Internet Addiction in Preuniversity Students in East Malaysia: Prevalence and its Association with Stress and Depression : Malaysian Journal of Psychiatry

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Original Article

Internet Addiction in Preuniversity Students in East Malaysia: Prevalence and its Association with Stress and Depression

Cheah, Whye Lian,; Bo, Myat Su1; Yee, Lai Hui; Idris, Atiqah Safawati Binti2; Bia, Brianna Jaswinta Anak2; Deser, Kimberly Claire2; Lim, Han Yong2

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Malaysian Journal of Psychiatry: Jan–Jun 2022 - Volume 31 - Issue 1 - p 13-18
doi: 10.4103/mjp.mjp_4_22
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The Internet has become a significant aspect of our lives; it revolutionized our day-to-day communications, making our interactions borderless and timeless.[12] Based on the statistics published online by Clement in 2018,[3] there was an estimated 3.896 billion internet users in the world. A survey by Malaysian Communications and Multimedia Commission (2018) reported that there are approximately 28.7 million Internet users, constituting 87.4% of the total population of Malaysia.[4] Among the age groups, young adults aged 20 years and below spent the most hour on the internet, an average of 8 h/day.[4] While many people use the Internet to facilitate and improve their lives, there is a growing concern about the negative impact of excessive Internet. Excessive use of internet can lead to adverse health status such as poor performance in the workplace and school, disrupted sleep and poor social interaction with friends and families.

Internet addiction is defined as people who have pathological use of the Internet, leading to poor control preoccupations or behaviors and failure to fulfill major roles and obligations. Many college students, especially those who leave home for the first time entering college or university, often undergo stress, anxiety, and depression due to fear about their future. These fears result from uncertainties about leaving friends and family and being unable to balance study and personal life or relationship issues.[5] Moreover, there are different coping mechanisms for stress, anxiety, and depression. There are three categories of commonly used coping strategies: problem-focused (e.g. engaging in the behaviour of solving a problem), active-emotional (e.g. venting and expressing their feeling), and avoidant-emotional (e.g. denying or dissenting).[6]

Many studies have associated stress, depression, and coping with Internet addiction among young adults and adolescents, suggesting that Internet use can be both a source and a solution to cope with stress and depression.[7] Past research into motivations for Internet use found motives such as entertainment, information seeking, passing of time, recognition gaining, and relationship maintenance help individuals cope with stressful life events.[8] It is believed that these individuals rely on excessive Internet use as an alternative to solve their problems that lead to Internet addiction. Problematic Internet users are more likely to use Internet activities to cope with negative effects such as stress, loneliness, and depression.[910] According to the literature, these problematic Internet users who are depressed do not want to socialize face-to-face with people, have difficulty with social relations tolerance, and have withdrawal syndromes. Using the Internet may help these people feel more “connected” and cope with their day-to-day mental and psychological problems.[11]

There were several related studies conducted in Malaysian among young adults, focusing on the comparison between those with and without Internet addiction and their associated factors but not on the severity of the Internet addiction.[1213] The consensus on the definition of Internet addiction and its classification is still debatable, even though some definitions may now be based on many hours spent in nonwork technology-related computer/internet/video game activities. However, the effect of Internet addiction on adolescents’ and young adults’ physiological and psychological health is tremendous. Thus, understanding the problem and providing timely support is crucial to preventing long-lasting psychological impacts on these young people.

Local studies carried out in Sarawak only focus on the psychometric analysis of the Internet addiction test (IAT).[14] Given the above background, this study examined the differences between noninternet addiction, problematic Internet use, and pathological Internet use and their association with stress and depression.


This cross-sectional study was approved by Universiti Malaysia Sarawak Faculty of Medicine and Health Sciences Medical Ethics. It was conducted from January to May 2019 at one of the public universities in Sarawak. The students were aged 18–19 years old, attending preuniversity education. Using OpenEpi (version 3) (, an open-source calculator, with a sampling frame of 710 students (from preuniversity), the prevalence of 36.9%,[13] the confidence level of 5%, design effect of 1, the attrition rate of 20%, the minimum sample size required for this study was 287.

The timetable of the classes was obtained from the university’s administrative office. The classes were randomly selected, and all the students in the selected class were invited to participate in this study. Respondents were briefed on the study, and written consent was obtained. Students with a previous history of mental illness were excluded from this study.

A self-administered questionnaire was used to collect the data. The questionnaire consists of:

Sociodemographic information

Information on sociodemography and their education profile was collected.

