The Impact of the COVID-19 Pandemic on the Prevalence and Severity of Internet Addiction: Current and Future Public Health Challenges

Bashir M. Rezk, PhD

Professor, Department of Natural Sciences, Southern University at New Orleans, 6400 Press Drive, New Orleans, LA 70126 USA; Office Phone. +1(504)284-5405; E-mail: batteia@suno.edu

Illya Tietzel, PhD

Professor, Department of Natural Sciences, Southern University at New Orleans, 6400 Press Drive, New Orleans, LA 70126 USA; Phone. 504-286-5111; E-mail: itietzel@suno.edu

BACKGROUND

Over the past few years, there has been a significant rise in internet usage, raising considerable concerns about the potential dangers associated with excessive internet use and the development of Internet addiction.¹ When a newly discovered coronavirus, originally named 2019-nCoV and now known as severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) (Coronavirus disease-2019 (COVID-19)), was first identified in Wuhan, Hubei Province, China, it initially spread rapidly within China and to various other countries.^2,3 In December 2019, the first reported COVID-19 outbreak occurred and aroused global attention, leading to COVID-19 restrictions, further emphasizing their importance. The global number of internet users witnessed a substantial surge, skyrocketing from 738 million in 2000 to 4.9 billion in 2021.¹ This increase amounts to a staggering growth of over 567% within a span of only two decades. Internet addiction has been extensively investigated on a global scale, encompassing various characteristics that have the potential to negatively impact social, psychological, and functional aspects.⁴ Additionally, other variables have been widely explored, such as depression, sleeping patterns, body weight, aggressiveness, and other addictive substances.⁴ Furthermore, the general population has experienced relatively high rates of anxiety symptoms (ranging from 6.33-50.9%), depression symptoms (ranging from 14.6-48.3%), and post-traumatic stress disorder symptoms (ranging from 7-53.8%) during this global health crisis.^3,5,6

In 2018, the concept of “death by digital distraction”, which refers to the extreme consequence of excessive personal technology use, emerged on the internet through a concerning publication by the U.S. Naval Institute.⁷ Digital technology is clearly highlighted as a powerful “new drug”, referring to national statistics suggesting that 78% of Americans between 18 and 24-years of age use social media, online dating, video games, online pornography, and other personal digital technology multiple times a day, often to an extent that raises grounds for concern.⁸ Furthermore, digital addicts exhibit a wide range of behavioral symptoms, including eating disorders and withdrawal from outdoor and social activities.⁹ It is important to consider the evidence that suggests dysfunctional melatonin and vitamin D metabolism in these individuals when developing treatment approaches.⁹ The conclusions drawn provide a comprehensive understanding of digital addiction, highlighting the significance of sleep deficit as one of the key contributing factors.⁹

The global number of smartphone users is expected to experience a steady rise from 2023-2028, with an overall increase of 910.3 million users, which is a 17.33% increase.¹⁰ Following five consecutive years of growth, it is estimated that the smartphone user base will reach a new peak of 6.2 billion users in 2028.¹⁰ It is worth mentioning that the number of smartphone users has consistently been on the rise in recent years. Smartphone users are limited to internet users of any age using a smartphone.¹⁰

METHODS

In this literature review, we used the results of the 15 different studies^11-25 that have been conducted worldwide overall from the published articles at PubMed and Google Scholar as mean references. These studies collectively examined the effects of COVID-19 on Internet addiction, as demonstrated in Table 1 and Figure 1. To compare the prevalence of Internet addiction before and after the COVID-19 pandemic, we utilized the t-test statistical method.

Figure 1. Represents the Prevalence Rates of Internet Addiction Derived from Fifteen Studies Conducted in Diverse Countries

A review of literature published between 2000 and 2009 on Medline and PubMed focusing on “Internet addiction” in the United States and Europe showed that the prevalence rates of Internet addiction range from 1.5-8.2%, which is not COVID-19-related, although the specific diagnostic criteria and assessment questionnaires varied across countries.²⁶ Throughout the previous decade, the prevalence of Internet addiction worldwide exhibited substantial variation, ranging from 1.6% in Europe to 44% in India, with an average of 15%.^27,28 However, based on the current review, which includes 15 studies conducted globally, the average prevalence of Internet addiction during the COVID-19 pandemic ranged from 4.8% in Turkey to 88.1% in Nigeria, with an overall average of 42%. Using the t-test statistical methodology, we observed a substantial increase in the average rate of Internet addiction from 15% before the COVID-19 pandemic²⁷ to 42% during the COVID-19 pandemic, representing a 2.8-fold increase, as shown in Figure 2. Cross-sectional studies conducted on patient samples demonstrate a significant comorbidity between Internet addiction and psychiatric disorders, especially affective disorders (such as depression), anxiety disorders (including generalized anxiety disorder and social anxiety disorder), and attention deficit hyperactivity disorder (ADHD).²⁶ Various factors are found to be predictive of the severity of internet use, including personality traits, parenting and familial factors, alcohol use, and social anxiety.²⁶ There was a significant positive correlation between Internet addiction and aggressive behavior, and anxiety, but not depression, mediated the effect of Internet addiction on aggressive behavior.²⁰ Furthermore, the public health model recognizes addiction as an outcome of interactions between individuals, digital media, and the environment.²⁹ These circumstances further emphasize our awareness towards recognizing a new global syndrome, Internet addiction, driven by increasingly challenging public health and psychosocial conditions.¹⁰

The COVID-19 pandemic posed substantial challenges to the current state of public health, despite advances in medicine. The lack of a strong medical infrastructure to restrict the virus’s spread, as well as the initial lack of a quick vaccination, led to the virus’s global spread.³⁰ Consequently, quarantine measures were put in place, but unfortunately, a concurrent 2.8-fold increase in Internet addiction compared to pre-pandemic levels was also observed (Figure 2). Looking ahead, the future of public health will be influenced by various factors, including scientific and technological advancements and the development of medical systems capable of effectively managing pandemics.³¹ Additionally, policy decisions, global cooperation, and societal changes will play crucial roles in shaping public health outcomes.³² Addressing these challenges and seizing opportunities will necessitate collaboration between governments, international organizations, healthcare professionals, and communities worldwide.

Figure 2. Illustrates the Average Rates of Internet Addiction before and during the COVID-19 Pandemic

CONCLUSION

During the COVID-19 pandemic era, there has been a significant increase in Internet addiction on a global scale. This Internet addiction is significantly associated with psychosocial problems and is severely affected by diverse sociodemographic factors that vary across regions and countries. Moreover, it has significant mental health consequences, including anxiety, depression, loneliness, aggressiveness, and sleep disturbances. The detrimental effects of Internet addiction on public health necessitate the development and provision of evidence-based services tailored to the specific problem type and severity experienced by each individual.

RECOMMENDATIONS

To effectively prevent and treat Internet addiction, which is recognized as a novel global syndrome and has severely impacted public health worldwide, it is essential to adopt a comprehensive approach that prioritizes the well-being of the younger generation. Importantly, urgent attention is needed to implement educational measures and new public health strategies that can protect and support young adults, youths, and adolescents, with the aim of preventing any additional harm and improving public health.

ACKNOWLEDGMENT

The authors, acknowledged the Department of Health, State of Louisiana, and Health Disparities for their support in conducting this work.

CONFLICTS OF INTEREST

The authors declare that this review article was conducted without any commercial or financial associations that could be seen as a potential conflict of interest.

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