6.3 STATEMENT OF PROBLEM - RGUHS by yangxichun

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                           ANNEXURE – II


                                I YEAR M. Sc. NURSING
                                BGS COLLEGE OF NURSING
                                APOLLO PREMISES


     SUBJECT                    MENTAL HEALTH NURSING

4.   DATE OF ADMISSION TO THE 15-06-2010






                     “We all have ability. The difference is how we use it. ”

                                                                         -Stevie Wonder.

        The Internet is a global system of interconnected computer networks that use the

standard Internet Protocol Suite to serve billions of users worldwide. It is a network of

networks that consists of millions of private, public, academic, business, and government

networks, of local to global scope, that are linked by a broad array of electronic and optical

networking technologies. The Internet carries a vast range of information resources and

services, such as the inter-linked hypertext documents of the World Wide Web (WWW) and

the infrastructure to support electronic mail.1

        Most traditional communications media including telephone, music, film, and

television are being reshaped or redefined by the Internet. Newspaper, book and other print

publishing have to adapt to Web sites and blogging. The Internet has enabled or accelerated

new forms of human interactions through instant messaging, Internet forums, and social

networking. Online shopping has boomed both for major retail outlets and small artisans and

traders. Business-to-business and financial services on the Internet affect supply chains across

entire industries.1, 2

        We are in a country of billion people and we have measly 52 million active users

according the yearly. Overall, 71 million users accessed Internet in year 2009, with 52

Million “active” users who accessed it at least once in a month. Youth in India is getting

hooked onto Internet– Overall 72% of young people access Internet on regular basis.3

        The foremost target of internet has always been the communication and internet has

excelled beyond the expectations. Still innovations are going on to make it faster, more

reliable. By the advent of computer’s Internet, our earth has reduced and has attained the

form of a global village. Information is probably the biggest advantage internet is offering.

The Internet is a virtual treasure trove of information. Any kind of information on any topic

under the sun is available on the Internet, Students and children are among the top users who

surf the Internet for research.4

        Today, it is almost required that students should use the Internet for research for the

purpose of gathering resources. Teachers have started giving assignments that require

research on the Internet. Entertainment is another popular raison d'être why many people

prefer to surf the Internet. Downloading games, visiting chat rooms or just surfing the Web

are some of the uses people have discovered. There are numerous games that may be

downloaded from the Internet for free. Many services are now provided on the internet such

as online banking, job seeking, purchasing tickets for your favourite movies, guidance

services on array of topics engulfing the every aspect of life, and hotel reservations. Often

these services are not available off-line and can cost you more. 5

        Spamming refers to sending unwanted e-mails in bulk, which provide no purpose and

needlessly obstruct the entire system. Such illegal activities can be very frustrating for you,

and so instead of just ignoring it, you should make an effort to try and stop these activities so

that using the Internet can become that much safer. Pornography is perhaps the biggest threat

related to your children’s healthy mental life. There are thousands of pornographic sites on

the Internet that can be easily found and can be a detrimental factor to letting children use the


       As the Internet increasingly becomes part of our lives, Internet addiction disorder has

received much attention. Internet addicts may withdraw from social and interpersonal

interactions other than those on the Internet. Their family relationships and academic or

occupational functioning may deteriorate. Several withdrawal symptoms have been identified,

including nervousness, agitation, and aggression, as well as an addiction syndrome that

includes the presence of withdrawal symptoms, increasing tolerance, and loss of control. A

high rate of co morbid mental disorders has also been reported, especially depressive

symptoms and social impairment.7


       The number of internet users worldwide is expected to touch 2.2 billion by 2013 and

India is projected to have the third largest online population during the same time says a

report. The number of people online around the world will grow more than 45 per cent to 2.2

billion users by 2013 and Asia will continue to be the biggest Internet growth engine. India

will be the third largest internet user base by 2013 - with China and the US taking the first

two spots, respectively," technology and market research firm Forrester Research said in a

report. India's number of Internet users was estimated to be 52 million in 2008, 71 million

users accessed Internet in year 2009.Internet has been perhaps the most outstanding

innovation in the field of communication in the history of mankind. As with every single

innovation, internet has its own advantages and disadvantages. But usually, greater

magnitude of advantages outweighs its disadvantages8.

