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18]

ORIGINAL ARTICLE

Use of Social Networking Site and Mental Disorders among Medical

Students in Kolkata, West Bengal
Lisa Barman1, Dipta Kanti Mukhopadhyay1, Gautam Kumar Bandyopadhyay2
Departments of 1Community Medicine and 2Psychiatry, College of Medicine and Sagore Dutta Hospital, Kolkata,
West Bengal, India

ABSTRACT

Background: Use of social networking sites (SNS) and prevalence of anxiety and depression among the young
population is on the rise.
Objectives: The aim of this study is to assess the pattern of use of SNS and the prevalence of anxiety and depression
among medical students as well as to examine the relation, if any, between the use of SNS and anxiety and depression.
Methods: A cross‑sectional study was conducted among 200 undergraduate students of a medical college in Kolkata,
West Bengal during 2017. Information on individual characteristics and use of SNS of medical students were collected
using a structured questionnaire. Anxiety and depression were measured using State‑Trait Anxiety Inventory (STAI)
and becks depression inventory (BDI). Prevalence was expressed in percentage and association was examined with
Mann–Whitney U‑test.
Results: More than 90% of students use more than one SNS or instant messaging system. One‑third remained active in
SNSs all through the day and around 80% for ≥4 h. Use of SNSs during odd hours was reported by 55% participants,
and 23.5% expressed their inability to spend a day without SNSs. Nearly 24% reported depression and 68.5% had state
anxiety. STAI and BDI scores were significantly (P < 0.05) higher among students who used SNSs for 4 h or more, used
it during odd hours or stated inability to spend a day without SNSs than their counterparts.
Conclusion: The use of SNS by medical students was pervasive. More use of SNSs and dependence on it were associated
with anxiety and depression.

Key words: Anxiety, depression, medical students, social networking sites

INTRODUCTION because of the rapid development of social networking. It

has an enormous effect on how people interact with each
Social networking sites (SNS) can be defined as “a group other, sometimes being the first line of communication. In
of Internet‑based applications that allow the creation and research in 2015, it was noted that adolescents are avid
exchange of user‑generated content.”[1] For the past decade, users of SNS, with approximately 71% of them using more
there is a huge change in the field of communication than one online sites and Facebook was the most (41%)
widely used SNS.[2] It can be really assumed how much
Address for correspondence: Dr. Dipta Kanti Mukhopadhyay,
Lokepur, Near N.C.C. Office, Bankura‑722 102,
This is an open access journal, and articles are distributed under the terms of
West Bengal, India.
the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License,
E‑mail: diptakanti@gmail.com
which allows others to remix, tweak, and build upon the work non-commercially,
as long as appropriate credit is given and the new creations are licensed under
Access this article online the identical terms.
Quick Response Code
For reprints contact: reprints@medknow.com
Website:
www.indianjpsychiatry.org

How to cite this article: Barman L, Mukhopadhyay DK,

DOI: Bandyopadhyay GK. Use of social networking site and mental
disorders among medical students in Kolkata, West Bengal.
10.4103/psychiatry.IndianJPsychiatry_210_18
Indian J Psychiatry 2018;60:340-5.

