F1000Research F1000Research 2046-1402 F1000 Research Limited London, UK 10.12688/f1000research.139923.1 Study Protocol Articles A cross sectional study to assess prevalence of internet addiction and its relationship with personality traits and associated psychiatric conditions in undergraduate medical students of an Indian university

[version 1; peer review: 1 not approved]

 Chadha Yatika Conceptualization Methodology Writing – Original Draft Preparation Writing – Review & Editing https://orcid.org/0000-0002-3742-2835 a 1 Patil Ragini Conceptualization Methodology Supervision Writing – Review & Editing 2 Post graduate resident, Department of Psychiatry, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India Associate Professor, Department of Psychiatry, Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra, 442001, India ytkchdh@gmail.com

No competing interests were disclosed.

 11 9 2023 2023 12 1131 21 8 2023 Copyright: © 2023 Chadha Y and Patil R 2023 This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background: In India, 622 million internet users were found out of which our nationally representative data suggest that about 20% to 40% of college students in India are at risk for internet addiction (IA). Therefore, the research on its addiction is on the rise and is an established concern.

Objectives: To study the prevalence of internet addiction in undergraduate medical graduates associating its impact, on personality traits and psychiatric conditions like depression, anxiety and stress.

Methods: It is a cross sectional study based on undergraduate medical students of Jawaharlal Nehru Medical College, Wardha. It is a convenience based sampling method and a Krejcie-Morgan Formula is used. Using this, the sample size came out to be 300. Clearance from the ethics committee will be obtained. An informed consent from the students will be taken, thereafter they will be asked to fill socio demographic data and then will be subjected to the following questionnaires:

Young’s Internet addiction test

DASS 21

Brief Big Five inventory scale

Results: We will be able to determine the prevalence of internet addiction among medical students after we have the results from the aforementioned questionnaires, their personality traits and development of psychiatric co- morbidities like depression, anxiety and stress.

Conclusions: We’ll be able to know the prevalence of internet addiction in medical students, their personality traits and the development of psychiatric co- morbidities like depression, anxiety and stress.

 internet addiction depression anxiety stress personality adolescence medical undergraduates The author(s) declared that no grants were involved in supporting this work. Introduction

In today’s day and age there are 5 billion internet users worldwide and around 622 million in 2020 in India alone (according to the IAMAI-Kantar ICUBE 2020 report). Most of our day-to-day work is directly or indirectly associated with internet be it for study purposes, online shopping, interpersonal communication or even distracting a toddler. The research on its addiction is on the rise and is an established concern. Studies suggest that approximately 20% to 40% of students in India are at a risk for internet addiction (IA). 1 An individual could be so engrossed that they land up disregarding areas of their life. 2 Research indicates that adolescents with internet addiction may, neglect other creative activities and if familial altercations present, peers involved in substance abuse, or living in rural areas could be the factors associated with increased Internet addiction which in turn is associated with poor mental health status and low self-esteem. 3 In a study when subjects were screened for depression using the BDI, less than one third (30.2%) of the total participants were positive for depression. This finding is also in line with the global literature, 27 and a little higher than that reported. 4 A connection with internet addiction and the changes it brings to personality is something to dig more into, even though an association was found that people with internet addiction were self-reliant, preferred solitary activities and tend to restrict their social activities and its association with psychiatric conditions, 5 is more frequent than expected. People with internet addiction obtained higher ranking in depression, anxiety, and lower rank on global functioning relative to healthy controls. They used impulsive coping mechanisms, and experienced more socio-emotional impairment. 6 In this study we will be specifically aiming towards deleterious effects internet addiction has left on the lives of medical undergraduate students to help them identify at first if it is a problem thereafter to assess for association with psychiatric illness.

