Skip to main content

Internet addiction and relationships with depression, anxiety, stress and academic performance among Egypt pharmacy students: a cross-sectional designed study


Background and Aims

Pharmacy students represent the future of healthcare professionals and with daily use of the internet for different activities has made internet addiction (IA) of a growing concern. The main objectives of this study were to 1) assess internet addiction among pharmacy undergraduate students as well as factors associated with it; 2) assess the relationships between internet addiction and common mental disorders (depression, anxiety, and stress), in addition to academic performance and body mass index factors.


We utilized a cross-sectional questionnaire that was conducted among 808 students of Egypt university pharmacy students across the country. The surveys used included: Young Internet Addiction Test (YIAT) and the Depression Anxiety Stress Scales (DASS 21).


YIAT average score was 44.75 (19.72%); prevalence rate of potential IA was 311 (38.5%) with no gender significant difference. We couldn’t detect any type of correlation between potential IA and GPA. However, a robust correlation was found between internet addiction vs depression, anxiety and stress collectively.


Internet addiction is usually associated with mental related disorders thus it is of paramount important to identify it among students. Different therapeutic interventions could include management to IA and common psychological disorders such as depression, anxiety, and stress.

Peer Review reports


Internet usage has grown to more than 2.5 billion users worldwide [1] affecting mainly the young generation [2]. During the last decade, internet has become the essential tool for people to find information and communicate with each other. Yet, some people became addicted to the internet especially the young adults [3]. Internet addiction is defined as the excessive use of the internet in an uncontrolled time consuming manner which leads to timelessness and disruption of people's lives [4]. Such behavior may lead to psychological, social or personal adversities [5].

Some diagnostic criteria for internet addiction was developed by Yong et al. [6] to assess the core symptoms associated with internet addiction such as tolerance, impairment of control, preoccupation and excessive online time. The prevalence may vary according to age, sex and ethnicity, and is more common among college students [7]. A high prevalence of personality problems is observed in internet-addicted people [8, 9]. Mood disorders, poor sleep quality, impulsivity, low self -esteem, suicide, decreased physical activity, and health problems (migraine, back pain, obesity) are also reported to be associated with extensive use of internet [10,11,12,13].

According to World Health Organization (WHO), psychological disorders are one of the disability causes in the world [14]. Mental health problems include depression, anxiety and stress. Each one of them is considered a threat to the public health especially in the young population. Stress is considered a threat to the well- being of humans. It occurs whenever life's burdens exceed the person ability to withstand them resulting in mental and physiological changes that my alter their health and causes many diseases [15]. Anxiety, on the other hand, is seen as both a psychological and a physiological state as it affects the brain, physical activity, emotions, and behavior. Uneasiness, fear or worry all together are the consequences of stress [16]. If these symptoms persist, the person is at risk of developing depression. Depression is the feeling of guilt, worthlessness, irritability, restlessness and loss of interest in life pleasures. [17]

University students undergo a transitory period from being teenagers to become adults. Such transition can cause a lot of stress, depression and anxiety to some of them. A study conducted by Kavithah et al. and Amr et al. [18, 19] predicted the prevalence rates of depression and anxiety among students in Al-Mansura University, 28.3% and 21.2% respectively. Likewise, data were presented by Ibrahim et al. [20] suggested that 37.6% of Asyut University students suffered from moderate or severe depressive symptoms. Furthermore, a study was carried out in Saudi Arabia predicted the depression, anxiety and stress prevalence rates among its university students 48.1%, 58.9%, and 40.4% respectively [21]. Previous research studies assessed the correlation between emotional status and different factors may affect students such as weight, academic performance, internet addiction, and gender difference.

Many research studies addressed academic life stress among undergraduates as one of the causes of mental disorders. [22,23,24,25,26,27,28,29] It is crucial to determine the risk factor and prevalence of stress that medical students encounter almost every day in which affects their mental health, academic performance, and consequently their physical health. Abdulghani et al. [22] reported high stress rates associated with physical problems among medical students especially female students. Similarly, another study was carried out by [30] confirmed that stress and anxiety prevalence rates are higher in medical students in comparison with the nonmedical ones.