340 © 2018 Indian Journal of Psychiatry | Published by Wolters Kluwer ‑ Medknow

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Barman, et al.: Social networking and mental disorders in medical students
important these sites are in our daily lives from more than
one billion active users of Facebook.[3]
SNS acts as a two‑edged sword. They are used for academic
excellence. On the other hand, the excessive use of
online SNS can cause addiction and dependence, sleep
disturbance, and depression.[4] Recent research documented
an association between online social networking and
mental health.[3] As the popularity of SNS is surging among
the today’s young generation, any proposed psychiatric
conditions associated with it can pose serious public health
issue may be a global cyber‑epidemic. The most alarming
thing is most of the users do not realize the negative impact
of social media as they are already addicted to it.[5]
The medical profession is also joining the parade and
attracted substantial interest among educators and
institutions.[6] A recent meta‑analysis suggests that 75% of
medical students were regularly using SNS including the
compulsive/compensatory use of social networking and
India is no exception to that.[7‑9]
It is already established that the level of the stress among
medical students is much higher and this stress affects the
lives of the medical students‑their academic performance,
physical health as well as their psychological health.[10] As a
result of that depression and anxiety are not very uncommon
in medical students.[11‑13]
Empirical evidence regarding the magnitude of use of
SNS and its association with the mental health status of
medical students are scarce in India. On the backdrop of
these situations, the present study was conducted to assess
the pattern of use of SNSs, the prevalence of anxiety and
depression and their interrelation among undergraduate
medical students in a Medical College in Kolkata, West
Bengal.
MATERIALS AND METHODS
Study design, setting, and duration
A cross‑sectional descriptive epidemiological study was
conducted among the undergraduate medical students
who enrolled in the college from 2012 to 2016 academic
sessions in a Medical College in Kolkata, West Bengal
having a capacity of 100 students per year during the period
of June–August 2017.
Sample size and sampling technique
The available literature showed that the proportion of
medical students using SNS ranged from 67% to 75%.[6,13]
Assuming the proportion of students having one or more
accounts of SNSs as 67%, considering the confidence level
of 95%, the relative precision of 10%, the final sample size
was 189 which were rounded off to 200. As the number
of enrolled students is similar in each batch (year‑group),
Indian Journal of Psychiatry Volume 60, Issue 3, July-September 2018
40 students from each batch was selected through
simple random sampling from the list of students as per
Attendance Register of the College. As the diagnosis of
psychiatric diseases and/or psychotropic drugs might
alter the use of social media, students with clinically
diagnosed psychiatric illness and/or Students under
medication for any psychiatric illness were excluded
from the study.
Study tools
The study tool had three different sections:
1. Assessment of anxiety‑State Trait Anxiety
Inventory (STAI)
2. Assessment of depression‑Becks Depression
Inventory (BDI)
3. Structured Questionnaire for assessment of the use of
SNSs.
The section of a questionnaire for assessing the use of
SNS and its effect on daily life was pretested in a similar
population and validated with the help of psychiatrists,
public health specialists, and sociologists. For assessing
the use of SNSs, the participants were asked whether they
have any account in any of the SNS and instant messaging
software. If yes, they were asked to state how many times in
a day, on average, they visited the site (s) in the last 7 days.
They were also asked to state the average duration they
spent on each visit in the last 7 days. They were also asked
whether they wake up early or went to bed late to spend
time in SNSs. Their perceived ability to spend a day without
SNSs was also enquired. Effect of spending time in SNS on
their self‑confidence and their satisfaction with use were
assessed.
Validated English version of STAI questionnaire and the BDI
Scale was applied to the participants to screen anxiety and
depression among medical students. Specific cut‑off (39/40)
for college students as cited in the manual for STAI was
used to screen state anxiety among participants.[14] The BDI
was used as per guideline to screen depression.
Method of data collection
The study obtained clearance from the Institutional Ethics
Committee of the concerned Medical College. After
obtaining the written informed consent, the structured
questionnaire in English was distributed among the
selected students to collect information regarding their
sociodemographic characteristics such as age and gender.
The pattern of use of SNS and its effect on daily lives were
assessed along with screening of depression and anxiety.
Consecutive three visits were paid for each batch to include
the selected students.
Method of data analysis
The proportion was used to express the use of SNS as
well as the prevalence of screener positive depression
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Barman, et al.: Social networking and mental disorders in medical students

