Problematic Internet Use, Depressive Symptomatology and Suicidal Ideation in University Students During COVID-19 Confinement

  1. Verónica Villanueva-Silvestre 1
  2. Andrea Vázquez-Martínez 1
  3. Manuel Isorna-Folgar 2
  4. Víctor J. Villanueva Blasco 1
  1. 1 Universidad Internacional de Valencia
    info

    Universidad Internacional de Valencia

    Valencia, España

    ROR https://ror.org/00gjj5n39

  2. 2 Universidade de Vigo
    info

    Universidade de Vigo

    Vigo, España

    ROR https://ror.org/05rdf8595

Revista:
Psicothema

ISSN: 0214-9915 1886-144X

Ano de publicación: 2022

Volume: 34

Número: 4

Páxinas: 518-527

Tipo: Artigo

DOI: 10.7334/PSICOTHEMA2022.40 DIALNET GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: Psicothema

Obxectivos de Desenvolvemento Sustentable

Resumo

The aim was to estimate the rate of PIU in Spanish university students during the lockdown, taking sex and age into account, and to analyze its relationship with depression and suicidal ideation. Method: 921 university students (55% women) from 18 to 30 years old (M = 24.8 years; SD = 3) participated. Results: The results showed that 21% of the participants presented PIU, 25.1% moderate depression, 2.1% severe depression, and 6.6% suicidal ideation. The 18 to 21-year-old age group presented the highest rate of PIU (37.8%). A positive correlation was observed between PIU and depression (r = .38; p < .001), with a significantly higher mean score on the PHQ-9 (t(241.813) = -8.21; p < .001; d = .78) in university students with PIU (M = 9.8; SD = 5.1) than those without it (M = 6.4; SD = 4.1). The rate of severe depression was six times greater (χ2(3) = 73.25; p < .001) in undergraduates with PIU (6.2%) than those without PIU (0.8%). Moreover, 3.6% of university students with PIU presented suicidal ideation. Conclusions: These findings establish the association between PIU and depression and suicidal ideation in the university population, providing novel contributions for prevention policies.