       As the Internet increasingly becomes part of our lives, Internet addiction disorder has

received much attention. Internet addicts may withdraw from social and interpersonal

interactions other than those on the Internet. Their family relationships and academic or

occupational functioning may deteriorate. Several withdrawal symptoms have been identified,

including nervousness, agitation, and aggression, as well as an addiction syndrome that

includes the presence of withdrawal symptoms, increasing tolerance, and loss of control. A

high rate of co morbid mental disorders has also been reported, especially depressive

symptoms and social impairment. The Internet was originally designed to facilitate

communication and research activities. However, the dramatic increase in the use of the

Internet in recent years has led to pathological use (Internet addiction).9

       Many of the Indian Institutes of Technology (IIT) are restricting campus Internet use

during night hours, because of recent suicides being linked to the presumed anti-social

behaviour that Internet use promotes however, it is clear that Internet addiction is more of a

symptom than a cause of greater social problems. Such an authoritarian move may not prove

adequate enough to address the larger problems students face in dealing with the stress of

being in these high-pressure institutions in the context of a highly competitive global


       Online activities which, if done in person, would normally be considered troublesome,

such as compulsive gambling or shopping, are sometimes called net compulsions. Others,

such as reading or playing computer games, are troubling only to the extent that these

activities interfere with normal life. The Internet has unique psychological properties which

induce dissociation, time distortion, and instant gratification.11

       "Internet addicts suffer from emotional problems such as depression and anxiety-

related disorders and often use the fantasy world of the Internet to psychologically escape

unpleasant feelings or stressful situations." Over 60% of people seeking treatment for IAD

claim involvement with sexual activities online which they consider inappropriate, such as

excessive attention to pornography or involvement in explicit sexual conversations online.

More than half are also addicted to alcohol, drugs, tobacco, or sex etc. People who develop

problems with their Internet use may start off using the Internet on a casual basis and then

progress to using the technology in dysfunctional ways. Use of the Internet may interfere

with the person's social life, school work, or job-related tasks at work.12

        Investigator has personal experience how dangerous this situation because of

dysfunctional and pathological ways of using internet other than the education purposes. It

can be a nightmare; however investigator is aware of the biopsychosocial problems. For that

reason investigator is interested to create awareness among adolescents. Hence, there is need

to assess the internet addiction and its impact among adolescents. These instances provoked

the investigator to select the study on assessment of internet addiction and its relation with

psychosocial problems among adolescents in selected colleges.13


6.2.1 Studies related to internet addiction among adolescents.

6.2.2 Studies related to impact of internet addiction on psycho-social problems among


Studies related to internet addiction among adolescents:

       A descriptive study was conducted on uses and gratifications (U&G) theory, aids in

the assessment of people’s motivations for media usage, access and to understand their

attitude towards a particular medium. In this paper this theory has been applied to derive the

Internet gratification structure of Internet users in the Indian context. This study proceeds in

four stages. First, six gratifications for Internet use namely self development, wide exposure,

user friendly, relaxation, career opportunities, and global exchange were identified using the

exploratory factor analysis. Then the factors were subjected to confirmatory factor analysis.

Next with the use of t-tests the study identified the gratifications on which males and females

differ significantly. Finally, with the use of discriminant analysis it has been shown that the

light and heavy users of Internet differ on some of the gratification factors obtained in the


       A study was conducted to investigate the extent of Internet addiction in school

children 16-18 years old in India. The Davis Online Cognition Scale (DOCS) was used to

assess pathological Internet use. On the basis of total scores obtained (N = 100) on the

DOCS, two groups were identified—dependents (18) and non-dependents (21), using mean ±

½ SD as the criterion for selection. The UCLA loneliness scale was also administered to

the subjects. Significant behavioural and functional usage differences were revealed between

the two groups. Dependents were found to delay other work to spend time online, lose sleep

due to late-night logons, and feel life would be boring without the Internet. The hours spent

on the Internet by dependents were greater than those of non-dependents. On the loneliness

measure, significant differences were found between the two groups, with the dependents

scoring higher than the non-dependents.15

       An exploratory study was conducted on Internet addiction, usage, gratification, and

pleasure experience Taiwan’s college students. This study used the Uses and Gratifications

theory and the Play theory in mass communication. Nine hundred and ten valid surveys were

collected from 12 universities and colleges around Taiwan. The results indicated that Internet

addiction does exist among some of Taiwan’s college students. In particular, 54 students

were identified as Internet addicts. It was found that Internet addicts spent almost triple the

number of hours connected to the Internet as compare to non-addicts, and spent significantly

more time on BBSs, the WWW, e-mail and games than non-addicts. The addict group found

the Internet entertaining, interesting, interactive, and satisfactory. The addict group rated

