Journal of Affective Disorders 256 (2019) 668–672

Contents lists available at ScienceDirect

Journal of Affective Disorders

journal homepage: www.elsevier.com/locate/jad

Research paper

Relationship between internet addiction and depression among Japanese T

university students
⁎
Tomokazu Seki, Kei Hamazaki, Takashi Natori, Hidekuni Inadera
Department of Public Health, Faculty of Medicine, University of Toyama, 2630 Sugitani, Toyama, 930-0194 Japan

A R T I C LE I N FO A B S T R A C T

Keywords: Background: Internet addiction (IA) has various adverse effects. We sought to elucidate the relationship between
Depression IA and depression among university students and to identify factors associated with IA.
Internet addiction Methods: Anonymous, self-administered questionnaires were distributed to 5,261 students and comprised basic
Mobile phone use characteristics, lifestyle habits, anxieties, the Internet Addiction Test (IAT), and the Center for Epidemiological
University students
Self-Depression Scale.
Results: Responses were obtained from 4,490 students (response rate: 85.3%). After excluding those with
missing responses, 3,251 participants were analyzed (valid response rate: 61.8%). Logistic regression analysis
with severity of IA as the independent variable and depression as the dependent variable revealed that the odds
ratio (OR) for depression increased with severity of IA (mild addiction: OR=2.87, 95% confidence interval [CI]
=2.45−3.36; severe addiction: OR=7.31, 95% CI=4.61−11.61). In a logistic regression analysis with mobile
phone use as the independent variable and IA as the dependent variable, the highest OR was for message board
use (OR=3.74, 95% CI=2.53−5.53) and the lowest OR was for use of LINE instant messenger (OR=0.59, 95%
CI=0.49−0.70). Logistic regression analysis with academic department as the independent variable and in-
ternet addiction as the dependent variable revealed high ORs for the humanities department (OR=1.59, 95%
CI=1.18−2.16) and fine arts department (OR=1.55, 95% CI=1.07−2.23).
Limitations: The main limitations were the cross-sectional design, low valid response rate, single-university
setting, and possible social desirability bias.
Conclusions: Our results suggest a relationship between IA and depression in university students. IA tendency
differed according to mobile phone use and academic department, suggesting these factors are associated with
IA.

1. Introduction The internet also has a number of negative effects, however. We

The internet began to expand on a global scale in the 1990s and has
profoundly changed our lives. The rapid proliferation of smartphones
beginning in the 2010s has made internet usage even more common-
place. In Japan, the penetration rate of smartphones has exceeded 80%,
with the number of smartphone users exceeding 100 million. According
to Japan's Ministry of Internal Affairs and Communications
(MIC, 2015), more than 95% of Japanese people aged 13−49 years use
smartphones, primarily for e-mail, social media, and shopping. Ac-
cording to previous studies, internet-literate students with a strong
command of the internet perform well academically (Leung and Lee,
2012; Siraj, 2015). It is now safe to say that the internet is a funda-
mental part of daily life.
have seen the emergence of internet addiction, which is characterized
by that an inability to control excessive internet use, and results in
moderate to severe problems in daily life. The impact of such addiction
is similar to that of alcoholism or compulsive gambling (Young, 1996).
Beginning with findings of an association between internet addiction
and depression (Young and Rodgers, 1998), the spread of the internet
has been reported by many researchers worldwide to have led to a
relationship between internet addiction and mental health problems
such as depression, anxiety, stress, and reduced happiness (Akin, 2012;
Nassehi et al., 2017; Othman and Lee, 2017; Tran et al., 2017; Uddin
et al., 2016). Young people born in the internet age, so-called digital
natives, are considered to be particularly susceptible to internet ad-
diction due to being brought up in an environment where smartphones

Abbreviations: CES-D, Center for Epidemiological Self-Depression Scale; CI, confidence interval; IAT, Internet Addiction Test; OR, odds ratio
⁎
Corresponding author.
E-mail address: inadera@med.u-toyama.ac.jp (H. Inadera).