The internet addiction test

The Short Version of Young’s IAT was used in this study based on Pawlikowski et al.[15] The instrument consists of a two-factor structure, 12 items, using 5-point Likert scale from 1 to 5 (1 = never to 5 = very often) measuring the frequency of symptoms. The classification of this instrument was based score of >30 for problematic internet use and >37 for pathological internet use.[15] Based on Young,[16] problematic internet use refers to addictive behavior that includes excessive/poorly controlled preoccupations, urges, or behaviors that lead to impairment or distress. Pathological use, on the other hand, refers to mood-altering use of Internet, failure to fulfil major role obligations, guilt, and craving. Validation of this instrument has been done among university students and general public with Cronbach’s alpha ranging from 0.836 to 0.897.[16] For this study, a translated Malay version has been adopted from Ng et al.[17]

Patient Health Questionnaire

To measure the presence and severity of depression, the Patient Health Questionnaire was used. This assessment tool is a self-administered version of PRIME-MD that has been validated in large studies involving both hospitals and primary care clinics. Developed by Kroenke et al.,[18] this instrument is the most commonly used version in both clinical and research settings.

The instrument consists of 9 questions that use four responses – 0 = not at all, 1 = several days, 2 = more than half the days, and 3 = nearly every day. To diagnose major depression, five or more of the 9 depression symptom criteria with responses of score 2 (more than half of the days) and more (e.g., score 3 with the response of nearly every day) have been present in the past 2 weeks, together with the response of score 1 (several days) for Question 9 (thoughts that you would be better off dead or of hurting yourself in some way).

For measuring of severity, the scores from all items are added up and the classification of severity is based on 1–4 (minimal depression), 5–9 (mild depression), 10–14 (moderate depression), 15–19 (Moderately severe depression), and 20–27 (severe depression).

Perceived Stress Scale-10

Perceived Stress Scale-10 (PSS-10) is a self-reported tool with 10 items questions that measure individual’s perception on how stressful is his/her life for the past 1 month. The instrument uses 5-point Likert scale (0 = never, 1 = almost never; 2 = sometimes, 3 = fairly often, and 4 = very often). To obtain overall score, four of the item (4, 5, 6, and 7) score are reversed (e.g., 0 = 4, 1 = 3, 2 = 2, 3 = 1, and 4 = 0) and add up with the rest of the six items. The classification of the scale is 0–13 low perceived stress, 14–26 moderate perceived stress, and 27–40 high perceived stress. Psychometric testing of this instrument among college students showed good reliability of 0.92,[7] including the Malay translated version of 0.78.[19]

Data were entered and analyzed using IBM SPSS version 23 (IBM Corp., Armonk, NY). Cleaning and checking of the data were carried out before the analysis. Kolmogorov–Smirnov test was used to test the normality of the data. Descriptive analyses such as frequency and mean were carried out to describe the study’s background information, together with the tested variables – IAT, perceived stress, and depression. To answer the research objective, multinomial logistic regression was conducted to estimate the association between a set of independent variables and a multicategory nominal dependent variable (nonproblematic internet addiction, problematic internet addiction, and pathological internet addiction). P value will be used to find the statistical significance of the analysis.


Two hundred and sixty-six respondents participated in the study, with a response rate of 95.7%, composed of 202 females (75.9%) and 64 males (24.1%). The normality test was done using Kolmogorov–Smirnov test indicated that the data were normally distributed, D (266) = 0.676, P = 0.229. The mean age was 18.7 (0.28) years. More than half of the respondents were from Sarawak (56.4%) and Malay ethnicity (60.9%). The majority of the parents of the respondents were still married. About 47% of the respondents experienced boarding school life before entering this university. There were more respondents from the Biological Sciences class compared to Physical Science class. The mean cumulative grade point average results were 3.16 (0.48). Table 1 shows the details information on the sociodemographic and background of the respondents.

Table 1:
Sociodemographic and background of the respondents (n=266)

Table 2 presents the description information on the respondents’ stress, depression, and Internet Addiction profile according to gender. About 12% of the respondents reported having high perceived stress levels and 69.9% with moderately severe and severe depression. For the internet addiction profile, 21.4% reported to be problematic internet users, and another 21.4% were pathological internet users. There is no significant difference in perceived stress and depression. However, there were more males with pathological internet use compared to females (P = 0.015).

Table 2:
Stress, depression, and Internet addiction profile of the respondents according to gender (n=266)

Univariate analysis between IAT with other factors showed that gender, perceived stress, and depression were significant association with dependent variables. All the significant independent variables were selected to be analyzed in the final model using multinomial logistics regression based on P < 0.25.[20]

Based on the selected independent variables from Table 3 (gender, perceived stress, and depression), a multinomial logistic regression was used to analyze predictors for Internet addiction with noninternet addiction as the reference category and the other two (problematic internet addiction and pathological internet addiction) as a comparison [Table 4]. For the outcome of problematic internet addiction compared to noninternet addiction (reference category), there is no significant effect from gender, perceived stress, and depression on problematic Internet addiction.