Internet impacts on their studies and daily life routines significantly more negatively than the

non-addict group. The study also found that the most powerful predictor of Internet addiction

is the communication pleasure score, followed by BBS use hours, sex, satisfaction score, and

e-mail-use hours.16

       A study was conducted on Prevalence of Internet Addiction and Comparison of

Internet Addicts and Non-Addicts in Iranian High Schools In this study, 1968 high-school

students were selected randomly through clustering, who responded to the Persian version of

four measures: the Internet Addiction Test (IAT), UCLA Loneliness Scale, Rosenberg Self-

Esteem Scale, and Matson Evaluation of Social Skills. Of the sample, 977 students were

Internet users, who were classified into 37 Internet addicts, 304 possible Internet addicts, and

636 moderate users. Since possible addicts, moderate users, and nonusers can all be

considered non addicts, to make a comprehensive and controlled comparison between addicts

and non addicts, 37 possible addicts, 37 moderate users and 37 nonusers were matched with

the Internet addicts. Results suggest that Internet addicts are lonelier and have lower self-

esteem and poorer social skills than moderate users, but not necessarily than possible addicts

or nonusers.17

       A study was conducted on Comparison of Internet addicts and non-addicts in

Taiwanese high school. This study investigated the difference between Internet addicts and

non-addicts in Taiwanese high schools, and focused specifically on their Internet usage

patterns, and gratification and communication pleasures. A total of 1708 valid data samples

of high school adolescents were collected. Among this sample, 236 subjects (13.8%) were

identified as addicts using the eight-item Internet addiction Diagnostic Questionnaire

designed by Young Internet addiction survey. The analytical results revealed that Internet

addicts spent almost twice as many hours on line on average than the non-addicts. Notably,

surfing with a social/entertainment motivation and gratification was positively correlated with

Internet addiction. Furthermore, Internet addicts obtained markedly higher overall scores and

scored higher than non-addicts on four subscales (tolerance; compulsive use and withdrawal;

related problems, including family, school, health, and other problems; interpersonal and

financial problems). While Internet addicts perceived the Internet to have significantly more

negative influences on daily routines, school performance, teacher and parental relation than

non-addicts, both Internet addicts and non-addicts viewed Internet use as enhancing peer

relations. Moreover, students with personalities characterized by dependence, shyness,

depression and low self-esteem had a high tendency to become addicted18.

Studies related to effect of internet addiction on psycho-social problems among


       A comparative study was conducted to assess the Psychiatric Symptoms in

Adolescents with and without Internet Use. A total of 2,080 students (1,105 male, 975

female) were recruited for the study. Researchers were administered the Symptom Checklist-

90-Revision and Questions Related to Internet Use. Students in 10th through 12th grades

were recruited from 14 senior high schools in Sivas, Turkey. Data were collected from

October to May 2008. Data were analyzed after excluding the participants who provided

incomplete data. It was found that Internet use in adolescents was associated with more

severe psychiatric symptoms. Attention should be devoted to adolescents with Internet use

for the design of preventive strategies.19

       A study was conducted on Internet Addiction by using Internet Over-Users'

Psychological Profiles. The aims of this study were to identify the independent factors

associated with intermittent addiction and addiction to the Internet and to examine the

psychiatric symptoms in Korean adolescents when the demographic and Internet-related

factors were controlled. Male and female students (N = 912) in the 7th-12th grades were

recruited from 2 junior high schools and 2 academic senior high schools located in Seoul,

South Korea. A total of 851 subjects were analyzed after excluding the subjects who provided

 incomplete data. Results of the study shows approximately 30% (n = 258) and 4.3% (n = 37)

 of subjects showed intermittent Internet addiction and Internet addiction, respectively. In

 addition, male gender, chatting, and longer Internet use per day were significantly associated

 with Internet addiction. When the demographic and Internet-related factors were controlled,

 obsessive-compulsive and depressive symptoms were found to be independently associated

 factors for intermittent addiction and addiction to the Internet, respectively.20

        A co- relational survey was conducted on Internet addiction in Korean adolescents

 and its relation to depression and suicidal ideation. This study examined the relationship of

 Internet addiction to depression and suicidal ideation in Korean adolescents. The participants

 were 1573 high-school students living in a city who completed the self-reported measures of

 the Internet Addiction Scale, the Korean version of the Diagnostic Interview Schedule for

 Children-Major Depression Disorder-Simple Questionnaire, and the Suicidal Ideation

 Questionnaire-Junior. Among the samples, 1.6% was diagnosed as Internet addicts, while

