ABSTRACT
This study was conducted to determine the effect of internet addiction on the sleep quality of adolescents during the Coronavirus (COVID) period.
This cross-sectional, descriptive, and correlational design study was conducted in the high schools located in a city center between March-June 2021. The universe of the study consisted of students aged between 13 and 18 years old and the study was completed with 413 students. Demographic information form, internet addiction scale for adolescents (IASA) and Pittsburgh sleep quality index (PSQI) were used to collect data. In order to evaluate the data, number, mean, percentile distributions, t-test, analysis of variance (ANOVA), Kruskal-Wallis test and Spearman correlation analysis tests were used in SPSS 21 statistical program.
A total of 40.9% of the participants were found to spend 4-6 hours on the Internet during the pandemic and 85.2% had poor sleep quality. While the total mean scores obtained from the IASA was 20.30±8.87, it was 8.19±2.50 from the PSQI. The time spent daily on the Internet for non-educational purposes during COVID and the characteristics of the time spent on the internet compared to the pre- COVID period were significantly correlated with the mean total scores of IASA (p<0.05). A weak positive significant relationship was found between the total mean scores of the adolescents' IASA and PSQI scales (r=0.216, p<0.000).
In the study, more sleep problems were observed among the adolescents as their internet addiction levels increased throughout the study.
Keywords: Adolescents, COVID, pandemia, internet addiction, sleep quality
Introduction
Internet has become an almost inevitable necessity used by almost everyone due to the convenience it provides in communication and access to information. Addiction risk increases as the time connected to internet increases (1,2). Internet addiction creates a risk especially for the children and adolescents. Internet is preferred by the adolescents since it provides a social, free and unlimited, mysterious, active and rewarding environment, provides an easy access and functions as an instrument enabling them to make themselves heard (1,3).
Despite the high rate of data flow and potential educational value, excessive use of the internet and internet addiction have been found to affect the physical health, family life and academic performance of the adolescents in a negative way (1,4). Sleep problems are among the negative effects of internet addiction on physical health (4,5). In the previous studies, the technological device, and problematic internet usage has been reported to be correlated with poor sleep quality and lead to adverse sleeping traits such as delay in falling asleep and daytime sleepiness (6,7). During the Coronavirus disease-2019 (COVID-19) pandemic, the sleep patterns of the adolescents were also altered due to the changes in their daily routines and they reported experiencing sleep problems during the pandemic (8,9). Moreover, internet usage characteristics and sleep states of the adolescents were determined to be negatively influenced due to the increase in time spent during the COVID-19 pandemic (10,11). Nurses have roles and responsibilities for the protection and promotion of children and adolescent health in hospitals, schools and the field of public health. In this context, it is important for the nurses to participate in multidisciplinary studies including the adolescents and families for the protection of children and adolescents from internet addiction, recognition of early addiction signs and rehabilitation (12,13). It is also suggested that determination of the effects of internet addiction on sleep quality would provide guidance to the studies aiming to determine and rehabilitate addiction at an early period and to improve sleep quality. There are a limited number of studies in the literature investigating the effect of internet addiction on sleep quality among adolescents during the COVID-19 pandemic.
In this study, it was aimed to investigate the effect of internet addiction on the sleep quality of adolescents during COVID period.
Research questions
What is the level of internet addiction among the adolescents during COVID-19 pandemic?
What is the level of sleep quality among the adolescents during COVID-19 pandemic?
Does internet addiction have an effect on sleep quality among the adolescents during COVID-19 pandemic?
Materials and Methods
Type of the study
The study had a descriptive, correlational and cross-sectional design.
The universe and sample of the study
The universe of the study consisted of 2454 students aged between 13-18 years old who were studying in the high schools located in a city center in Blacksea Region between March-June 2021. Target sample size of the study was determined to be 332 students with an error rate of 5% within a confidence interval of 95%; and the study was completed with 413 students.
Data collection instruments
“Demographic ınformation form” which was prepared by the researcher and included questions to determine socio-demographic data of the students, their technological device usage behaviors and sleep characteristics, “Internet addiction scale for adolescents (IASA)” and “Pittsburgh sleep quality index (PSQI)” were used to collect data in the study.
Demographic information form: This form was prepared by the researchers in line with the literature and consisted of a total of 12 questions for determining socio-demographic variables of the students (age, sex, education levels of parents, employment status of the mother, income status of the family) and their technological device and internet usage characteristics (1,8).
IASA: The validity and reliability study of the scale was conducted by Taş (14). The IASA consists of 9 items and one factor. The total score that can be obtained from the scale ranges from 0 to 45. It is a 5-point Likert type scale (“never”, “rarely”, “sometimes”, “often” and “always”). There is no reverse-scored item on the scale. High scores that can be taken from the scale indicate a high level of internet addiction. Cronbach alpha internal consistency coefficient of the scale was 0.81 (14). Cronbach’s alpha was found as 0.96 in this study.