https://doi.org/10.1016/j.jad.2019.06.055
Received 26 April 2019; Received in revised form 24 June 2019; Accepted 30 June 2019
Available online 02 July 2019
0165-0327/ © 2019 Elsevier B.V. All rights reserved.
T. Seki, et al.
and other internet-connected devices are available from an early age
(Koo and Kwon, 2014; Kraut et al., 1998; Morrison and Gore, 2010).
Many studies on internet addiction among young people have been
conducted in Japan. A panel study conducted by Japan's MIC using the
Japanese version of the Internet Addiction Test (IAT) found strong in-
ternet addiction tendency among 2.3% of elementary school students
(ages 9 − 11 years), 7.6% of junior high school students (12−14
years), 9.2% of high school students (15−17 years), and 6.1% of uni-
versity students (MIC, 2013). Other studies have reported a relationship
between internet addiction and mental health problems such as de-
pression and loneliness (Ezoe and Toda, 2013; Takahira et al., 2008), as
well as relationships between excessive internet use and sleep habits,
disorderly eating habits, and reduced quality of life (Taguchi, 2008;
Takahashi et al., 2018).
Studies outside of Japan have found a relationship between internet
addiction and self-harm behaviors such as suicidal ideation and suicide
planning (Lin et al., 2014; Marchant et al., 2017). Depression associated
with internet addiction is considered a particularly important factor in
triggering suicidal ideation and suicide planning (Fu et al., 2010; Kaess
et al., 2014; Lam and Peng, 2010). Despite the above findings, most
studies on internet addiction and depression have not included suffi-
ciently large numbers of participants (Kuss et al., 2014).
To rectify this problem, we have conducted a questionnaire survey
with students across a wide range of academic departments with the
aim of elucidating the relationship between internet addiction and
depression among young people and identifying factors associated with
internet addiction.
2. Methods
Participants were 5261 first-year to sixth-year students at a national
university in Japan who were enrolled in seven departments (huma-
nities, economics, education, fine arts, science, pharmaceutical sci-
ences, and medicine). In Japan, unlike in the US, medical and pharmacy
programs are integrated six-year degree programs. The first two years
serve the same purpose as a 4-year degree in the US system, while the
last four years are equivalent to a 4-year doctoral program in medicine
or pharmacy in the US system.
In 2014, we conducted an anonymous, self-administered ques-
tionnaire survey comprising basic characteristics, lifestyle habits, an-
xieties, the IAT, and the Center for Epidemiological Self-Depression
Scale (CES-D). Most questionnaires were distributed and collected in
lectures, recitations, and seminars during class time. Some students
received the questionnaire from departmental offices or professors and
submitted them personally at a later date. The questionnaire included a
cover sheet with an explanation of the study and a consent form that
was intended for subjects to keep. Return of the completed ques-
tionnaire was taken as implied consent. This study was approved by the
institutional review board of the University of Toyama (No. 25-100 and
No. 30-97).
Internet addiction was assessed using a Japanese version of the IAT
(consisting of 20 items scored on a 5-point scale), which was developed
as a measure of the severity of internet addiction. In this study, as in the
above-mentioned study conducted by the MIC, a score of ≤ 39 was
classified as no addiction, a score of 40−69 was classified as mild ad-
diction, and a score of ≥ 70 was classified as severe addiction. In ad-
dition, 40 was set as a cutoff score to divide participants into a group
with no internet addiction (≤ 39) and a group with internet addiction
(≥ 40) (MIC, 2013). The reliability of the Japanese version of the IAT
has been demonstrated, with a Cronbach's α of 0.92. Formal validation
of the Japanese version was reported by Osada (2013).
Depression was assessed using a Japanese version of the CES-D
(consisting of 20 items scored on a 5-point scale), which was originally
developed as a measure of depression by Radloff (1977) and later va-
lidated in Japanese by Shima et al. (1985). In the present study, as in
the study by Shima et al. (1985) 16 was established as a cutoff score to
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Journal of Affective Disorders 256 (2019) 668–672
divide participants into a group of those with depressive symptoms (≥
16) and a group of those without depressive symptoms (≤ 15). The
CES-D is a highly regarded measure of depression and its validity and
reliability have been demonstrated (Radloff, 1991; Umegaki and Todo,
2017).
We excluded participants with missing responses for IAT score, CES-
D score, age, sex, year in university, anxieties (relationships with
friends, finances, or academics), gaming habit, alcohol consumption, or
smoking. Our analysis ultimately included 3251 participants (valid re-
sponse rate: 61.8%).
Data are expressed as the mean ± standard deviation (SD) or as the
number of participants (%). In descriptive statistics, the Kruskal-Wallis
test was used to analyze IAT score, CES-D score, and age among groups
with different severity of internet addiction (no addiction, mild addic-
tion, severe addiction). Spearman's χ2 test was used to analyze the re-
lationships of severity of internet addiction with sex, anxieties (re-
lationships with friends, finances, or academics), gaming habit, alcohol
consumption, and smoking (number of participants [%]). We also
performed three logistic regression analyses to examined whether the
odds ratio (OR) for depression would change based on the severity of
internet addiction and what factors were associated with internet ad-
diction. In one logistic regression analyses, we used severity of internet
addiction (reference: no addiction) as the independent variable, de-
pression as the dependent variable, and age, sex, anxieties, gaming
habit, smoking, and alcohol consumption as covariates. In the other two
logistic regression analyses, we examined the relationship of internet
addiction with mobile phone use and academic department (reference:
education department), with internet addiction as the dependent vari-
able and age, sex, anxieties, gaming habit, smoking, and alcohol con-
sumption as covariates.
In all tests, the level of statistical significance was defined as
α = 0.05. Statistics were analyzed using IBM SPSS Statistics Version 24
(IBM Japan, Tokyo).
3. Results
Responses were obtained from 4490 participants (response rate:
85.3%). Valid responses were obtained from 3251 participants (valid
response rate: 61.8%).
As shown in Table 1, mean overall IAT score was 41.5 ± 14.5; mild
and severe internet addiction was identified in 43.9% and 4.6% of the
university students, respectively. Mean overall CES-D score was
17.1 ± 9.5. Mean CES-D scores for the no addiction, mild addiction,
and severe addiction groups were 14.1 ± 8.3, 19.6 ± 9.1, and
26.7 ± 10.9, respectively. The percentage of participants with internet
addiction was significantly higher among men than among women
(n = 783 (50.6%) vs. n = 793 (46.6%); p < 0.01). The percentage of
participants with anxieties (relationships with friends, finances, or
academics) and gaming habit increased significantly with increasing
severity of internet addiction (p < 0.01). Internet addiction was not
significantly associated with age, alcohol consumption, or smoking
(p = 0.82, 0.11, and 0.36, respectively). Table 2 shows the odds ratios
and 95% confidence intervals for depressive symptoms according to
severity of internet addiction. The adjusted ORs in each model showed
no significant differences. As shown in Fig. 1, the OR for internet ad-
diction according to mobile phone use was highest for message boards
(OR=3.74, 95% confidence interval (CI)=2.53−5.53) and lowest for
the instant messaging app LINE (OR=0.59, 95% CI=0.49−0.70).
Fig. 2 shows that the OR for internet addiction according to academic
department (reference: education department) was highest for the hu-
manities department (OR=1.59, 95% CI=1.18−2.16), followed by the
fine arts department (OR=1.55, 95% CI=1.07−2.23) and the eco-
nomics department (OR=1.51, 95% CI=1.16−1.97).
T. Seki, et al. Journal of Affective Disorders 256 (2019) 668–672

