- Email: [email protected]
Online social networking addiction among college students in Singapore: Comorbidity with behavioral addiction and affective disorder
Accepted Manuscript Title: Online Social Networking Addiction among College Students in Singapore: Comorbidity with Behavioral Addiction and Affective Disorder Author: Catherine So-kum Tang Yvaine Yee Woen Koh PII: DOI: Reference:
S1876-2018(16)30237-4 http://dx.doi.org/doi:10.1016/j.ajp.2016.10.027 AJP 989
To appear in: Received date: Revised date: Accepted date:
24-5-2016 16-9-2016 29-10-2016
Please cite this article as: Tang, Catherine So-kum, Koh, Yvaine Yee Woen, Online Social Networking Addiction among College Students in Singapore: Comorbidity with Behavioral Addiction and Affective Disorder.Asian Journal of Psychiatry http://dx.doi.org/10.1016/j.ajp.2016.10.027 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Online Social Networking Addiction among College Students in Singapore: Comorbidity with Behavioral Addiction and Affective Disorder
Catherine So-kum Tang, The National University of Singapore, Department of Psychology, 9 Arts Link, The National University of Singapore, 117570. Email: [email protected] Yvaine Yee Woen Koh, The National University of Singapore, AS8 #07-56, 10 Kent Ridge Crescent (S) 119260, Kent Ridge Campus, Singapore. Email: [email protected]
Correspondence should be sent to Dr Yee Woen Koh, Present Address: AS8 #07-56, 10 Kent Ridge Crescent (S) 119260, Kent Ridge Campus, Singapore. Phone Number: (65)65168524, Email: [email protected]
1
Highlights
This study showed that 29.5% of the surveyed college students in Singapore were addicted to online social networking sites/platforms (SNS).
SNS addiction was also found to comorbid with unhealthy food intake and shopping addiction, as well as affective disorder of depression, anxiety, and mania.
Females relative to males were more likely to report both SNS addiction and affective disorder.
Compared to the total sample, students with SNS addiction were more likely to report affective disorder, unhealthy food intake, and shopping addiction.
Abstract Purpose of the research This study aimed to determine the prevalence of addiction to social networking sites/platforms (SNS) and its comorbidity with other behavioral addiction and affective disorder among college students in Singapore. 1110 college students (age: M=21.46, SD=1.80) in Singapore completed measures assessing online social networking, unhealthy food intake and shopping addiction as well as depression, anxiety and mania. Descriptive analyses were conducted to investigate the prevalence and comorbidity of behavioral addiction and affective disorder. Chi-square tests were used to examine gender differences.
The principal results The prevalence rates of SNS, food and shopping addiction were 29.5%, 4.7% and 9.3% respectively for the total sample. SNS addiction was found to co-occur with food addiction (3%), shopping addiction (5%), and both food and shopping addiction (1%). The comorbidity rates of SNS addiction
2
and affective disorder were 21% for depression, 27.7% for anxiety, and 26.1% for mania. Compared with the total sample, students with SNS addiction reported higher comorbidity rates with other behavioral addiction and affective disorder. In general, females as compared to males reported higher comorbidity rates of SNS addiction and affective disorder.
Major Conclusions SNS addiction has a high prevalence rate among college students in Singapore. Students with SNS addiction were vulnerable to experience other behavior addiction as well as affective disorder, especially among females.
Key words: social networking addiction, behavioral addiction, comorbidity, affective disorder
(216words)
1. INTRODUCTION Social networking sites/platforms (SNS) are web-based virtual communities where users interact with real-life friends and meet other people with shared interests. SNS (e.g., Facebook and Twitters) have attracted large numbers of users around the globe. Teenagers and college students tend to make the most use of SNS. About 24% of teens go online “almost constantly” (Lenhart et al., 2015) and 59.4% of college students visited social networking sites several times a day (Sponcil & Gitimu, 2013). . An international analysis in different countries showed cultural and regional differences in terms of SNS use. Evidence from previous studies showed that Singaporean adults spent the longest time on the Facebook to connect with friends and share updates on topical news (Experian, 2011) and 71% of Singaporeans had a Facebook profile (Internet World Statistics, 2016). US college students reported greater use of SNS than students in China (Jackson & Wang, 2013). In addition, there was 3
also gender difference in SNS use. Females relative to males reported greater overall use and time spent on SNS (Lenhart et al., 2015) SNS use can become addictive, especially among young people. Although not formally recognized as a clinical diagnosis, SNS addiction incorporates the experience of “classic” addiction symptoms similar to chemical addiction (Andreassen, 2015; Griffins et al., 2014; Kuss & Griffins, 2011; Ryan et al., 2014). These addiction symptoms include: neglecting personal/work life, preoccupation, mood alteration, withdrawal, inability to cut down, and relapse. However, an excessive use of SNS by itself does not necessarily equate with addiction. Reviews studies have shown that about 12% of US adults were addicted to Facebook, 24 to 35% of Chinese college students would be classified as addicted to SNS, and a low rate of 1.6% Facebook addiction was found among Nigerian undergraduate students (Andreassen, 2015; Kuss & Griffins, 2011) . There were no conclusive findings confirming higher rates of SNS addiction among females than males. Internet addiction, or problematic internet use, is characterized by excessive or poorly controlled preoccupations, urges or behaviors regarding internet use that lead to impairment or distress (Young, 2009). There is a paucity of study assessing the relationship between SNS addiction and internet addiction. A preliminary study suggested that the use of Facebook may contribute to the severity of symptoms associated with internet addiction (Kittinger et al., 2012). General internet addiction also tends to co-occur with other addiction such as substance use, gambling, overeating and excessive sedentary behavior (Kuss & Griffins, 2011). A study has found that 61% of the participants pursued at least one and 31% engaged in two or more problematic behavior of overeating and excessive internet use (Malat et al., 2010). Currently, there is not yet any published data on the cooccurrence between SNS addiction and other behavioral addiction. Since SNS use takes up a large amount of available time, it would only co-occur with other behavioral addiction that also has an outlet via SNS. In fact, SNS nowadays have become more diversified, and some sites can also be used for gaming, gambling as well as online shopping. It is plausible that SNS addicts may develop coaddiction with various activities that are available in these sites. Furthermore, there are already empirical evidences that documented the association between SNS use and affective disorder,
