Journal of Child and Adolescent Behavior
Open Access

Depression; Stress; Internet; Drug abuse

Introduction

The rapid rise in internet usage among adolescents for education & social media communications has raised concerns about the mental consequences in this easily influenced age group. The internet surfing provides a platform for formation of friendships of unknown quality as opposed to off line friendship. The online friendships are viewed as superficial and weak as they usually lack commitment & affection. Increased exposure to online friendship has shown to reduce exiting friendship affecting their stable mental health [1]. Within our society internet induced victimization and leading to depression has become a social mental health problem affecting these juveniles who are easily influenced.

As shown in the Stress Generation Model for depression, children with incrementally hike their levels of depression on a persistent victimization pathway [2]. Past research has demonstrated that that cyber bullied adolescents show a greater degree of depression [3].

Both Online and Offline victimization are independently associated with delinquent behaviour, depression & drug abuse [4]. Children who use internet extensively are not just increasing their duration of wastage of time but are prone to have increased anxiety and depression. Access and usage of internet has become an essential necessity for educational & communication needs. Reduction of face-to-face interactions leads to lack of development of communication skills. By 2019 November 31% of the internet users were children between 12-19 years & 38% of school going kids have access to Internet [5]. These figures will rise exponentially with the pandemic induced role of internet usage. With this information, we explored the effect of internet victimization & its effect on mental health mainly depression in school going adolescents.

Initial investigator child confidence & faithful relationship was established based on secrecy and after effects. Parental written permission was taken. Pediatrician, Pediatric clinical psychologist and one investigator assessed the mental health status of the child. A pretested self-reporting questionnaire (Table 1) was initially given as a cross section survey to assess as the presence of abuse regarding online violence & abuse in the last 9 months. 400 children aged between 13 to 18 years of 3 private & 1 government schools in Hyderabad were evaluated based on their responses. Those who reported online abuse were further evaluated for presence (more than 4 positive responses) and degree of depression using the PH-9 Patient Depression Questionnaire [6] (Figure 1). The responses were assed and scored as 0(never), 1(several days), 2 (3More than half the days), 3 nearly every day). A score was ascertained by totalling the response scores. Depression severity score total was interpreted as Minimal: 1-4, Mild: 5-9, Moderate: 10-14, moderately severe; 15-19 and Severe :> 15 [7].

Table 1: Self Reporting Questionnaire.

Figure 1: Patient Depression Questionnaire.

The internet usage was seen in 374 of the 400 children (93%). The age distribution of the internet users was 13-15 years167 (44.6%) and 16-18 years 207(55. 3%). The sex distribution was Male: Female 200:174 (53.4%:46.6%). The rate of internet usage was daily 286(76.4%), every 2-3 days 76(20.3) & weekly 12(3.2%). 168 of the 374 (44.9%) assessed were observed to have been victimized in the last 6 months. Boys were more predominantly abused (98-58%) as compared to girls (70-42%). The age distribution of the victims has been shown in Table 2.

Table 2: Age Distribution of Victims.

Analysis of the questionnaire the PHQ9 score was analysed and it was observed that 112 (66.6%) had some level of depression. In the population under study the various grades of depression have been shown in Table 3.

Table 3: Grades of Depression.

Minimal depression was observed among the nonusers of internet 2(7.6%) (p<0.0001). The cause of depression was not evaluated in this group. Data from the Self-reported questionnaire was analysed for specific responses to understand the cause of depression and these have been shown in Tables 4 and 5.

Table 4: Internet Usage & Victimization In Relation to Age.

Table 5: Internet Usage & Victimization In Relation To Gender.

Depression is a manifestation of varied psychological problems and the severity ranges depending upon the components involved, extraneous factors together with social & society interplay. Large number of school children between 13-18 years have had at least one episode of depression. In the present study 44.9 % children reported to have been victimized & of these 66.6% showed depressive symptoms which is similar to what has been observed in earlier research. There are consistent associations between cyber bullying and increased risk of depression. Depressed teenagers have also shown to easily be affected by cyber bullying [8]. Children between the age group 16 to 18 years are more exposed to the internet & being more labile to social pressures have a higher incidence of depression. Most the depressive episodes are minimal. Social media with images was associated with incidence of victimization & depression. There was gender equality seen in the usage of all types of internet media. Boys were seen to be more affected by verbal abuse & girls to personality abuse.

Persistent cyber bullying has shown to progress to psycho pathological disorders if left to chronicity [9]. Depressive children have been shown to develop cognitive defects, inferiority complexes, substance abusers & social misfits. [10]. Due to victimization by peers the bullied can develop negative social adaptive behaviours, negative inference, maladaptation leading to suicidal tendencies [11,12]. Changes in the internet usage on social media platforms and early identification is essential to alleviate the victimization of this fragile & nascent adolescent group. These measures will result in reduced incidence of depressive episodes.

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