Social Network Usage Among Medical Students and Its Relationship with Stress
Yıl 2024,
Cilt: 10 Sayı: 3, 416 - 425, 19.09.2024
Uğur Bilge
,
Levent Donmez
Öz
Objective: The increasing use of social network sites has become a globally widespread phenomenon. It is also known that medical students are being exposed to several stress factors. This study aims to predict the social networking habits and stress levels of medical students, as well as investigating the relationship between social network usage and stress levels, including personal attributes.
Methods: A questionnaire, involving the perceived stress scale and other characteristics of the participants, was carried out on 1311 medical students, educated at Xxxxxxx University Medical Faculty during the 2017-2018 academic years. This is a cross-sectional study, and the dataset was analysed by logistic regression.
Results: Students who use any one of the three main social network sites (Facebook, Instagram and Twitter) were 1203 (91.8%), and there were found to be 108 students who used no social media (8.2%). Of the students, 992 (75.7%) used Facebook, 928 (70.8%) used Instagram and 512 (39.1%) used Twitter. 269 students (20.5%) used Facebook previously and now have stopped using it. A total of 766 (58.4%) students spent more than one hour per day on social media. According to the logistic regression analysis; the academic year of students, gender, unhappiness with being in the medical faculty, feeling lonely, stress coping scores and stable parental relationships were related significantly to stress level. After adjusting other variables, frequent social media users were 1.3 times more stressed than others (OR=1.35; 95% CI=1.05-1.74; p<0.05).
Conclusion: The frequency of social media use in medical students is similar to others in the same age group in other countries, and there seems to be a link between social media use and stress. To improve and support medical education, social media use must be added as a factor in addition to other stress factors already known. Frequent social network users’ psychological, behavioural and physical development should be monitored closely to improve the health of this group.
Destekleyen Kurum
This study was supported by The Scientific Research Projects Coordination Unit of Akdeniz University under number TSA-2018-3537
Proje Numarası
TSA-2018-3537
Teşekkür
Surveyors (Silan Turk, Sule Comlekcioglu, Meryem Sagir, Kadriye Karadag, Ayman Abu Ghdaib, Pelin Cimen, Merve Yilmaz, Burak Ferli, Nursel Eren, Tugba Demir, Bilal Oztas) for data collection
Kaynakça
- 1- KussDJ, Griffiths MD. Social Networking Sites and Addiction: Ten Lessons Learned. Int. J. Environ. Res. Public Health 2017; 14:311.
- 2- Kuss DJ, Griffiths MD. Online Social Networking and Addiction-A Review of the Psychological Literature. Int. J. Environ. Res. Public Health 2011; 8:3528-52.
- 3- Statista (the statistical portal) Number of social media users worldwide from 2010 to 2021 (in billions). Available online: https://www.statista.com/statistics/278414/number-of-worldwide-social-network-users/(accessed on 25 Feb 2019).
- 4- Statista (the statistical portal) Social Media Statistics & Facts. Available online: https://www.statista.com/topics/1164/social-networks/ (accessed on 25 Feb 2019).
- 5- Oberst U, Wegmann E, Stodt B, Brand M, Chamarro A. Negative consequences from heavy social networking in adolescents: The mediating role of fear of missing out. Journal of Adolescence 2017; 55:51-60.
- 6- Lin LY, Sidani JE, Shensa A, Radovic A, Miller E, Colditz JB, Hoffman BL, Giles LM, Primack BA.Association between Social Media Use and Depression among U.S. Young Adults. Depress Anxiety 2016; 33(4):323–31.
- 7- Banjanin N, Banjanin N, Dimitrijevic I, Pantic I. Relationship between internet use and depression: Focus on physiological mood oscillations, social networking and online addictive behavior. Computers in Human Behavior 2015; 43:308–12.
- 8- Primack BA, Shensa A, Escobar-Viera CG, Barrett EL, Sidani JE, Colditz JB, James AE. Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among U.S. young adults. Computers in Human Behavior 2017; 69:1-9.