4
including depression and anxiety in both Western and Asian countries (Andreassen, 2015; Kuss & Griffins, 2011; Ryan et al., 2014; Rosen et al., 2013). It is thus argued that SNS addicts are at high risks of experiencing negative mental health symptoms. SNS addiction is worthy of individual attention, particularly when considering its potential comorbidity with behavioral addiction and mental health problem. This study focused on the prevalence of SNS addiction and its co-occurrence with other behavioral addiction (unhealthy food intake and shopping addiction) and affective disorder (depression, anxiety, and mania) among college students in Singapore. 2. SUBJECTS AND METHODS 2.1 Sampling A convenience sample of 1110 college students aged between 18-25 years old were recruited from a major comprehensive university in Singapore. The students were recruited from different departments of the university via advertisement in university websites, students activity centers, and dormitories. A total of 1300 questionnaires were distributed and 1110 valid questionnaires were collected, with a response rate of 84.6%. 2.2 Instruments Social networking Addiction A modified version of the 6-item Bergen Facebook Addiction Scale (BFAS) was used to measure SNS addiction (Andreassen et al., 2012). The original term “Facebook use” was changed to “online social networking” to include the use of various SNS (Andreassen, 2015; Griffins et al., 2014). Scoring 3 or above on at least four of the six items is categorized as SNS addiction. Internal reliability of this scale for this study was .83. Food Addiction The modified Yale Food Addiction Scale (mYFAS) was used to measure addiction to unhealthy food intake (Flint et al. 2014). This scale includes 1 question from each of the 7 diagnostic items plus 2
5
individual items that assess the presence of clinically significant impairment and distress respectively. Scoring at least three symptoms and the criterion of a clinically significant impairment or distress is used to identify food addiction. Internal consistency of this scale for this study was .85. Shopping Addiction The 7-item Compulsive Buying Scale (Faber & O’guinn, 1992) was used to measure shopping addiction. Individuals scoring at or below 1.34 are classified as with shopping addiction. The internal reliability of this scale for this study was .68. Affective Disorder Depression, anxiety and mania were measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013). Scoring at least 5 of the 9 items on the depression scale during the same 2 week period is used to classify depression. Scoring 3(or more) of the 6 symptoms on the anxiety scale (with at least some symptoms having been present for more days than not for the past 6 months) is used to identify anxiety. Soring 3 (or more) of the 7 symptoms in the mania scale is used to classify mania. Internal reliabilities for this study were .87 for depression, .82 for anxiety, and .76 for mania. 2.3 Data Analysis The data were analyzed with the computerized statistical package, SPSS version 23. The original cut off scores of the scales were used to ascertain the rates of behavioral addiction and affective disorder. Descriptive statistics including mean, SD, frequencies and percentages were used to describe the data. 2.4 Ethics The study was approved by the Institutional Review Board of the affiliated university of the authors. Informed written consents were obtained before students individually completed a set of anonymous self-administered questionnaire. 3. RESULTS 6
3.1 Sample Characteristics The study sample consisted of 1110 (416 males, 694 females) university college students in Singapore. The mean ± SD of age was 21.46 ± 1.80 years old, and about one third were first year students. 3.2 Prevalence and Comorbidity of SNS Addiction with Food and Shopping Addiction Among all surveyed students, the prevalence rates were: 29.5% for SNS networking addiction, 4.7% for food addiction, and 9.3% for shopping addiction (Table 1). About 3% of the total sample reported both SNS and food addiction, 5% reported both SNS and shopping addiction, and 1% reported all three measured behavioral addiction. Females relative to males reported higher cooccurrence rates of SNS and shopping addiction (p<.05). 3.3 Comorbidity of Behavioral Addiction and Affective Disorder among the Total Sample For the total sample (N=1110), the comorbidity rates were 21% for SNS addiction and depression, 27.7% for SNS addiction and anxiety, and 26.1% for SNS addiction and mania (Table 1). More females than males reported both SNS addiction and affective disorder (p<.001). For food addiction, the comorbidity rates were 3.7% for depression, 4.7% for anxiety, and 4.3% for mania. For shopping addiction, the comorbidity rates were 7.3% with depression, 9% with anxiety, and 8.3% with mania. More females than males reported both shopping addiction and anxiety (p<.05). About 2-3% of all surveyed students reported SNS and food addiction as well as affective disorder. About 4-5% reported SNS and shopping addiction as well as affective disorder. About 1% reported all three behavioral addiction and affective disorder. More females than males reported the co-occurrence of SNS addiction, shopping addiction and affective disorder (p<.05). 3.4 Comorbidity of Behavioral Addiction and Affective Disorder among SNS Addiction Subsample
