Reference: J Pediatr 2018 Jun;197:262-267
As internet use has become more prevalent worldwide, pathologically excessive internet use has led to the emergence of the concept of “internet addiction”. Internet addiction, though not officially recognized in the DSM-IV or V, was first described in 1995 (Indian J Psychiatry 2016). In the past decade, increasing numbers of publications and clinical studies on the subject often disagree regarding diagnostic criteria, terminology, and classification of the disorder, creating barriers to conceptualization (Addict Behav 2014). Internet addiction and pathological use of social media are steadily becoming a worldwide social and medical issue leading to significant psychological impairment (World J Psychiatry. 2016). Association with other comorbidities, including panic disorder, obsessive compulsive disorder, depression, anxiety, substance abuse, and ADHD emphasizes the importance of additional research (Addict Behav 2014). The study described below aims to provide insight regarding internet addiction and its association with increased suicidality in adolescents.
This prospective cohort study examined 1,861 adolescents attending a senior high school in Taipei City, Taiwan from September 2006 to September 2008. Students were evaluated with the Chen Internet Addiction Scale (score range 0-104) at baseline; a score of > 63 was considered positive for internet addiction (Kaohsiung J Med Sci 2005). Other assessment tools completed at the onset of the study included Pittsburg Sleep Quality Index, Beck’s Depression Inventory-II, Beck’s Anxiety Inventory, and the World Health Organization Quality of Life Short Version. Of the 1,861 participants, 1,735 were classified as having no history or prior self-harm/suicidality in the 6 months prior to study entry and 1,507 of the 1,735 students completed 1-year follow-up assessments. These 1,507 students were included in the statistical analysis. These students were predominantly male (82.4%) and had a mean age of 16 years.
At baseline, 23% of the included students met the Chen Internet Addiction Scale criteria for internet addiction. Statistical analysis revealed that there were no significant baseline differences between students with and without internet addiction using the other assessment tools. Baseline internet addiction was however present in 40.7% of the students who developed self-harm/suicidality compared to only 21.2% of those who did not (incidence rate ratio 2.41, 95% CI 1.16-4.99). Overall, internet addiction was found to be associated with a slightly increased risk for incident self-destructive behavior, even after adjusting for potentially confounding variables such as baseline depression, anxiety, sleep quality, and quality of life scores.
This study is one of few that analyzes data associated with pathologic internet use and its correlation with self-harm or suicidality. Although the study was not generalizable due to the narrow sample population, excessive internet use in this group was found to be associated with an increased risk of incident self-harm and suicidality. Further research is necessary to extrapolate these correlations to other populations around the world.
For more information, see the Depression in children and adolescents topic in Dynamed Plus. DynaMed users, see the Depression in children and adolescents topic in Dynamed Classic.