- 9- Yoon S, Kleinman M, Mertz J, Brannick M. Is social network site usage related to depression? A meta-analysis of Facebook–depression relations. Journal of Affective Disorders 2019; 248:65–72.
- 10- Pantic I. Online Social Networking and Mental Health. Cyberpsychology, Behavior, and Social Networking 2014; 17(10):652-7.
- 11- Surís JC, Akre C, Piguet C, Ambresin AE, Zimmermann G, Berchtold A. Is internet use unhealthy? A cross-sectional study of adolescent internet overuse. Swiss Med Wkly 2014; 144: w14061.
- 12- Lee YS, Han DH, Yang KC, Daniels MA, Na C, Kee BS, Renshaw PF. Depression like characteristics of 5HTTLPR polymorphism and temperament in excessive internet users. Journal of Affective Disorders 2008; 109:165–9.
- 13- Muench F, Hayes M, Kuerbis A, Shao S. The independent relationship between trouble controlling Facebook use, time spent on the site and distress. Journal of Behavioral Addiction 2015; 4(3):163–9.
- 14- Turner RJ, Wheaton B, Lloyd DA. The Epidemiology of Social Stress, American Sociological Review 1995; 60(1):104-125.
- 15- Kessler RC, Greenberg PE. Chapter 67: The Economic Burden of Anxiety and Stress Disorders. In: Davis KL, Charney D, Coyle JT, Nemeroff C, editors. Neuropsychopharmacology. The Fifth Generation of Progress. Edited by American College of Neuropsychopharmacology; 2002. p.981-92.
- 16- Kalia M. Assessing the Economic Impact of Stress-The Modern Day Hidden Epidemic. Metabolism 2002; 51(6):49-53.
- 17- Noorbala AA, Rafiey H, Alipour F, Moghanibashi-Mansourieh A. Psychosocial Stresses and Concerns of People Living in Tehran: A Survey on 6000 Adult Participants. Iran J Psychiatry 2018; 13(2):94-102.
- 18- Yang L, Zhao Y, Wang Y, Liu L, Zhang X, Li B, Cui R. The Effects of Psychological Stress on Depression. Current Neuropharmacology 2015; 13:494-504.
- 19- Buitron V, Hill RM, Pettit JW, Green KL, Hatkevich C, Sharp C. Interpersonal stress and suicidal ideation in adolescence: An indirect association through perceived burdensomeness toward others. Journal of Affective Disorders 2016; 190:143–9.
- 20- Buscemi V, Chang WJ, Liston MB, McAuley JH, Schabrun SM. The role of perceived stress and life stressors in the development of chronic musculoskeletal pain disorders: a systematic review. Journal of Pain. 2019; 20(10):1127-39.
- 21- Fanavoll R, Nilsen TI, Holtermann A, Mork PJ. Psychosocial work stress, leisure time physical exercise and the risk of chronic pain in the neck/shoulders: Longitudinal data from the Norwegian HUNT Study. Int J Occup Med Environ Health 2016;29(4):585-95.
- 22- Gasperin D, Netuveli G, Dias-da-Costa JS, Pattussi MP. Effect of psychological stress on blood pressure increase: a meta-analysis of cohort studies. Cad Saude Publica 2009; 25(4):715-26.
- 23- Li J, Zhang M, Loerbroks A, Angerer P, Siegrist J. Work stress and the risk of recurrent coronary heart disease events: A systematic review and meta-analysis. Int J Occup Med Environ Health 2015; 28:8-19.
- 24- Bot I, Kuiper J. Stressed brain, stressed heart? The Lancet. 2017; 389(10071):770-1.
- 25- Rahman AGA, Al Hashim BN, Al Hiji NK, Al-Abbad Z. Stress among medical Saudi students at College of Medicine, King Faisal University. J PrevMed Hyg 2013; 54:195-9.
