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 Table of Contents  
ORIGINAL ARTICLE
Year : 2022  |  Volume : 6  |  Issue : 2  |  Page : 82-86

Internet addiction predicted insomnia among bangladeshi undergraduate students at the time of the COVID-19 pandemic


1 Department of Physiotherapy and Rehabilitation, Uttara Adhunik Medical College and Hospita; Hasna Hena Pain and Physiotherapy and Public Health Research Center, Dhaka, Bangladesh
2 Department of Neurosurgery, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
3 Department of Public Health, North South University, Dhaka, Bangladesh

Date of Submission15-Oct-2021
Date of Acceptance29-Mar-2022
Date of Web Publication16-May-2022

Correspondence Address:
Dr. Mohammad Ali
Department of Physiotherapy and Rehabilitation, Uttara Adhunik Medical College and Hospital, Sector-09, Uttara Model Town, Dhaka 1230
Bangladesh
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/hm.hm_66_21

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  Abstract 


Objective: The prevalence of Internet addiction (IA) and insomnia among the student cohort was high. The COVID-19 pandemic adversely influenced both critical emerging public health concerns. Our study aimed to determine the prevalence of IA and insomnia and assess the relationship among the problems at the crucial time of the COVID-19 pandemic. Methods: A pilot survey was conducted among undergraduate students of an educational institute by inviting participants to use an electronically randomly selected e-mail address provided by the affiliated institute. Descriptive analysis was conducted to identify the student subgroups with a higher prevalence of insomnia; however, a multiple regression analysis was employed to identify the predictors of insomnia. Results: Insomnia and IA prevalence was 49.4% and 81.7%, respectively. Age group, gender, relationship status, family income, family type, living location, tobacco use, and exercise habits and physical illness history were associated with insomnia. However, regression analysis suggested that maintaining a relationship, being physically ill in the last year, and IA could predict insomnia independently. Conclusion: Institutional initiatives are recommended to reduce the high burden of insomnia and IA. A large sample size cross-sectional and longitudinal study is warranted to generalize these findings and determine the in-depth relationship between IA and insomnia.

Keywords: COVID-19, insomnia, Internet addiction, pandemic, student welfare


How to cite this article:
Ali M, Tasnim Z, Ahsan GU. Internet addiction predicted insomnia among bangladeshi undergraduate students at the time of the COVID-19 pandemic. Heart Mind 2022;6:82-6

How to cite this URL:
Ali M, Tasnim Z, Ahsan GU. Internet addiction predicted insomnia among bangladeshi undergraduate students at the time of the COVID-19 pandemic. Heart Mind [serial online] 2022 [cited 2022 Oct 2];6:82-6. Available from: http://www.heartmindjournal.org/text.asp?2022/6/2/82/345287




  Introduction Top


Internet addiction (IA) may be defined by excessive or poorly controlled amusement, urges, or behaviors regarding the smart device, such as smartphone use and Internet access that lead to prejudice or anguish.[1] The condition is increasingly drawing attention from the popular media, public health experts, and researchers, and this attention has paralleled the growth in smart devices and Internet access.[2]

Experts have classified IA in many ways, including addictive disorders alongside alcohol or drug use disorder or obsessive-compulsive or impulse-control disorder.[3],[4],[5] Similarly, IA diagnosis received numerous screening tools. To date, the diagnosis of IA is still a complex issue.[6] However, a 20-item scale named the IA test (IAT) measures the degree of amusement, compulsive use, behavioral problem, emotional changes, and impact of general functioning related to computer use. The IAT was valid and reliable, particularly for younger subjects such as college students.[7]

COVID-19-related educational institutions' shutdown forced students to compensate with virtual education systems.[8] Consequently, past studies revealed a high prevalence of IA among students during the pandemic.[9],[10] A systematic review and meta-analysis also concluded that the prevalence of IA is much higher than the prepandemic time among several cohorts worldwide.[11] In Bangladesh, a pandemic time study reported that more than 90% of students suffered from IA.[12]

On the other hand, insomnia is one of the significant public health problems of the current pandemic. A systemic review concluded that the prevalence of insomnia among South Asian students was significantly high during the pandemic.[13] Unsurprisingly, studies conducted among Bangladeshi professionals' cohorts found a high prevalence of mental health symptoms and insomnia related to the COVID-19 pandemic.[14],[15]

Although a study conducted before the COVID-19 pandemic found a positive correlation between IA and insomnia among Bangladeshi students,[16] there are scarce pandemic time data on insomnia prevalence and the association between IA and insomnia among Bangladeshi students. This pilot study aimed to examine the association and predictability of IA and insomnia among undergraduate students in Bangladesh.


