Computers in Human Behavior 43 (2015) 308–312

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Computers in Human Behavior

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

Relationship between internet use and depression: Focus on

physiological mood oscillations, social networking
and online addictive behavior
Nikolina Banjanin a, Nikola Banjanin b, Ivan Dimitrijevic c, Igor Pantic d,⇑
a
University of Belgrade, School of Medicine, Institute of Hygiene and Medical Ecology, Dr Subotica 8, RS-11000 Belgrade, Serbia
b
Clinical Hospital Center Zemun, Vukova 9, RS-11080 Zemun, Belgrade, Serbia
c
University of Belgrade, School of Medicine, Clinical Center of Serbia, Clinic for Psychiatry, Pasterova 2, RS-11000 Belgrade, Serbia
d
University of Belgrade, School of Medicine, Institute of Medical Physiology, Visegradska 26/II, RS-11129 Belgrade, Serbia

a r t i c l e i n f o a b s t r a c t

Article history: The aim of the research was to investigate the potential relationship between internet addiction and
depression in adolescents. A cross-sectional observational study was conducted on a sample of 336 high
school students in Belgrade, Serbia. Each student was given a questionnaire consisting of Center for
Keywords: Epidemiologic Studies of Depression Scale for Children (CES-DC), Young Internet Addiction Test (IAT)
Mood as well as general questions related to internet and social networking site (SNS) use. The results of our
Internet study indicate that internet use and level of internet addiction measured with IAT scale are positively
Depression
correlated with depressive symptoms. No such relationship existed between the time spent on social
Correlation
Facebook
networking sites and depression, as well as between depression symptoms and SNS-related activities
such as the number of Facebook friends. Neither the time spent on SNSs nor SNS-related activities had
significant effect on the observed relationship between level of internet addiction and depression.
! 2014 Elsevier Ltd. All rights reserved.

1. Introduction
With the development of information technology, over the past
two decades, many new issues have emerged regarding the poten-
tial connection between internet use and certain mental health
problems. Several studies have so far suggested that internet use
in general, as well as certain specific online activities, such as social
networking may be associated with feelings of loneliness, low self-
esteem and depression.
In 1998, Kraut et al. published one of the first studies on the
issue of internet and mental health, with the results indicating that
online activities are related to the reduction of communication
between family members, and increased symptoms of depression.
According to the observation, which was named ‘‘internet para-
dox’’, internet as a social technology decreases social involvement
of users as well as their psychological well-being (Kraut et al.,
1998). This research was later extensively cited and discussed,
and numerous other efforts have been made to confirm or deny
the connection between internet and symptoms of depression
(Jelenchick, Eickhoff, & Moreno, 2013; Kraut et al., 1998; Pantic,
⇑ Corresponding author. Tel.: +381 113607097; fax: +381 113611261.
E-mail address: igor.pantic@mfub.bg.ac.rs (I. Pantic).
2014b; Pantic et al., 2012). So far, most of the research has been
done on normal, healthy subjects (children, adolescents, students,
etc.), and there is no proof that online activities cause or are related
to depression as a clinical entity. However, some authors did indi-
cate that internet use is associated with dysphoric mood often
within a physiological range, measured by conventional psychiat-
ric scales (Jelenchick et al., 2013; Kraut et al., 1998; Pantic,
2014b; Pantic et al., 2012).
During the last 10 years, with the creation and popularity of
social networking, profound changes have been introduced in the
way people communicate and interact in an online environment.
Social networking sites (SNSs) today have more than one billion
active users and many experts estimate that this number will fur-
ther increase in the future. Recently, a number of authors have
expressed concern that internet use in general, social networking,
or at least certain online activities done on SNSs, might be related
to mood disorders although there have been several conflicting
reports on this issue (Gonzales & Hancock, 2011; Stieger &
Burger, 2010; Tucker, 2010; Yao, He, Ko, & Pang, 2014; Zhang
et al., 2012). For example, in 2012, Pantic et al. published a study
on social networking and depression in adolescents in which the
authors stated that the time spent on Facebook and other SNS plat-
forms is positively related to depression symptoms quantified by

