Problematic Internet Use and Stress Levels in Students of Health and Social Sciences

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International Journal of Caring Sciences                 January – April 2020 Volume 13 | Issue 1| Page 438

Original Article

       Problematic Internet Use and Stress Levels in Students of Health
                             and Social Sciences

Serap Unsar, PhD
Professor, Trakya University, Faculty of Health Sciences, Department of Medical Nursing, Edirne,
Melahat Akgun Kostak, PhD
Associate Professor, Trakya University, Faculty of Health Sciences, Department of Child Health and
Disease Nursing, Edirne, Turkey
Sevil Yilmaz, PhD
Assistant Professor, Istanbul University, Faculty of Nursing, Mental Health and Psychiatric Nursing,
Istanbul, Turkey
Sevgi Ozdinc, PhD
Assistant Professor, Trakya University, Faculty of Health Sciences, Department of Physical Therapy and
Rehabilitation, Edirne, Turkey
Ozturk Selda
Research Assistant, Trakya University, Faculty of Health Sciences, Department of Mental Health and
Psychiatric Nursing, Edirne, Turkey
Agah Sinan Unsar, PhD
Professor, Trakya University Faculty of Economics and Administrative Sciences, Business Department.
Edirne, Turkey
Correspondence: Melahat Akgun Kostak, Associate Professor, Trakya University, Faculty of Health
Sciences, Department of Child Health and Disease Nursing, Edirne, Turkey. E mail:

Background: Internet use has become increasingly widespread among young people throughout the world.
Uncontrolled and excessive use of the internet by university students can cause serious harm to health. Young
people commonly face both physical and psychological harm from long-term Internet use or Internet addiction.
Objective: This study aims to determine the relationship between Internet use and stress levels in university
students and the factors affecting them.
Methodology: This descriptive study was conducted with a total of 433 students from the Nursing, Physical
Therapy and Rehabilitation Departments of the Faculty of Health Sciences and Business and Labor Economics
of the Faculty of Economics and Administrative Sciences in Turkey.
Results: The study found that the average duration of students’ Internet use per week was 23.1±20.1 hours. The
students’ average Online Cognitive Scale (OCS) and average Stress Scale (SS) scores were 85.3±32.9 and
17.9±10.2, respectively. The OCS scores of the nursing students were lower than those of the Business
Administration students (p
International Journal of Caring Sciences              January – April 2020 Volume 13 | Issue 1| Page 439