Previous research studies discussed the relation between internet addiction and different mental disorders. A study was conducted in Lebanon revealed a significant correlation between internet addiction and DASS scores, where IAS was 16.8% among college students [31]. Another study was conducted in Turkey also revealed that 27% of undergraduate medical students were addicted to internet [32].

Among the major public health concerns that require a thorough attention are overweight and obesity. Unnecessary fats deposited in the body lead to such conditions. Thus, calculating the measure of obesity is crucial to prevent any health problems. For example, obesity is defined as using the body mass index (BMI) equation, where a person’s weight (in kilograms) or (in pounds) and his or her height (in meters) or (in inches) plugged in an equation to determine whether he or she is obese or overweight. Usually a person with a body mass index equals to 30 is obese, while the person with a BMI equals to or more than 25 is overweight. [33]

According to the World Health Organization (WHO), obesity has now become the highest prevalence in all the World Health Organization regions not just in the Americas. Statistics reveal that 62% of adults are overweight or obese. This epidemic did not only affect adults but also children and adolescents, in which 20% to 25% are either overweight or obese. Lung disease, diabetes mellitus, type-2 diabetes, sleep difficulty, cardiovascular diseases, musculoskeletal disorders, and low self-esteem are all consequences to overweight and obesity. In addition, overweight children have a higher risk of staying overweight or obese as adults. [34]

The growth of obesity is also remarkable according to Centers for Disease Control and Prevention (CDC), 39.8% of adults above 20 has obesity (2015–2016), and 71.6% of adults aged above 20 suffer from overweight (2015–2016) (“Obesity and Overweight,” n.d.) in US. Previous studies have provided a comprehensive analysis of associations between obesity and different emotional status. Based on the global statistics on mental health, around 1-in-7 people in the world, which falls within (11–18%), suffer from one or more mental disorders. Worldwide, around one billion people in 2017 have experienced one. The prevalence in Egypt is 14.57% while in United States is 17.34% (2017). [34]

Eliacik et al. have claimed a relation between internet addiction and degree of obesity during adolescence [35]. It is well known that obese individuals are more prone to be depressed, have lower performance in school compared to healthy peers. [36]. Insomnia and short sleep duration is associated with high food intake and internet use [37, 38]. Sedentarism has been associated with excessive use of internet which is related to decreased energy expenditure or lower physical activity [39,40,41].

A study was conducted by (Peltzer et al., 2014) [42] to assess the prevalence of overweight and obese people among students enrolled in different universities in the world. The data suggested that Egyptian university students have higher rates of obesity especially females. Similarly, another study conducted in Saudi Arabia revealed high rates of overweight and obesity especially in the female group. [43] In addition, others have reported higher rates of obesity among male university students in Saudi Arabia. [44, 45]

Research has lately focused on the link between emotional status and obesity. Most of the researches done before that focused mainly on obesity and depression. However, other psychiatric morbidities, other than depression, should be taken into account. In Arab countries, recent studies from Egypt, Saudi Arabia, and United Arab Emirates reported high rates of anxiety and depression. The mental disorders in Egypt are associated with many factors such as demographic, social, behavioral and educational factors. Much of the literature suggested that Egyptian medical students are at higher risk of developing emotional status problems than any other groups. Academic stress is one of the risk factors they encounter every day. [17]

Our hypothesis was that internet addition is a serious problem among pharmacy students, examining its association with the emotional status is of great concern to take the proper measures to address this issue. Internet addiction may affect the emotional and mental status of students through depression, anxiety and stress and thus affect their overall academic performance and their career goals.

The objectives of this study are: 1) Assess potential internet addiction using (Kimberly S.Young, 1995) in pharmacy students among different universities in Egypt, as well as socio-demographic factors and other factors associated with it; 2) Assess the relationship between potential internet addiction and different common mental disorders such depression, anxiety, and stress among students using DASS as a valid questionnaire.


The objectives of this study are to determine prevalence and correlation of emotional status, body image and internet addiction with academic performance among Egyptian pharmacy students.


Study design and participants

The cross-sectional study conducted on pharmacy students in all grade levels during the academic year 2019–2020 (November 2019-May 2020). The mean age of students participated was 21.16 (1.64%).