http://dx.doi.org/10.1016/j.chb.2014.11.013
0747-5632/! 2014 Elsevier Ltd. All rights reserved.
 N. Banjanin et al. / Computers in Human Behavior 43 (2015) 308–312
Beck depression inventory (Pantic et al., 2012). It was estimated
that interpersonal connections made on SNSs may lack the neces-
sary quality when compared to conventional, ‘‘face-to-face’’ com-
munication between individuals.
Another reason why in scientific literature social networking is
often connected with depression, is the assumption that an inter-
net user often perceives his SNS ‘‘friends’’ as being happier and
more successful. In computer-mediated communication, and espe-
cially in social networking setting, people tend to exaggerate their
personal, professional and other qualities while at the same time
concealing their potential faults. According to Chou and Edge this
may be one of the factors affecting mood in online users (Chou &
Edge, 2012). Mehdizadeh (2010) additionally point the possible
negative impact of computer mediated communication on self-
esteem, possibly associated with increased narcissistic conduct
(Mehdizadeh, 2010).
The time average internet user spends on various online
activities has recently increased so much that many authors today
use the term ‘‘internet addiction’’ in order to describe similarities
between compulsive internet behavior and certain elements of
substance dependence (Cash, Rae, Steel, & Winkler, 2012;
Fioravanti, Dettore, & Casale, 2012; Lee, Han, Kim, & Renshaw,
2013; Pramanik, Sherpa, & Shrestha, 2012; Rodgers, Melioli,
Laconi, Bui, & Chabrol, 2013). Despite numerous studies on the
issue of internet and social networking addiction, these conditions
are not officially recognized as mental disorders according to the
DSM and other classification and diagnostic tools. Nevertheless,
most authors agree that internet addiction may be a serious public
health concern which may have detrimental effects on overall psy-
chological well-being (Akin, 2012; Alavi et al., 2012; Fioravanti
et al., 2012; Pramanik et al., 2012; Smahel, Brown, & Blinka,
2012; Tonioni et al., 2012).
In our study, on a population of high school students, we tested
the relationship between level of internet addiction and depressive
symptoms using the established psychiatric scales. Based on the
previously published data the research was done based on two
hypotheses:
1. There is a statistically significant positive correlation between
internet use and depression, or, in other words, depression level
increases as the internet use increases and vice versa.
2. Time spent on social networking is positively correlated with
level of depression and significantly impacts the above men-
tioned relationship.
2. Methods
A cross-sectional observational study was conducted in 2014 on
a sample of 336 students (average age 18 years, 116 males and 222
females) from central Belgrade High School, Serbia. All partici-
pants, as well as the teaching supervisors had previously been
informed about the details of the study and agreed to participate.
Each student was given a questionnaire consisting of Center for
Epidemiologic Studies of Depression Scale for Children, Young
Internet Addiction Test as well as general questions related to
internet and social networking use.
Center for Epidemiologic Studies of Depression Scale for
Children (CES-DC) is a 20 statement self-report test, today com-
monly used for quantification of depression symptoms in children
and adolescents. The CES-DC inventory is thought to have the espe-
cially high reliability and validity for the age groups between 12
and 18 years (Fendrich, Weissman, & Warner, 1990). In CES-DC
scoring system, each statement has 4 possible answers: ‘‘Not At
All’’, ‘‘A Little’’, ‘‘Some’’, ‘‘A Lot’’ based on which, the points are
added in order to calculate the final score which can range
between 0 and 60. Higher CES-DC score indicates a higher
309
depression level (Faulstich, Carey, Ruggiero, Enyart, & Gresham,
1986; Olsson & von Knorring, 1997).
Young Internet Addiction Test, designed by Dr. Kimberly Young
is a 20 item inventory that is a reliable quantification of internet
use and internet-related addictive behavior (Faraci, Craparo,
Messina, & Severino, 2013; Jelenchick, Becker, & Moreno, 2012).
It consists of questions related to compulsory internet use, effects
of internet on offline activities and responsibilities (school grades,
overall performance and productivity, relationships with other
people, etc.). Each question is answered using the following scale:
0-Does not apply; 1-Rarely; 2-Occasionally; 3-Frequently; 4-Often;
5-Always. The higher final score indicates greater use of internet
and potential addiction. The range of scores for the Young Addic-
tion test is from 20 to 100 points. The score above 50 points indi-
cates that internet use is causing significant problems in normal
social functioning of an individual (Young, 2014). For details
regarding IAT and CES-DC questionnaires and protocols, the reader
is referred to previously published works (Faulstich et al., 1986;
Olsson & von Knorring, 1997; Yao et al., 2014; Young, 1999, 2014).
Apart from completing Internet Addiction Test (IAT) and CES-DC,
the participants were also asked questions about the average time
spent on social networking, number of friends on their Facebook
accounts as well as the number of self-portrait photographs posted
on their Facebook account (if any). The data was collected and ana-
lyzed blindly. Statistical analysis was done using SPSS statistical
software (SPSS, Chicago, IL). Multivariate regression analysis was
used for determining the relationship between the variables. P
value less than 0.05 was considered statistically significant.
3. Results
Average values of CES-DC and IAT scores in the study sample
were 18.45 ± 9.16 (males 16.22 ± 8.09, females 19.91 ± 9.93,
p < 0.01) and 24.74 ± 17.33 (males 24.40 ± 14.46, females 24.78 ±
18.68, p > 0.05), respectively. There was a statistically highly signif-
icant positive correlation between these two scores (r = +0.27,
p < 0.001). This relationship implies that as the level of internet
addiction increased, depressive symptoms also increased and vice
versa. The results of the two inventories for each participant are
plotted in Fig. 1. When the data were analyzed for males and
females separately, the correlation was present in both subsam-
ples, although in females it was much stronger (r = +0.17 and
r = +0.30, respectively). Gender as a confounding factor did not sig-
nificantly influence the overall relationship between CES-DC and
IAT scores, or CES-DC and time spent on social networking activi-
ties. Age of participant, being relatively homogenous with standard
deviation of only 0.83 years, also did not significantly impact the
tested correlations.
Fig. 1. The plotted data for CES-DC and IAT scores. Statistically significant
(p < 0.0001) positive correlation was observed between the two variables. The
central regression line represents possible linear relationship.
310 N. Banjanin et al. / Computers in Human Behavior 43 (2015) 308–312