and state anxiety. Differences in anxiety and depression Table 1: Distribution of study participants according to
scores (measured using STAI and BDI) according to use of social networking sites
the pattern of use of SNS were examined with Mann– Variables Categories n (%)
Whitney‑U (MW‑U) test as the scores were considered as Frequency of use per day At least hourly 65 (32.5)
ordinal data. 8‑23 times/day 57 (28.5)
4‑7 times/day 50 (25.0)
RESULTS 1‑3 times/day 21 (10.5)
< once/day 7 (3.5)
Duration of use per day Always open 58 (29.0)
Characteristics of study subjects 4‑23 h/day 99 (49.5)
The final analysis was performed with a filled‑in questionnaire 2‑4 h/day 32 (16.0)
of 200 medical students enrolled in College of Medicine <2 h/day 11 (5.5)
Used late night/early morning Often 36 (18.0)
and Sagore Dutta Hospital, Kamarhati, Kolkata. More than
Sometimes 74 (37.0)
half of the students aged 21–23 years while the mean age Never 79 (39.5)
(± standard deviation) of the sample was 21.6 (±1.8) years. Can’t recall 11 (5.5)
There was an almost equal representation of male (51.0%) Stated ability to spend a day without Unable 14 (7.0)
and female students (49.0%). accessing SNSs Not sure 33 (16.5)
Sometimes 28 (14.0)
Certainly 125 (62.5)
Use of social networking sites SNS – Social networking sites
All the study participants used SNSs, and among them, only
8.0% use one SNS. More than half of students (50.5%) used two
Table 2: Association between use of social networking
SNSs while around two‑fifth students (41.5%) used three or
sites and becks depression inventory score
more SNSs. “WhatsApp” was the most preferred SNS (97.9%)
Variable Category n Mean #MW‑U P
followed by “Facebook” (91.4%) and “Instagram” (30.5%). rank
Communication with the friends and families was the most
Number of SNS used <3 117 95.87 4313.500 0.178
common (59.0%) cited reasons for using SNSs followed ≥3 83 107.03
by entertainment (43.1%) and education and professional Frequency of use per day <4 times 28 77.52 1764.500 0.023
activities (31.4%). ≥4 times 172 104.24
Duration of use per day ≤4 h 43 79.91 1831.500 0.042
>4 h 157 103.85
As noted in Table 1, around one‑third students (32.5%), Used late night/early No 90 85.90 3636.00 0.001
SNSs were accessed at least once in an hour, while more morning Yes 110 112.45
than half (53.5%) used it at least 4‑hourly in a day. Almost Stated ability to spend Yes 152 92.22 2390.000 0.000
one‑tenth students (10.5%) used SNSs 1–3 times a day, a day without accessing No 48 126.71
SNSs
rest are an occasional user. Around 80.0% of the students
#MW‑U=Mann–Whitney U. SNS – Social networking sites
accessed SNSs for at least 4 h a day and 29.0% students
remained available in SNSs all through the day. One‑fifth
study participants (18.0%) often wake up early or went to Table 3: Association between use of social networking
bed late night to spend time in SNSs and another 37.0% sites and State Trait Anxiety Inventory ‑S score
did it for sometimes. Around one‑fourth (23.5%) students Variable Category n Mean #MW‑U P
were either not sure or expressed their inability to spend a rank

day without SNSs. Another 14.0% reported that they could Number of SNS used <3 117 98.13 4578.500 0.492
≥3 83 103.84
spend a day without SNSs in some particular times. Frequency of use per day <4 times 28 75.75 1715.00 0.015
≥4 times 172 104.53
Only 7.0% always definitely felt satisfied with the use of Duration of use per day ≤4 h 43 79.18 1811.000 0.035
SNSs and slightly more than half (52.5%) were satisfied to >4 h 157 103.97
some extent. Another 30.5% were not sure and one‑tenth Used late night/early No 90 87.56 3785.000 0.004
morning Yes 110 111.09
was not at all satisfied with the use of SNSs. Stated ability to spend Yes 152 92.11 2372.500 0.000
a day without accessing No 48 127.07
Prevalence of depression and anxiety SNSs
As per score obtained in Beck’s Depression Inventory (BDI), #MW‑U=Mann–Whitney U. SNS – Social networking sites
one‑fifth of the study participants had mild‑to‑moderate
depression and another 4.0% had severe depression. Association of use of SNSs with depression and
anxiety [Tables 2 and 3]
According to the score obtained in State and Trait Anxiety The BDI score and STAI‑S score were higher among students
Inventory‑State (STAI‑S), 59.0% had moderate anxiety, and who used more than three SNS than those who used <3,
9.5% had severe anxiety at the time of assessment. but the differences were not statistically significant for