  Methods Top


Study design and participants

Two hundred undergraduate students from an educational institution were invited through an electronically randomly selected e-mail address provided by the respective institute. Data were collected between August 23 and September 10, 2021, for this cross-sectional pilot study. The questionnaire was generated using Google Forms. All the participants were required to give informed consent for participation and collection and analysis of their data by ticking the “Yes, I agree and as a result of this give my informed consent” box on the online form before partaking in the online questionnaire.

Ethical approval

We conducted the study according to the guidelines in the Declaration of Helsinki. The Ethical Review Committee approved all procedures involving human subjects of Uttara Adhunik Medical College and Hospital. Prospective registration for the observational study was obtained from the World Health Organization-endorsed Clinical Trials Registry-CTRI/2021/08/035701.

Sociodemographic, educational, and health condition data

Information regarding participants' age, gender, relationship status, study group, study year, family income, family type, current living location, religious practice habit, exercise habit, tobacco use history, physical illness history in the last year, chronic condition, and COVID-19 infection history consisted of the first part of the questionnaire.

Internet addiction test

The second part of the questionnaire consisted of the IAT scale initially developed by Dr. Kimberly Young.[5] The IAT questionnaire received validation in Asian countries among student cohorts.[17],[18] This questionnaire was used as a screening tool to examine the level of IA. It consists of 20 items to examine symptoms of IA based on a five-point Likert scale ranging from 0 to 5 (0 = not applicable, 1 = rarely, 2 = occasionally, 3 = frequently, 4 = often, and 5 = always). Finally, the scores of all questions were summed, and the level of IA was evaluated based on the final score ranging from 0 to 100. Study participants were classified into four subcategories: a total point of 0–19 indicates the absence of addiction, and a total of 20–39 points indicates a low level of addiction. From 40 to 69 points, the average Internet user represents a moderate level of addiction, whereas the result of 70–100 points refers to a severe level of IA.[19] The internal consistency coefficient (Cronbach's alpha) on this sample was 0.899.

Insomnia Severity Index

Finally, the seven-item Insomnia Severity Index (ISI) was used to measure insomnia severity. Each item is valued on a 0–4 scale, and the total score ranges from 0 to 28. A cumulative score of 8 and above is considered to indicate symptoms of insomnia.[14],[20]

Statistical analysis

Descriptive statistics were computed to describe the demographic characteristics of the study participants. Chi-squared tests were used to enumerate insomnia proportions and draw comparisons between subgroups. Responses were compared for various sociodemographic, education, and health-related characteristics and IA by dichotomizing the independent variable as either having or not having insomnia. To calculate the adjusted odds ratio (AOR) with a 95% confidence interval, multiple logistic regression analyses were performed with insomnia as a dependent variable and sociodemographic, education, and health-related characteristics and IA as predictor variables for insomnia. The Hosmer–Lemeshow goodness-of-fit test was used to ensure that the models adequately fit the data. The significance level was set at P < 0.05, and SPSS (version 22.0; IBM Corp; USA; RRID: SCR_002865).


  Results Top


Participants' characteristics

[Table 1] shows the sociodemographic characteristics, education, and health-related data of the 153 students who participated in this study. The mean age of the participants was 23.58 years (standard deviation ± 3.96). The majority of the study participants were male (59.6%), single (75.8%), from science group (64.7), studying in the final year (41.8%), from high-income families (57.5%), from the nuclear family (60.8%), living in an urban area (56.9%), regular religious practitioner (77.1%), and did not perform 30 min physical exercise (56.9%), did not use tobacco (85.6%), did not face physical illness last year (53.6%), did not have a chronic condition (83.0%), and had no history of COVID-19 infection (76.5%). Overall, IA was detected among 81.7% of participants. However, [Figure 1] shows that 36.6% of participants were mildly Internet addicted, whereas 41.8% and 3.2% were moderately and severely Internet addicted, respectively.
Table 1: Descriptive analysis: Association between sociodemographic, educational, and health-related factors, Internet addiction, and insomnia

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Figure 1: Distribution of Internet addiction frequency among the participants

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Descriptive analysis

Statistically significant differences in insomnia were found based on sociodemographic, education, and health-related diversities, with the highest prevalence of insomnia among the students aged between 22 and 25 years (61.7%, P = 0.008), male (57.1%, P = 0.041), those maintained a relationship (92.3%, P = 0.001), those studied arts and business (72.2%, P = < 0.001), student of 3rd-year (57.1%, P = 0.006), those come from high income family (61.4%, P = 0.006), those lived with nuclear family (60.2, P = 0.002), those lived in urban are (59.8%, P = 0.010), those who are not a regular religious practitioner (65.7%, P = 0.038), and those who did not perform regular 30 min exercise (57.5, P = 0.042), those who currently a tobacco user (77.3%, P = 0.006), and those who faced physical illness last year (66.2%, P = < 0.001). Furthermore, a higher percentage of participants who were diagnosed with IA suffered from insomnia (56.8%, P = 0.001).