Sample size

The study targeted pharmacy students in Egypt. The total number of students participated in the study is 808.

Study instruments

Students were asked to fill out on campus and online self-reported questionnaires which took approximately 10 min to answer and collected data on: demographics, anthropometrics, psychological assessment and internet addiction.

Demographic data

Age, gender, university, college, academic year, and grade /GPA performance.

Anthropometric measurements

The body weight in kilograms and height in meters reported by each participant. According to WHO, the body mass index was calculated as body weight in kg divided by height in m.2. BMI of 18.5 is classified as underweight and 25–29.9 is overw eight and BMI of 30 is considered as obese. [46]

Psychological assessment

Pharmacy students were subjected to the Arabic and English version of Depression Anxiety Stress Scales (DASS-21). It is composed of three-self report scales designed to measure the different emotional status. The 21 DASS questions were adjusted according to their importance and the Egyptian students’ culture. Each of the three DASS contains seven items, scored on a four- point scale to rate the extent to which participants have experiences each state over the past few weeks. Corresponding answers for each items are scored 0–3 as follow: 0 indicates " Did not apply to me at all" – 1 indicates "Applied to me to some degree, or some of the time" – 2 indicates " Applied to me to a considerable degree or a good part of time" – 3 indicates "Applied to me very much or most of the time".

Internet addiction diagnostic questionnaire

To test the extent of internet addiction among pharmacy students, the internet addiction diagnostic questionnaire (Kimberly S.Young, 1995) was used. The questionnaire consists of 20 questions that evaluate the symptoms on a five-point scale (0 = Does not apply, 1 = seldom, 2 = sometimes, 3 = often, 4 = often, 5 = always). The numbers for each response were added to determine the final score after all questions were answered. The higher the score, the greater the degree of addiction and concerns emerging from internet use.

We performed Cronbach’s alpha test validate the reliability of the questionnaires used. Alpha values for all questionnaires used were between 0.8–0.89, which means the internal consistency is good for all items in the questionnaires. (Table 1).

Table 1 Cronbach’s-Alpha values for the DASS-21 subscales and IAT

Statistical analysis

The statistical analysis was performed using SPSS software for Windows (version 20.0). At 0.05, the significance level was set. The mean and the standard deviation (SD) for continuous variables and percentage for categorical variables were used to summarize sample characteristics. Internet addiction users were categorized as normal or potential internet users. Multivariate analysis was necessary to determine the effect of multiple explicative explanatory variables and which of the explanatory factors act independently on the internet addiction.

Univariate analysis independent variables were conducted using the Chi-square independence tests or Fisher Exact test. Subsequently, logistic regression analysis was done with the dichotomized internet addiction as the dependent variable. According to the Enter method participants’ characteristics and scores that showed associations with p-value < 0.25 in univariate analysis, were candidates for the multivariate model. Collinearity among independent variables was verified, expressed as variance inflation factor.

Ethical considerations

Before study start-up, permission was taken from the ethics committee of the Faculty of Pharmacy at the British University in Egypt. The participants were briefed about the study rationale and were reassured about the confidentiality safeguards for their personal information and responses. The answered survey submission was considered as consent for study participation. Respondents’ participation was completely consensual, anonymous and voluntary.

All methods were performed in accordance with the relevant guidelines and regulations by the Research Ethics Committee, Faculty of Pharmacy, the British University in Egypt, Cairo, Egypt (protocol # EX-1502). Informed consent was obtained from all participants who filled out the online questionnaires during this study.


Subjects’ characteristics

During the course of this study, a total of 808 participants completed the devised online survey questions. Among these, the average age (measured in years) was 21.6 ± 1 and 594 students (73.5%) were females. When identifying the academic performance, only 15 students (1.9%) got a GPA of A (3.6 out of 4 and higher) while 657 (81.3%) got a GPA of B and B + (Table 2). With regards to the students’ BMI, results disclosed that 509 students have normal BMI (63%) while 274 students have a BMI of overweight and higher (33.9%).