Table 1
Characteristics of participants according to severity of internet addiction.
No addiction (n = 1675) Mild addiction (n = 1426) Severe addiction (n = 150) Overall (N = 3251) P value

IAT score, mean ± SD 29.9 ± 5.5 51.0 ± 7.9 78.9 ± 8.3 41.5 ± 14.8 <0.01a
CES-D score, mean ± SD 14.1 ± 8.3 19.6 ± 9.1 26.7 ± 10.9, 17.1 ± 9.5 <0.01a
Age, mean ± SD 20.9 ± 2.2 20.9 ± 2.1 20.9 ± 2.1 20.9 ± 2.2 0.82a
Men, n (%) 765 (45.7) 700 (49.1) 83 (55.3) 1548 (47.6) 0.025b
Anxiety about relationships with friends, n (%) 747 (44.6) 846 (59.3) 105 (70.0) 1698 (52.2) <0.01b
Anxiety about finances, n (%) 353 (22.1) 442 (31.0) 70 (46.7) 865(26.6) <0.01b
Anxiety about academics, n (%) 625 (37.3) 752 (52.7) 79 (52.7) 1456 (44.8) <0.01b
Gaming habit, n (%) 249 (14.9) 322 (22.6) 47 (31.3) 618 (19.0) <0.01b
Alcohol consumption, n (%) 1319 (78.7) 1134 (79.5) 113 (75.3) 2556 (78.6) 0.11b
Smoking, n (%) 125 (7.5) 105 (7.4) 6 (4.0) 236 (7.3) 0.36b

IAT: Internet Addiction Test; SD: standard deviation.

a
Kruskal–Wallis test.
b
Spearman's χ2 test.