Referencias bibliográficas

  • Afrin, D., Islam, M. U., Rabbiand, F., & Hossain, A. (2017). The schoollevel factors associated with internet addiction among adolescents: A cross-sectional study in Bangladesh. Journal of Addiction and Dependence, 3(2), 170-174. https://doi.org/10.15436/2471-061X.17.1686
  • Ahorsu, D. K., Imani, V., Lin, C.Y., Timpka, T., Broström, A., Updegraff, J. A., Årestedt, K., Griffiths, M. D., & Pakpour, A. H. (2022). Associations between fear of COVID-19, mental health, and preventive behaviours across pregnant women and husbands: an actor-partner interdependence modelling. International Journal of Mental Health and Addiction, 20, 68-82. https://doi.org/10.1007/s11469-020-00340-x
  • Al-Halabí, S., & Fonseca-Pedrero, E. (2021). Suicidal behavior prevention: The time to act is now. Clínica y Salud, 32(2), 89-92. https://doi.org/10.5093/clysa2021a17
  • Al-Halabí, S., & García Haro, J. M. (2021). Tratamientos psicológicos para la conducta suicida. En E. Fonseca-Pedrero (Coord.), Manual de tratamientos psicológicos. Adultos [Manual of psychological treatments. Adults] (pp. 639-675). Pirámide.
  • Al-Halabí, S., Sáiz, P. A., Burón, P., Garrido, M., Benabarre, A., Jiménez, E., Cervilla, J., Navarrete, M.S., Díaz-Mesa, E.M., García-Álvarez, L., Muñiz, J., Posner, K., Oquendo, M.A., García-Portilla, M.P. & Bobes, J. (2016). Validación de la versión en español de la Columbia-Suicide Severity Rating Scale (Escala Columbia para Evaluar el Riesgo de Suicidio) [Validation of the Spanish version of the Columbia-Suicide Severity Rating Scale]. Revista de Psiquiatría y Salud Mental, 9(3), 134-142. https://doi.org/10.1016/j.rpsm.2016.02.002
  • Apaza, C. M., Sanz, R. S. S., & Arévalo, J. E. S. (2020). Factores psicosociales durante el confinamiento por el Covid-19–Perú [Psychosocial factors during confinement by Covid-19-Peru]. Revista Venezolana De Gerencia, 25(90), 402-410. https://www.redalyc.org/articulo.oa?id=29063559022
  • Aznar-Díaz, I., Kopecký, K., Romero, J. M., Cáceres, M. P., & TrujilloTorres, J. M. (2020). Patologías asociadas al uso problemático de Internet. Una revisión sistemática y metaanálisis en WOS y Scopus [Pathologies associated with the problematic use of the internet. A systematic review and meta-analysis in WOS and Scopus]. Investigación Bibliotecológica, 34(82), 229-253. https://doi.org/10.22201/iibi.24488321xe.2020.82.58118
  • Balhara, Y. P. S., Doric, A., Stevanovic, D., Knez, R., Singh, S., Chowdhury, M. R. R., Kafali, H. Y., Sharma, P., Vally, Z., Vu, T.V., Arya, S., Mahendru, A., Ransing, R., Erzin, G., & Hong, H.C. (2019). Correlates of problematic internet use among college and university students in eight countries: An international cross-sectional study. Asian Journal of Psychiatry, 45, 113-120. https://doi.org/10.1016/j.ajp.2019.09.004
  • Banerjee, D. (2020). The COVID-19 outbreak: Crucial role the psychiatrists can play. Asian Journal of Psychiatry, 50, Article 102014. https://doi.org/10.1016/j.ajp.2020.102014
  • Barrera-Herrera, A., Neira-Cofré, M., Raipán-Gómez, P., RiquelmeLobos, P., & Escobar-Alaniz, B. (2019). Apoyo social percibido y factores sociodemográficos en relación con los síntomas de ansiedad, depresión y estrés en universitarios chilenos [Perceived social support and sociodemographic factors in relation to symptoms of anxiety, depression and stress in Chilean university students]. Revista de Psicopatología y Psicología Clínica, 24(2), 105-115. https://doi.org/10.5944/rppc.23676
  • Blasi, D., Giardina, A., Giordano, C., Coco, G., Tosto, C., Billieux, J., & Schimmenti, A. (2019). Problematic video game use as an emotional coping strategy: Evidence from a sample of MMORPG gamers. Journal of Behavioral Addictions, 8(1), 25-34. https://doi.org/10.1556/2006.8.2019.02
  • Bousoño,M., Al-Halabí, S., Burón, P., Garrido, M., Díaz-Mesa, E.V., Galván, G., García-Álvarez, L., Carli, V., Hoven, C., Sarchiapone, M., Wasserman, D., Bousoño, M., García-Portilla, M.P., Iglesias, C., Sáiz, P.A. & Bobes, J. (2017). Uso y abuso de sustancias psicotrópicas e internet, psicopatología e ideación suicida en adolescentes [Substance use or abuse, internet use, psychopathology and suicidal ideation in adolescents]. Adicciones, 29(2), 97-104. https://www.redalyc.org/articulo.oa?id=289150531004
