Iran Journal of Nursing

Introduction
Today, the use of information and communication technology has become popular. For the majority of people, the Internet is an information source and a platform for social communication and self-education. The Internet has advantages and disadvantages. It provides opportunities for creative expression and social support; however, its excessive use causes internet addiction and dependence. During the last decade, problematic Internet use (PIU) has been raised as a clinical disorder in adolescents. Studies on adolescents have shown that PIU is associated with psychological disorders such as depression and aggression and a decrease in the quality of interpersonal relationships. The PIU is an important social concern in different countries, especially among students. School students may be less likely to seek help from others when faced with problems, which can increase their dependence on the Internet and its problematic use. The PIU can be a maladaptive emotion regulation strategy through failed problem-solving and avoidance. A few studies have been conducted on PIU in Iranian students, necessitating more research. Therefore, this study aims to evaluate the PIU among high school students in Tehran, Iran.

Materials & Methods
In this descriptive cross-sectional study, 256 second-year high school students in Tehran city were included using a convenience sampling method in 2022. The data collection tools were a demographic form and the Problematic Internet Use Questionnaire (PIUQ), completed based on a self-report method by students. The demographic form surveys age, gender, educational level, field of study, grade point average, family economic status, living arrangement, and birth rank. The PIUQ, developed by Thatcher and Goolam in 2005, has 20 items that measure the three dimensions of online preoccupation (10 items), adverse effects (7 items), and social interactions (3 items). The items are rated on a 5-point Likert scale and the total score ranges from 20 and 100. A higher score indicates a higher level of PIU. The data was analyzed in SPSS software, version 16 using descriptive (mean and standard deviation) and inferential (independent t-tests, analysis of variance) statistics.

Result
The mean age of the students was 17.33±0.67 years, and most of them had age>18 years (45.7%). The mean PIUQ score was 50.27±8.19 out of 100. Among the PIUQ domains, social interactions had the highest mean (2.59±0.55), while adverse effects had the lowest mean (2.44±0.51). In the online preoccupation domain, the highest score was for the item “Do you find yourself looking forward to spending time on the Internet and feeling as if you can’t wait to be online?” With a mean of 2.79±0.86 and the lowest score was for the item “Do you find that you keep secrets from others regarding your time spent on the Internet?” With a mean of 2.2±0.82. In the dimension of adverse effects, the highest score was for the item “Have you experienced a situation where you tried to escape problems by going onto the Internet?” with a mean of 2.55±0.81, and the lowest score was for the item “Have you ever suffered any serious adverse physical/health-related consequences because of your use of the Internet?” With a mean of 2.33±0.91. In the dimension of social interactions, the highest score was for the item “Do you prefer online socializing to other forms of socializing?” with a mean of 2.69±0.80, and the lowest score was for the item “Do you tend to seek out certain individuals on the Internet?” With a mean of 2.47±0.84. There was no significant difference in the PIUQ score based on any demographic variables (P>0.05).

Conclusion 
High school students in Tehran prefer online social socializing to other social activities, which can lead them to be weak in face-to-face social communication. Considering that inappropriate and problematic use of the Internet can cause students to experience physical and mental consequences, the development of educational programs for them to reduce the adverse effects of PIU is recommended for high school officials. These programs can be implemented by school counselors. 

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Iran University of Medical Sciences (Code: IR.IUMS.REC.1401.728). All ethical principles were considered in this article. The participants were informed about the study objectives and methods. They were assured of the confidentiality of their information and were free to leave the study at any time, and if desired, the research results would be available to them.

Funding
This study was extracted from the master’s thesis of Arman Naeemi at the Department of Psychiatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran. This article was extracted from the master’s thesis of Arman Naeimi, funded by Iran University of Medical Sciences.

Authors' contributions
Conceptualization: Arman Naeemi and Marjan Mardani Hamooleh; Research: Marjan Mardani Hamooleh and Mahnaz Ghaljeh; Data analysis: Shima Haghani; Project Management: Marjan Mardani Hamoleh and Arman Naeemi; Editing & review: Marjan Mardani Hamooleh

Conflict of interest
The authors declared no conflict of interest.