Table 2 university students in Iran (Bahrainian et al., 2014), and 2.0% among
Odds ratio and 95% confidence intervals of depressive symptoms according to junior high school students in Japan (Kawabe et al., 2016). Compared
severity of internet addiction. with these results, the prevalence of severe internet addiction among
No addiction Mild addiction Severe addiction Japanese university students in this study is high.
In terms of the relationship between internet addiction and de-
No (%) 1675 (51.5) 1426 (43.9) 150 (4.6) pression, some previous studies have reported that people with de-
Model 1 1.00 3.17 (2.74–3.68) 9.08 (5.84–14.11)
pression or other mental health problems are susceptible to addiction to
Model 2 1.00 3.21 (2.77–3.72) 9.33 (6.00–14.52)
Model 3 1.00 2.87 (2.45–3.36) 7.31 (4.61–11.61) gaming and mobile phones (Choo et al., 2010; Elhai et al., 2017), while
other studies have reported that depression is a major factor in sus-
Model 1: No adjustment; Model 2: Adjustment for age and sex; Model 3: Model ceptibility to internet addiction (Kuss et al., 2014; Young and Rodgers,
2 + Adjustment for anxieties, gaming habit, smoking, and alcohol consump- 1998). A study in which pharmacotherapy was given to participants
tion. with depression and internet addiction found that internet addiction
improved (Kuss and Lopez-Fernandez, 2016). However, longitudinal
4. Discussion studies on internet addiction have noted that participants with high
scores on internet addiction measures are prone to develop more severe
The results of this study suggest that as internet addiction becomes internet addiction and also to have mental health problems such as
more severe, its relationship with depression becomes stronger. In ad- depression (Ko et al., 2014; Lau et al., 2017; Strittmatter et al., 2016).
dition, the use of message boards on mobile phones was suggested to be Continued use of the internet for health purposes is also reported to be
strongly associated with internet addiction. Belonging to the huma- associated with more severe depression (Bessiere et al., 2010). In ad-
nities department, the fine arts department, or the economics depart- dition, internet addiction is significantly associated with dissociation
ment was also suggested to be associated with internet addiction. and other forms of reduced sociality (Canan et al., 2012). The above
The prevalence of severe internet addiction in this study was slightly studies suggest a vicious cycle in which depression and internet ad-
lower than the figure of 6.1% reported among university students by diction enhance each other as follows: people rely on the internet to
the MIC (2013). This disparity is possibly due to overestimation of in- relieve daily stress, causing them to use the internet excessively, thus
ternet addiction in the MIC study, which was a panel study of internet causing them to be less social; the resulting deterioration of inter-
users. As indicated by Kuss et al. (2014), there is no gold standard personal relationships in the real world and on the internet causes
measure of internet addiction. Consequently, the prevalence of internet further stress, which exacerbates depression, which people try to relieve
addiction varies greatly among the plethora of addiction measures used by burying themselves in the internet.
and prevalence rates are generally not comparable across studies. Pre- Male sex is a reported risk factor for internet addiction (Ostovar
vious studies that used an IAT score of 70 as a cutoff for severe internet et al., 2016; Tsai et al., 2009). We also found that the percentage of
addiction have reported internet addiction rates of 2.5% among high participants with an internet addiction was significantly higher among
school students in South Korea (Choi et al., 2009), 2.2% among men than among women. Previous studies have indicated that men are

Fig. 1. Odds ratios of internet addiction according to mobile phone/smartphone use among university students.

