Internet, studying and daily rhythm: health symptoms among higher education students

Introduction

The Internet can be considered as a digital environment where higher education (HE) students search and share information in their academic studies [1]. Besides its use in studying, the Internet is used for activities related to occupational tasks, completing errands, communicating, leisure time, and social networking, among other uses [2], [3], [4]. Before the global COVID-19 outbreak in the year 2020, HE students spent an average of four to 5 h online daily, although the total amount of time varied largely [5, 6]. The majority of this time was used for information seeking and in social networking using smartphones and tablets [7], [8], [9]. Concurrently, the rates for HE students’ excessive Internet use has increased, causing online activities to turn compulsive and interfering with normal activities of daily living and studying [7, 10], [11], [12], [13], such as rejection of daily chores; disruption of basic human needs like sleeping, eating, or resting; and disruptions in social relationships [13]. Also, excessive Internet use has been found to be associated with study motivation and academic performance by impacting the cognitive skills needed to be able to study [7].The epidemiology of excessive Internet use has been ambiguous [14]. Health-affecting excessive use is referred to in the literature as problematic, pathological, or addictive use of the Internet, and there are many alternative expressions due to various ways of measuring the phenomenon [14]. Comprehensive evidence on the concept and the criteria of excessive Internet use can be found in the literature [14].

Different models exist to explain the excessive use of the Internet, such as the cognitive-behavioral model of pathological use of the Internet developed by Davis (2001) and the socio-cognitive model of unregulated Internet usage developed by LaRose, Lin, and Eastin (2003) [15, 16]. The cognitive-behavioral model of pathological use of the Internet suggests that individuals who suffer from psychosocial problems are more likely to develop problems in their Internet usage. The model views pathological use of the Internet as a result of maladaptive cognition about the self and the world, along with the behaviors that increase and reinforce them [15]. In the socio-cognitive model of unregulated Internet usage, the focus is on self-regulation. The model suggests that problems in Internet use are a result of poor self-regulation where individual control, judgement, and adjustment of behavior are lacking [16].

Recent studies suggest that 4–22% of HE students experience problems in their Internet use. The wide range can be explained by the differences in assessment tools as well as with different conceptualizations that have been exploited [4, 13], [14], [15]. Among HE students, excessive Internet use have been found to be prevalent among both women and men, and younger students have demonstrated higher rates of excessive use compared to older students [2, 5]. Also, online behaviors such as excessive gaming, gambling, adult entertainment, shopping online, web surfing, and social networking have been linked to excessive use of the Internet among students [10, 13]. These behaviors may result in health problems, including psychological health symptoms and disorders (cluster of symptoms), such as depression, anxiety, stress, eating disorders, fear of missing out (FOMO), social isolation, loneliness, and increased suicide risk [15], [16], [17], [18], as well as physical health symptoms, such as headaches, fatigue, dizziness, weight gain, musculoskeletal symptoms, and upper extremity and neck symptoms [2, 17, 18]. Also, it has been underlined that within psychological health symptoms, the relationship with excessive Internet use may be reciprocal and bidirectional [12]. On the other hand, it is noteworthy to recall that the Internet is also used to prevent and treat the above-mentioned health issues [14, 19]. For example, medical and psychological consultation and psychotherapy are also obtainable online [14, 20]. There are also Internet-delivered health interventions for anxiety and depression disorders, diet and physical activity, disease management, and chronic pain [19].

This study contributes to the existing literature by examining whether self-reported problems of studying and daily rhythm caused by time spent online are related to psychological and physical health symptoms among HE students. Although there has been research on excessive Internet use within the last decade [14], more studies are needed regarding psychological and physical health, which are deeply intertwined and may even lead to chronic conditions [21]. Nevertheless, exploring the above-mentioned association in the context of studying and daily life, enables to identify to role of time spent online among HE students.

Materials and methods

Results

Discussion

This study highlights that self-reported problems of studying and daily rhythm caused by time spent online, higher amount of Internet use by time spent, older age, and female gender were associated with psychological health symptoms among HE students. Currently during the COVID-19 pandemic, increased use of the Internet has increased the likelihood for developing excessive Internet use patterns. This has especially been identified in individuals with pre-existing mental health conditions [25], [26], [27]. It is worth noting that when examining mental health conditions, the female gender is more prone to experience psychological symptoms of depression, anxiety, eating, or somatoform disorders, while males tend more towards substance use and antisocial disorders [28]. In the previous literature, relationships between various psychological symptoms and excessive use of the Internet, including daily longtime use of the Internet, have been found among both genders [14]. Psychological symptoms associated with excessive use of the Internet have varied with respondent age, due to different online activities among people of different ages [29]. Psychological withdrawal symptoms, such as depression and anxiety, have especially been associated with online activities of shopping, gambling, and gaming [14, 15]. It is a necessity to keep all online behaviors (for example, continuous viewing of social media, e-mail, or the news) at reasonable and controlled levels to avoid negative effects on psychological well-being [27]. Also, the HE institutions are in a key position to spread information on excessive Internet use by encouraging students to make reasonable use of the Internet from the perspective of benefits to study motivation and academic performance [7]. In Finland, HE students’ study ability, including personal resources, study skills, study environment, teaching, and promotion of health, is examined by the Finnish Student Health Service (FSHS), a national student health service for UNI and UAS students. The FSHS does preventive work through health checks and electronic questionnaires where multiple health- and study ability-related habits are screened for early detection of health concerns in student health care [30]. The health checks and questionnaires offer an opportunity to recognize excessive or problematic use of the Internet. Among the students, identified problems on Internet use are related to online problem gambling, and a need to take this account in student health care in areas of health promotion and clinical care has been recognized. Online problem gambling could be approached, for example, as one of the factors influencing psychic, physical, and social problems [31]. HE students’ health and study ability and the well-being of study communities are also promoted in Finland from the HE institution perspective, with the help of many multidisciplinary actors, services, and projects [32, 33].