Introduction                                           al., 2014). Yang and Tung (2007) reported that
                                                       people with Internet addiction have family,
Internet use has become increasingly widespread
                                                       school, financial, health, communication
in all areas of life, especially among young
                                                       problems. Some studies found that individuals
people, throughout the world (Casale, Lecchi &
                                                       with Internet addiction used the Internet for fun,
Fioravanti, 2014; Ceyhan, 2010). International
                                                       interaction, and the feeling of satisfaction
epidemiological studies consider Internet
                                                       (Batigun & Kilic, 2011), while individuals
addiction to be a public health problem
                                                       without Internet addiction used it rather for
worldwide; a prevalence study conducted among
                                                       research and chatting (Kayri & Gunuc, 2010;
university students indicated that prevalence of
                                                       Adalier & Balkan, 2012).
Internet addiction is around 8% to 13% (Chou et
al., 2015). Students starting their university         Some previous studies found that Internet use
education use the Internet to do their homework,       was widespread among university students (Akin
do academic research, and find out their course        & Iskender, 2011; Ceyhan, 2010; Sahin, 2011).
grades (Rotsztein, 2003; Adalier & Balkan,             Institutions of higher education encourage new
2012). In addition, students can quickly and           students to use the Internet for many reasons, and
easily access the Internet from many places in         even provide students with an e-mail address
their universities such as libraries, computer         upon enrolment. The opportunity to use the
laboratories, dormitories, shopping centers and        Internet in education institutions is provided to
cafe (Tsimtsiou et al., 2015).                         students either low-cost or free of charge, which
                                                       makes the Internet an affordable and useful
According to the Internet World Usage Statistics,
                                                       option for students (Rotsztein, 2003).
45% of the world population uses the Internet
(Internet World Stats, 2015). The Household            Being a student at a university and university life
Information Technologies Research conducted in         itself are situations that cause anxiety and stress.
Turkey (Turkish Statistical Institute, 2014) found     Many young people are faced with problems like
that 16–24 age group ranks first in Internet use,      anxiety about making new friends, leaving
with a usage rate of 73%. It was found that this       family, adapting to dormitory life, economic
rate was 92.9% with high school, a bachelor’s          difficulties, future profession, and work life.
degree, and those having a higher degree such as       These social, cultural, and economic changes can
a master degree level of education (TSI, 2014).        adversely affect young people psychologically
                                                       (Yan, Li & Sui, 2013) and cause to spend much
Casale, Lecchi and Fioravanti (2014) found that
                                                       more time on internet (Casale et al., 2014). Sun
users used the internet the most for social media,
                                                       et al. (2016) reported that they had found higher
information collection, chatting, sending e-mails,
                                                       stress levels with university students. Chou et al.
and shopping, and Chou and Hsia (2000) found
                                                       (2015) found that 17% of university students
that university students used the Internet
                                                       were addicted to the internet. In some previous
primarily for chat program, surfing, and playing
                                                       studies, Jie et al. (2014) and Yan et al. (2013)
games. Ergin, Uzun and Bozkurt (2013) stated
                                                       stated that there is a positive correlation between
that university students in Turkey used the most
                                                       stressful life events and Internet addiction.
the internet for chat, web surfing, and lessons
                                                       Internet addiction has rapidly become
and games the most.
                                                       widespread in recent years, especially among
While some people can limit the amount of time         university students. Young people commonly
they use the Internet, some cannot; these people       face both physical and psychological harm from
are adversely affected in terms of finances,           long-term Internet use or Internet addiction
academics, human relationships, and many other         (Yang et al., 2014; Yang & Tung, 2007). The
areas of life as a result of misuse of the Internet    main purposes of this study are to determine
(Tsimtsiou et al., 2015; Ata, Akpinar & Kelleci,       Internet usage of university students in the
2011). Internet addiction is defined as the            Faculty of Health and Social Sciences, their
inability to limit Internet use, continued use of      levels of Internet addiction, and the correlations
the Internet despite its harms, and manifestation      between their levels of stress and Internet
of symptoms such as stress, excessive                  addiction as well as the factors affecting them.
nervousness, depression, social isolation, loss of
academic post and job, divorce, weakening in
decision-making ability (Thatcher, Wretschko &         Design and sample: This is a cross-sectional
Fridjhon, 2008; Ozcan & Buzlu, 2005; Alam et           study aimed evaluating the effect of problematic
International Journal of Caring Sciences              January – April 2020 Volume 13 | Issue 1| Page 440