The average time spent on social networking was 3.11 ± 2.82 h

(males 2.97 ± 2.55 h, females 3.20 ± 2.94 h, p > 0.05). Approxi-
mately 90.18% of the sample had a user account on Facebook with
at least 1 ‘‘friend’’. Also, in a sample of Facebook users, no signifi-
cant correlation (p > 0.05) existed between the number of online
friends and depression. The plotted data for number of Facebook
friends and CES-DC score are shown in Fig. 2. The number of Face-
book friends did not significantly impact the relationship between
CES-DC and IAT scores.
Plotted data for CES-DC score and number of self-portrait
photographs shared on Facebook are presented in Fig. 3. No
statistically significant relationship has been found (p > 0.05).
Multivariate regression analysis showed that the number of self-
portrait photographs did not significantly influence the correlation
between CES-DC and IAT scores.
Also, there was no significant relationship between the time
spent on social networking and depressive symptoms (p = 0.36, Fig. 4. The time spent on social networking and CES-DC score. No significant
correlation (p > 0.05) was detected.
r = +0.05). Fig. 4 represents plotted values of the time expenditure
and CES-DC score. Multivariate regression analysis showed that the
time spent on social networking had no significant influence on the Table 1
correlation between the scores of CES-DC and IAT. The results of Multiple regression analysis for CES-DC score as a dependent variable. Apart from r
multiple regression analysis for CES-DC score as a dependent var- and p values (which describe the strength of correlation between CES-DC and other
iable are presented in Table 1. variables), the table also shows unstandardized coefficients (with standard devia-
tions) as determinants of usefulness of the presented MRA models in prediction of
As an addition to these results, we also determined the Body
CES-DC.
mass index (BMI) for each participant based on their height and
weight. Average BMI values for males and females were 21.31 ± Model Unstandardized r t p
coefficients
2.25 and 20.47 ± 3.33, respectively (p > 0.05). After multiple
B Std.
Error
Young score 0.155 0.032 0.28 4.86 <0.001
Time spent on SNSs !0.080 0.200 !0.02 !0.40 0.68
No. of Facebook friends 0.001 0.001 0.04 0.85 0.39
No. of self-portrait !0.001 0.001 !0.02 !0.51 0.60
photographs

regression analysis, it was determined that Body mass index was

not a significant confounding factor in the observed relationship
between CES-DC and IAT scores. Also, the lack of correlation
between depression and social networking activities was not in
any way influenced by the values of BMI.