Table 2 Demographic characteristics of sample population (N = 808)

Emotional status and internet addiction among Egypt pharmacy students

The mean score of DASS depression scale was 8.85 (5.26%). In particular, 20.7% of the students reported an extremely severe depression status, while 23.6% displayed a normal status (Table 3). With respect to the level of anxiety, 20.5% of the students reported an extremely level of anxiety, 12.1% reported a severe anxiety level, 15.2% a moderate level while 34.9% reported a normal level of anxiety (Table 3). Regarding stress level among students, 8% of the student reported an extremely severe level of stress, 14.1% severe level of stress, 19.7% reported a moderate level of stress and 44.1% reported to have a normal level (Table 3). On the other hand, IAT showed that 38.5% of the students have a potential for internet addiction which represents a high risk factor that may affect emotional status, social activities and academic performance among pharmacy students in Egypt (Table 3).

Table 3 Number and percentage of students in each category of the applied questioners: DASS and IAT (N = 808)

Univariate analysis

The univariate analysis showed that potential internet addiction was not significantly different between males and females (p-value = 0.297). GPA, depression, anxiety and stress were significantly related to potential internet addiction (p-value = 0.03, < 0.001, < 0.001, < 0.001 respectively); however, neither age nor BMI, was significantly related to internet use (Table 4).

Table 4 Univariate analysis of the relationships between potential internet addiction and participants’ characteristics (N = 808)

GPA is the average of all the grades students receive during their undergraduate study with a GPA of 4.0 meaning that the student has earned all As in his or her classes.

IA and depression, anxiety and stress

IA was clearly associated with all the three variables of DASS 21 score. In bivariate analysis, there was a strong positive correlation between IAT scores and depression, anxiety and stress scores. Moreover, depression, anxiety and stress scores also correlated positively with each other (Table 5). On the other hand, a weak negative correlation was observed between IAT and GPA.

Table 5 Correlation analysis between population characteristics and IAT score

Logistic regression model

The logistic regression model showed that age, depression and stress were significantly associated with internet addiction. In other words, it was found that the psychological variables of depression and stress, but not anxiety, were significant predictors of IA. Also, GPA score was observed as a predictor for IA (Table 6).

Table 6 Multiple logistic regression for the predictors of internet addiction in pharmacy students


The goal of this study was to find out how common potential IA is among Egyptian university pharmacy students, to assess correlations between IA and participant characteristics (primarily age, gender, GPA, and BMI), and to look into probable links between IA, anxiety, depression, and stress. Our research found that IA was unrelated to gender, age, or GPA, and that 38.5 percent of individuals had IA symptoms, with a mean YIAT score of 44.75. These findings are similar to those previously published for young adults. [47, 48] In addition, different research had been performed in Asia showed such significance. [49, 50] Some research mentioned that IA incidence turned into better in males [51], while others did not find difference between genders [52]. Some studies have shown that internet addiction could affect students' studying performance as students tend to spend much of their time using the internet.

[53,54,55,56]. However, that was not the case in our finding as we found a weak negative correlation between IA and GPA, which contradicts others’ findings. This could be explained that the time of internet use reported by the students in this study could have a big part of it invested in their studies, meaning that they spend more time on the internet to get their projects or assignments done.

One of the objectives of the present research was to study the impact of gender on the scores of internet addiction behavior. Schere et al. reported that male gender is a significant predictor of the internet addiction. However, we have reported that gender is not correlated to IA. This could be explained that maybe decades ago there was a difference between male and female use of internet but looks like there is no difference these days.

When analyzing despair, our effects additionally confirmed that 20.7% of individuals suffered from clinically giant stage of despair and a sturdy correlation became discovered among ability net dependency and despair. Depression occurrence stated on this examine is regular with the character of the pattern studied (younger students) and is similar to what's stated in teens elderly 18 to 23 [57]. Anxiety is commonly taken into consideration terrible results or headaches of net addiction [17].

Detecting elements related to educational overall performance in college students is of huge significance due to the fact an inverse relation exists among educational overall performance, stress, depression, tension and internet addiction [58].

Strength and limitations

Our findings must be viewed in light of the study's methodology and limitations. We based our findings on self-reported behaviors. The most often used instruments for measuring physical and mental health evaluation subjective problems are self-reporting questionnaires. [59,60,61] The self-report method represents the interviewee's point of view and may be more appropriate for reporting.