 Rationale

The internet being a part of our day to day lives. Now to an extent that we are dependent on it. According to the existing data where 622 million users were found in India alone in 2020, which is a huge population that needs to be looked over as to assess how its overuse is causing an effect on people and to what extent is leaving a permanent mark on our lives by altering people’s personality and making people more vulnerable towards psychiatric illnesses like anxiety and depression. Therefore, it becomes all the more necessary, even though these parameters have been researched individually, to relate the psychiatric co-morbidities that are associated with internet addiction and the implications it has on a person’s personality.

Aim/Objectives

Prevalence of internet addiction among undergraduate medical students.

Psychiatric conditions in undergraduate students with internet addiction.

Personality traits of students with internet addiction.

Protocol

Material and methods

Study design: Cross sectional study.

Study population: Undergraduate medical students of Jawaharlal Nehru medical college Wardha.

Type of sampling: Convenience sampling.

Formula used: Krejcie-Morgan Formula Sample size : x 2 N P 1 − P / e 2 N − 1 + x 2 P 1 − P

At 95% confidence level with degree of freedom 1, the chi-square value (x 2) is equal to 3.84 (standard value from the table)

e = margin of error (5%) = 0.05

P = Population proportion = 50% = 0.5

N = Population size = Number of undergraduate students = 1000 n = 3.84 × 1000 × 0.5 × 1 − 0.5 / 0.05 2 × 999 + 3.84 × 0.5 × 0.5 = 277.65

Therefore, the number of students needed in the study (n) is 300.

Reference: Krejcie, R.V., and Morgan, D.W., (1970), Determining sample size for research activities, Educational and Psychological Measurements, pp. 607-610.

 Inclusion criteria

Undergraduate medical students of JNMC Wardha from 1st year to final year MBBS.

Students should be consenting for the survey which will be in a written format.

Exclusion criteria

Subjects not willing to give written informed consent.

 Tools to be used

Young’s Internet addiction test

The 20-item test gauges the extent of internet addiction. It was designed to be a diagnostic tool based on DSM 1V. In this assessment, greater severity is indicated by a higher score. A score of 0–30 shows average internet use, 31–49 indicates mild internet use, 50–79 indicates moderate internet use, and 80–100 indicates severe online dependence. 7

DASS-21

It is known as the depression anxiety stress scale and it was formulated to assess these psychiatric illness. 8

Brief big five inventory scales

This test is applied when the personality of a subject needs to be assessed. It consists of five factors: agreeableness, conscientiousness, extraversion, openness, and stress tolerance. Personality tests that are based on this model assess as to which trait a person lies in. 9

Statistical analysis

All the results will be calculated using SPSS version 27. Descriptive statistics will be performed over mean and standard deviation median and range for quantitative assessment of the parameters & amp; qualitative assessment will be performed for finding prevalence of internet addiction, personality traits in frequency (%). Analytical results will be calculated using a Chi square test for finding association between prevalence of Internet Addiction & personality traits among depression, anxiety & stress over mild moderate & amp; severe category. Different scales (Young Internet Addiction test, DASS 21. Brief big five inventory scale) for assessment will be analysed and will be correlated using a person’s correlation. A free version of this software called Deducer can be used to corroborate the results. 10

Limitations

The design of this study is cross sectional.

It is limited to a batch of medical university students.

Expected outcome

We’ll be able to determine the incidence of internet addiction among medical students, learn about the personality attributes of those individuals, and link it to psychiatric co-morbidities including depression, anxiety, and stress.

Dissemination: The study will be published in an indexed journal.

Study status: Study is yet to commence.

