PROBLEMATIC INTERNET USE AMONG HEALTHCARE PROFESSIONALS: EMERGING BEHAVIORAL PATTERNS IN SOCIAL NETWORKING SITES ADDICTION

RESULTS: The Response rate was 87% with 54% males and 56% females. The prevalence of internet addiction was 79%(n=69). Out of them 36% (n=31) had mild, 41% (n=36) had moderate addiction while 2% (n=2) had severe addiction. Pattern of internet addiction symptomatology shows that prevalence of IA is higher in excessive use (87.35%) & lack of control (77.01%) while least in anticipation (35.63%) category. Statistically significant difference was seen in behavioral patterns among addicted and nonaddicted medical and dental doctors.

Literature suggests that health professionals show an increasing trend in the usage of mobile phones and SNS in the past decade. According [17,18] to Takesh Sato the prevalence of IA is 8 to [17] 10% in students, Sumit reported that 94.05% of MBBS students use internet and SNS on mobile phone regularly. Kohler reported that 87% of healthcare professionals use internet on [19] mobile phone during clinical practice . These alarming statistics suggest that health professionals are at increased risk of falling a prey to internet addiction and hence its [20] negative effects . In Pakistan the users of SNS have increased numerous folds over the last th decade placing Pakistan 7 among Asia's [21] countries in internet usage . Limited work has been done in Pakistani context to ascertain the prevalence of internet addiction in doctors and health care professionals. A study conducted in Agha khan reports 74% minimal addicts, 24% [22] moderate addicts and 2 % severe addicts . [23] Another study by Ahmer Z reports 65.6% minimal addicts, 18.5 % moderate addicts and 0.9% severe addicts.

INTRODUCTION:
Humans value relativeness and hence interpersonal communication is of prime [1,2] significance to them . The traditional face to face communication has evolved over time and internet based social media is the new technology on board. Drastic proliferation within IT sector has changed the conducts of [3,4] interpersonal communication globally .
Young's Internet Addiction test (YIAT) is a 20- [24] item test, developed by Kimberly Young for the measurement of severity of self-reported compulsive use of internet classifying it as impulse control disorder. Internet refers to all kind of online activities and SNS usage. Youngs test is validated and reliable tool which Cronbach alpha of 0.89. This tool has been tested across many regions and has proved to be valid and reliable tool for measurement of [25] severity of internet addiction . Due to scarce literature in this domain and the emerging mental health disease burden in our society. It's the need of hour that we explore the prevalence and impact of excessive SNS and internet use. IA is not a disorder for everyone, but those with borderline tendency may fall victim to IA due to personal, environmental and contextual influences leading to social isolation, d e p r e s s i o n , d i s b a l a n c e s p e r s o n a l a n d [26,27] professional life . This will ultimately effect both the personal life of the doctors as well as the health care delivery to the patients. So, this study is a small brick in exploring the newly emerging IA among healthcare professionals.
Internet has encompassed all aspects of society and an exponential rise in its users worldwide indicates that the dependence to Internet is [5,6,7] increasing over time . The use is always beneficial but the abuse of even the most effective technology makes it lethal to mankind. There has been much debate on the use, over use and addiction regarding internet and social [ 8 , 9 ] networking sites usage . Contrary to substance abuse or chemical addiction, internet addiction (IA) is difficult to point out due to its overarching boundaries of practical usage & information providence vs. its overuse. So, internet overuse or addiction may easily be justified and signs may be masked if one doesn't self-evaluate periodically. Social media addiction has emotional, psychological, physical, interpersonal, well-being and [10,11,12,13] performance effects on one's life . Due to these far-reaching consequences IA has been included in DSM-V Mental Health Classification [9,14] criteria in Compulsive-Impulsive spectrum . Among internet usage, Social Networking Sites (SNS) addiction has the most far reaching effects on its users. So, a multi-dimensional syndrome called PIU i.e. Problematic Internet Use has been defined which encompasses cognitive & behavioral effects which negatively effects social, academic, personal and professional life. IA leads to social isolation, depression, relational problems, academic failures, personal and professional loss of [15, productivity, joblessness and marital discord 16] . SOCIAL NETWORKING SITES ADDICTION SOHAIL M., RAUF H., et al.
The prevalence of internet addiction was reported to be 79% (n=69). Out of them 36% (n=31) had mild addiction, 41% (n=36) had moderate addiction while 2% (n=2) had severe addiction (Figure-I). Out of 100 participants, 89 returned the questionnaires, 2 questionnaires were incomplete and excluded from the study (Response rate =87%). There were 54% (n=47) males and 56% (n=40) females including all categories of House officers, Postgraduate trainee, Medical officers and consultants. Mean age of participants was 29.40+4.13 years.
Differences in behavioral pattern were found when the cross tabulation was done between BP dichotomous responses and IA scale (5-point Likert responses) using fisher's exact test. The groups of moderate and severe addiction were merged for this step. Among the three groups of non-addicts minimally addicted and moderately to severely addicted categories, higher frequencies of behavioral changes due to problematic internet usage were observed in moderate to severe addicts. The results were statistically significant having P-value <0.05 in all categories (Table-III).
Pattern of internet addiction symptomatology shows that prevalence of IA is higher in excessive use (87.35%) & lack of control (77.01%) while least in anticipation (35.63%) category (Table-II).
About 98% (n=85) of the participants were registered with Facebook, followed by 97% (n=84) for Whatsapp & 92% (n=80) for you tube while 82% (n=71) were registered to some medical education sites/Apps. The main reasons for using Internet was chatting 92% (n=80), social networking 87% (n=76), file sharing 87 %( n=76), educational purpose 86% (n=75), watching movies 80% (n=70) followed by stalking 63% (n=55) ( Table-I [23,24,25] using printed questionnaires . YIA scale with high face validity and reliability of 0.899 Cronbach alpha was used after receiving permission through email.In addition to the demographic information, YIA scale consist of 20 questions in 6 domains of Salience, Excessive use, Neglect work, Anticipation, Lack of control & Neglect social life with total score [24] ranging from 0-100 . The participants recorded their response on a 5-point Likert scale for each question.Individual results of IA s c a l e q u e s t i o n s o f e a c h d o m a i n w e r e aggregated to give a consolidated score for the said domain which was then re-categorized into 4 classes i.e. normal use (score <30), mild addiction (score 31-49), moderate addiction (score 50-79), severe addiction (score >80) by calculating severity impairment index. BP scale consisted of 16 questions in 2 domains of SNS usage type and SNS usage pattern with dichotomous response options. No incentive or reward was given to the participants for inclusion in the study. Collected data was entered into SPSS 23 and prepared for analysis. The data for each group was summarized using descriptive statistics (means, percentages, frequencies & SD). The means of behavioral patterns were cross tabulated against the 4 addiction categories. Fisher's exact test was used to report the difference between SNS behavioral pattern and IA categories. A P-value of < 0.05 was taken to be significant.    respectively . Srijampana et al reported 11.8% moderate and 0.5% severe while [33] Chaudhari reported overall prevalence of 58.87% with 7.47% moderate to severe addiction in general population. Ranganatha, [34,35,36] Ratan, Chakraborti [23] soil for development of internet addiction . As IA is a recognizable disorder so planned interventions are required at both formal and informal level to fight this evil, for which counseling should be considered as a workable [23,24] option . The main reason for internet dependence in this study was reported to be the use of Facebook for social connectivity and WhatsApp for instant massaging. In contrast to this, a study conducted in Saudi Arabia and other in Karachi Pakistan reports reading about news updates as the most common reason for [23] internet dependence . Paul reported 96.3% use of internet for Instant messaging and 77.8% for news updates while Bashir reported 32% use of internet for communication and [28,11] 24% for entertainment . The use of Internet for stalking other people is reported to be prevalent in 63% of people in this study. In contrast to it 4.1% of students in Karachi reported stalking as a cause of internet use. This alarming rise is a warning sign for parents, families, doctors and society at large as it will warrant grave consequences if not dealt with [23] appropriately . Difference among the three categories of addicts in relation to the behavioral patterns due to SNS usage in this study indicates statistically significant highest prevalence of behavioral issues in moderate to severe addiction category followed by mild and normal use category. Contrastingly frequency of behavioral pattern alteration was reported to be highest in mild category as compared to other in a study conducted in Karachi and [23,37] another in US . Internet Addiction is a recognizable disorder from the spectrum of Problematic Internet Use. This study reports the prevalence of internet addiction among health care professionals and burden of multiple behavioral patterns in association with IA, which is an emerging mental health concern.

REFERENCES
CONFLICT OF INTEREST: All authors disclose no conflict of interest.

Grant Support & Financial Disclosures:
None.