The questionnaires were designed in a scale pattern to encourage answer and with a shorter interview period to prevent disrupting the students, in the hopes that the questionnaire's simplicity would make it easier for respondents to provide correct data. Notwithstanding these limitations, the findings observed in this study are important and warrant further investigations.

To the best of our knowledge, this is the first study to examine the relationship between three psychosocial stressors in Egyptian university pharmacy students: anxiety, depression, stress, and IA. Because this addiction frequently coexists with other psychological issues, and IA could be one visible tip of a complicated iceberg, our findings highlight the need of identifying and providing assistance to students with possible IA.


Internet addiction is usually associated with mental related disorders thus it is of paramount important to identify it among students. Different therapeutic interventions could include management to IA and common psychological disorders such as depression, anxiety, and stress. Based on that it is advised to increase awareness among students on the internet associated health risks, which could affect their mental health status. Moreover, universities and colleges should offer psychiatrist office services to provide continuing counseling for students. Further studies in this field should throw light on relation between IA and drug abuse and other illicit drug consumption among college students.

Availability of data and materials

The datasets generated and/or analyzed during the current study are not publicly available due to patients’ privacy but are available from the corresponding author on reasonable request.


  1. - e Marketer. (n.d.). Social Networking Reaches Nearly One in Four Around the World - eMarketer. Retrieved August 15, 2020, from

  2. Christakis DA, Moreno MA. October 5). Trapped in the net: Will internet addiction become a 21st-century epidemic? Arch Pediatr Adolesc Med. 2009;163:959–60.

    Article  PubMed  Google Scholar 

  3. Ozcinar Z. The relationship between internet addiction and communication, educational and physical problems of adolescents in north cyprus. Aust J Guid Couns. 2011;21(1):22–32.

    Article  Google Scholar 

  4. Weinstein A, Lejoyeux M. August). Internet addiction or excessive internet use. Am J Drug Alcohol Abuse. 2010;36:277–83.

    Article  PubMed  Google Scholar 

  5. - Fatehi, F. et al. (n.d.). Quality of Life in Medical Students With Internet Addiction - PubMed. Retrieved July 26, 2020, from

  6. - Kimberly S.Young. (n.d.). NetAddiction | Internet Addiction Test (IAT). Retrieved June 3, 2020, from

  7. Pujazon-Zazik M, Park MJ. To Tweet, or Not to Tweet: Gender Differences and Potential Positive and Negative Health Outcomes of Adolescents’ Social Internet Use. American Journal of Men’s Health. 2010;4(1):77–85.

    Article  PubMed  Google Scholar 

  8. Dalbudak E, Evren C, Aldemir S, Evren B. The severity of Internet addiction risk and its relationship with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students. Psychiatry Res. 2014;219(3):577–82.

    Article  PubMed  Google Scholar 

  9. Floros G, Siomos K, Stogiannidou A, Giouzepas I, Garyfallos G. The relationship between personality, defense styles, internet addiction disorder, and psychopathology in college students. Cyberpsychol Behav Soc Netw. 2014;17(10):672–6.

    Article  PubMed  Google Scholar 

  10. An J, Sun Y, Wan Y, Chen J, Wang X, Tao F. Associations between problematic internet use and adolescents’ physical and psychological symptoms: Possible role of sleep quality. J Addict Med. 2014;8(4):282–7.

    Article  PubMed  Google Scholar 

  11. Kim JH, Lau CH, Cheuk KK, Kan P, Hui HLC, Griffiths SM. Brief report: Predictors of heavy Internet use and associations with health-promoting and health risk behaviors among Hong Kong university students. J Adolesc. 2010;33(1):215–20.

    Article  PubMed  Google Scholar 

  12. Lin IH, Ko CH, Chang YP, Liu TL, Wang PW, Lin HC, Yen CF. The association between suicidality and Internet addiction and activities in Taiwanese adolescents. Compr Psychiatry. 2014;55(3):504–10.