7
Relative to the total sample, students who reported SNS addiction (N=327) showed higher comorbidity rates with other behavioral addiction and affective disorder (Table 2). Among the SNS addiction subsample, 10.1% also reported food addiction, 16.8% reported shopping addiction, and 3.4% reported both food and shopping addiction. The SNS subsample also showed high cooccurrence of affective disorder, being 71.2% for depression, 93.9% for anxiety, and 88.5% for mania. About 7.6-10% of the SNS subsample reported both food addiction and affective disorder, 1316% reported both shopping addiction and affective disorder, and about 3% reported food and shopping addiction as well as affective disorder. More females than males reported both shopping addiction and affective disorder (p< .05). 4. DISCUSSION This study showed a high rate (29.5%) of SNS addiction among college students in Singapore. This result was consistent with previous studies that indicated 24 to 35% of Asian students would be classified as addicted to SNS (Andreassen, 2015; Kuss & Griffins, 2011). The present study also indicated that females and males did not differ significantly on SNS addiction. However, it should be noted that there may be gender differences in motivations for SNS use (Lenhart et al., 2015) Some studies have found that females used SNS to maintain contacts with actual friends, entertainment, and passing time; whereas males were more likely to use SNS for making new friends, learning, and social identity gratifications (Kuss & Griffins, 2011). Currently, there is scarce information about the comorbidity of SNS addiction with other behavioral addiction. However, this comorbidity must be addressed in clinical practice to improve identification and treatment outcome. This study showed that SNS addiction could co-occur with unhealthy food intake and shopping addiction. These findings were consistent with previous studies that showed the co-occurrence of excessive internet use and overeating (Malat et al., 2010). These results supported the accessibility and availability hypothesis (Kuss & Griffins, 2011), which argues that SNS addiction can co-occur with other activities that are available or promoted on SNS. Indeed, in some SNS such as Facebook, there are ample promotional messages/information on food and online shopping. 8
There is increasing concern over the impact of internet and mobile technology on the psychological health of users. Consistent with findings of review studies (Andreassen, 2015; Kuss & Griffins, 2011; Ryan et al., 2014; Rosen et al., 2013), the present study found high comorbidity rates between SNS addiction and affective disorder. The social skill model of problematic internet use may be extended to explain the high comorbidity rates of SNS addiction (Caplan, 2010). According to this model, individuals who demonstrate deficient self-regulation of SNS use, tend to engage in online social networking as a means of escaping from negative mood state, such as loneliness or anxiety. The use of SNS alleviates negative mood (mood alteration), which in turn reinforces further SNS use (Ryan et al., 2014). Alternatively, SNS addicts feel depressed and anxious because of the pressure to access the sites frequently due to the fear of missing out and to keep up with demands on relationship maintenance, constant social comparison with others, relationship turbulence with the public nature of conflict on the SNS, and frequent violation of privacy (Fox & Moreland, 2015).
5. Limitations This study recruited only college students and used self-report instruments instead of diagnostic tools to define behavioral addiction and affective disorder. There was no external validation of the frequency of behavioral addiction; and symptoms of depression, anxiety, and mania were not evaluated by mental health professionals. Thus, our findings may reflect either an over- or under-estimation of the condition. Demographic data such as ethnicity, faculty and department of study, social economic status of the families etc. were not collected in the study. Stratification using only gender might fail to address and identify the group that are more vulnerable to behavioral addiction and affective disorder. In addition, only cross-sectional data was collected and homogeneity of various SNS was assumed without examining the specific nature of SNS sites. As such, caution should be exercised in generalizing and interpreting the present results.
6. Conclusions College students in Singapore are vulnerable to SNS addiction and associated behavioral addiction and affective disorder, especially among females. Findings can guide the design of more effective prevention and treatment programs that also address the comorbid addiction and mental health symptoms of students who are addicted to online social networking. 9
REFERENCE Andreassen, C. S., 2015. Online social network site addiction: A comprehensive review. Cur. Addict. Rep. 2, 175-184. Andreassen, C. S., Torsheim, T., Brunborg, G.S., Pallensen, S., 2012. Development of a Facebook addiction scale 1, 2. Psychol. Rep. 110(2), 501-517. American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders (DSM5®): American Psychiat Pub. Caplan, S. E., 2010. Theory and measurement of generalized problematic Internet use: A two-step approach. Comput. Hum. Behav. 26, 1089-1097. Experian, H., 2011. Experian global analysis reveals Singaporeans spend the most time on facebook. https://www.experianplc.com/media/news/2011/experian-global-analysis-reveals-singaporeans-spendthe-most-time-on-facebook/ (accessed 16.03.23) Faber, R. J. & O'guinn, T. C., 1992. A clinical screener for compulsive buying. J. Consum. Res. 459469. Flint, A. J., Gearhardt, A.N., Corbin, W.R., Brownell, K.D., Field, A.E., Rimm, E.B., 2014. Foodaddiction scale measurement in 2 cohorts of middle-aged and older women. Am. J. Clin. Nutr. 99(3), 578-586. Fox, J. & Moreland, J., 2015. The dark side of social networking sites: An exploration of the relational and psychological stressors associated with Facebook use and affordances. Comput. Hum. Behav. 45, 168-176. Griffins, M.D., Kuss, D.J., Demetrovics, Z., 2014. Social networking addiction: An overview of preliminary findings. doi:http://dx.doi.org/10.1016/B978-0-12-407724-9.00006-9 (accessed 16.03.23).