4. Discussion

Fig. 2. Plotted data for CES-DC score and number of Facebook friends. No
statistically significant relationship has been found (p > 0.05).
Fig. 3. Plotted data for CES-DC score and number of self-portrait photographs
shared on Facebook. No statistically significant relationship has been found
(p > 0.05).
The results of our study indicate that internet use and level of
internet addiction measured with Young IAT scale are positively
correlated with depressive symptoms. No such relationship existed
between the time spent on social networking sites and depression,
as well as between depression symptoms and SNS-related activi-
ties such as the number of Facebook friends or the number of
self-portrait photographs. Neither the time spent on SNSs nor
SNS activities had significant effect on the observed relationship
between level of internet addiction and depression. To our knowl-
edge, this is the first study to compare and correlate the results of
IAT and CES-DC scales on a population of high school students and
to demonstrate that the correlation is independent from social
networking.
Computer-mediated communication, according to some
authors, may lead to the altered perception of other users’ physical,
educational, moral, and other qualities. In 2012, Chou and Edge pub-
lished a report indicating that this online communication may cre-
ate a wrong impression that other online users are happier (Chou &
Edge, 2012). Another factor that must be taken into account when
investigating the connection between internet and depression, is
potential relationship between internet-based interactions and
self-esteem. Computer mediated communication, according to
 N. Banjanin et al. / Computers in Human Behavior 43 (2015) 308–312
some studies might be related to reduction one’s self-esteem and
increase of narcissistic behavior (Mehdizadeh, 2010). Certain
aspects of self-esteem and narcissism are known to be connected
to the development of depression. In our study we tried to include
this narcissistic component of internet use by investigating the
number of self-portrait photographs posted online. According to
the recent views publically expressed by several experts, these pho-
tographs have been linked to narcissistic behavior (Alloway, Runac,
Qureshi, & Kemp, 2014; Rutledge, 2014). However, our results
clearly showed that this SNS activity is not related to depression,
and additionally, that it does not influence in any way the relation-
ship between internet addiction level and depressive symptoms.
Therefore, the true reasons for this relationship may be found in
other aspects of internet use, such as perhaps email checking, gen-
eral net browsing, and computer games.
It seems, indeed, that connection between internet use and
mood is much more complex than previously thought. Recent
study by Kraut and associates (in methodology, Center for Epide-
miologic Studies of Depression Scale was used) suggested that
when internet is used for strengthening communication and inter-
action with family members and friends, the depression symptoms
might in fact be reduced. On the other hand, other online activities,
such as searching for health information, may increase depression
(Bessiere, Pressman, Kiesler, & Kraut, 2010). According to our opin-
ion, it is possible that using internet for enhancing social support
(i.e. using Facebook to communicate with family members living
abroad) may be beneficial for mental health. In contrast, excessive
computer mediated communication, and addictive online behavior
that reduce the available time for conventional face-to face interac-
tion, might be one of the causes of depression in internet users.
This dual effect of SNS on may be one of the reasons why so far
proving the connection between internet (and social networking)
and depression has been so difficult.
It should also be noted that our study only tested the existence
and strength of correlation between internet use and depression
which does not prove causal relationship. As internet use may
cause depression, it is also possible that already depressed individ-
ual may want to spend more time online, rather than engaging in
conventional social interactions.
Another significant limitation of our study is the lack of socio-
economic descriptors of the study sample. In the future, in order
to test the causality between internet use and depression, as well
as relationship between social networking and mental health,
apart from gender, age and BMI, various other confounding factors
will need to be taken into account. These factors include, but are
not limited to financial situation, parent education, relationship
status (boyfriend/girlfriend), strength of social connections in real
life, etc.
Most of the research published so far on the issue of internet
and mental health focused on healthy population samples,
such as university students, adolescents, and school children.
(Jelenchick et al., 2013; Pantic, 2014a; Smahel et al., 2012) Depres-
sive symptoms were measured using conventional tools such as
Center for Epidemiologic Studies of Depression Scale, Beck Depres-
sion Inventory and other established scoring systems. We should
always have in mind that there is very little data regarding the
potential relationship between internet and depression as a clinical
entity, and so far, there have been no indications this connection
exists. Therefore, it should be emphasized that ‘‘depression symp-
toms’’ in our study should be discussed part of physiological mood
oscillations, rather than depression as a mental illness.
5. Conclusion
In conclusion, our study demonstrates that there is a statisti-
cally significant positive correlation between the level of internet
311
addiction and depression symptoms in high school students. No
such relationship existed between depression and time spent on
social networking. Social networking - related activities were not
a significant confounding factor in the relationship between overall
internet use and depression. To our knowledge this is the first
study to test the relationship between the scores of ‘‘Center for
epidemiologic studies of depression test’’ and ‘‘Young internet
addiction test’’ in a population of adolescents. These results pro-
vide a basis for further research on potential impact of internet
use on mental health.
Acknowledgments
Dr. Igor Pantic (the corresponding author) is a project
participant in Grants 175059 and 41027 of the Serbian Ministry
of Science and Education, as well as Head of the Project 62013 of
the DEGU Society, Belgrade, Serbia.
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