    Article  PubMed  Google Scholar 

  13. Naseri L, Mohamadi J, Sayehmiri K, Azizpoor Y. erceived social support, self-esteem, and internet addiction among students of Al-Zahra University, Tehran, Iran. Iran J Psychiatry Behav Sci. 2015;9(3):e421.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Noorbala AAFS, Kamali K, Bagheri Yazdi SA, Hajebi A, Mousavi MT, Akhondzadeh S, Faghihzadeh E, Nouri B. Mental health survey of the adult population of Iran in 2015. Arch Iran Med. 2017;20(3):128–34.

    PubMed  Google Scholar 

  15. - Cohen S, Kessler RC, Gordon LU. Strategies for measuring stress in studies of psychiatric and physical disorders. Measuring stress: A guide for health and social scientists. 1995. pp. 3–26.

  16. Wahed WYA, Hassan SK. Prevalence and associated factors of stress, anxiety and depression among medical Fayoum University students. Alexandria Journal of Medicine. 2017;53(1):77–84.

    Article  Google Scholar 

  17. Wahed WYA, Hassan SK. Prevalence and associated factors of stress, anxiety and depression among medical Fayoum University students. Alexandria Journal of Medicine. 2017;53(1):77–84.

    Article  Google Scholar 

  18. M Amr 2008 Does Gender Predict Medical Students’ Stress in Mansoura, Egypt? Med Educ Online 13

  19. - D. Kavitha. Way to Develop the Faculty Competence. Asian J. Nur. Edu. & Research 1(2): April-June 2011; Page 45–47

  20. Ibrahim AK, Kelly SJ, Glazebrook C. Analysis of an Egyptian study on the socioeconomic distribution of depressive symptoms among undergraduates. Soc Psychiatry Psychiatr Epidemiol. 2012;47(6):927–37.

    Article  PubMed  Google Scholar 

  21. AlQahtani AA, Nahar S, AlAhmari S, AlQahtani KS. Association between obesity and mental disorders among male students of King Khalid University, Abha. Saudi Arabia Saudi Journal of Obesity. 2015;3(2):48.

    Article  Google Scholar 

  22. Abdulghani HM, AlKanhal AA, Mahmoud ES, Ponnamperuma GG, Alfaris EA. Stress and its effects on medical students: A cross-sectional study at a college of medicine in Saudi Arabia. J Health Popul Nutr. 2011;29(5):516–22.

    Article  PubMed  PubMed Central  Google Scholar 

  23. - Vella Durai N.. A Study to Assess the Effectiveness of Teaching Programme on Social Anxiety among Adolescents in Selected Schools at Puliangudi, Thirunelveli District, Tamilnadu. Asian J. Nur. Edu. & Research 1(2): April-June 2011; Page 68–70.

  24. - C. Elizabeth Jebakani . Effectiveness of Reminiscence Therapy on Stress and Coping Strategies among Elderly. Asian J. Nur. Edu. and Research 1(3): July-Sept. 2011; Page 73–75

  25. - Sasmita Das, Prasanna Baby. Perceived stress and its association with selected factors among nursing students in a baccalaureate programme. Asian J. Nur. Edu. and Research 2(4): Oct-Dec. 2012; Page 215–217

  26. - R. Naganandini. Effectiveness of Structured Stress Management, Module on Stress of Primi Mothers During, Early Postnatal period in a selected Private Hospital, Salem, Tamil Nadu. Asian J. Nur. Edu. and Research 2(4): Oct-Dec. 2012; Page 220–221

  27. - P. Radha. Stress Management. Asian J. Management 2(4): Oct.-Dec., 2011 page 202–203.

  28. - K. Sasikala. Tips To Defuse Anger in Workplace. Asian J. Nur. Edu. & Research 1(1): Jan.-March 2011; Page 23–24.

  29. - J. Violet Jayamani. Orthorexia Nervosa. Asian J. Nur. Edu. & Research 1(2): April-June 2011; Page 48–50

  30. Al-Dabal BK, Koura MR, Rasheed P, Al-Sowielem L, Makki SM. A comparative study of perceived stress among female medical and non-medical university students in Dammam, Saudi Arabia. Sultan Qaboos Univ Med J. 2010;10(2):231–40.

    PubMed  PubMed Central  Google Scholar 

  31. Younes F, Halawi G, Jabbour H, Osta N. El, Karam L, Hajj A, Khabbaz LR. Internet addiction and relationships with insomnia, anxiety, depression, stress and self-esteem in university students: A cross-sectional designed study. PLoS ONE. 2016;11(9):e0161126.