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Barman, et al.: Social networking and mental disorders in medical students
BDI (MW‑U = 4313.0; P = 0.178) or STAI‑S (MW‑U = 4578.5;
P = 0.492).
Significant differences in BDI score (MW‑U = 1764.5;
P = 0.023) and STAI‑S (MW‑U = 1715.0; P = 0.015) score
between students who used SNS four times or more per
day and those who used <4 times a day were statistically
significant.
Similarly, students who used SNS for 4 h or more per
day scored significantly higher in BDI (MW‑U = 1831.5;
P = 0.042) and STAI‑S (MW‑U = 1811.0; P = 0.035) than
those who used SNS for less duration.
Students who wake up early or go to bed late at
night to spend time in SNS were more likely to have a
higher score in BDI (MW‑U = 3636.0; P = 0.001) and
STAI‑S (MW‑U = 3785.0; P = 0.004) scales than those who
do not.
Students who were sure that they could spend a day without
SNS were more likely to score lower in BDI (MW‑U = 2390.0;
P < 0.001) and STAI‑S (MW‑U = 2372.5; P < 0.001) than
those who apprehended difficulties in doing so.
DISCUSSION
While the communication facilities of social media have
transformed the lives of young adults across the globe
in a positive way, it might also affect the development
and wellbeing of young people adversely.[15] Debates are
encircling around the question that whether the use of
SNS and instant messaging are causative factors for mental
disorders or it is the increased case ascertainment and
greater societal concern which leads to increase reporting
of mental disorders among adolescents and youth.
Use of social networking sites
Because of the emerging use of SNSs, face‑to‑screen
interaction is much more than face‑to‑face interaction. That
may lead to depression and loneliness, anxiety perceiving
people around doing better jobs, or may help in depressed
persons with social withdrawal to connect, take tips, joining
online help groups.
Use of SNS was universal among the undergraduate medical
students in the present study with more than two‑fifths
of them using three or more social media. Among the
different platforms, WhatsApp emerges to be the most
popular, followed by Facebook with >90.0% of the study
participants using these, corroborating earlier research in
India.[4] Although the percentages of respondents using
Facebook and WhatsApp were found to be higher than
some previous researches,[2,16] figures similar to our study
has been reported among adolescents in US,[17] medical
students in India,[8] Australia,[18] and UK.[19]
Indian Journal of Psychiatry Volume 60, Issue 3, July-September 2018
Regarding use frequency, this study showed that the medical
students were avid users of SNS with around one‑third of
the students accessing SNSs at least once in an hour and
nearly 60.0% used it at least once in a day. Duration wise,
around 80.0% students reported to use SNSs for > 4 h while
one‑third of the participants remain logged in throughout
the whole day. This suggests heavy and frequent use among
the participants, which is relatable to the previous study
conducted by Goel et al. and Hall et al.[8,20]
One of the interesting findings was that around 18% of
the study subjects often wake up early or went to bed
late night to spend more time in SNS. Another 38% did it
for sometimes, making around 56% odd time users of SNS
found in our study‑which corroborates similar findings
from Madaiah et al.[4] Although the reported proportion of
participants who expressed their inability to spend a day
without SNSs in the referred study was almost three times
higher than that of the present study.[4]
Kraut et al. showed that SNSs helped youth to satisfy with
larger network and larger estimated audiences, the level
of satisfaction attained by the participants in this study
was mixed.[21] Strikingly, around one‑third of participants
reported that they perceived positive effect on using SNSs
on their self‑confidence and well‑being, on contrary to the
previous study conducted by Kross et al.[22]
Prevalence of depression and anxiety
Around one‑fourth of participants reported screener positive
depression in the present study, while Kulsoom et al. reported
a high prevalence of depression (43%) among the participants
and Yusoff et al. noted very low prevalence of depression.[11,12]
On the other hand, the prevalence of moderate and severe
anxiety was at par with the earlier studies.[11,12]