  • Cheng, Y., Tseng, P., Lin, P., Chen, T., Stubbs, B., Carvalho, A. F., Wu, C., Chen, Y., & Wu, M. (2018). Internet addiction and its relationship with suicidal behaviors: a meta-analysis of multinational observational studies. The Journal of Clinical Psychiatry, 79(4), Article 9291. https://doi.org/10.4088/JCP.17r11761
  • Deleuze, J., Maurage, P., Schimmenti, A., Nuyens, F., Melzer, A., & Billieux, J. (2019). Escaping reality through videogames is linked to an implicit preference for virtual over real-life stimuli. Journal of Affective Disorders, 245, 1024-1031. https://doi.org/10.1016/j.jad.2018.11.078
  • Diez-Quevedo, C., Rangil, T., Sanchez-Planell, L., Kroenke, K., & Spitzer, R. L. (2001). Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients. Psychosomatic Medicine, 63(4), 679-686. https://doi.org/10.1097/00006842-200107000-00021
  • Fonseca-Pedrero, E., Pérez-Álvarez, M., Al-Halabí, S., Inchausti, F., Muñiz, J., López-Navarro, E., Pérez, A., Lucas, B., Debbané, M., Bobes-Bascarán, M., Gimeno-Peón, A., Prado-Abril, J., FernándezÁlvarez, J., Rodríguez-Testal, J., González, D., Díez-Gómez, A., García, J.M., García-Cerdán, L., Osma, J., […] Quilez, A. (2021). Tratamientos psicológicos empíricamente apoyados para adultos: una revisión selectiva [Evidence-based psychological treatments for adults: a selective review]. Psicothema, 33(2), 188-197. https://doi.org/ 10.7334/psicothema2020.426
  • Frangos, C. C., Fragkos, K. C., & Kiohos, A. (2010). Internet addiction among Greek university students: Demographic associations with the phenomenon, using the Greek version of young’s internet addiction test. International Journal of Economic Sciences and Applied Research, 3(1), 49-74. https://econpapers.repec.org/article/teijournl/v_3a3_3ay_3a2010_3ai _3a1_3ap_3a49-74.htm
  • García-Peñalvo, F. J., Corell, A., Abella-García, V., & Grande, M. (2020). Online assessment in higher education in the time of COVID-19. Education in the Knowledge Society, 21, 1-26. https://doi.org/10.14201/eks.23013
  • Gavurova, B., Ivankova, V., & Rigelsky, M. (2020). Relationships between perceived stress, depression and alcohol use disorders in university students during the COVID-19 pandemic: a socio-economic dimension. International Journal of Environmental Research and Public Health, 17(23), Article 8853. https://doi.org/10.3390/ijerph17238853
  • González, N., & Estévez, A. (2017). El apoyo social percibido moderador entre el uso problemático de internet y la sintomatología depresiva en jóvenes adultos [Moderating perceived social support between problematic internet use and depressive symptomatology in young adults]. Salud y Drogas, 17(1), 53-62. https://www.redalyc.org/pdf/839/83949782006.pdf
  • Granados, J. A., Gómez, O., Islas, M. I., Maldonado, G., Martínez, H. F., & Pineda, A. M. (2020). Depression, anxiety and suicidal behavior in medical training at a University in Mexico. Investigación en Educación Médica, 9(35), 65-74. https://doi.org/10.22201/facmed.20075057e.2020.35.20224
  • Gupta, A., Khan, A. M., Rajoura, O. P., & Srivastava, S. (2018). Internet addiction and its mental health correlates among undergraduate college students of a university in north India. Journal of Family Medicine and Primary Care, 7(4), 721-727. https://doi.org/10.4103/jfmpc.jfmpc_266_17
  • Hassan, T., Alam, M., Wahab, A., & Hawlader, M. (2020). Prevalence and associated factors of internet addiction among young adults in Bangladesh. Journal of the Egyptian Public Health Association, 95, Article 3. https://doi.org/10.1186/s42506-019-0032-7
  • Huang, Y., & Zhao, N. (2020). Chinese mental health burden during the COVID-19 pandemic. Asian Journal of Psychiatry, 51, Article 102052. https://doi.org/10.1016/j.ajp.2020.102052
  • Instituto Nacional de Estadística (2019). Encuesta sobre Equipamiento y Uso de Tecnologías de Información y Comunicación en los Hogares [Survey on Equipment and Use of Information and Communication Technologies in Households].
  • Islam, M.A., & Hossin, M. Z. (2016). Prevalence and risk factors of problematic internet use and the associated psychological distress among graduate students of Bangladesh. Asian Journal of Gambling Issues and Public Health, 6(1), 1-14. https://doi.org/10.1186/s40405-016-0020-1
  • Islam, M. S., Ferdous, M. Z., & Potenza, M. N. (2020). Panic and generalized anxiety during the COVID-19 pandemic among Bangladeshi people: An online pilot survey early in the outbreak. Journal of Affective Disorders, 276, 30-37. https://doi.org/10.1016/j.jad.2020.06.049
  • Islam, M. S., Sujan, M.S.H, Tasnim, R., Sikder, M.T., Potenza, M.N. & Van Os, J. (2020). Psychological responses during the COVID-19 outbreak among university students in Bangladesh. PloS One, 15(12), Article e0245083. https://doi.org/10.1371/journal.pone.0245083
  • Johnson, J. G., Harris, E. S., Spitzer, R. L., & Williams, J. B. (2002). The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients. Journal of Adolescent Health, 30(3), 196-204. https://doi.org/10.1016/S1054-139X(01)00333-0
  • Kim, K., Ryu, E., Chon, M., Yeun, E., Choi, S., Seo, J., & Nam, B. (2006). Internet addiction in Korean adolescents and its relation to depression and suicidal ideation: a questionnaire survey. International Journal of Nursing Studies, 43(2), 185-192. https://doi.org/10.1016/j.ijnurstu.2005.02.005
  • King, C.A., Kramer, A., Preuss, L., Kerr, D.C.R., Weisse, L., & Venkataraman, S. (2006). Youth-Nominated Support Team for suicidal adolescents (Version 1): A randomized controlled trial. Journal of Consulting and Clinical Psychology, 74(1), 199-206. https://doi.org/10.1037/0022-006X.74.1.199
  • Knipe, D., Hawton, K., Siynor, M., & Niederkrotenthaler, T. (2021). Researchers must contribute to responsible reporting of suicide. BMJ, 372, Article n351. https://doi.org/10.1136/bmj.n351
  • Kitazawa, M., Yoshimura, M., Hitokoto, H., Sato-Fujimoto, Y., Murata, M., Negishi, K., Mimura, M., Tsubota, K., & Kishimoto, T. (2019). Survey of the effects of internet usage on the happiness of Japanese university students. Health and Quality of Life Outcomes, 17(1), 1-8. https://doi.org/10.1186/s12955-019-1227-5
  • Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
  • Laconi, S., Rodgers, R. F., & Chabrol, H. (2014). The measurement of Internet addiction: A critical review of existing scales and their psychometric properties. Computers in Human Behavior, 41, 190-202. https://doi.org/10.1016/j.chb.2014.09.026
  • Lam, L. T., & Peng, Z. (2010). Effect of pathological use of the internet on adolescent mental health: a prospective study. Archives of Pediatrics & Adolescent Medicine, 164(10), 901-906. https://doi.org/10.1001/archpediatrics.2010.159
  • Ley de protección de datos personales y garantía de derechos digitales, del 5 de diciembre [Spanish Organic Law 3/2018 on personal data protection and digital rights guarantee]. Boletín Oficial del estado, 294, del 6 de diciembre de 2018. https://www.boe.es/eli/es/lo/2018/12/05/3
  • Lin, L. Y., Sidani, J. E., Shensa, A., Radovic, A., Miller, E., Colditz, J. B., Hoffman, B. L., Giles, L. M., & Primack, B. A. (2016). Association between social media use and depression among US young adults. Depression and Anxiety, 33(4), 323-331. https://doi.org/10.1002/da.22466
  • Ma, Z., Zhao, J., Li, Y., Chen, D., Wang, T., Zhang, Z., Chen, Z., Yu, Q., Jiang, J., & Fan, F. (2020). Mental health problems and correlates among 746 217 college students during the coronavirus disease 2019 outbreak in China. Epidemiology and Psychiatric Sciences, 29, Article e181. https://doi.org/10.1017/S2045796020000931
  • Machimbarrena, J. M., González-Cabrera, J., Ortega-Barón, J., BeranuyFargues, M., Álvarez-Bardón, A., & Tejero, B. (2019). Profiles of problematic internet use and its impact on adolescents’ health-related quality of life. International Journal of Environmental Research and Public Health, 16(20), Article 3877. https://doi.org/10.3390/ijerph16203877
  • Mamun, M. A., & Griffiths, M. D. (2019). The assessment of internet addiction in Bangladesh: Why are prevalence rates so different? Asian Journal of Psychiatry, 40, 46-47. https://doi.org/10.1016/j.ajp.2019.01.017
  • Morrison, C. M., & Gore, H. (2010). The relationship between excessive Internet use and depression: a questionnaire-based study of 1,319 young people and adults. Psychopathology, 43(2), 121-126. https://doi.org/10.1159/000277001