    Article  Google Scholar 

  32. Yücens B, Üzer A. The relationship between internet addiction, social anxiety, impulsivity, self-esteem, and depression in a sample of Turkish undergraduate medical students. Psychiatry Res. 2018;267:313–8.

    Article  PubMed  Google Scholar 

  33. De Onis M, Onyango A. W., Borghi E, Siyam A, Nishida C, Siekmann J. Development of a WHO growth reference for school-aged children and adolescents. Bull World Health Organ. 2007;85(9):660–7.

    Article  PubMed  PubMed Central  Google Scholar 

  34. - CDC. (n.d.). Strategies to Prevent Obesity | Overweight & Obesity | CDC. Retrieved December 11, 2019, from

  35. Eliacik K, Bolat N, Koçyiğit C, Kanik A, Selkie E, Yilmaz H, Catli G, Dundar NO, Dundar BN. Internet addiction, sleep and health-related life quality among obese individuals: a comparison study of the growing problems in adolescent health. Eat weight disorder. 2016;21(4):709–17.

    Article  Google Scholar 

  36. - Facts about childhood obesity. www.healthykidshealthy 2009–06.pdf. (accessed May 2016)

  37. Burt J, Dube L, Thibault L, Gruber R. Sleep and eating in childhood: a potential behavioral mechanism underlying the relationship between poor sleep and obesity. Sleep Med. 2014;15:71–5.

    Article  PubMed  Google Scholar 

  38. Lin YH, Gau SS. Association between morningnesseveningness and the severity of compulsive Internet use: the moderating role of gender and parenting style. Sleep Med. 2013;14:1398–404.

    Article  PubMed  Google Scholar 

  39. Matusitz J, McCormick J. Sedentarism: the effects of Internet use on human obesity in the United States. Soc Work Public Health. 2012;27:250–69.

    Article  PubMed  Google Scholar 

  40. Davis RE, Cole SM, Blake CE, McKenney-Shubert SJ, Peterson KE. Eat, play, view, sleep: exploring Mexican American mothers’ perceptions of decision making for four behaviors associated with childhood obesity risk. Appetite. 2016.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Li M, Deng Y, Ren Y, et al. Obesity status of middle school students in Xiangtan and its relationship with Internet addiction. Obesity (Silver Spring). 2014;22:482–7.

    Article  Google Scholar 

  42. Peltzer K, Pengpid S, Alafia Samuels T, Özcan NK, Mantilla C, Rahamefy OH, Gasparishvili A. Prevalence of overweight/obesity and its associated factors among university students from 22 countries. Int J Environ Res Public Health. 2014;11(7):7425–41.

    Article  PubMed  PubMed Central  Google Scholar 

  43. - Al-Nozha, M. M., Al-Mazrou, Y. Y., Al-Maatouq, M. A., Arafah, M. R., Khalil, M. Z., Khan, N. B., … Nouh, M. S. (2005). Obesity in Saudi Arabia. Saudi Medical Journal, 26(5), 824–829.

  44. - Al-Rethaiaa, A. S., Fahmy, A. E. A., & Al-Shwaiyat, N. M. (2010). Obesity and eating habits among college students in Saudi Arabia: A cross sectional study. Nutrition Journal, 9(1).

  45. Chandrakala M. Lifestyle Modification to Combat Adolescent Obesity. Asian J Nur Edu Research. 2011;1(3):82–4.

    Google Scholar 

  46. Balakrishnan P. Anthropometric Measurements. Asian J Nur Edu Research. 2012;2(1):40–2.

    Google Scholar 

  47. Kawabe K, Horiuchi F, Ochi M, Oka Y, Ueno S. Internet addiction: Prevalence and relation with mental states in adolescents. Psychiatry Clin Neurosci. 2016;70(9):405–12.

    Article  PubMed  Google Scholar 

  48. Ko CH, Yen JY, Yen CF, Chen CS, Chen CC. January). The association between Internet addiction and psychiatric disorder: A review of the literature. Eur Psychiatry. 2012;27:1–8.