Acknowledgments
The authors would like to thank all the participants for their cooperation.


References

1. Kumar N, Kumar A, Mahto SK, Kandpal M, Deshpande SN, Tanwar P. Prevalence of excessive internet use and its correlation with associated psychopathology in 11th and 12th grade students. Gen Psychiatr. 2019; 32(2):e100001.  [DOI:10.1136/gpsych-2018-100001] [PMID] 
2. Rastegarian A, Bazrafshan A, Keshavarz P. Happiness and internet addiction among high school girls in Iran: A single-center experience. Iran J Psychiatry. 2022; 17(4):388-394.  [DOI:10.18502/ijps.v17i4.10687] [PMID] 
3. Feher A, Fejes E, Kapus K, Jancsak C, Nagy GD, Horvath L, et al. The association of problematic usage of the internet with burnout, depression, insomnia, and quality of life among Hungarian high school students. Front Public Health. 2023; 11:1167308. [DOI:10.3389/fpubh.2023.1167308] [PMID] 
4. Benedetto L, Rollo S, Cafeo A, Rosa GD, Pino R, Gagliano A, et al. Emotional and behavioural factors predisposing to internet addiction: The smartphone distraction among Italian high school students. Int J Environ Res Public Health. 2024; 21(4):386. [DOI:10.3390/ijerph21040386] [PMID] 
5. Sayılı U, Vehid S, Erginöz E. Problematic internet use in Turkish high school students: Prevalence and related factors. Am J Health Behav. 2021; 45(1):31-43. [DOI:10.5993/AJHB.45.1.3] [PMID]
6. Mousavi SV. [Prevalence of internet addiction and the status of the use of virtual social networks in Iranian Teenagers and Youths in 2018 (Persian)]. J Mil Med. 2022; 22(3):281-8. [DOI:10.30491/JMM.22.3.281]
7. Özaslan A, Yıldırım M, Güney E, Güzel HŞ, İşeri E. Association between problematic internet use, quality of parent-adolescents relationship, conflicts, and mental health problems. Int J Ment Health Addict. 2022; 20(4):2503-19. [DOI:10.1007/s11469-021-00529-8]
8. Opakunle T, Opakunle O, Toki D, Aloba O, Nwozo C. Drug abuse among Nigerian high-school adolescents: Exploring the relationship with problematic internet use, suicidality, anxiety, depression, and self-esteem. Int J Med Health Dev. 2022; 27(3):277-84. [DOI:10.4103/ijmh.IJMH_17_22]
9. Joseph J, Varghese A, Vijay V, Dhandapani M, Grover S, Sharma SK, et al. Problematic internet use among school-going adolescents in India: A systematic review and meta-analysis. Indian J Community Med. 2022; 47(3):321-7. [DOI:10.4103/ijcm.ijcm_1129_21] [PMID] 
10. Moreno M, Riddle K, Jenkins MC, Singh AP, Zhao Q, Eickhoff J. Measuring problematic internet use, internet gaming disorder, and social media addiction in young adults: Cross-sectional survey study. JMIR Public Health Surveill. 2022; 8(1):e27719.  [DOI:10.2196/27719] [PMID] 
11. Nguyen TTP, Do HN, Vu TBT, Vu KL, Nguyen HD, Nguyen DT, et al. Association of Individual and Neighborhood Characteristics to Problematic Internet Use among Youths and Adolescents: Evidence from Vietnam. Int J Environ Res Public Health. 2023; 20(3):2090.  [DOI:10.3390/ijerph20032090] [PMID] 