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Internet World Statistics., 2016. Research report on Asia marketing research, Internet usage, population statistics and Facebook information. doi:http://www.internetworldstats.com/asia.htm (accessed 16,08.17). Jackson, L. A. & Wang, J.L., 2013. Cultural differences in social networking site use: A comparative study of China and the United States. Comput. Hum. Behav. 29(3), 910-921. Kittinger, R., Correia, C. J., & Irons, J. G. (2012). Relationship between Facebook use and problematic Internet use among college students. Cyberpsychol. Behav. Soc. Netw., 15(6), 324-327.
Kuss, J. & Griffins, M.D., 2011. Online social networking and addiction: A review of the psychological literature. Int. J. Environ. Res. Public. Health. 8, 3528-3552.
Lenhart., A., Duggan.,M., Perrin., A., Stepler., R,. Rainie., H., & Parker., Kim., 2015. Teens,social media & technology overview 2015. Leung,L., & Lee, P.S. (2012). The influences of information literacy, internet addiction and parenting styles on internet risks. New Media Soc, 14(1), 117-136. Malat, J., Collins, J., Dhayanandhan, B., Carullo, F., Turner, N.E., 2010. Addictive behaviors in comorbid addiction and mental illness: Preliminary results from a self-report questionnaire. J. Addict. Med. 4(1), 38-46. Rosen, L. D., Whaling, K., Rab, S., Carrier, L.M., Cheever, N.A., 2013. Is Facebook creating “iDisorders”? The link between clinical symptoms of psychiatry disorders and technology use, attitudes and anxiety. Comput. Hum. Behav. 29, 1243-1254. Sponcil, M. & Gitimu,P., 2013. Use of social media by college students: Relationship to communication and self-concept. J. Tech. Res., Vol 4, 1. Young, K. 2009. Facebook Addiction Disorder. The Centre for Online Addiction: Bradford, PA, USA.
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Table 1. Comorbidity of Behavioral Addiction and Affective Disorder for Total Sample (N=1110)
Comorbidity Behavioral Addiction
Depression
Anxiety
Mania
Social Networking Addiction Total
29.5%
21.0%**
27.7%**
26.1%**
Male
22.1%
13.9%
19.5%
19.2%
Female
33.9%
25.1%
32.6%
30.3%
Total
4.7%
3.7%
4.7%
4.3%
Male
3.9%
3.1%
3.8%
3.6%
Female
5.3%
2.5%
5.0%
4.6%
Total
9.3%
7.3%
9.0%*
8.3%
Male
7%
5.5%
6.7%
6.3%
10.7%
8.4%
10.4%
9.5%
Total
3.0%
2.3%
3.0%
2.8%
Male
2.6%
2.2%
2.6%
2.4%
Female
3.2%
2.3%
3.2%
3.0%
Food Addiction
Shopping Addiction
Female
Social Networking + Food Addiction
Social Networking
12
+ Shopping Addiction Total
5.0%*
3.9%*
4.8%*
4.6%*
Male
2.9%
2.2%
2.6%
2.4%
Female
6.2%
4.9%
6.1%
5.9%
Total
1.0%
0.9%
1.0%
0.9%
Male
1.0%
0.7%
1.0%
0.7%
Female
1.0%
1.0%
1.0%
1.0%
Social Networking + Food + Shopping Addiction
Note: N = 1110 for total sample (416 males, 694 females) * Significant Gender Differences at p < .05 ** Significant Gender Differences at p< 0.001
13
Table 2. Comorbidity of Behavioral Addiction and Affective Disorder for Social Networking Addiction Subsample (N=327) Comorbidity Behavioral Addiction
Depression
Anxiety
Mania
Social Networking Addiction Total
100%
71.2%**
93.9%**
88.5%**
Male
100%
63.0%
88.0%
87.0%
Female
100%
74.0%
96.2%
89.4%
Total
10.1%
7.6%
10.1%
9.5%
Male
12.0%
9.8%
12.0%
10.9%
9.4%
6.8%
9.4%
8.9%
Total
16.8%*
13.1%*
16.2%*
15.6%*
Male
13.0%
9.8%
12.0%
10.9%
Female
18.3%
14.5%
17.9%
17.4%
Total
3.4%
3.1%
3.4%
3.1%
Male
4.3%
3.3%
4.3%
3.3%
Female
3.0%
3.0%
3.0%
3.0%
Social Networking + Food Addiction
Female
Social Networking + Shopping Addiction
Social Networking + Food + Shopping Addiction
14
Note: N = 327 for social networking subsample (92 males, 235 females) * Significant Gender Differences at p < .05 ** Significant Gender Differences at p< 0.001
15
S1876-2018(16)30237-4 http://dx.doi.org/doi:10.1016/j.ajp.2016.10.027 AJP 989
To appear in: Received date: Revised date: Accepted date:
24-5-2016 16-9-2016 29-10-2016
Please cite this article as: Tang, Catherine So-kum, Koh, Yvaine Yee Woen, Online Social Networking Addiction among College Students in Singapore: Comorbidity with Behavioral Addiction and Affective Disorder.Asian Journal of Psychiatry http://dx.doi.org/10.1016/j.ajp.2016.10.027 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Online Social Networking Addiction among College Students in Singapore: Comorbidity with Behavioral Addiction and Affective Disorder
Catherine So-kum Tang, The National University of Singapore, Department of Psychology, 9 Arts Link, The National University of Singapore, 117570. Email: [email protected] Yvaine Yee Woen Koh, The National University of Singapore, AS8 #07-56, 10 Kent Ridge Crescent (S) 119260, Kent Ridge Campus, Singapore. Email: [email protected]
Correspondence should be sent to Dr Yee Woen Koh, Present Address: AS8 #07-56, 10 Kent Ridge Crescent (S) 119260, Kent Ridge Campus, Singapore. Phone Number: (65)65168524, Email: [email protected]
1
Highlights
This study showed that 29.5% of the surveyed college students in Singapore were addicted to online social networking sites/platforms (SNS).
SNS addiction was also found to comorbid with unhealthy food intake and shopping addiction, as well as affective disorder of depression, anxiety, and mania.
Females relative to males were more likely to report both SNS addiction and affective disorder.
Compared to the total sample, students with SNS addiction were more likely to report affective disorder, unhealthy food intake, and shopping addiction.
Abstract Purpose of the research This study aimed to determine the prevalence of addiction to social networking sites/platforms (SNS) and its comorbidity with other behavioral addiction and affective disorder among college students in Singapore. 1110 college students (age: M=21.46, SD=1.80) in Singapore completed measures assessing online social networking, unhealthy food intake and shopping addiction as well as depression, anxiety and mania. Descriptive analyses were conducted to investigate the prevalence and comorbidity of behavioral addiction and affective disorder. Chi-square tests were used to examine gender differences.
The principal results The prevalence rates of SNS, food and shopping addiction were 29.5%, 4.7% and 9.3% respectively for the total sample. SNS addiction was found to co-occur with food addiction (3%), shopping addiction (5%), and both food and shopping addiction (1%). The comorbidity rates of SNS addiction
2
and affective disorder were 21% for depression, 27.7% for anxiety, and 26.1% for mania. Compared with the total sample, students with SNS addiction reported higher comorbidity rates with other behavioral addiction and affective disorder. In general, females as compared to males reported higher comorbidity rates of SNS addiction and affective disorder.
Major Conclusions SNS addiction has a high prevalence rate among college students in Singapore. Students with SNS addiction were vulnerable to experience other behavior addiction as well as affective disorder, especially among females.
Key words: social networking addiction, behavioral addiction, comorbidity, affective disorder
(216words)
1. INTRODUCTION Social networking sites/platforms (SNS) are web-based virtual communities where users interact with real-life friends and meet other people with shared interests. SNS (e.g., Facebook and Twitters) have attracted large numbers of users around the globe. Teenagers and college students tend to make the most use of SNS. About 24% of teens go online “almost constantly” (Lenhart et al., 2015) and 59.4% of college students visited social networking sites several times a day (Sponcil & Gitimu, 2013). . An international analysis in different countries showed cultural and regional differences in terms of SNS use. Evidence from previous studies showed that Singaporean adults spent the longest time on the Facebook to connect with friends and share updates on topical news (Experian, 2011) and 71% of Singaporeans had a Facebook profile (Internet World Statistics, 2016). US college students reported greater use of SNS than students in China (Jackson & Wang, 2013). In addition, there was 3
also gender difference in SNS use. Females relative to males reported greater overall use and time spent on SNS (Lenhart et al., 2015) SNS use can become addictive, especially among young people. Although not formally recognized as a clinical diagnosis, SNS addiction incorporates the experience of “classic” addiction symptoms similar to chemical addiction (Andreassen, 2015; Griffins et al., 2014; Kuss & Griffins, 2011; Ryan et al., 2014). These addiction symptoms include: neglecting personal/work life, preoccupation, mood alteration, withdrawal, inability to cut down, and relapse. However, an excessive use of SNS by itself does not necessarily equate with addiction. Reviews studies have shown that about 12% of US adults were addicted to Facebook, 24 to 35% of Chinese college students would be classified as addicted to SNS, and a low rate of 1.6% Facebook addiction was found among Nigerian undergraduate students (Andreassen, 2015; Kuss & Griffins, 2011) . There were no conclusive findings confirming higher rates of SNS addiction among females than males. Internet addiction, or problematic internet use, is characterized by excessive or poorly controlled preoccupations, urges or behaviors regarding internet use that lead to impairment or distress (Young, 2009). There is a paucity of study assessing the relationship between SNS addiction and internet addiction. A preliminary study suggested that the use of Facebook may contribute to the severity of symptoms associated with internet addiction (Kittinger et al., 2012). General internet addiction also tends to co-occur with other addiction such as substance use, gambling, overeating and excessive sedentary behavior (Kuss & Griffins, 2011). A study has found that 61% of the participants pursued at least one and 31% engaged in two or more problematic behavior of overeating and excessive internet use (Malat et al., 2010). Currently, there is not yet any published data on the cooccurrence between SNS addiction and other behavioral addiction. Since SNS use takes up a large amount of available time, it would only co-occur with other behavioral addiction that also has an outlet via SNS. In fact, SNS nowadays have become more diversified, and some sites can also be used for gaming, gambling as well as online shopping. It is plausible that SNS addicts may develop coaddiction with various activities that are available in these sites. Furthermore, there are already empirical evidences that documented the association between SNS use and affective disorder,
4
