence and well-being, on contrary to the previous study conducted by Kross et al.
Prevalence of depression and anxiety
Around one-fourth of participants reported screener positive depression in the present study, while Kulsoom et al. reported a high prevalence of depression (43%) among the participants and Yusoff et al. noted very low prevalence of depression., On the other hand, the prevalence of moderate and severe anxiety was at par with the earlier studies.,
Social networking site use and prevalence of depression and/anxiety
Affective disorders such as depression, anxiety were reported to have a bidirectional relation with the social environment of the individual that modulates the onset and maintenance of illness. The social characteristics affected by mental health conditions are completely relevant to their sense of well-being. Current mental health theories suggest that the presence of wellbeing is not synonymous to the absence of mental illness; a complete model of mental health requires not just absence of psychopathology, but also a focus on positive indices of functioning such as subjective well-being. Depression and anxiety have high levels of comorbidity and may influence the size and structure of the social network of an individual., Individuals with anxiety/depression have an impoverished social network, and on the other side, impoverished social networks are often a risk factor for depression and anxiety by reducing access to “buffering” social support and increasing feelings of isolation.,
Although the number of SNSs used had no bearings on depression and anxiety of study participants in the present study, the depression and anxiety scores were found to be higher in students who use SNS frequently and for a longer duration. This finding is corroborative to the numerous previous literature.,,, Neira et al. also reported a significant association between frequency of social network use and depression. Kross et al. illustrated that more use of social networks exposed the young adults to experiences of negative affect and reduced their sense of well-being. It was also noted that participants who reported depressive mood were more likely to use social media to express their feelings. Young people with affective disorders were found to be less likely to have face-to-face communication and therefore tend to communicate with virtual friends.,
The prominent risk factors related to social media for depression and anxiety were frequent social comparison, perceived negative interaction, addictive/problematic use and rumination. We also found in the present study that students, who reported to use SNSs in odd hours, i.e., staying up late night or waking up early or both, were more likely to have higher score in depression and anxiety scales than the students who did not. Student who reported that they could spend a day without using any SNSs were less likely to have depression and anxiety than the persons who apprehended difficulties in doing that. These indicated a sort of dependence on social media and might be the early symptoms of problematic SNS use. Working at odd hours might disrupt the circadian rhythm of the students which in turn made them vulnerable to mood disorders. In summary, the present study shows significant association of high usage of social media with anxiety and depression among medical students in Kolkata, West Bengal in the present socio-cultural context.
Strength and limitations
This study attempted to bring out empirical evidence regarding the relation between use of SNS and depression and/anxiety among the medical students in Indian socio-cultural context, data on which are scarce. In this study, the screener instrument was used to measure depression and anxiety instead of a detailed clinical interview, which is subject to the over-estimation of the burden. As the use of SNS and depression/anxiety was measured at the same time in this cross-sectional study, it might not be free from reverse-causality bias.
| Conclusion|| |
The present study revealed that use of SNS was almost universal among study participants and majority of them were avid users of SNSs. A significant proportion of medical students have a massive affinity toward SNSs. Intense use of SNS including using those in odd hours were found to be significantly associated with depression and anxiety. The problem is relatively young still important enough for proper intervention. More intensive researches are needed to get a solution to the tangled relation between SNS use and mental health issues.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Dr. Dipta Kanti Mukhopadhyay
Lokepur, Near N.C.C. Office, Bankura-722 102, West Bengal
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]