12. Parashkouh NN, Mirhadian L, EmamiSigaroudi A, Leili EK, Karimi H. Addiction to the Internet and mobile phones and its relationship with loneliness in Iranian adolescents. Int J Adolesc Med Health. 2018; 33(1). [DOI:10.1515/ijamh-2018-0035] [PMID]
13. Effatpanah M, Moharrami M, Rajabi Damavandi G, Aminikhah M, Hosein Nezhad M, Khatami F, et al. Association of internet addiction with emotional and behavioral characteristics of adolescents. Iran J Psychiatry. 2020; 15(1):55-66. [DOI:10.18502/ijps.v15i1.2440] [PMID] 
14. Restrepo A, Scheininger T, Clucas J, Alexander L, Salum GA, Georgiades K, et al. Problematic internet use in children and adolescents: Associations with psychiatric disorders and impairment. BMC Psychiatry. 2020; 20(1):252. [DOI:10.1186/s12888-020-02640-x] [PMID]
15. Khalil SA, Kamal H, Hussien Elkholy H. The prevalence of problematic internet use among a sample of Egyptian adolescents and its psychiatric comorbidities. Int J Soc Psychiatry. 2022; 68(2):294-300. [DOI:10.1177/0020764020983841] [PMID]
16. Ge J, Liu Y, Cao W, Zhou S. The relationship between anxiety and depression with smartphone addiction among college students: The mediating effect of executive dysfunction. Front Psychol. 2023; 13:1033304.  [DOI:10.3389/fpsyg.2022.1033304] [PMID]
17. Eichenberg C, Schneider R, Rumpl H. Social media addiction: Associations with attachment style, mental distress, and personality. BMC Psychiatry. 2024; 24(1):278. [DOI:10.1186/s12888-024-05709-z] [PMID]
18. Layegh H, Abazari M. [Improper use of the internet and its relationship with daytime sleepiness in medical sciences students at Ardabil University of Medical Sciences (Persian)]. J Health. 2019; 10(3):379-86. [DOI:10.29252/j.health.10.3.379]
19. Thatcher A. Development and psychometric properties of the Problematic Internet Use Questionnaire. S Afr J Psychol. 2005; 35(4):793-809. [DOI:10.1177/008124630503500410]
20. Ranjbar H, Arab M, Hatamizadeh M, Shabani F, Nasri N. [The survey of relationship between Problemathic internet use with lonliness and satisfaction with life in internet users of Kerman (Persian)]. Adv Nurs Midwifery. 2017; 26(93):31-40. [Link]
21. Khine AT, Saw YM, Htut ZY, Khaing CT, Soe HZ, Swe KK, et al. Assessing risk factors and impact of cyberbullying victimization among university students in Myanmar: A cross-sectional study. Plos One. 2020; 15(1):e0227051. [DOI:10.1371/journal.pone.0227051] [PMID] 
22. Yu Y, Yang X, Wang S, Wang H, Chang R, Tsamlag L, et al. Serial multiple mediation of the association between internet gaming disorder and suicidal ideation by insomnia and depression in adolescents in Shanghai, China. BMC Psychiatry. 2020; 20(1):460. [DOI:10.1186/s12888-020-02870-z] [PMID] 
23. Wartberg L, Kammerl R. Empirical relationships between problematic alcohol use and a problematic use of video games, social media and the internet and their associations to mental health in adolescence. Int J Environ Res Public Health. 2020; 17(17):6098. [DOI:10.3390/ijerph17176098] [PMID]
24. Chen R, Liu J, Cao X, Duan S, Wen S, Zhang S, et al. The relationship between mobile phone use and suicide-related behaviors among adolescents: The mediating role of depression and interpersonal problems. J Affect Disord. 2020; 269:101-7.  [DOI:10.1016/j.jad.2020.01.128] [PMID]
25. Fan Z, Chen M, Lin Y. Self-control and problematic internet use in college students: The chain mediating effect of rejection sensitivity and loneliness. Psychol Res Behav Manag. 2022; 15:459-70. [DOI:10.2147/PRBM.S352060] [PMID] 
26. Lee JY, Ban D, Kim SY, Kim JM, Shin IS, Yoon JS, et al. Negative life events and problematic internet use as factors associated with psychotic-like experiences in adolescents. Front Psychiatry. 2019; 10:369. [DOI:10.3389/fpsyt.2019.00369] [PMID] 
27. Zhai B, Li D, Li X, Liu Y, Zhang J, Sun W, Wang Y. Perceived school climate and problematic internet use among adolescents: Mediating roles of school belonging and depressive symptoms. Addict Behav. 2020; 110:106501.  [DOI:10.1016/j.addbeh.2020.106501] [PMID]