including depression and anxiety in both Western and Asian countries (Andreassen, 2015; Kuss & Griffins, 2011; Ryan et al., 2014; Rosen et al., 2013). It is thus argued that SNS addicts are at high risks of experiencing negative mental health symptoms. SNS addiction is worthy of individual attention, particularly when considering its potential comorbidity with behavioral addiction and mental health problem. This study focused on the prevalence of SNS addiction and its co-occurrence with other behavioral addiction (unhealthy food intake and shopping addiction) and affective disorder (depression, anxiety, and mania) among college students in Singapore. 2. SUBJECTS AND METHODS 2.1 Sampling A convenience sample of 1110 college students aged between 18-25 years old were recruited from a major comprehensive university in Singapore. The students were recruited from different departments of the university via advertisement in university websites, students activity centers, and dormitories. A total of 1300 questionnaires were distributed and 1110 valid questionnaires were collected, with a response rate of 84.6%. 2.2 Instruments Social networking Addiction A modified version of the 6-item Bergen Facebook Addiction Scale (BFAS) was used to measure SNS addiction (Andreassen et al., 2012). The original term “Facebook use” was changed to “online social networking” to include the use of various SNS (Andreassen, 2015; Griffins et al., 2014). Scoring 3 or above on at least four of the six items is categorized as SNS addiction. Internal reliability of this scale for this study was .83. Food Addiction The modified Yale Food Addiction Scale (mYFAS) was used to measure addiction to unhealthy food intake (Flint et al. 2014). This scale includes 1 question from each of the 7 diagnostic items plus 2
5
individual items that assess the presence of clinically significant impairment and distress respectively. Scoring at least three symptoms and the criterion of a clinically significant impairment or distress is used to identify food addiction. Internal consistency of this scale for this study was .85. Shopping Addiction The 7-item Compulsive Buying Scale (Faber & O’guinn, 1992) was used to measure shopping addiction. Individuals scoring at or below 1.34 are classified as with shopping addiction. The internal reliability of this scale for this study was .68. Affective Disorder Depression, anxiety and mania were measured by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) (American Psychiatric Association, 2013). Scoring at least 5 of the 9 items on the depression scale during the same 2 week period is used to classify depression. Scoring 3(or more) of the 6 symptoms on the anxiety scale (with at least some symptoms having been present for more days than not for the past 6 months) is used to identify anxiety. Soring 3 (or more) of the 7 symptoms in the mania scale is used to classify mania. Internal reliabilities for this study were .87 for depression, .82 for anxiety, and .76 for mania. 2.3 Data Analysis The data were analyzed with the computerized statistical package, SPSS version 23. The original cut off scores of the scales were used to ascertain the rates of behavioral addiction and affective disorder. Descriptive statistics including mean, SD, frequencies and percentages were used to describe the data. 2.4 Ethics The study was approved by the Institutional Review Board of the affiliated university of the authors. Informed written consents were obtained before students individually completed a set of anonymous self-administered questionnaire. 3. RESULTS 6
3.1 Sample Characteristics The study sample consisted of 1110 (416 males, 694 females) university college students in Singapore. The mean ± SD of age was 21.46 ± 1.80 years old, and about one third were first year students. 3.2 Prevalence and Comorbidity of SNS Addiction with Food and Shopping Addiction Among all surveyed students, the prevalence rates were: 29.5% for SNS networking addiction, 4.7% for food addiction, and 9.3% for shopping addiction (Table 1). About 3% of the total sample reported both SNS and food addiction, 5% reported both SNS and shopping addiction, and 1% reported all three measured behavioral addiction. Females relative to males reported higher cooccurrence rates of SNS and shopping addiction (p<.05). 3.3 Comorbidity of Behavioral Addiction and Affective Disorder among the Total Sample For the total sample (N=1110), the comorbidity rates were 21% for SNS addiction and depression, 27.7% for SNS addiction and anxiety, and 26.1% for SNS addiction and mania (Table 1). More females than males reported both SNS addiction and affective disorder (p<.001). For food addiction, the comorbidity rates were 3.7% for depression, 4.7% for anxiety, and 4.3% for mania. For shopping addiction, the comorbidity rates were 7.3% with depression, 9% with anxiety, and 8.3% with mania. More females than males reported both shopping addiction and anxiety (p<.05). About 2-3% of all surveyed students reported SNS and food addiction as well as affective disorder. About 4-5% reported SNS and shopping addiction as well as affective disorder. About 1% reported all three behavioral addiction and affective disorder. More females than males reported the co-occurrence of SNS addiction, shopping addiction and affective disorder (p<.05). 3.4 Comorbidity of Behavioral Addiction and Affective Disorder among SNS Addiction Subsample