  • Odaci, H., & Çikrici, Ö. (2017). An exploration of the associations among internet use, depression, anxiety and stress among youths. Mediterranean Journal of Clinical Psychology, 5(3), 1-13. https://doi.org/10.6092/2282-1619/2017.5.1635
  • Oka, T., Hamamura, T., Miyake, Y., Kobayashi, N., Honjo, M., Kawato, M., Kubo, T., & Chiba, T. (2021). Prevalence and risk factors of internet gaming disorder and problematic internet use before and during the COVID-19 pandemic: A large online survey of Japanese adults. Journal of Psychiatric Research, 142, 218-225. https://doi.org/10.1016/j.jpsychires.2021.07.054
  • Pettorruso, M., Valle, S., Cavic, E., Martinotti, G., Di Giannantonio, M., & Grant, J. E. (2020). Problematic Internet use (PIU), personality profiles and emotion dysregulation in a cohort of young adults: trajectories from risky behaviors to addiction. Psychiatry Research, 289, Article 113036. https://doi.org/10.1016/j.psychres.2020.113036
  • Polo del Río, M., Lázaro, S. M., del Barco, B. L., & Castaño, E. F. (2017). Abuso del móvil en estudiantes universitarios y perfiles de victimización y agresión [Mobile phone abuse in university students and profiles of victimization and aggression]. Adicciones, 29(4), 245- 255. https://www.redalyc.org/articulo.oa?id=289153037004
  • Qiu, J., Shen, B., Zhao, M., Wang, Z., Xie, B., & Xu, Y. (2020). A nationwide survey of psychological distress among Chinese people in the COVID-19 epidemic: implications and policy recommendations. General Psychiatry, 33, Article e100213. https://doi.org/10.1136/gpsych-2020-100213
  • Ramón-Arbués, E., Gea-Caballero, V., Granada-López, J. M., Juárez-Vela, R., Pellicer-García, B., & Antón-Solanas, I. (2020). The prevalence of depression, anxiety and stress and their associated factors in college students. International Journal of Environmental Research and Public Health, 17(19), Article 7001. https://doi.org/10.3390/ijerph17197001
  • Restrepo, J. E., Sánchez, O. A., Vallejo, G. C., Quirama, T. C., Sánchez, Y. O., & Cardona, P. D. (2018). Depresión y su relación con el consumo de sustancias psicoactivas, el estrés académico y la ideación suicida en estudiantes universitarios colombianos [Depression and its relationship with the consumption of psychoactive substances, academic stress and suicidal ideation in colombian university students]. Health and Addictions, 18(2), 227-239.
  • https://dialnet.unirioja.es/servlet/articulo?codigo=6546342
  • Rial, A. R., Gómez, P., Isorna, M., Gallego, M. A., & Mallou, J. V. (2015). EUPI-a: Escala de Uso Problemático de Internet en adolescentes. Desarrollo y validación psicométrica [PIUS-a: Problematic Internet Use Scale in adolescents. Development and psychometric validation]. Adicciones, 27(1), 47-63. https://doi.org/10.20882/adicciones.193
  • Rodrigues, B., Marques, M., Pereira, A. T., & Macedo, A. (2020). Internet use patterns and the relation between generalized problematic internet use and psychological distress in Portuguese university students. Revista de Psicopatologia y Psicologia Clinica, 25(1), 31-39. https://doi.org/10.5944/rppc.25324
  • Sánchez-Álvarez, N., Extremera, N., Rey, L., Chang, E.C. & Chang, O. D. (2020). Frequency of Suicidal Ideation Inventory: Psychometric Properties of the Spanish Version. Psicothema, 32(2), 253–260. https://doi.org/10.7334/psicothema2019.344
  • Salari, N., Hosseinian-Far, A., Jalali, R., Vaisi-Raygani, A., Rasoulpoor, S., Mohammadi, M., Rasoulpoor, S., & Khaledi-Paveh, B. (2020). Prevalence of stress, anxiety, depression among the general population during the COVID-19 pandemic: a systematic review and metaanalysis. Globalization and Health, 16, 1-11. https://doi.org/10.1186/s12992-020-00589-w
  • Schimmenti, A., Billieux, J., & Starcevic, V. (2020). The four horsemen of fear: An integrated model of understanding fear experiences during the COVID-19 pandemic. Clinical Neuropsychiatry, 17(2), 41-45. https://doi.org/10.36131/CN20200202
  • Servidio, R., Bartolo, M. G., Palermiti, A. L., & Costabile, A. (2021). Fear of COVID-19, depression, anxiety, and their association with Internet addiction disorder in a sample of Italian students. Journal of Affective Disorders Reports, 4, Article 100097. https://doi.org/10.1016/j.jadr.2021.100097