internet use on stress levels students of health       Cetin in 2007. The Depression Anxiety Stress
and social sciences. This research was conducted       Scale (DASS) consists of 42 items. The scale is
at a university located in the northwest of            scored as follows: “Did not apply to me at all” =
Turkey, with three different departments, total of     0, “Applied to me to some degree, or some of the
433 students from the Faculty of Health                time” = 1, “Applied to me to a considerable
Sciences, Department of Nursing (n = 191),             degree, or a good part of time” = 2 and “Applied
Department       of    Physical     Therapy    and     to me very much, or most of the time” = 3. The
Rehabilitation (n= 114), the Faculty of                DASS consists of three sub-scales and a total of
Economics and Administrative Sciences,                 42 items to examine depression (14 questions),
Department of Business and Labor Economics (n          anxiety (14 questions), and stress (14 questions).
= 128) between 03/01/2015 and 04/01/2015.              High scores received from the scale indicate that
Data collection: The questionnaire forms, scales,      the individual has the relevant problem. Total
and purpose of the study were described by the         scores in the scale range from 0–42 for each sub-
researchers in classrooms at appropriate course        scale. While Akin and Cetin (2007) found the
times. The forms were distributed to students          Cronbach alpha internal consistency coefficient
who volunteered to participate in the study. It        of the Depression, Anxiety, Stress Scale to be
took 15 to 20 minutes for the students to fill out     0.89, the Cronbach alpha internal consistency
the forms. Questions, if any, were answered.           coefficient for the stress sub-scale was found to
Measurements: The study data were collected            be 0.92. The DASS Stress Sub-scale (SS) was
using the Questionnaire Form, Online Cognitive         used in this study and the Cronbach alpha value
Scale (OCS) and Stress Scale (SS).                     of the scale was found to be 0.93.
Questionnaire Form: The questionnaire was              Ethical Considerations: For this study, Consent
prepared by the researchers in accordance with         No. 03/11, dated 02/18/2015, was obtained from
the literature (Yang et al., 2014; Ata, Akpinar &      the Ethics Committee, Dean’s Office, Trakya
Kelleci, 2011; Batigun & Kilic, 2011; Akin &           University, Medical Faculty, and written
Iskender, 2011; Alam et al., 2014; Casale, Lecchi      permissions from the Dean’s Office, Faculty of
& Fioravanti, 2014). The questionnaire                 Health Sciences and Faculty of Business
comprised a total of 23 questions, 14 of which         Administration (where the study was conducted)
covered the socio-demographic characteristics of       were obtained. The students were given
students and their families (age, gender,              information about the study and its purpose
department, class in school, place of residence,       before they completed the questionnaire forms
etc.) and 9 of which covered Internet usage            and scales. The students’ verbal consent was
characteristics of students (duration of daily and     obtained. The student volunteers were instructed
weekly Internet use, purpose of Internet use,          not to write their names on the questionnaire
place of access to the Internet, etc.).                forms and scales since the data would be used
Online Cognitive Scale (OCS): Online Cognitive         only for scientific purposes.
Scale was developed by Davis, Flett and Besser         Data Analysis: The data was analyzed using
(2002) to assess Problematic Internet use. It          Statistical Package for Social Sciences for
comprises       four    sub-scales:     Loneliness-    Windows Program (SPSS 18.0). The data
Depression, Decreased Impulse Control, Social          relating students' sociodemographic and internet
Support, and Attention Distraction. It is a seven-     usage were analysed by percent, mean and
point Likert-type scale of 36 items, varying from      standard deviation. The normal distribution of
“Strongly Disagree” = 1 to “Strongly Agree” = 7.       the data was analysed using the Kolmogorov
The scale is assessed by calculating total scores      Smirnov test. In comparing the average scores of
and sub-scale scores. Higher scores are                scale between the characteristics of the students,
considered to be “problematic use.” The Turkish        t-test and Mann Whitney U tests were used in the
validity and reliability study of the scale was        two groups, One-Way (ANOVA) and Kruskal
performed by Ozcan and Buzlu (2005). Ozcan             Wallis tests were used in the triple groups.
and Buzlu (2005) found Cronbach’s alpha value          Spearman's correlation analysis was used for
of the scale to be 0.92. In the present study,         comparison of the students’ scores of scale. The
Cronbach’s alpha value of the scale was found to       results obtained were evaluated at a confidence
be 0.94.                                               interval of 95% and significance level of p <
Stress Scale (SS): The reliability and validity        0.05.
study of the scale, developed by Lovibond and          Limitations of the study: This study was
Lovibond (1995), was performed by Akin and             conducted with students from two health and one
International Journal of Caring Sciences               January – April 2020 Volume 13 | Issue 1| Page 441

social departments of a university. The study              books/newspapers. Internet access points were as
results cannot be generalized to all university            follows: 85% (n = 368) of the participants
students, and the results may vary when                    accessed the Internet via telephone, 59.4% (n =
additional data is added. However, this study has          257) via personal computer, 17.8% (n = 77) from
provided scientific data on problematic Internet           an Internet cafe/library, and 9.5% (n = 41) from a
use by university students.                                friend’s home (see Table 2 and Figure 1).
Results                                                    The students’ average scores on the Online
                                                           Cognition Scale (OCS) were 85.3 ± 32.9 and
A total of 433 students participated in this study.
                                                           their average scores on the Stress Sub-scale (SS)
The average age of the students in the study was
                                                           were 17.9 ± 10.2. Average OCS scores of the
19.8 ± 1.6, and 72.7% (n = 315) of them were
                                                           Business Administration students were found to
female. Almost half of the students (44.1%) were
                                                           be higher than those of the nursing students (p =
nursing students and the other half (45.9%) (n =
                                                           .017). OCS scores of the freshman were found to
195) were freshman. Of the total number of
                                                           be higher than those of students from other years
students, 51.3% lived in a city for most of their
                                                           (p < .001). OCS scores of the students using the
lives, 12.2% were smokers, and 18% (n = 78)
                                                           Internet for chatting and gaming purposes were
used alcohol (see Table 1).
                                                           found to be higher (p = .006, p = .035;
It was found that the students used the Internet           respectively). The Internet addiction level of the
for 200.9 ± 163.7/minutes within a day and 23.1            students from the Department of Business
± 20.1/hours within a week. Of the students in             Administration and Department of Labor
the study group, 77.8% (n = 337) used the                  Economics and Industrial Relations, the
Internet for homework and research, 58.9% (n =             freshman, and those who used the Internet rather
255) for chatting, 43.6% (n = 189) for web-                for chatting and gaming purposes, was higher (p
surfing, and 41.1% (n = 178) to read                       < .001) (see Table 3).