    Article  CAS  PubMed  Google Scholar 

  49. Anand N, Thomas C, Jain PA, Bhat A, Thomas C, Prathyusha PV, Cherian AV. Internet use behaviors, internet addiction and psychological distress among medical college students: A multi centre study from South India. Asian J Psychiatr. 2018;37:71–7.

    Article  PubMed  Google Scholar 

  50. Tateno M, Teo AR, Shiraishi M, Tayama M, Kawanishi C, Kato TA. Prevalence rate of Internet addiction among Japanese college students: Two cross-sectional studies and reconsideration of cut-off points of Young’s Internet Addiction Test in Japan. Psychiatry Clin Neurosci. 2018;72(9):723–30.

    Article  PubMed  Google Scholar 

  51. Ni X, Yan H, Chen S, Liu Z. Factors influencing internet addiction in a sample of freshmen university students in China. Cycberpsychol Behav. 2009;12(3):327–30.

    Article  Google Scholar 

  52. - Barber A (1997). Net‟s educational value questioned. USA Today, March 11:4D.

  53. - Brady K (1996). Dropout rise a net result of computers. The Buffalo News, A1

  54. Griffith M. Does internet and computer „addiction“ exist? Some case study evidence.cyber Psychol. Behav. 2000;3:211–8.

    Google Scholar 

  55. Young KS. Internet addiction: The emergence of a new clinical disorder. Cyber Psychol Behav. 1998;1:237–44.

    Article  Google Scholar 

  56. Macur M, Király O, Maraz A, Nagygyörgy K, Demetrovics Z. Prevalence of problematic internet use in Slovenia. Zdravstveno Varstvo. 2016;55(3):202–11.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Bahranian SA, Haji Alizadeh K, Raeisoon MR, Hashemi O, Khazaee A. Relationship of Internet addiction with self-esteem and depression in university students. J Prev Med Hyg. 2014;55(3):86–9.

    Google Scholar 

  58. Lodha P. Internet Addiction, Depression, Anxiety and Stress among Indian Youth. Indian J Ment Health. 2018;5(4):427.

    Article  Google Scholar 

  59. Fischer A, Fischer M, Nicholls RA, Lau S, Poettgen J, Patas K, Gold SM. Diagnostic accuracy for major depression in multiple sclerosis using self-report questionnaires. Brain Behav. 2015;5(9):e00365.

    Article  Google Scholar 

  60. - Ortega-Montiel, J., Posadas-Romero, C., Ocampo-Arcos, W., Medina-Urrutia, A., Cardoso-Saldaña, G., Jorge-Galarza, E., & Posadas-Sánchez, R. (2015). Self-perceived stress is associated with adiposity and atherosclerosis. the GEA Study. BMC Public Health, 15(1).

  61. White K, Scarinci I. C. Comparison of self-rated health among Latina immigrants in a Southern U.S. City and a national sample. Am J Med Sci. 2015;350(4):290–5.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


Not applicable.


Open access funding provided by The Science, Technology & Innovation Funding Authority (STDF) in cooperation with The Egyptian Knowledge Bank (EKB).

Author information

Authors and Affiliations



Conceived and designed the experiments: Michael Ibrahim and Moustafa Sayed. Performed the experiments:Michael Kamal Ibrahim  and Moustafa Sayed. Analyzed the data: Michael Kamal Ibrahim and Moustafa Sayed. Wrote the paper: Christina Medhat Naiim, Marina Aboelsaad  and Moustafa Sayed. The author(s) read and approved the final manuscript.

Corresponding author

Correspondence to Moustafa Sayed.

Ethics declarations

Ethics approval and consent to participate

All procedures were ethically approved by the Research Ethics Committee, Faculty of Pharmacy, the British University in Egypt, Cairo, Egypt (protocol # EX-1502). Informed consent was obtained from all participants who filled out the online questionnaires during this study.

Consent for publication

Not applicable.

Competing interests

The authors have declared that no competing interests exist.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sayed, M., Naiim, C., Aboelsaad, M. et al. Internet addiction and relationships with depression, anxiety, stress and academic performance among Egypt pharmacy students: a cross-sectional designed study. BMC Public Health 22, 1826 (2022).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: