Association of internet addiction with depression, anxiety, stress, and the quality of sleep: Mediation analysis approach in Serbian medical students

Exponential Internet growth, despite functional use in human communication and useful impact on the technological development of the society, has nevertheless demonstrated some downsides in recent years. A growing body of evidence shows both linear and/or nonlinear association between excessive Internet use (e.g., Internet addiction (IA)) and depression followed by depression-related psychopathology (e.g., anxiety, stress, and sleep quality). Some academic groups, such as medical students, have demonstrated to be at high risk for both IA and depression development. However, little is known whether the association between IA and depression is bi-directional or unidirectional, and to what extent the IA-depression relationship is mediated by anxiety, stress, and the quality of sleep. The present cross-sectional study investigated behavioral mechanisms underlying the IA-depression association, mediated by anxiety, stress, and the quality of sleep in a sample of Serbian medical students (N = 161). Participants filled out paper-and-pen questionnaires including the Internet Addiction Test (IAT); self-report questionnaires of Internet use; Depression, Anxiety and Stress scales (DASS-21), and the Pittsburgh Sleep Quality Index (PSQI). We provide strong evidence that IA predicts depression and vice versa clarifying a bi-directional path; however, whereas the IA-depression association was partially mediated by anxiety and stress, the depression-IA path was not intervened by mediators. In addition, the IA-quality of sleep path was fully mediated by anxiety. These results provide evidence for a bi-directional hybrid path between IA and depression, highlighting the mediation role of anxiety and stress. This study may contribute to the academic community by improving mental health prevention programs for medical students.