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 Table of Contents  
Year : 2021  |  Volume : 37  |  Issue : 3  |  Page : 277-279

Digital technology use among adolescents in a psychiatric inpatient setting

1 Department of Psychiatry, Institute of Neurosciences Kolkata, Kolkata, West Bengal, India
2 Department of Child and Adolescent Psychiatry, NIMHANS, Bengaluru, Karnataka, India

Date of Submission19-Jul-2021
Date of Decision17-Sep-2021
Date of Acceptance17-Sep-2021
Date of Web Publication30-Sep-2021

Correspondence Address:
Dr. Sk Altaf Hossien
Institute of Neurosciences Kolkata, 185/1 A.J.C. Bose Road, Kolkata - 700 017, West Bengal
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijsp.ijsp_219_21

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Technology enhances social communication and connectedness, people. However, it may predispose youth with socioemotional and psychological vulnerabilities, such as mental health disorders, to further behavioral and emotional dysregulation and adverse experiences such as cyber-bullying. We assessed digital technology use among adolescents requiring psychiatric inpatient care, i.e., with moderate-severe mental health morbidity. We found that over 95% of adolescents had regular digital technology use, via mobiles or tablets. The prevalence of problematic use was ~30% while technology addiction could be detected in close to 6%. A particularly concerning issue was the near-constant use of technology throughout the day, in almost 40% of adolescents, especially those with externalizing disorders, severely compromising time remaining for other developmentally appropriate engagements. Our findings suggest the need to incorporate assessment of digital technology use in the clinical evaluation of adolescents with mental illnesses. This would have critical implications for developmentally informed, life-skills-based interventions that are contemporaneous with the rapidly evolving digital-human interface in this population.

Keywords: Adolescents, digital technology, screen use

How to cite this article:
Hossien SA, Sharma E, Girimaji SC. Digital technology use among adolescents in a psychiatric inpatient setting. Indian J Soc Psychiatry 2021;37:277-9

How to cite this URL:
Hossien SA, Sharma E, Girimaji SC. Digital technology use among adolescents in a psychiatric inpatient setting. Indian J Soc Psychiatry [serial online] 2021 [cited 2022 Sep 25];37:277-9. Available from: https://www.indjsp.org/text.asp?2021/37/3/277/327283

  Introduction Top

Excessive use of digital technology is a prevalent and oft-discussed child and adolescent mental health issue in the current times. Adolescents' use of digital technology spans a spectrum of patterns from occasional access to parental digital devices to a near-constant use with a self-owned device. According to some studies, over 90% of teenagers are online every day, with nearly one-third of them through access to a smartphone.[1] In an Indian study, nearly 75% of adolescents were moderate Internet users, however, <1% satisfied the criteria for Internet addiction.[2] While engagement with digital technology has possible benefits by enhancing communication, social connections, and technical skills,[3] excessive use has potential negative impact on mental health and development. Long hours of digital technology use (including online activities, television, gaming, etc.) have been associated with low academic achievement,[4] an increased risk of depression,[5] attention impairments,[6] new-onset attention deficit hyperactivity disorder,[7] complex risks from circumstances involving privacy disclosure, besides a decline in familial interpersonal relationships and social circle, with a consequent increase in loneliness.[8] These risks are further compounded in adolescents with existing mental illnesses. We examined digital technology use among adolescents in a psychiatric inpatient setting.

  Methods Top

We examined 70 adolescents, aged 12–17 years (mean ± standard deviation = 14.8 ± 2.4), consecutively admitted for 3 months (March–May 2019), for various mental health concerns associated with moderate-severe disability. The sample was predominantly female (53%), from an urban background (>60%). The Diagnostic and statistical manual-5-[9] based diagnoses were categorized into internalizing disorders (depressive or anxiety disorders) (61.4%), externalizing disorders (oppositional defiant disorders, conduct disorders, substance use disorders) (21.4%), serious mental illnesses (schizophrenia or other psychotic disorders and bipolar affective disorder) (11.4%) and neurodevelopmental disorders (autism spectrum disorders, attention deficit hyperactivity disorder, tic disorders) (5.7%). Digital technology use was evaluated using a semi-structured questionnaire with questions about the type of device used, age of onset of regular use, duration of daily usage, predominant time of use (morning/afternoon/night), mode of use (online/offline), and the primary purpose of use. The frequency of different kinds of digital technology use was assessed with the Media and technology usage and attitude scale.[10] This scale includes 50 items on all possible kinds of technology uses (i.e., smartphones, overall social media use, Internet browsing, E-mailing, media sharing, text messaging, video gaming, online gaming, online-friendships, Facebook, phone-calling, television, etc.) and examines the frequency of engaging in these activities on a 10-item response scale – never, once a month, several times a month, once a week, several times a week, once a day, several times a day, once an hour, several times an hour, and all the time. The severity of technology use was categorized into appropriate use, problematic use (excessive and poorly controlled preoccupations, urges or behavior regarding technology use and Internet access that lead to impairment and distress, emotional and social consequences for the user),[11] and technology addiction (excessive use associated with salience, tolerance, withdrawal, with a feeling of euphoria, conflict, tendency to relapse, and multiple negative consequences).[12]

  Results Top

Around 96% of adolescents used digital technology regularly. Among them, 90% used a smartphone or tablet. Fifty-three percent of adolescents had their personal digital devices. Regular use of a digital device started at a mean age of 13 ± 2.35 years. On an average, daily use was around 4 h, most of them (60%) using during night hours and in online activities (85%). Around 40% of adolescents, especially those with externalizing disorders, reported a near-constant use of their digital devices throughout the day. Another 52% had at least a daily use. Adolescents most commonly used digital devices for entertainment (e.g. listening to music or watching videos) (82.9%), followed by social networking (75.7%) and gaming (45.7%). Problematic use was found in 30% of adolescents, another 6% met the criteria for technology addiction.

  Discussion Top

Digital technology is now integrated into the daily lives of adults and adolescents alike, a reflection of recent socioeconomic-cultural changes. However, the prevalence and patterns of use reported here, among adolescents with serious mental health problems, is concerning. Externalizing disorders, combined with low self-esteem, become a fertile ground for problematic use. Adolescents with externalizing disorders have cognitive risks (poor executive functional abilities and socioemotional skills) that make them, particularly vulnerable to the detrimental impact of digital technology use. This is reflected in a higher prevalence of problematic use in our inpatient sample than has previously been reported among adolescents in the general population.[2]

Activity scheduling with both relaxing, and intellectually engaging activities are important components of the nonpharmacological management of mental health problems in this age group. Heavy time and intellectual investment in digital technology leave little time for other conducive and healing activities. Moreover, vulnerable adolescents (due to age and mental morbidity) could be prone to behavioral and emotional dysregulation with the stresses and demands of digital technology use. A more nuanced exploration of the nature, pattern of use, maintaining factors, and perceived positive and negative impacts would further elucidate the mechanistic underpinnings of the bidirectional relationship between digital technology use and mental morbidity. It is important to understand that the bidirectional relationship can have both positive and negative connotations.[13] On the one hand, continued access to family and friends through online social networks could secure a sense of social support and enhance emotional regulation, while on the other, constant engagement with a group of friends, who may themselves have socioemotional difficulties, could limit access to and use of activities and social interactions potentially more conducive to mental health. In addition, there is commonly a parent-adolescent conflict over generationally acceptable/normative digital technology use that changes with the increasingly digital world we live in.

Our findings suggest the need to incorporate assessments for digital technology use during clinical evaluation of adolescents with mental health problems. This has critical implications for developmentally informed, life-skills-based interventions that are contemporaneous with the rapidly evolving digital-human interface in this population.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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Goel D, Subramanyam A, Kamath R. A study on the prevalence of internet addiction and its association with psychopathology in Indian adolescents. Indian J Psychiatry 2013;55:140-3.  Back to cited text no. 2
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Peiró-Velert C, Valencia-Peris A, González LM, García-Massó X, Serra-Añó P, Devís-Devís J. Screen media usage, sleep time and academic performance in adolescents: Clustering a self-organizing maps analysis. PLoS One 2014;9:e99478.  Back to cited text no. 4
Bickham DS, Hswen Y, Rich M. Media use and depression: Exposure, household rules, and symptoms among young adolescents in the USA. Int J Public Health 2015;60:147-55.  Back to cited text no. 5
Swing EL, Gentile DA, Anderson CA, Walsh DA. Television and video game exposure and the development of attention problems. Pediatrics 2010;126:214-21.  Back to cited text no. 6
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Kraut R, Patterson M, Lundmark V, Kiesler S, Mukopadhyay T, Scherlis W. Internet paradox. A social technology that reduces social involvement and psychological well-being? Am Psychol 1998;53:1017-31.  Back to cited text no. 8
American Psychiatric Association, editor. Diagnostic and Statistical Manual of Mental Disorders: DSM-5. 5th ed. Washington, D.C: American Psychiatric Association; 2013. p. 947.  Back to cited text no. 9
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Shapira NA, Lessig MC, Goldsmith TD, Szabo ST, Lazoritz M, Gold MS, et al. Problematic internet use: Proposed classification and diagnostic criteria. Depress Anxiety 2003;17:207-16.  Back to cited text no. 11
Griffiths M. Technological addictions. In Clinical psychology forum 1995 Feb (pp. 14-14). Division of Clinical Psychology of the British Psychol Soc.  Back to cited text no. 12
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