Internet Addiction and Mental Distress Among Undergraduate Medical Students: A Sequential Explanatory Mixed-Methods Study
Abstract
Background: Problematic internet use is increasingly relevant among medical students because of extensive academic and recreational dependence on digital technology. This study assessed moderate/severe internet addiction, mental distress, associated factors, and experiences underlying severe internet addiction. Methods: A sequential explanatory mixed-methods study was conducted among 200 undergraduate medical students at a teaching hospital in Eastern India. Stratified random sampling selected 50 students from each of four MBBS phases. Internet addiction was assessed using the 20-item Internet Addiction Test (IAT), with scores ≥50 defining moderate/severe addiction. Mental distress was assessed using the SRQ-20, with scores ≥8 indicating distress. Bivariate analyses and separate multivariable logistic regression models were performed. Variables with p<0.20 and epidemiological relevance were considered for multivariable analysis. Sparse cells were assessed, and during- and post-working-hour categories were combined in the internet-addiction model because of complete separation. All 14 students with severe addiction underwent in-depth interviews, followed by thematic analysis and integration using a joint display. Results: Moderate/severe internet addiction was present in 95/200 (47.5%; 95% CI: 40.7–54.4%), while mental distress was present in 72/200 (36.0%; 95% CI: 29.7–42.9%). IAT and SRQ-20 scores were positively correlated (Spearman’s rho=0.463, p<0.001). Screen time was independently associated with internet addiction (AOR 1.38, 95% CI 1.19–1.54) and mental distress (AOR 1.18, 95% CI 1.06–1.31). Qualitative analysis identified coping escape, entertainment/social validation, and loss of control with late-night use. Conclusion: Problematic internet use and mental distress were common and significantly correlated among medical students. The findings represent associations and do not establish causality or temporal direction. Key words: Internet addiction; medical students; mental distress; IAT; SRQ-20; mixed-methods study; screen time.