  50        43.6                                                                            41.1
  40                                                               32.3

*More than one option is checked   Figure 1: Students’ Internet usage purposes
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Table 1. Socio-demographic and Internet use characteristics of the students (n=433)
Characteristics                         n (%) or Mean ± SD
 Age                                         19.8 ± 1.6
  Female                                     315 (72.7)
  Male                                       118 (27.3)
  Nursing                                    191 (44.1)
  Business and Labor                         128 (29.6)
  Physical Therapy and                       114 (26.3)
  1                                          195 (45.0)
  2                                           87 (20.1)
  3                                          111 (25.6)
  4                                            40 (9.2)
 Background (where the student grew up)
  Village                                     66 (15.2)
  Town                                       145 (33.5)
  City                                       222 (51.3)
  Yes                                         53 (12.2)
  No                                         380 (87.8)
 Alcohol Usage
  Yes                                         78 (18.0)
  No                                          355 (82.0
Duration of Internet use
(minutes/day)                              200.9 ± 163.7
Duration of Internet use
(hours/week)                                 23.1 ± 20.1
Place of access to the Internet*
 Telephone                                   368 (85.0)
 Personal computer                           257 (59.4)
 Internet cafe/library                        77 (17.8)
 Friend’s home                                 41 (9.5)
*More than one option is checked
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Table 2. Comparison of some characteristics of the students with their average OCS and
SS scores

                                                OCS                                      SS
Characteristics                n              Mean ± SD             p-value           Mean ± SD              p-value*

 Nursing                      191             81.0 ± 29.7                               18.5 ± 9.7
 Economics                    128             93.2 ± 37.9           0.017**            17.8 ± 10.6              0.435
 and Business
 Physical                     114             83.7 ± 30.7                              17.1 ± 10.4
 Therapy and
 Female                       315             83.4 ± 31.4           0.83***            18.4 ± 9.8            0.166***
 Male                         118             90.1 ± 36.3                              16.9 ± 11.0

 Freshman                     195             93.5 ± 36.5                              17.9 ± 10.6
 Sophomore                    87              82.5 ± 31.8
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Table 3. Correlation between the students’ OCS and SS scores and certain parameters

                                            OCS                 SS
Age                           rs            -.225             -.056