 Discussion

Joseph et al., 1 in 2021 concluded using the Young Internet Addiction Test (Y-IAT) Studies carried out in 19 states of India were responsible for the 19.9% incidence of IA. Widyant et al. 2 in 2005 assessed susceptible populations for overuse of the Internet. According to the findings of this study, online socialisation was a major factor in the emergence of problematic Internet use. Loneliness also played a larger role than depression in the development of problematic Internet use, and reports of the drawbacks of excessive internet use (forgetting about work and social life, failing relationships, losing control, etc.), which are similar to those of other, more well-established addictions. Yen et al. 3 Older individuals (>15 years old) had the highest rate of Internet addiction, followed by younger boys (15 years old), according to a 2009 study that found the discriminating characteristics for adolescents with Internet addiction. The reasons that contributed to the population’s rising rate of internet addiction included depression and inadequate family supervision. Paudel et al. 4 His research on undergraduate students in Nepal in 2021 came to the conclusion that internet addiction was linked to both depression and poor sleep. Of the study’s participants, 49.8%, 45.5%, and 4.7%, respectively, reported moderate internet use, mild issues caused by internet use, and severe problems caused by internet use. According to the PSQI cut-off score of five, about 42.3% (n = 209) of participants reported having bad sleep, while approximately 30.2% (n = 149) of participants tested positive for depression using the BDI cut-off score of thirteen. Thirty two percent (30.2%) of all subjects tested positive for depression. Shaw et al., 5 in 2008 found that 52% of individuals matched the criteria for at least one personality disorder, with borderline personality disorder being the most common (24%), followed by narcissistic 19% and antisocial 19%. The criteria for a current disorder, mood disorders (24%), anxiety (19%), and psychotic disorders (14%) were met by nearly 30% of the participants. Younes et al., 6 in 2016 revealed that potential Internet addiction was associated to gender and more prevalent in men. With a mean score of 30, 16.80% of individuals appeared to be at risk for internet addiction. Additionally, it showed that 9.8% of subjects experienced clinically significant insomnia, and a direct link between sleeplessness and possible internet addiction was discovered. The number of students who experience anxiety, despair, or stress is higher among potential internet addicts, which is associated with internet addiction.

Ethical considerations

Confidentiality will be ensured for all participants. Prior to taking part in the process, participants must obtain written consent and will be informed that they have the option to revoke their consent at any moment, in which we shall not to include them in the study.

Participants will have access to a secure setting where they can communicate honestly about their illness.

The study’s objective will be explicitly disclosed to participants, and the sample will be chosen willingly.

Approval for this protocol has been gained by the Institutional Ethics Committee of Datta Meghe Institute of Higher Education and Research Sawangi (M) Wardha- 442107 Maharashtra, India.

Data availability

No underlying data associated.

Zenodo: “A cross sectional study to assess prevalence of internet addiction and its relationship with personality traits and associated Psychiatric conditions in undergraduate medical students of Indian University”, DOI: 10.5281/zenodo.8207397.

This project contains the following underlying data:

Yatika spirit checklist.docx (SPIRIT reporting guidelines).

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

 Acknowledgements

The above mentioned authors have contributed equally to the design, concept, editing and study process for the article.

 References Joseph J Abin VVV Dhandapani M : Prevalence of Internet Addiction among college students in the Indian setting: a systematic review and meta-analysis. Gen. Psychiatr. 2021;34(4):e100496. 34504996 10.1136/gpsych-2021-100496 PMC8381302 Widyanto L Griffiths M : ‘Internet addiction’: a critical review. Int. J. Ment. Heal. Addict. 2006;4(1):31–51. 10.1007/s11469-006-9009-9 Yen CF Ko CH Yen JY : Multi dimensional discriminative factors for Internet addiction among adolescents regarding gender and age. Psychiatry Clin. Neurosci. 2009;63(3):357–364. 19566768 10.1111/j.1440-1819.2009.01969.x Paudel L Sharma P Kadel AR : Association between Internet Addiction, Depression and Sleep Quality Among Undergraduate Students of Medical and Allied Sciences. Shaw M Black DW : Internet addiction. CNS Drugs. 2008;22(5):353–365. 10.2165/00023210-200822050-00001 Younes F Halawi G Jabbour H : Internet addiction and relationships with insomnia, anxiety, depression, stress and self-esteem in university students: A cross-sectional designed study. PLoS One. 2016, 12;11(9):e0161126. 27618306 10.1371/journal.pone.0161126 PMC5019372 Young KS : Caught in the net: How to recognize the signs of internet addiction--and a winning strategy for recovery. John Wiley & Sons;1998 Feb 27. Lovibond PF Lovibond SH : The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav. Res. Ther. 1995 Mar 1;33(3):335–343. 7726811 10.1016/0005-7967(94)00075-U John OP Srivastava S : The Big-Five trait taxonomy: History, measurement, and theoretical perspectives. Chapman G : Deducer Quick Start Guide. 10.5256/f1000research.153243.r406714 Reviewer response for version 1 Naeem Noor-i-Kiran 1 Referee ABWA Medical College, Faisalabad, Pakistan

Competing interests: No competing interests were disclosed.