 38.0% was classified as possible Internet addicts. The prevalence of Internet addiction did not

 vary with gender. The levels of depression and suicide ideation were highest in the Internet-

 addicts group. Future studies should investigate the direct relationship between psychological

 health problems and Internet dependency.21

        A study was conducted on Internet use and its relation with the psychosocial situation

for a sample of university students. This study was carried out to determine the general

characteristics of Internet use among university students in Turkey and to examine the relation

between the Internet use and the psychosocial conditions of the students. Among the 730

university students who participated, the average age was 20.84 (SD=1.95), and the majority

were females. The average Internet use period of the students was detected as 2.80 (SD=1.33)

years for females and 3.59 (SD=1.60) years for males. The average score of the Online

Cognition Scale (OCS) used for determining problematic use was 84.64 (SD=33.50): for

females, 77.99 (SD=30.70); for males, 92.16 (SD=34.96). Students of social sciences scored

highest on the OCS. It was determined that as the OCS score increased, students' performance

of Internet activities such as general information searches and academic research decreased

and that performance of interactive and entertainment Internet activities such as chat, financial

transactions, game playing, sex, downloading programs, and listening to MP3s increased.22

         A study was conducted on Immersion experience of the cyber world of adolescents.

The purpose of this research was to explore the cyber world immersion experience of

adolescents. Multiple strategies for data collecting were used such as in depth face-to-face

interview; analysis of adolescent' writings; and analysis of examples of phenomenon in the

realistic world. The sample group consisted of 10 adolescents. Although the experience was

different for all adolescent interviewed, the essential themes of experience emerged: "fill up",

"homoeologous feeling", "the older generation has a conflicting negative opinion", "change in

social character", "become habitually skeptic", "have bad health", "mean of superiority and

getting everything solved", "ease of access", "monetary benefit", "addiction to the computer",

"forget real life solved stress", "do harm to society", "take comfort", or "new job". Accordingly

the investigator suggests that contact with various software is necessary in adolescents, and

good quality contents function to prepare and activate adolescents to apply the internet for

good use.23

         A study was conducted on effects of an empowerment education program in the

prevention of internet games addiction in middle school students. The purpose of this study

was to determine effects of an empowerment education program (EEP) on internet games

addiction, empowerment, and stress in middle school students. The EEP used in this study was

based on the Freire's Empowerment Education Model. The research design of this study was a

non-equivalent control group pretest-posttest design for 48 middle school students, who were

conveniently assigned to an experimental group or a control group. The first hypothesis that,

"the experimental group would have higher empowerment scores than the control group." was

supported. The second hypothesis that, "the experimental group would have lower internet

games addiction scores than the control group." was supported. The third hypothesis that, "the

experimental group would have lower stress scores than the control group." was supported. We

suggest, therefore, that the EEP should be used with adolescent to help them control their

stress, internet games addiction and to increase their empowerment24..


 A descriptive correlation study to assess internet addiction and its relation with

 psychosocial problems among adolescents in selected colleges at Mysore.


     1. To determine the internet addiction among adolescents.

     2. To determine the psychosocial problems among adolescents with internet addiction.

     3. To find out relation between internet addiction and psychosocial problems among


     4. To find out association between internet addiction and selected demographic variables

        among adolescents.

     5. To find out association between psychosocial problems and selected demographic

        variables among adolescents.


    Internet addiction: It is the problematic use of the Internet, including the various aspects

     of its technology, such as electronic mail (e-mail) and the World Wide Web. In some

     respects, addictive use of the Internet resembles other so-called "process" addictions, in

     which a person is addicted to an activity or behavior (including gambling, shopping, or

    certain sexual behaviors) rather than a substance (mood-altering drugs, tobacco, food,


    In this study internet addiction refers to overuse internet other than the educational

    purpose for seeking pleasure or gratification such social networking, gaming, gambling,

    cyber pornography.

   Psychosocial problems:        Of or involving the influence of social factors or human

    interactive behavior.

    It refers to psychological and social problems among adolescents. Psychological

    problems refer to anxiety, depression, stress, insomnia, and feeling of isolation. Social

    problems refer to family burden, social isolation, dependency and financial problems.

   College students:       Refers to the students studying in pre-universities and Degree



    The study assumes that:

    1) College students use internet excessively for the social networking and entertainment


    2) The college students have some psycho social problems due to over usage of internet.


The study is limited to:

    1) The students who are using internet daily.

    2) The students who are studying in pre university and degree colleges at Mysore.

    3) Those who are present at the time of data collection in college.


At 0.05 level of significance.

H1: There will be a significant relationship between the level of Internet addiction and

          psychosocial problems among adolescents.

H2. There will be a significant association between the level of Internet addiction and

          selected demographic variables.