Multiple logistic regression analysis

[Table 2] presents the predictors of insomnia. A multiple regression analysis was conducted to examine the predictors of insomnia by including factors significantly associated with insomnia in the descriptive analysis. In this multiple regression model, groups with significantly higher odds of insomnia being participants who maintained a relationship (AOR: 10.431, P = 0.050) had faced physical illness last year (AOR: 3.780, P = 0.003). Finally, IA predicted insomnia significantly (AOR: 5.873, P = 0.009) in this regression model.
Table 2: Multiple logistic regression: Predictors of insomnia

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  Discussion Top


Half of the respondents had insomnia symptoms in the current pilot study, while four out of five participants had IA. Maintaining a relationship (other than marriage), being physically ill last year, and IA were strong predictors of insomnia. Study findings potentially indicate the need for an extensive sample size study to confirm vulnerable subgroups and discuss interventions to reduce the prevalence of insomnia and IA among student cohorts in Bangladesh during and after the COVID-19 pandemic.

To the best of our knowledge, this is the first study that measured the prevalence of insomnia and determined the predictability between IA and insomnia among a Bangladeshi undergraduate student cohort during the COVID-19 pandemic. A COVID-19 time study conducted among young Bangladeshi adults found insomnia among only 13% of the participants,[21] much lower than the prevalence we observed in the current study. On the other hand, we found a similar prevalence rate of IA in our study compared to the previous Bangladeshi survey conducted among students at the time of the pandemic.[12] Furthermore, in line with the findings of a prepandemic time study,[16] we found a strong relationship between IA and students' insomnia.

Our study revealed that the prevalence of insomnia was significantly higher among male students. A meta-analysis suggested that the prepandemic prevalence of insomnia among women was considerably higher than that among men;[22] however, another systematic review and meta-analysis of pandemic time cross-sectional studies suggested that the prevalence of insomnia was matched with men and women.[23] However, another pandemic time Bangladeshi study conducted on health-care workers found a higher prevalence of insomnia in men.[14] The current study findings indicated a need for additional insomnia-related surveys in undergraduate students. On the other hand, in line with the pandemic time Bangladeshi study,[24] we found a higher prevalence of insomnia among males who maintained a relationship and lived in an urban area. Furthermore, our study found a significant association between tobacco use, lack of physical exercise, and insomnia, supporting previous studies' systematic reviews.[25],[26]

In this pandemic, physical illness other than coronavirus predicted the general population's mental health, including students.[27] The current study also found a significantly high prevalence of insomnia among students who faced physical illness last year. Nonetheless, unlike other studies,[28],[29],[30] we did not find any association between chronic disease and history of coronavirus infection and insomnia in the current analysis. The age of the participants might be a factor of mitigation in this case.

Limitations

This study has a few limitations. First, universal limitations of cross-sectional study and limitations of IAT and ISI must be admitted in this study. Second, the current study is a small primary analysis sample; thus, the results should be generalized for Bangladeshi student cohorts with caution. Third, we have selected the educational institute conveniently that might induce selection bias. Randomly selected larger sample size cross-sectional studies are warranted to generalize the preliminary results and understand the anachronism relationship between IA and insomnia during and after the COVID-19 pandemic.

In recent years, emotional dysregulation has been often explored because of its potentially unifying and transdiagnostic function of several psychopathological evidence.[31] In this regard, problematic Internet use has been considered a possible attempt to cope with unpleasant feelings by escaping into an online life.[32] A systematic review concluded that IA might represent a coping strategy to compensate for emotional regulation deficits among adolescents and young adults. The lack of social support and the lack of a relationship with parents negatively affect emotional regulation abilities, increasing the adolescents' and young adults' risk of developing IA and the emerging adults' problematic social networking.[33] We did not receive data regarding mentioned variables and participants' substance use, preexisting mental health conditions, and medication history to strengthen the study outcomes. Future studies should include variables related to emotional dysregulation.


  Conclusion Top


The current study found a high load of IA and insomnia among undergraduate students in Bangladesh. Along with sociodemographic, education, and health-related factors, IA was strongly associated with insomnia. Institutional inquiry and attention is recommended to mitigate the load and discuss further initiatives.

Acknowledgment

The authors would like to thank the participants for providing us the data.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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