PSQI: PSQI was developed by Buysse et al. (15) and adapted to Turkish by Agargun et al. (16). PSQI is composed of 24 questions evaluating sleep quality and disorder during the past one month. 19 questions are self-report questions and the other 5 are the questions to be answered by the spouse or roommate and excluded from scoring and they are evaluated for clinical information. Nineteen questions of the scale, that are scored, consist of 7 domains which are subjective sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disturbance, sleep medication and daytime sleep dysfunction. Each domain is assessed over 0-3 points. Total scale score, that is total PSQI value, is obtained when the scores of all domains are summed up. The higher the score means there is a problem related to sleep. Total score varies between 0-21 points. A total score greater than 5 indicates a “poor sleep quality”. Cronbach alpha value of the scale is 0.80 (16). It was found to be 0.74 in this study.
Data collection
School managers were met and they were informed about the aim of the study after all necessary ethics approval and institutional permissions were obtained to conduct this study at schools. Later on, students were instructed about the aim of the study in their class whatsapp groups through school managers and teachers. Then, a Google form was created and sent to the students to collect data of the study.
Ethical aspect of the study
Ethics approval of the study was taken from Social Sciences Research Ethics Committee of the Relevant University (date: 05.28.2021; no: 2021/487) and the institutional permission was taken from the National Education Directorate of the city where the study would be conducted. Managers of the relevant schools were met and they were informed about the aim of the study. Students were informed about the study in the first page of online link before filling out data collection instruments and they were asked to mark the statement as “I consent to participate in the study” if they approved to participate. The students who filled out the online form were deemed to have accepted to participate in the study. The confidentiality of the answers of the students was ensured and they were only seen on Google forms via electronic mail which was defined on behalf of researchers.
Statistical Analysis
Data obtained in the study were analyzed by SPSS 22 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.) program. At first, the Kolmogorov-Smirnov test was used for the normality assumption of data in the study. Numbers, percentages, mean, standard deviation and median were used for descriptive statistics. Parametric tests (independent samples t-test, One-Way variance analysis and Tukey post-hoc multiple comparison test) were used for the analyses of parametric data with normal distribution. Spearman correlation analysis was used to determine the correlation between the scores of the IASA and the PSQI. The results were accepted as statistically significant at a significance level of p<0.05 within a confidence interval of 95%.
Results
Mean age of the adolescents included in the study was 15.78±1.23 years old; 50.1% were between 15-16 years old and 51.1% were females. While 40.9% of the mothers were elementary school graduates, 25.4% of the fathers were found to be undergraduate and graduates. It was also found that 91.3% of the mothers were unemployed and 58.4% had an income equal to the expenses (Table 1).
While 64.9% of the adolescents stated that they had their own tablet/computer, 95.9% had a smartphone. A total of 40.9% of them reported spending 4-6 hours on the internet per day for non-educational purposes during the COVID-19 pandemic period and 58.3% told that the time they spent on the internet increased compared to the pre-COVID-19 period. While 72.4% of families were found not to put any restrictions on their children regarding the use of the internet during this period and 36.1% of the adolescents rarely had conflicts about the use of the internet (Table 2).
The total mean score of the adolescents from the IASA was found as 20.30±8.87. Moreover, their total mean score from PSQI was found as 8.19±2.50 and the mean scores of the domains of PSQI were found as 1.88±0.72 for subjective sleep quality, 1.88±1.56 for sleep latency, 1.45±0.58 for sleep duration, 0.46±0.80 for sleep efficiency, 1.65±1.07 for sleep disturbance, 0.06±0.31 for sleep medication and 0.82±0.84 for daily sleep dysfunction. A total of 85.2% of the adolescents had a total PSQI score greater than 5 and thus had a poor sleep quality (Table 3).
Total mean IASA scores were found to have statistically significant differences in terms of time spent on the internet for non-educational purposes during the COVID-19 period, the characteristics of the time spent on the internet compared to the pre-COVID-19 period and adolescent’s status of experiencing conflicts with their families about internet usage (p<0.05). Besides, statistically significant differences were found in total mean PSQI scores in terms of adolescents’ status of experiencing conflicts with their families about internet usage (p<0.05) (Table 4).
When the correlations between total IASA and PSQI and their domains in the study were examined, a significant, positive but weak correlation was found between total scale scores (r=0.216, p<0.000). IASA scale was found to have a significant, positive but very weak correlations with 2nd (r=0.173, p<0.000), 3rd (r=0.024, p<0.000) and 6th (r=0.057, p<0.05) and a significant, negative and weak correlation with 1st domain of PSQI (r=-0.303, p<0.000) (Table 5).