           7.1 SOURSE OF DATA COLLECTION: students from the selected colleges at


           7.1.1 RESEARCH DESIGN: Descriptive correlation survey.

           7.1.2 SETTING: Selected colleges in Mysore.

           7.1.3 POPULATION: adolescents from selected pre degree and degree colleges.


           7.2.1 Sampling technique: purposive sampling.

           7.2.2 Sample: College students from selected colleges in Mysore

           7.2.3 Sample size: 100 Samples

           7.2.4 SAMPLE CRITERIA: Inclusion criteria:

          Students aged above 16years and below 24years.

          Both males and females.

          Both pre-university and degree students.

          Those who use internet other than the educational purpose. Exclusion criteria:

          Students who refuse to participate in the study.

       Those who are not using internet.

       Students less than 16years not going to take.

7.2.5 Data collection method:

   1. Prior to the data collection permission will be obtained from the concerned college

        authorities for conducting the study.

   2. Subjects will be selected according to the selection criteria and confidentiality will be


   3. Written consent will be obtained from subjects.

   4. The knowledge of the subject will be assessed by administering structured

        knowledge questionnaire.

7.2.6 Data analysis plan:

        Data will be analyzed by using the descriptive and inferential statistics and findings

will be presented in the form of tables and figures.

7.3. Does the study require any investigation or intervention to be conducted on patients

or humans or animals?


7.4 Has ethical clearance been obtained from any institution?

   NO, permission will be obtained from the concerned authority prior to the data collection.


1."Internet Addictive Disorder (IAD)Diagnostic Criteria". http://www.psycom.net/iadcriteria

html. Retrieved 2009-01-31. (http://en.wikipedia.org/wiki/Internet).

2. DeAngelis, Tori.     (2000, April).   American Psychological Association.      Is Internet

Addiction Real?        Retrieved November 20, 2003, from the World Wide Web:


3. Beard, K., and E. Wolf. "Modification in the Proposed Diagnostic Criteria for Internet

Addiction." Cyberspychology & Behavior 4 (2001): 377-383.

4. "Medical association backs off labeling 'video-game addiction'". Los Angeles Times

(Tribune Company).

5.Available at http://books.google.co.in/books? hl=en&lr=&id=dCwpAiGycekC&oi=fnd&pg



6."Why      Internet     Addiction       Still    Doesn’t      Exist".    PsychCentral.com.


Retrieved 2009-09-15.

7. "Modification in the proposed diagnostic criteria for Internet Addiction". Cyberspychology

& Behavior 4 (3). June 1, 2009.

8. Block, J.J. (2008). "Issues for DSM-V: Internet Addiction". American Journal of

Psychiatry. 165:3; March 2008; p. 306-307.

9. Byun, S., et al. (2008). Internet Addiction: Meta synthesis of 1996–2006 Quantitative

Research. Cyber psychology & Behavior, 12, 1-5.available online.

10. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. (1994).

Washington D.C.: American Psychiatric Association.

11. Internet Addiction: A Handbook and Guide to Evaluation and Treatment by Kimberly S.

Young and Cristiana Nabuco de Abreu (Hardcover - Oct 26, 2010) ,

12. In The Shadows of The Net: Breaking Free from Compulsive Online Sexual Behavior by

Patrick Carnes Ph.D., David L. Delmonico Ph.D., Elizabeth Griffin M.A., and Joseph M.

Moriarity (Paperback - Sep 15, 2007).

13. Young, K. (2009). Issues for Internet Addiction as a New Diagnosis in the DSM-V.

Washington, District of Columbia, US: American Psychological Association. Retrieved from

PsycEXTRA database.


issue=7; spage=13;epage=18;aulast=Singh; type=3.

15."Cybersex/Cyberporn                       Addiction"                         Netaddiction.com.

http://www.netaddiction.com/cybersexual_addiction.htm. Retrieved 2009-08-09.

16."Experts       debate       Internet      addiction".         Physorg.com.        2006-11-14.

http://www.physorg.com/news82749930.html. Retrieved 2009-08-09.

17. http://www.liebertonline.com/doi/abs/10.1089/cpb.1998.1.237

18. http://www.liebertonline.com/doi/abs/10.1089/109493101300210286

19. http://allpsych.com/journal/internetaddiction.html

20. http://ajp.psychiatryonline.org/cgi/content/full/165/3/306



22. http://onlinejournals.www60.search.tifloripa.com/psychologyjournalsonle/



24. http://www.nursingplanet.com/Nursing_Research/nursing_journals.htm

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