The results from the current study indicate that gender affects self-reporting of problems of studying and daily rhythm caused by time spent online. Compared to females, males with these problems reported having more symptoms of anxiety, depression, or feeling low. Within both genders, associations between diverse psychological health symptoms and problems of studying and daily rhythm caused by time spent online were found. Many studies have associated male gender as a risk factor for excessive use of the Internet, specifically online activity of gaming and cybersexual activities, even though research indicates that females are as vulnerable to excessive use as are males [14, 29]. Furthermore, as this study demonstrated a relationship between HE students’ psychological health symptoms and problems of studying and daily rhythm caused by time spent online, more studies that include online activity measures for further assessment of this relationship are needed for clarification.

According to Kimberly Young, who first introduced the concept of Internet addiction in 1998, excessive use of the Internet may result in changes of physical well-being, resulting from behaviors such as failure to eat for long periods, increase in sedentary lifestyle, and problems with sleeping [15, 34]. In the 25 years since then, an accumulating body of research has confirmed HE students’ excessive use of the Internet to be associated with many physical symptoms such as headaches and neck symptoms [2, 17]. Results from this study indicated that problems of studying and daily rhythm caused by time spent online, a higher amount of Internet use by time, and female gender were associated with physical symptoms among HE students. These results from the current study agree with previous findings, although physical symptoms are common among both genders [2]. In addition, HE students in general are known to have a high prevalence of physical complaints, of which some could be from studying in a seated position [22]. Examining the effect of prolonged sitting on students’ physical symptoms is noteworthy, since prolonged sitting is considered one of the health risks for multiple chronic conditions, obesity, and diabetes as well as stress, anxiety, and depression [2, 18]. Physical symptoms that are a consequence of excessive Internet use might be more noticeable and therefore may help to identify additional problems with HE student Internet use.

According to the results of this study, 23% of students reported having problems of studying and 21% of problems with daily rhythm due to their time spent on the Internet. Fortunately, comprehensive prevention strategies and professional treatments exist to address HE students’ Internet use-related problems [14]. These difficulties can be approached in various ways, for instance, from the perspective of psychological dependency, patterns related to cognition and behaviors, or as a clinical disorder or disease [14, 15, 18, 20]. Primary steps for individuals, including HE students, involve self-regulation with self-monitoring and commitment to limited Internet usage with a behavioral perspective [20]. In addition, motivational interviewing by mental health professionals, cognitive therapy, virtual reality therapy, and psychotropic medications can be used to treat psychological symptoms associated with excessive and/or addictive use of the Internet [14, 18]. In contrast, it is also possible to use the Internet from a “healthy” point of view. According to Davis (2001), who developed the cognitive-behavioral model of pathological use of the Internet, as introduced in the Introduction, healthy Internet use refers to using the Internet for a purpose and for a reasonable amount of time, without cognitive or behavioral discomfort, and the ability to separate Internet communication from real-life communication by employing the Internet as a helpful tool, rather than a source of identity [15]. In addition, as the Internet is also used for communication, its possibilities to function as an environment or as a social community could be considered in future studies from the social health perspective, as only a small number of studies have explored this perspective [35]. Nevertheless, since Internet use is currently an integral element of the HE student environment in studying and in daily life, both positive and negative aspects are important to consider. Also, the popularity of answering the survey of this study electronically instead of by postal mail demonstrates that students are living in a technological era with Internet connectivity and behavior [7].

As a limitation to this study, the methodology deployed self-reported questionnaires for data collection. Further, using qualitative or mixed methods could have provided more depth. Comparison to previous data collected with the same instrument was not possible due to the addition of new questions on problems of studying and daily rhythm caused by time spent online. The association between problems of studying and daily rhythm, higher amount of Internet use, and health symptoms should be interpreted with caution, as an external cause, such as substance use, might result in the phenomena mentioned. Moreover, the influences can be bidirectional. Finally, since this study comprised a cohort of only Finnish HE students, the generalizability of the results in another geographical context is limited. Also, the COVID-19 pandemic has changed Internet use prevalence worldwide since this survey was conducted. When looking at the survey’s low response rate (31% for the study), it is good to be aware that the behavior of those who did not respond to the survey may be different from those who responded. Information about the representativeness of the data in general is available from the University Student Health Survey report [22]. Regardless of these limitations, this study provides important evidence regarding HE students’ problems of studying and daily rhythm caused by time spent online and related health symptoms.

Conclusions

One fifth of students in the current study reported having problems of studying and daily rhythm due to their time spent on the Internet. These problems and spending more time online were associated with psychological and physical health symptoms among HE students. The findings can be used from a prevention standpoint regarding early identification and further in regard to the need for seeking professional treatment. The findings can be utilized in health promotion projects targeted to groups of HE students with potential excessive use of the Internet. Also, the HE institutions are in a key position in spreading information on the risks of excessive Internet use.