Discussion
In the study, the majority of the adolescents were found to spend more time on the internet compared to the pre-COVID-19 period and their internet addiction levels were found to increase as time spent on the internet per day increased (Tables 2, 3). Many national and international studies conducted during the pandemic found that children spent more time with technological devices (2,8). Zengin et al. (8) reported that 36.6% of the children spent 3-4 hours and 32.0% spent more than 4 hours with television, tablet or phones per day during the COVID-19 pandemic. Moreover, Dong et al. (17) indicated that the rate of using technological devices all day was 27% among the children and adolescents before the pandemic whereas this rate increased another 50% during the pandemic. These results show that adolescents spent more time with technological devices during the pandemic since they stayed at home. The time spent on the internet for no reason is a significant factor in the diagnosis of internet addiction and the increase in this time causes addiction (5). The studies which have been carried out since the emergence of the COVID-19 pandemic have revealed an increase in the duration of using technological devices. This situation also increases the risk of developing internet addiction.
It was determined that adolescents, who had conflicts with their parents about the use of internet, experienced more internet addiction and sleep problems (Table 4). Previous studies have shown that adolescents, who have a quality relationship with their parents, have less internet addiction (1,18). Moreover, excess use of internet has been observed among the adolescents as parental surveillance is decreased (19,20). Again, negative factors such as domestic violence and some parental attitudes (indifferent, authoritarian and protective parents) have been reported to be effective on internet addiction among the adolescents (1,18,20). These results show that parental role is important in controlling internet usage of adolescents and the characteristic of the communication between adolescent and the parent and parental attitudes might be effective on internet addiction.
In the current study, most of the adolescents were found to have poor sleep quality (Table 3). In many studies conducted with adolescents before the COVID-19 pandemic, their sleep quality was found to be poor (7,21). Also, the studies, which were conducted with adolescents during the COVID-19 pandemic period, showed that their sleep quality was affected negatively due to the pandemic, their sleeping habits changed, they slept later, daytime sleepiness increased and sleep quality was disturbed (8,22).
In the study, it was also observed that adolescents experienced more sleep problems as their internet addiction levels increased (Table 5). Previous studies have shown that sleep problems are associated with problematic internet usage (23,24). The study by Chen and Whu (25) reported in their study, which was carried out with the same adolescent group at two different times before and after pandemic, that the temporal relationships between sleep problems and problematic smartphone use are reciprocal. In the study by Masthi et al. (26), it was indicated that the group with social media addiction experienced more sleep problems. Koças and Şaşmaz (7) identified internet addiction as the factor that alleviated sleep quality among the high school students. In the study by Sulun et al. (5), it was revealed that daytime sleepiness increased as the risk of smartphone addiction increased among the adolescents. In their study with students, Kootesh et al. (27) stated that internet addicted group had a poor sleep quality. Moreover, many studies have reported that internet- and online game-addicted adolescents have more sleep problems compared to those who are not (28,29).
Study Limitations
The conduction of the study in a single city center and the interpretation of the results based on self-report of the students were the limitations of the current study.
Conclusion
It was found in this study that most adolescents spend more time on the internet compared to the pre-COVID-19 pandemic period and this situation increased their internet addiction levels. It was also determined that their sleep quality was negatively affected during the pandemic. Moreover, adolescents in the study were found to have more sleep problems as their internet addiction levels increased.
Internet addiction, that is among the significant causes of sleep disorders seen among the adolescents, has gained more importance during the pandemic. As in other addiction types, studies should be carried out to rehabilitate adolescents and to improve the quality of their sleeping activity in internet addiction. It is important for the nurses working in the fields of community and pediatric health to participate in educational studies aiming conscious and safe use of internet to enhance awareness on internet addiction among the children, adolescents and families. Moreover, nurses should counsel adolescents and families especially during the pandemic period in order to prevent addiction or decrease internet use by recognizing physical problems such as sight problems, headache and sleep problems that may occur in adolescents as a result of internet addiction. Struggling with internet addiction of adolescents, who are the future of the society, will improve life quality and well-being level of whole society.
Acknowledgments
The authors would like to thank all the adolescents who participated in the study voluntarily.
Ethics
Ethics Committee Approval: Ethics approval of the study was taken from Social Sciences Research Ethics Committee of the Relevant University (date: 05.28.2021; no: 2021/487) and the institutional permission was taken from the National Education Directorate of the city where the study would be conducted.
Informed Consent: Informed consent was obtained.
Peer-review: Externally peer-reviewed.
Authorship Contributions
Concept: Z.Ö.S., Design: E.T.B., Data Collection or Processing: Z.Ö.S., E.T.B., Analysis or Interpretation: Z.Ö.S., E.T.B., Writing: E.T.B.
Conflict of Interest: No conflict of interest was declared by the authors.
Financial Disclosure: The authors declared that this study received no financial support.