 1 9 2025 Copyright: © 2025 Naeem NiK 2025 This is an open access peer review report distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. recommendation reject

The authors present a cross-sectional study protocol aimed at assessing the prevalence of internet addiction among undergraduate medical students at Jawaharlal Nehru Medical College, Wardha, and its relationship with personality traits and psychiatric conditions such as depression, anxiety, and stress. The study uses a convenience sample of 300 students, determined via Krejcie-Morgan formula, and plans to administer validated instruments including Young’s Internet Addiction Test (Y-IAT), DASS-21, and the Brief Big Five Inventory. The authors expect to report prevalence, correlations with psychiatric comorbidities, and associations with personality traits.

Strengths

The topic is highly relevant, given the increasing prevalence of internet use and its psychological impacts among medical students.

The use of validated tools (Y-IAT, DASS-21, and Big Five Inventory) adds strength and comparability with global literature.

Ethical considerations are clearly described, with informed consent and ethics approval in place.

The rationale is well-founded, drawing from national and international data.

Concerns & Suggestions

Rationale and Objectives

The rationale is generally well described, but parts of the introduction are repetitive and could be streamlined. The objectives are stated clearly, though the third aim (“Personality traits of students with internet addiction”) could be phrased more precisely as “association of personality traits with internet addiction.”

Study Design

The cross-sectional design is appropriate for prevalence estimation but limits causal interpretation. This limitation is acknowledged but should be discussed more fully in terms of the inability to determine temporal relationships between internet use and psychiatric morbidity.

Methods

The sampling approach (convenience sampling) may introduce bias and limit generalizability. The authors should explain why probability sampling was not feasible.

More detail is needed on how participants will be approached, recruited, and consented to avoid selection bias.

The plan to use SPSS and chi-square tests is reasonable, but the statistical analysis section is overly simplistic. The authors should clarify how they will handle potential confounding variables (e.g., year of study, gender, socioeconomic background).

The authors mention “correlation using Pearson’s correlation,” but this assumes continuous normally distributed data. They should clarify how they will check assumptions and whether non-parametric methods will be applied if necessary.

 Results (Expected Outcomes)

The protocol clearly states expected outcomes, but the language should avoid certainty (“We will be able to determine...”) and instead use conditional phrasing (“The study aims to determine…”).

Discussion & Literature Review

The discussion is mostly a collection of previous prevalence studies. It would benefit from more synthesis and identification of the knowledge gap this study specifically addresses. For example, why is it particularly important to study medical undergraduates in this institution, beyond global trends?

Data Management & Accessibility

The authors plan to make tools and protocols accessible on Zenodo, which is commendable. However, since no underlying dataset yet exists, they should specify how anonymized data will be made available upon study completion.

Required Revisions to Ensure Scientific Soundness

Clarify the sampling process and justify the use of convenience sampling.

Expand on statistical methods, including how confounders will be adjusted for and how assumptions will be tested.

Refine phrasing in objectives and outcomes to reflect aims rather than guaranteed results.

Provide a stronger justification for conducting the study at this site and the specific contribution to literature.

Ensure the discussion synthesizes rather than merely summarizes past studies

Is the study design appropriate for the research question?

Partly

Is the rationale for, and objectives of, the study clearly described?

Partly

Are sufficient details of the methods provided to allow replication by others?

Partly

Are the datasets clearly presented in a useable and accessible format?

Partly

Reviewer Expertise:

Well being.

I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above.