Internet addiction test: Croatian preliminary study

Everyday use of the internet provides a number of advantages in professional and private activities, but the virtual environment also provides settings for new types of risk behaviors of individuals. The problematic use of the internet includes the phenomenon of internet addiction. The internet addiction has been in a focus of researchers and experts over the last two decades, and Dr. Kimberly Young is the author of the Internet Addiction Test tool that has been widely used for research and detection purposes of addictive symptoms in individuals [53]. The aforementioned author also carried out the first empirical study on internet addiction in 1996, and she has been systematically investigating this field since then.

Although internet addiction is not included in the official classification system of mental illness and disorder, and there are no formal diagnostic criteria available in the International Classification of Diseases and Related Health Problems (ICD-10) (WHO, [51]) and DSM-5 [2], except online gaming disorder. On Ansembly of WHO in May 2018 ICD 11 was presented for adoption by Member States and with this changes Internet gaming disorder has been classified as psychiatric disorder in the International Classification of Diseases and Related Health Problems (ICD-11). Implementation of ICD 11 will start at 1 January 2022 allowing the states to adapt and prepare the changes in their national policies [52]. On the other hand, the phenomenon of internet addiction is recognized by practitioners and professionals. Internet addiction centers have been active in the treatment of addictive behavior for a number of years ([37], http://​netaddiction.​com/​). Mihajlov and Vejmelka [35] state that internet addiction treatment has recently been present in the practice of Croatian medical institutions and that today there are departments of daily hospitals for the treatment of addiction on the internet as well as individual and group treatment at certain psychiatric departments (http://​www.​pbsvi.​hr). Although the addiction treatment practice on the internet is beginning to develop in some countries, there is a lack of research in this area.

In literature, it is possible to find different terminology for the same phenomenon such as “compulsive internet use”, “excessive use of the internet”, “problematic use of the internet”, “pathological internet usage”, “internet addiction”, “computer dependence” and “net addiction” ([39]., [21]., [55].). In this paper, we will use the term internet addiction. Young [53] describes internet addiction as an impulse control disorder that does not include narcotics, while the extended definition of the same author states that this is a condition in which an individual loses control over the use of the internet and continues to use it excessively to the point of experiencing problematic outcomes with negative influences [54]. The difficulties encountered by people who use the internet excessively are categorized into five areas: academic, interpersonal relationships, financial, professional and physical [53].

The research was conducted in March and April 2016 in 9 randomly selected secondary schools in Croatia, in 18 classes. The schools from the sample were different sizes from 7 to 44 classes in rural and urban area contributing to representative research results. The study was approved by the Ethics Commission of the Faculty of Law, University of Zagreb, and the implementation of research by school principals. All standards of the Code of Ethics of Conducting Research with Children [1] were applied. According to the section 3 of the national Code of Ethics of Conducting Research with Children for this study, along with the approval from the competent body for the ethical regulation and with the informed verbal consent of the participants, it was necessary to send the written information about the research to their parents prior to the data collection, along with the contact information of the researchers. This procedure was applied in this research providing parents possibility to contact the researchers about the child participation in the research. The parental consent was not collected because under the Ethical code, for children who are over 14 years of age only participants give consent when the research does not involve deception and it does not have potential risks, discomfort, or adverse effects. The participants ware offered the possibility of contacting the relevant organizations who work with children and youth if they wish to discuss topics from the field of research. The data collection was done via web questionnaires that the students filled during their computer science class. Described procedure was approved by Ethical committee of the Faculty of Law at the University of Zagreb.

The aim of this study was to determine the level of internet addiction on a sample of high school students in Croatia. Since this is the first significant, preliminary representative research of Internet addiction on high school population in Croatia, the results of prevalence of Internet addiction on this sample are also significant for the national coverage. At the same time, the purpose of the research was to provide national results from the research conducted by standardized instrument to allow comparable data with internationally available findings. In order to determine the level of addiction to the internet on individual dimensions, it was necessary to undertake the factorization of the IAT. Specifically, previous studies have shown that, despite the high internal homogeneity of the test, there are numerous variations in the factor structure [8, 19, 22, 30, 50]. On the sample of high school students in Croatia, a high internal consistency of the whole test was determined (.91). Principal components analysis found that the IAT on a high school sample has a three-factor structure with dimensions:

Although many structural variations have been identified in the research, some similarities with previous research exist. Chang and Law [8], and Lai et al. [31] in their research conducted in China also gained a three-factor structure of the test with similar dimensions as we did. Their dimensions of withdrawal and social problems point to a high degree of correspondence with the dimension of “social problems” obtained through this research, while the definition of time management and performance points to similarities with neglect of work and lack of self-control. However, the third dimension obtained in both previous studies on a sample of Chinese students - the substitution of reality, although similar in content, points to deviations from the dimension of Emotional and cognitive internet preoccupation, given that, in the study presented here, this dimension has a wider range and contains a larger number of items. Although the greatest resemblance to this research exists with the studies conducted in China, we find some similarities with studies conducted in European countries of a more similar cultural environment. Dimensions similar to Emotional and cognitive internet preoccupation were obtained in German [3] and the Finnish sample [42], and similarities with the dimension Neglect of work and lack of self-control were also obtained in German [3], Italian [19] and the English sample [50]. The dimension of Social Problems points to the equivalence to the dimension obtained in Italian [19] and the English sample [50].

In order to examine the level of internet addiction on a sample of high school students in Croatia, the students were categorized into four proposed categories by authors and researchers [50, 53]. The highest number of high school students belongs to the low-level addiction category (39%). This score represents the average online users with complete internet usage control. Only 3.4% of high school students belong to the category with a severe level of addiction, but up to 32% of the students belong to the moderate level of addiction. According to the author’s instructions, the score of more than 40 on the test indicates that respondents show signs of addiction on the internet. The category of respondents belonging to the moderate level of addiction level has a score of more than 40 and can be considered a sign of addiction to the internet. We can conclude that 35.4% of high school students report signs of internet addiction suggesting the risk of more serious problems in using the internet. In a recent meta-analysis of 164 independent samples of 31 countries, the highest prevalence of high internet addiction was found in the Middle East (10.9%). The following are Southeast Europe with a prevalence of 6.1% while the North and West Europe countries show the lowest percentage of prevalence of internet addiction (2.6%). In the sample of high school students, this percentage is 3.4% and is somewhat higher than the average of Western European countries. Nevertheless, research conducted in Italy on a large sample of young people aged 14 to 21 shows that less than 1% of young people show a high level, while only 5% show a moderate level of addiction. This percentage is far less than 35.4% of students in Croatia who belong to these two categories. Based on the results on IAT dimensions in our sample it is evident that pupils who show signs of internet addiction achieve the highest results on the dimension of Emotional and cognitive internet preoccupation. Based on the multivariate tests conducted in this study, it is possible to conclude that the majority of the role in internet addiction risk has Emotional and cognitive internet preoccupation, while Neglecting work and lack of self-control and Social problems are of lesser importance. Similar results were obtained from the authors of the study conducted on a sample of students in Finland [42], where the intergroup difference on the dimension scores among groups based on the addiction risk is the largest in the similar dimension - reliance on online life.

Gender differences in the level of internet addiction were also the subject of this research. Univariate testing did not confirm the existence of gender differences in the overall outcome of the test, but multivariate testing on dimensions and overall results confirmed the existence of gender differences. Girls achieve higher results than boys on Neglecting work and lack of self-control dimension, while at the Social Problems factor girls show statistically significantly lower results than boys. It is interesting to note that on the dimension Emotional and cognitive internet preoccupation that plays the main role in the internet gender differences were not confirmed. The results obtained are in line with some of the previous research. Lai et al. [31] also confirm that greater social problems due to online addiction are reported by men. The lower score of female respondents on the dimension of Neglecting work and lack of self-control is consistent with the results of Sinkkonen, Puhakka & Meriläinen [42] that confirm that female respondents report less self-control when using the internet than male respondents. These results indicate that gender differences on internet dependency cannot be inferred in general, on the overall outcome of the test, but it is also necessary to examine specific differences in some aspects of internet addiction. Gender differences should also be considered in the context of time spent on the internet. The greater risk of internet addiction is probably linked to different patterns of internet usage. Men spend more time playing games online, while women spend more time on social networks and e-mails, and the activity of playing games shows a risk towards addictive behavior [17]. Therefore, different ways of expressing addiction for men and women can be related to different forms of internet usage. In further research, it is also necessary to examine ways of using the internet in high school samples.

