Impulsivity Mediates Associations Between Problematic Internet Use, Anxiety, and Depressive Symptoms in Students: A Cross-Sectional COVID-19 Study

Abstract

Background: Problematic internet use (PIU) is a serious global mental health issue that especially manifested during the Coronavirus disease (COVID-19) pandemic. Engagement in PIU as an impulsive coping with mental distress may pose a long-lasting threat to develop anxiety and depressive disorders. The first aim of our study was to investigate the prevalence of PIU and mental distress symptoms during the COVID-19 pandemic among university students in Lithuania. The second aim was to test the hypothesis that PIU affects anxiety and depressive symptoms through the mediating role of impulsivity.Methods: The cross-sectional study was comprised of 619 university students (92.9% females and 7.1% males) with a mean age of 22 ± 3 years who participated in an online survey from May to November, 2020. Participants completed the following scales: the Problematic Internet Use Questionnaire-9, the Generalized Anxiety Disorder Questionnaire-7, the Patient Health Questionnaire-9, and the Barratt Impulsiveness Scale-11. K-means cluster analysis and one-way multivariate analysis of variance were used for group comparison in terms of internet use time and habit change during COVID-19 pandemic. Structural equation modeling was applied to examine the mediating effect of impulsivity in association between PIU and mental distress, while controlling for age.Results: In sum, 45.1% of the participants reported PIU and 38.1% had markedly expressed symptoms of anxiety while 43.6% of the students reported moderate to severe depressive symptoms. During the COVID-19 pandemic 76% of the students reported at least moderate increase in their internet use time. Anxiety and depressive symptoms were significantly higher in the group of frequent internet users. The results of the structural equational modeling analysis showed a statistically significant effect of PIU on subjective anxiety symptoms and the statistically significant effect of PIU on subjective depression symptoms, both mediated via impulsivity.Conclusions: During COVID-19 pandemic, PIU, anxiety and depression symptoms are highly prevalent among students. Findings also suggest that relationships between PIU, anxiety and depressive symptoms are mediated via impulsivity. These results underscore the importance of the inclusion of impulsivity factor in the studies analyzing longitudinal effects of PIU on mental distress during COVID-19 pandemic.

Compulsive Internet Use Scale: Psychometric Properties and Associations With Sleeping Patterns, Mental Health, and Well-Being in Lithuanian Medical Students During the Coronavirus Disease 2019 Pandemic

“…The effect size of these results varied from small in the case of anxiety, sleep quality, and well-being indices to medium in the case of depression symptoms. A recent study conducted in Lithuania in the general student population showed significant associations between PIU (as measured by the PIUQ-9 questionnaire), anxiety, and depressive symptoms (Gecaite-Stonciene et al, 2021). Similarly, symptoms of anxiety, depression, and sleep disturbances were associated with PIU among the medical population in studies conducted in other countries (Capetillo-Ventura and Juárez-Treviño, 2015;Younes et al, 2016;Grover et al, 2019;Shadzi et al, 2020).…”

“…The study results suggest a relationship between a higher CIUS total score and lower subjective sleep quality. Kalmbach et al (2017) suggest that sleep deprivation among physiciansin-training leads to higher medical error rates and may also have a negative effect on the mental health of doctors (Gecaite-Stonciene et al, 2021).…”

“…However, in Lithuania, a scarcity of available instruments remains for investigating PIU. Most of the existing studies conducted in Lithuania focused on children and teenagers (Blinka et al, 2015;Škarupová et al, 2015;Ustinavičiene et al, 2016), and only two investigated PIU symptoms among students using a psychometrically sound nine-item PIU questionnaire, namely, the PIUQ-9 (Burkauskas et al, 2020;Gecaite-Stonciene et al, 2021). Consequentially, it is of crucial importance to update the toolbox of PIU measurements to investigate the symptomatology in specific samples of individuals who might be particularly vulnerable to the phenomena.…”

Problematic internet use prior to and during the COVID-19 pandemic

“…In pre-pandemic contexts, multiple studies reported a robust relationship between affect (in particular, negative affect and emotion dysregulation), impulsivity (especially, negative urgency), and an increased risk for problematic internet use (MacLaren et al, 2011;Ostinelli et al, 2021;Velotti et al, 2021). Preliminary data from studies conducted during the COVID-19 pandemic also showed significant relationships between emotional symptoms (anxiety, stress, and/or depression), impulsivity, and heightened internet use (Albertella et al, 2021;Boursier et al, 2020Boursier et al, , 2021Gecaite-Stonciene et al, 2021;Giardina et al, 2021;Sharman et al, 2021;Teng et al, 2021). These studies suggest that exacerbated emotional problems derived from the pandemic and prolonged isolation, along with a certain predisposition to act rashly when facing negative emotional states, may increase the risk for problematic internet use.…”

The Association Between Social Support, COVID-19 Exposure, and Medical Students' Mental Health

“…A meta-analysis showed that approximately one-third of college or university students had depressive or anxiety symptoms ( 9 ). Different testing procedures, dates, scales, or the cutoff points of scales may result in varied prevalence rates ( 9 ), such as 12% in Greece ( N = 1,104) ( 10 ) and nearly half in France ( N = 619) ( 11 ). An online survey conducted among 11,787 Chinese college students in February 2020 showed that the prevalence rates of depressive [the Patient Health Questionnaire—nine-item (PHQ-9) ≥ 5] and anxiety [the seven-item Generalized Anxiety Disorder Scale (GAD-7) ≥ 5] symptoms were 25.9 and 17.8%, respectively ( 12 ).…”