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Relative to the total sample, students who reported SNS addiction (N=327) showed higher comorbidity rates with other behavioral addiction and affective disorder (Table 2). Among the SNS addiction subsample, 10.1% also reported food addiction, 16.8% reported shopping addiction, and 3.4% reported both food and shopping addiction. The SNS subsample also showed high cooccurrence of affective disorder, being 71.2% for depression, 93.9% for anxiety, and 88.5% for mania. About 7.6-10% of the SNS subsample reported both food addiction and affective disorder, 1316% reported both shopping addiction and affective disorder, and about 3% reported food and shopping addiction as well as affective disorder. More females than males reported both shopping addiction and affective disorder (p< .05). 4. DISCUSSION This study showed a high rate (29.5%) of SNS addiction among college students in Singapore. This result was consistent with previous studies that indicated 24 to 35% of Asian students would be classified as addicted to SNS (Andreassen, 2015; Kuss & Griffins, 2011). The present study also indicated that females and males did not differ significantly on SNS addiction. However, it should be noted that there may be gender differences in motivations for SNS use (Lenhart et al., 2015) Some studies have found that females used SNS to maintain contacts with actual friends, entertainment, and passing time; whereas males were more likely to use SNS for making new friends, learning, and social identity gratifications (Kuss & Griffins, 2011). Currently, there is scarce information about the comorbidity of SNS addiction with other behavioral addiction. However, this comorbidity must be addressed in clinical practice to improve identification and treatment outcome. This study showed that SNS addiction could co-occur with unhealthy food intake and shopping addiction. These findings were consistent with previous studies that showed the co-occurrence of excessive internet use and overeating (Malat et al., 2010). These results supported the accessibility and availability hypothesis (Kuss & Griffins, 2011), which argues that SNS addiction can co-occur with other activities that are available or promoted on SNS. Indeed, in some SNS such as Facebook, there are ample promotional messages/information on food and online shopping. 8
There is increasing concern over the impact of internet and mobile technology on the psychological health of users. Consistent with findings of review studies (Andreassen, 2015; Kuss & Griffins, 2011; Ryan et al., 2014; Rosen et al., 2013), the present study found high comorbidity rates between SNS addiction and affective disorder. The social skill model of problematic internet use may be extended to explain the high comorbidity rates of SNS addiction (Caplan, 2010). According to this model, individuals who demonstrate deficient self-regulation of SNS use, tend to engage in online social networking as a means of escaping from negative mood state, such as loneliness or anxiety. The use of SNS alleviates negative mood (mood alteration), which in turn reinforces further SNS use (Ryan et al., 2014). Alternatively, SNS addicts feel depressed and anxious because of the pressure to access the sites frequently due to the fear of missing out and to keep up with demands on relationship maintenance, constant social comparison with others, relationship turbulence with the public nature of conflict on the SNS, and frequent violation of privacy (Fox & Moreland, 2015).
5. Limitations This study recruited only college students and used self-report instruments instead of diagnostic tools to define behavioral addiction and affective disorder. There was no external validation of the frequency of behavioral addiction; and symptoms of depression, anxiety, and mania were not evaluated by mental health professionals. Thus, our findings may reflect either an over- or under-estimation of the condition. Demographic data such as ethnicity, faculty and department of study, social economic status of the families etc. were not collected in the study. Stratification using only gender might fail to address and identify the group that are more vulnerable to behavioral addiction and affective disorder. In addition, only cross-sectional data was collected and homogeneity of various SNS was assumed without examining the specific nature of SNS sites. As such, caution should be exercised in generalizing and interpreting the present results.
6. Conclusions College students in Singapore are vulnerable to SNS addiction and associated behavioral addiction and affective disorder, especially among females. Findings can guide the design of more effective prevention and treatment programs that also address the comorbid addiction and mental health symptoms of students who are addicted to online social networking. 9
REFERENCE Andreassen, C. S., 2015. Online social network site addiction: A comprehensive review. Cur. Addict. Rep. 2, 175-184. Andreassen, C. S., Torsheim, T., Brunborg, G.S., Pallensen, S., 2012. Development of a Facebook addiction scale 1, 2. Psychol. Rep. 110(2), 501-517. American Psychiatric Association, 2013. Diagnostic and statistical manual of mental disorders (DSM5®): American Psychiat Pub. Caplan, S. E., 2010. Theory and measurement of generalized problematic Internet use: A two-step approach. Comput. Hum. Behav. 26, 1089-1097. Experian, H., 2011. Experian global analysis reveals Singaporeans spend the most time on facebook. https://www.experianplc.com/media/news/2011/experian-global-analysis-reveals-singaporeans-spendthe-most-time-on-facebook/ (accessed 16.03.23) Faber, R. J. & O'guinn, T. C., 1992. A clinical screener for compulsive buying. J. Consum. Res. 459469. Flint, A. J., Gearhardt, A.N., Corbin, W.R., Brownell, K.D., Field, A.E., Rimm, E.B., 2014. Foodaddiction scale measurement in 2 cohorts of middle-aged and older women. Am. J. Clin. Nutr. 99(3), 578-586. Fox, J. & Moreland, J., 2015. The dark side of social networking sites: An exploration of the relational and psychological stressors associated with Facebook use and affordances. Comput. Hum. Behav. 45, 168-176. Griffins, M.D., Kuss, D.J., Demetrovics, Z., 2014. Social networking addiction: An overview of preliminary findings. doi:http://dx.doi.org/10.1016/B978-0-12-407724-9.00006-9 (accessed 16.03.23).