Social networking site use and prevalence of depression
and/anxiety
Affective disorders such as depression, anxiety were reported
to have a bidirectional relation with the social environment of
the individual that modulates the onset and maintenance of
illness.[23] The social characteristics affected by mental health
conditions are completely relevant to their sense of well‑being.
Current mental health theories suggest that the presence of
wellbeing is not synonymous to the absence of mental illness;
a complete model of mental health requires not just absence
of psychopathology, but also a focus on positive indices of
functioning such as subjective well‑being.[24] Depression and
anxiety have high levels of comorbidity and may influence the
size and structure of the social network of an individual.[25,26]
Individuals with anxiety/depression have an impoverished
social network, and on the other side, impoverished social
networks are often a risk factor for depression and anxiety by
reducing access to “buffering” social support and increasing
feelings of isolation.[27,28]
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Barman, et al.: Social networking and mental disorders in medical students
Although the number of SNSs used had no bearings on
depression and anxiety of study participants in the present
study, the depression and anxiety scores were found to be
higher in students who use SNS frequently and for a longer
duration. This finding is corroborative to the numerous
previous literature.[23,29‑31] Neira et  al. also reported a
significant association between frequency of social
network use and depression.[32] Kross et  al. illustrated
that more use of social networks exposed the young
adults to experiences of negative affect and reduced their
sense of well‑being.[22] It was also noted that participants
who reported depressive mood were more likely to use
social media to express their feelings.[33] Young people
with affective disorders were found to be less likely to
have face‑to‑face communication and therefore tend to
communicate with virtual friends.[33,34]
The prominent risk factors related to social media for
depression and anxiety were frequent social comparison,
perceived negative interaction, addictive/problematic use
and rumination.[35] We also found in the present study
that students, who reported to use SNSs in odd hours,
i.e., staying up late night or waking up early or both, were
more likely to have higher score in depression and anxiety
scales than the students who did not. Student who reported
that they could spend a day without using any SNSs were
less likely to have depression and anxiety than the persons
who apprehended difficulties in doing that. These indicated
a sort of dependence on social media and might be the
early symptoms of problematic SNS use. Working at odd
hours might disrupt the circadian rhythm of the students
which in turn made them vulnerable to mood disorders.[14]
In summary, the present study shows significant association
of high usage of social media with anxiety and depression
among medical students in Kolkata, West Bengal in the
present socio‑cultural context.
Strength and limitations
This study attempted to bring out empirical evidence
regarding the relation between use of SNS and depression
and/anxiety among the medical students in Indian
socio‑cultural context, data on which are scarce. In this study,
the screener instrument was used to measure depression
and anxiety instead of a detailed clinical interview, which
is subject to the over‑estimation of the burden. As the use
of SNS and depression/anxiety was measured at the same
time in this cross‑sectional study, it might not be free from
reverse‑causality bias.
CONCLUSION
The present study revealed that use of SNS was almost
universal among study participants and majority of them
were avid users of SNSs. A significant proportion of medical
students have a massive affinity toward SNSs. Intense use
of SNS including using those in odd hours were found to
344
be significantly associated with depression and anxiety.
The problem is relatively young still important enough for
proper intervention. More intensive researches are needed
to get a solution to the tangled relation between SNS use
and mental health issues.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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