The results of this study should be considered in the context of some disadvantages and recommendations for further research. One of the main disadvantages of this study was the clusterization of the sample on the grade division level. While due to the ethical considerations we were unable to collect the data on the specific grade division of the participants and control for the grouping effects, it is recommended for future studies to examine clusterization effects using multilevel models. In addition to examining the usage of the internet, it is also necessary to examine the time spent on the internet that has not been investigated by this research. The question is whether individuals are dependent on the internet in general, or on certain activities on the internet. Earlier research suggests that interactive internet functions are associated with its excessive use and that individuals involved in online interactive applications show a tendency to addictive behaviors ([15, 33]; Li & Chung, 2006). This study did not investigate how much time the respondents spent on certain activities on the internet, and did not distinguish the activities on the internet for educational purposes and leisure activities. Some shortcomings of this research are reflected in the very shortcomings of IAT as the questionnaire that was used. The item that has the smallest correlation with the overall score on the test in this research is about how often students ignore intimacy with their partner. Finding of this preliminary research propose that this assessment on intimacy with the partner is presumably not appropriate for high school students and this should be taken into account in future research. Adaptation of internet addiction measures for different age groups is necessary in order to be applicable in all age groups. Also, given that the structure of the test itself has high variations between cultures and also between the countries of similar cultures, the question whether the diagnostic criteria of test results and categorization of subjects should be the same in all test applications. It is therefore necessary to measure cultural invariance of IAT and to conduct validation studies using contrast groups of children who exhibit the symptoms of internet addiction in clinical situations and children who do not exhibit such symptoms.

In the future, it is necessary to examine the temporal stability of this construct. Temporal stability and repeated need for use of addictive substances are the criteria for assessing all forms of addiction (ICD-10). Lam [32] used the IAT to test its temporal validity and found that only 17% of subjects who showed signs of addiction had the same results re-applied after 2 years. The question is whether these findings are the result of the internet addiction itself or the fact that internet addiction is not a mental disorder. In the upcoming version of this ICD-11 classification (expected in 2018), it still discussed whether the problematic use of the internet is an independent disorder or the internet is a medium where various forms of dysfunction of the impulse control disorder are manifested. Studies on the temporal stability of this construct are necessary to determine if internet addiction has the diagnostic prerequisites to be classified as the independent mental disorder. On the other hand, in the context of the DSM-5 manual ([2], pp. 795), the possibility of the inclusion of the internet Gaming Disorder in the further editions of the manual is being discussed. Internet addiction is not mentioned here because of the ambiguity of discerning non-normative behavior in the context of business obligations or other disorders (eg. sexual content) and in the DSM it is stated that additional research is needed to determine internet usage patterns that correspond to the diagnostic criteria of addiction (pp. 798). So far, only gambling addiction has been included among addictions even though there is no active substance, but research using IAT points to subjective problems indicated by the use of the internet. These measures, though expressed as a self-assessment of the condition, point to practical significance in dealing with adolescents, especially in situations where daily functioning is impaired and may be an indicator of some other difficulties. It is also important to systematically monitor the prevalence of internet addiction indicators as well as the difficulties associated with excessive use of the internet to provide a measure of difficulty detection and comorbidity with other disorders. Such a measure is especially needed for monitoring the impact of prevention and intervention programs.

To conclude, this application of the Internet Addiction Test to the sample of high school students in Croatia found that 3.4% of high school students reported high levels of internet addiction, while 35.4% of respondents reported some signs of addiction. Cognitive and emotional preoccupation with the internet has the most significant role in internet addiction risk. This finding can be used by practitioners in developing interventions as well as prevention of internet addiction. The prevention programs should be focused on the constructive use of adolescents’ own free time. Prevention activities, as well as treatment of young people with a high level of internet dependence, need to focus on the area of emotional and social competence as well as the responsible use of media content and modern technology. The analysis of gender differences showed that although there are no significant effects on the total score, there are differences on Social problems where boys score higher than girls and on Neglecting work and lack of self-control where girls score higher than boys. Program interventions on safe and adequate ways of using the internet are necessary at an earlier age, in order to reduce the risk of high levels of internet addiction in the adolescent period. A group that needs special attention to prevention is the one that shows signs of moderate levels of addiction on the internet. Given that this category is the third of our sample, it is clear that programs of both indicated and selective prevention should be systematically planned for the general population of adolescents as well as for the groups in risk. Further studies in this area need to be set up within the framework of a systematic, multivariate, psycho-social conceptual framework, and it would be interesting to check out the relationship between the level of addiction to the internet and the emergence of other problematic behaviors of young people such as the substance abuse and other behavioral problems present in the population of young people.