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university students and adolescents and that there      In this study, it was determined that the lower the
was a negative correlation between their social         students’ university years and ages, the higher
support levels and Internet addiction. Aker et al.      their Internet addiction levels. Similarly, Sahin
(2017) revealed that depression, anxiety and            (2011) and Yang and Tung (2007) found a
insomnia, and familial social support predicted         negative relationship between year-age and
smartphone       addiction.       Personal       and    Internet addiction level. It is reported that
environmental factors can pose a risk for               increased duration and addiction level occur at
increasing young people's stress levels. Young          younger ages because children meet the Internet
people can see the Internet as a way of escape to       at earlier stages in their lives, a phenomenon that
overcome the problems they face in their                is of great concern to social scientists (Alam et
schools, families, or social lives; this leads to an    al., 2014; Sahin, 2011; Yang & Tung, 2007). In
increase in the duration of their Internet use and      their study, Wang et al. (2011) found the Internet
accordingly, their levels of stress.                    addiction level of high school students to be
                                                        12.2%. In a study conducted with high school
It was determined that the students used the
                                                        students, Sasmaz et al. (2013) reported that
Internet for 23.1 hours per week, 3.35 hours per
                                                        15.1% of the participants were in the group with
day (200.9 minutes/day). Young and Rodger
                                                        Internet addiction disorder and that the level of
(1998) discovered that the average duration of
                                                        Internet addiction was higher in freshman and
Internet use was 38.5 hours per week for users
                                                        sophomore students. It is stated in the literature
with problematic use and 4.9 hours per week for
                                                        that the age at which children start using the
normal use. Koc (2011) reported a higher
                                                        Internet is decreasing, and that young people are
number of psychiatric symptoms in university
                                                        at risk (Yang & Tung, 2007; Sahin, 2011; Wang
students using the Internet for six hours per day.
                                                        et al., 2011). Therefore, it is necessary to
Yang and Tung (2007) reported the duration of
                                                        organize training programs to raise public
weekly Internet use as 21.2 hours in their study
                                                        awareness on proper Internet use and increase
conducted with adolescents. In some studies
                                                        awareness among university students about
conducted in Turkey, Adalier and Balkan (2012)
                                                        Internet addiction and its effects.
reported that the average duration of daily
Internet use by university students was 1–3             In this study, the OCS scores of the students
hours, while Ata, Akpinar and Kelleci (2011)            using the Internet for gaming and chatting were
reported that duration as 1.93 hours. We can say        found to be high. Internet addiction levels of the
that the increase in the frequency of Internet use      students using the Internet for gaming and
is due to its use for both educational and non-         chatting were also found to be high in agreement
educational purposes, such as communication,            with other studies described in the literature
entertainment, chatting, gaming, etc.                   (Chou & Hsiao, 2000; Canan, 2010; Ergin, Uzun
                                                        & Bozkurt, 2013). Using the Internet for chatting
According to this study, Internet addiction levels
                                                        and gaming extends the duration of Internet use,
of the students from the Faculty of Business
                                                        and consequently, increases the level of
Administration were higher than those of
                                                        addiction. Jang, Hwang and Choi (2013) reported
students from the Department of Nursing (Table
                                                        that chatting and increased duration of daily
3). Orsal et al. (2013) reported that Internet
                                                        Internet use was associated with Internet
addiction levels of the students from the Faculty
of Economics and Administrative Sciences were
higher than those of students from other                In this study, Internet addiction and the students’
departments. Similarly, Ozcan and Buzlu (2007)          stress levels increased as the average duration of
reported that Internet addiction levels of the          daily and weekly Internet use increased. Andreou
students from the Faculty of Social Sciences            and Svoli (2013) reported that the extent of
were higher. These results are attributed to two        Internet usage was an important indicator for all
main factors: nursing programs are intensive            aspects of Internet addiction. A positive
(more intensive theoretical and clinical practice       correlation has been found between Internet
courses), and students in the social sciences take      addiction levels and Internet usage for
fewer credit-bearing courses; since they have           individuals in several studies conducted in recent
more spare time, their increased Internet use           years (Yang & Tung, 2007; Thatcher, Wretschko
leads to higher levels of Internet addiction.           & Fridjhon, 2008; Kayri & Gunuc, 2010;
                                                        Batigun & Kilic, 2011).
International Journal of Caring Sciences                January – April 2020 Volume 13 | Issue 1| Page 446

Conclusion                                               Bilgel N., & Bayram N. (2010). Turkish version of
                                                             the depression anxiety stress scale (DASS 42):
To conclude, this study found that stress levels             Psychometric        properties.    Archives     of
and problematic Internet usage levels among                  Neuropsychiatry 47:118-26.
university students increased as the duration of         Canan F. (2010). The association between internet
their Internet use increased. In addition, it was            addiction, dissociation, and socio-demographic
found that stress levels and problematic Internet            features among college students. Unpublished
usage levels among university students increased             Doctoral Thesis, Duzce University Medical
as their ages and university years decreased.                Faculty, Turkey.
Intensive use of the Internet by young people is         Casale S., Lecchi S., & Fioravanti G. (2014). The
                                                             association between psychological well-being and
inevitable, because the Internet is an important
                                                             problematic use of internet communicative
tool for the integration of today’s society with             services among young people. The Journal of
the modern world. Therefore, it is necessary to              Psychology 149(5):480-497.
raise awareness among Internet users about               Ceyhan E. (2010). Predictiveness of identity status,
effective and proper use of the Internet rather              main internet use purposes and gender on
than preventing its use. We recommend                        university students’ the problematic internet use.
educational and institutional arrangements to                Educational Sciences: Theory & Practice
help effective and proper use of the Internet.               10(3):1323-1355.
                                                         Chou C., & Hsiao M.C. (2000). Internet addiction,
Acknowledgements: The authors thank all of                   usage, gratification, and pleasure experience: The
the students, management of Faculty of Health                Taiwan college students’ case. Computers &
Sciences who participated in this study.                     Education 35:65-80.
                                                         Chou W.P., Ko C.H., Kaufman E.A., Crowell S.E.,
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