  • Shadzi, M. R., Salehi, A., & Vardanjani, H. M. (2020). Problematic internet use, mental health, and sleep quality among medical students: A path-analytic model. Indian Journal of Psychological Medicine, 42(2), 128-135. https://doi.org/10.4103/IJPSYM.IJPSYM_238_19
  • Shigemura, J., Ursano, R. J., Morganstein, J. C., Kurosawa, M., & Benedek, D. M. (2020). Public responses to the novel 2019 coronavirus (2019€) in Japan: Mental health consequences and target populations. Psychiatry and Clinical Neurosciences, 74(4), 277-283. https://doi.org/10.1111/pcn.12988
  • Spitzer, R. L., Kroenke, K., Williams, J. B., & Patient Health Questionnaire Primary Care Study Group, & Patient Health Questionnaire Primary Care Study Group (1999). Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. JAMA, 282(18), 1737-1744. https://doi.org/10.1001/jama.282.18.1737
  • Starcevic, V., & Khazaal, Y. (2017). Relationships between behavioural addictions and psychiatric disorders: What is known and what is yet to be learned?. Frontiers in Psychiatry, 8, Article 53. https://doi.org/10.3389/fpsyt.2017.00053
  • Sun, Y., Li, Y., Bao, Y., Meng, S., Sun, Y., Schumann, G., Kosten, T., Strang, J., Lu, L., & Shi, J. (2020). Brief report: increased addictive internet and substance use behavior during the COVID‐19 pandemic in China. The American Journal on Addictions, 29(4), 268-270. https://doi.org/10.1111/ajad.13066
  • The jamovi project (2022). Jamovi (version 2.3.9) [Computer Software]. Retrieved from https://www.jamovi.org
  • Tateno, M., Teo, A. R., Shiraishi, M., Tayama, M., Kawanishi, C., & Kato, T. A. (2018). Prevalence rate of Internet addiction among Japanese college students: Two cross‐sectional studies and reconsideration of cut‐off points of Young’s Internet Addiction Test in Japan. Psychiatry and Clinical Neurosciences, 72(9), 723-730. https://doi.org/10.1111/pcn.12686
  • Torales, J., O’Higgins, M., Castaldelli-Maia, J. M., & Ventriglio, A. (2020). The outbreak of COVID-19 coronavirus and its impact on global mental health. International Journal of Social Psychiatry, 66(4), 317-320. https://doi.org/10.1177/0020764020915212
  • Uddin, M. S., Al Mamun, A., Iqbal, M. A., Nasrullah, M., Asaduzzaman, M., Sarwar, M. S., & Amran, M. S. (2016). Internet addiction disorder and its pathogenicity to psychological distress and depression among university students: A cross-sectional pilot study in Bangladesh. Psychology, 7(8), 1126-1137. https://doi.org/10.4236/psych.2016.78113
  • Ueno, T., Ito, K., Murai, T., & Fujiwara, H. (2020). Mental Health Problems and Their Association With Internet Use in Medical Residents. Frontiers in Public Health, 8, Article 587390. https://doi.org/10.3389/fpubh.2020.587390
  • Vigna-Taglianti, F., Brambilla, R., Priotto, B., Angelino, R., Cuomo, G., & Diecidue, R. (2017). Problematic internet use among high school students: Prevalence, associated factors and gender differences. Psychiatry Research, 257, 163-171. https://doi.org/10.1016/j.psychres.2017.07.039
  • Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho, C. S., & Ho, R. C. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. International Journal of Environmental Research and Public Health, 17(5), Article 1729. https://doi.org/10.3390/ijerph17051729
  • Wathelet, M., Duhem, S., Vaiva, G., Baubet, T., Habran, E., Veerapa, E., Debien, C., Molenda, S., Horn, M., & Grandgenèvre, P. (2020). Factors associated with mental health disorders among university students in France confined during the COVID-19 pandemic. JAMA Network Open, 3(10), Article e2025591. https://doi.org/10.1001/jamanetworkopen.2020.25591
  • World Health Organization. (2020). Mental health and psychosocial considerations during the COVID-19 outbreak-18 March (No. WHO/2019-nCoV/MentalHealth/2020.1). https://www.who.int/docs/default-source/coronaviruse/mental-healthconsiderations.pdf
  • Young, K. S. (2004). Internet addiction: A new clinical phenomenon and its consequences. American Behavioral Scientist, 48(4), 402-415. https://doi.org/10.1177/0002764204270278
  • Zhang, Y., Peters, A., & Chen, G. (2018). Perceived stress mediates the associations between sleep quality and symptoms of anxiety and depression among college nursing students. International Journal of Nursing Education Scholarship, 15(1), Article 20170020. https://doi.org/10.1515/ijnes-2017-0020