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Internet World Statistics., 2016. Research report on Asia marketing research, Internet usage, population statistics and Facebook information. doi:http://www.internetworldstats.com/asia.htm (accessed 16,08.17). Jackson, L. A. & Wang, J.L., 2013. Cultural differences in social networking site use: A comparative study of China and the United States. Comput. Hum. Behav. 29(3), 910-921. Kittinger, R., Correia, C. J., & Irons, J. G. (2012). Relationship between Facebook use and problematic Internet use among college students. Cyberpsychol. Behav. Soc. Netw., 15(6), 324-327.
Kuss, J. & Griffins, M.D., 2011. Online social networking and addiction: A review of the psychological literature. Int. J. Environ. Res. Public. Health. 8, 3528-3552.
Lenhart., A., Duggan.,M., Perrin., A., Stepler., R,. Rainie., H., & Parker., Kim., 2015. Teens,social media & technology overview 2015. Leung,L., & Lee, P.S. (2012). The influences of information literacy, internet addiction and parenting styles on internet risks. New Media Soc, 14(1), 117-136. Malat, J., Collins, J., Dhayanandhan, B., Carullo, F., Turner, N.E., 2010. Addictive behaviors in comorbid addiction and mental illness: Preliminary results from a self-report questionnaire. J. Addict. Med. 4(1), 38-46. Rosen, L. D., Whaling, K., Rab, S., Carrier, L.M., Cheever, N.A., 2013. Is Facebook creating “iDisorders”? The link between clinical symptoms of psychiatry disorders and technology use, attitudes and anxiety. Comput. Hum. Behav. 29, 1243-1254. Sponcil, M. & Gitimu,P., 2013. Use of social media by college students: Relationship to communication and self-concept. J. Tech. Res., Vol 4, 1. Young, K. 2009. Facebook Addiction Disorder. The Centre for Online Addiction: Bradford, PA, USA.
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Table 1. Comorbidity of Behavioral Addiction and Affective Disorder for Total Sample (N=1110)
Comorbidity Behavioral Addiction
Depression
Anxiety
Mania
Social Networking Addiction Total
29.5%
21.0%**
27.7%**
26.1%**
Male
22.1%
13.9%
19.5%
19.2%
Female
33.9%
25.1%
32.6%
30.3%
Total
4.7%
3.7%
4.7%
4.3%
Male
3.9%
3.1%
3.8%
3.6%
Female
5.3%
2.5%
5.0%
4.6%
Total
9.3%
7.3%
9.0%*
8.3%
Male
7%
5.5%
6.7%
6.3%
10.7%
8.4%
10.4%
9.5%
Total
3.0%
2.3%
3.0%
2.8%
Male
2.6%
2.2%
2.6%
2.4%
Female
3.2%
2.3%
3.2%
3.0%
Food Addiction
Shopping Addiction
Female
Social Networking + Food Addiction
Social Networking
12
+ Shopping Addiction Total
5.0%*
3.9%*
4.8%*
4.6%*
Male
2.9%
2.2%
2.6%
2.4%
Female
6.2%
4.9%
6.1%
5.9%
Total
1.0%
0.9%
1.0%
0.9%
Male
1.0%
0.7%
1.0%
0.7%
Female
1.0%
1.0%
1.0%
1.0%
Social Networking + Food + Shopping Addiction
Note: N = 1110 for total sample (416 males, 694 females) * Significant Gender Differences at p < .05 ** Significant Gender Differences at p< 0.001
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Table 2. Comorbidity of Behavioral Addiction and Affective Disorder for Social Networking Addiction Subsample (N=327) Comorbidity Behavioral Addiction
Depression
Anxiety
Mania
Social Networking Addiction Total
100%
71.2%**
93.9%**
88.5%**
Male
100%
63.0%
88.0%
87.0%
Female
100%
74.0%
96.2%
89.4%
Total
10.1%
7.6%
10.1%
9.5%
Male
12.0%
9.8%
12.0%
10.9%
9.4%
6.8%
9.4%
8.9%
Total
16.8%*
13.1%*
16.2%*
15.6%*
Male
13.0%
9.8%
12.0%
10.9%
Female
18.3%
14.5%
17.9%
17.4%
Total
3.4%
3.1%
3.4%
3.1%
Male
4.3%
3.3%
4.3%
3.3%
Female
3.0%
3.0%
3.0%
3.0%
Social Networking + Food Addiction
Female
Social Networking + Shopping Addiction
Social Networking + Food + Shopping Addiction
14
Note: N = 327 for social networking subsample (92 males, 235 females) * Significant Gender Differences at p < .05 ** Significant Gender Differences at p< 0.001
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