670
T. Seki, et al.
Fig. 2. Odds ratio of internet addiction according to university department (reference: education department).
more susceptible to internet addiction than women because men are
more likely to play video games (Kawabe et al., 2016; Ko et al., 2005).
In addition, internet gaming is considered a risk factor for internet
addiction (Kuss et al., 2013; Morrison and Gore, 2010). The above
suggests that sex differences in internet addiction may be affected by
sex differences in the use of addictive content.
In addition to internet gaming, social networking is also considered
a risk factor for internet addiction (Kuss et al., 2013). The desire to
maintain connections formed on social media may lead to excessive
social networking (Griffiths, 2013). In the present study, message board
use was suggested to pose a particular risk of internet addiction,
whereas the use of LINE was suggested to potentially reduce the risk of
internet addiction. A previous study found that its internet addiction
group included a significantly high percentage of participants who used
chat/community websites for long periods (Morrison and Gore, 2010).
Another study reported that online communication with friends and
family reduces depression, meaning that the internet can help to
strengthen social connections (Bessiere et al., 2010). Together, these
findings suggest that the anonymity and interactions with large num-
bers of people involved in message boards can easily degrade online
relationships (e.g., due to online abuse), and attempts to relieve the
resulting stress lead to further addiction. In contrast, LINE involves
communication with friends and family, which is surmised to relieve
stress and yield other positive effects.
A 2016 survey on university students’ learning conducted by the
National Institute for Educational Policy Research (NIER) compared
weekly study time by major among first-year and second-year students,
who spend long periods of time in classes. Students in STEM fields
(science, technology, engineering, and mathematics) were found to
spend relatively long periods of time in classes as well as on preparation
and review. In contrast, students in liberal arts (fine arts, humanities,
etc.) were found to spend relatively little time in class, or on prepara-
tion or review (NIER, 2016). In addition, previous studies have reported
that boredom (i.e. excessive free time) leads to internet use and is
therefore a major risk factor in internet addiction (Biolcati et al., 2018;
Wegmann et al., 2018). In light of the above findings, the results of the
present study suggest that students in the economics department and
the humanities department have relatively large amounts of free time,
which tend to be spent on internet gaming and social media, which
increase susceptibility to internet addiction. In contrast, it is suggested
that students in the education department and the department of
671
Journal of Affective Disorders 256 (2019) 668–672
medicine spend relatively long periods of time studying outside of
classes (writing lab reports, etc.), thus reducing their internet use and
consequently reducing their susceptibility to internet addiction. In
order for students in liberal arts programs to increase engagement in
their studies and avoid the temptation of excessive internet use, we
suggest that universities take steps to make their educational programs
more rigorous and practical. For example, because humanities depart-
ments include a number of fields of research, such as linguistics, an-
thropology, and historical science, it would be reasonable to allocate
more of a student's time to research, academic writing, gaining quali-
fications, or attending symposia.
5. Limitations
Firstly, because this study had a cross-sectional design, we cannot
determine any cause or effect regarding the results. Secondly, the study
was conducted at a single university, so the participants may not be
representative of the population of Japanese university students
overall. Thirdly, the low valid response rate of approximately 50% in-
dicates possible selection bias. Fourthly, because this study involved a
questionnaire survey, respondents may have underreported informa-
tion that would cast them in a bad light. Lastly, because the online
services available to us change greatly every year, the results may not
sufficiently reflect the current internet environment.
6. Conclusion
The results of this study suggest a relationship between internet
addiction and depression among Japanese university students. Our re-
sults also indicate that internet addiction is associated with mobile
phone use and academic department. In the future, following the same
group of participants over time may lead to a deeper understanding of
these results.
CRediT authorship contribution statement
Tomokazu Seki: Conceptualization, Data curation, Formal analysis,
Writing - original draft, Writing - review & editing. Kei Hamazaki:
Conceptualization, Data curation, Formal analysis, Writing - review &
editing. Takashi Natori: Conceptualization, Writing - review & editing.
Hidekuni Inadera: Data curation, Funding acquisition, Writing -
T. Seki, et al.
review & editing.
Acknowledgements
We are grateful to Ms. Nozomi Kawaguchi, Ms. Fumie Ohno, Dr.
Mika Kigawa, Dr. Zheng-Guo Cui, and Dr. Ryoko Morozumi of the
University of Toyama for technical assistance.
Conflict of interest
All authors declare that there are no conflicts of interest associated
with this publication and there has been no significant financial support
for this work that could have influenced its outcome.
Funding
This work was supported by intramural grants-in-aid for scientific
research. The funding sources had no role in study design; in the col-
lection, analysis and interpretation of data; in the writing of the report;
and in the decision to submit the article for publication.
Supplementary materials
Supplementary material associated with this article can be found, in
the online version, at doi:10.1016/j.jad.2019.06.055.
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