Table 3:
Univariate analysis between Internet addiction test with other factors (n=266)
Table 4:
Multinomial logistics regression on factors associated with Internet addiction (final model included only significant variables at 0.05 level)

On the outcome of pathological internet addiction compared to noninternet addiction (reference category), males have a 178% (adjusted odds ratio = 2.78) higher pathological internet addiction when compared to females. In relation to depression, those who have minimal, mild, and moderate depression are 32.5% less likely to be pathological Internet addiction. Perceived stress was not a significant predictor of Internet addiction.


The results indicated that 42.8% of the respondents had Internet addiction. Of these, 21.4% had pathological Internet addiction, and 21.4% had problematic internet addiction. Past studies on Internet addiction have reported a large variation in terms of prevalence rate, ranging from 5.8% to 36.9%.[131421] Such variation happened due to the differences in study design, diagnostic and assessment method, use of different screening instruments, and cultural factors.[22] The availability of various scales with different cutoff points on the same measures made the comparison even more complicated. The current study reported a high prevalence of 42.8% of internet addiction, consistent with other Asian studies where the prevalence rate was notably higher among Asian countries such as the Philippines (50.9%) and Japan (47.5%).[23] It might suggest that ethnicity, cultural, and environmental factors were associated with Internet addiction.[24] Yen et al.[25] believed that Internet activities and online gaming are the most developed areas in many Asian countries, targeting adolescents and young adults. Facing strong academic competition and stress, the Internet provides a virtual world in which adolescents and young adults seek ways to cope with their problems in both study and social life. In addition, the mean (standard deviation [SD]) age of this studied sample was 18.7 (0.28) years, which is consistent with literature that indicated Internet addiction was higher among students under 20 years of age.[26]

This study has adopted the recommendation by Pawlikowski et al.[15] using the degree of Internet addiction in its classification-problematic internet addiction (one standard deviation above the mean) and pathological internet addiction (two standard deviations above the mean). Comparing the two levels of Internet addiction, results showed that symptoms of depression and gender were significant and independent predictors of pathological Internet addiction but not perceived stress.

The result of this study was consistent with Gunay et al.,[26] where the risk of Internet addiction was found to be about 2.5 times higher in students with depression symptoms than those without depressive symptoms. Adolescents who have preexisting psychopathological symptoms and have the symptoms of depression use the Internet to avoid and escape from psychological distress.[27] It was postulated that adolescents or young adults aged 18–19 years old are more vulnerable in handling emotional matters due to a lack of emotional and psychological maturity, self-control, and cognitive abilities.[2829] It was further supported by Bahrainian et al.[30] that the use of the Internet is highly associated with coping styles and ways of compensating for deficiencies in life such as low self-esteem. These individuals often turned to the Internet to overcome their shortcomings, leading to increased Internet use, which eventually turns into a dependent relationship Internet addiction.

Our study showed that male respondents were more pathological Internet users, consistent with other studies.[2631] Based on empirical studies, the Internet was regarded as a technological “boy toy” that men developed for men.[3233] Although recent research indicated that the gender gap in Internet use is diminishing, males are more likely to become internet dependent because of their experience and skills in using the internet and have more entertainment purposes than females.[34] Studies in Korea showed that parents are more concerned about their boys’ internet use because boys are more accessible to the Internet and vulnerable to all online materials, including online games and sexual/violent related materials.[35]

Although this study provides an essential insight into Internet addiction from a local perspective, some limitations need to be mentioned. First, this was a cross-sectional study. Therefore, this study cannot explain the cause and effect between variables. In addition, this study was carried out in one of the public universities in Sarawak, and its results cannot be generalized to other regions and universities. Due to the survey being carried out based on self-administered, the respondents might under-report or over-report to meet the desirable manner.


Despite the noted limitation, our study provides important information on the prevalence of Internet addiction behavior and its associated factors. The study revealed that problematic and pathological Internet use is prevalent in our sample, and pathological Internet addiction was associated with the symptom of depression and gender. For the outcome of problematic internet addiction compared to non-internet addiction (reference category), there is no significant effect from gender, perceived stress, and depression on problematic Internet addiction. However, on the outcome of pathological Internet addiction compared to noninternet addiction (reference category), male has higher pathological Internet addiction as compared to female. In relation to depression, those who have moderate severe-to-severe depression are more likely to be pathological Internet addiction as compared to noninternet addiction. Perceived stress was not a significant predictor of Internet addiction. Early intervention and detection of problematic internet use among adolescents and young adults may prevent the development of maladaptive coping responses that lead to internet addictive use, thus preventing negative psychosocial complications. The findings of this study may assist universities or academic institutions with designing effective cognitive-behavioral intervention and prevention programs both at the individual and community level.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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Depression; Internet addiction use; stress; university students

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