- 26- Cihan FG, Kutlu R, Karademirci MM. Occupational Future Concerns and Stress Management Conditions of Intern Doctors. JAREM 2017; 7:122-7.
- 27- Chowdhury R, Mukherjee A, Mitra K,Naskar S, Karmakar PR, Lahiri SK. Perceived psychological stress among undergraduate medical students: Role of academic factors. Indian J Public Health 2017; 61:55-7.
- 28- Goodwin R, Palgi Y, Lavenda O, Hamama-Raz Y, Ben-Ezra M. Association between Media Use, Acute Stress Disorder and Psychological Distress. Psychother Psychosom 2015; 84:253–4.
- 29- SchouAndreassen C, Billieux J, Griffiths MD, Kuss DJ, Demetrovics Z, Mazzoni E, Pallesen S. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study. Psychology of Addictive Behaviors 2016; 30(2):252-62.
- 30- Bilgrami Z, McLaughlin L, Milanaik R, Adesman A. Health implications of new-age technologies: a systematic review. Minerva Pediatr 2017; 69(4):348-67.
- 31- Cheng YS, Tseng PT, Lin PY, Chen TY, Stubbs B, Carvalho AF, Wu CK, Chen YW, Wu MK. Internet Addiction and Its Relationship with Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies. J Clin Psychiatry 2018; 79(4):17r11761.
- 32- Pontes HM, Taylor M, Stavropoulos V. Beyond "Facebook Addiction": The Role of Cognitive-Related Factors and Psychiatric Distress in Social Networking Site Addiction. Cyberpsychol Behav Soc Netw 2018; 21(4):240-47.
- 33- Orsal O, Orsal O, Unsal A, Ozalp SS. Evaluation of Internet Addiction and Depression Among University Students. Procedia - Social and Behavioral Sciences 2013; 82:445-54.
- 34- Carter A, Forrest JI, Kaida A. Association Between Internet Use and Body Dissatisfaction Among Young Females: Cross-Sectional Analysis of the Canadian Community Health Survey. J Med Internet Res 2017; 19(2):e39.
- 35- Akin A, Akin U. The mediating role of social safeness on the relationship between Facebook (®) use and life satisfaction. Psychol Rep 2015; 117(2):341-53.
- 36- Lazarus RS, Folkman S. Stress, appraisal, and coping. 1984 by Springer Publishing Company, Inc. 11 West 42nd Street. New York, NY 10036-8002
- 37- Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health SocBehav 1983; 24(4):385-96.
- 38- Eun-Hyun Lee RN. Review of the Psychometric Evidence of the Perceived Stress Scale. Asian Nursing Research 2012; 6:121-7.
- 39- Bilge A, Ögce F, Ekti Genc R, Tuna Oran N. Psychometric Properties of a Turkish Version of the Perceived Stress Scale (PSS). Ege Üniversitesi Hemşirelik Yüksek Okulu Dergisi 2009; 25(2):61-72.
- 40- Orucu MC, Demir A. Psychometric evaluation of perceived stress scale for Turkish University students. Stress and Health 2009; 25:103–9.
- 41- Kaya C, Tansey TN, Melekoglu M, Cakiroglu O, Chan F. Psychometric evaluation of Turkish version of the Perceived Stress Scale with Turkish college students. J Ment Health 2017; 20:1-7.
- 42- Subrahmanyama K, Reich SM, Waechter N, Espinoza G. Online and offline social networks: Use of social networking sites by emerging adults. Journal of Applied Developmental Psychology 2008; 29:420–33.
- 43- Greenwood S, Perrin A, Duggan M. “Social Media Update 2016”. Pew Research Center, November 2016.
- 44- Anderson M, Jiang J. “Teens, Social Media & Technology 2018”. Pew Research Center, May 2018.
- 45- Smith A, Anderson M. “Social Media Use in 2018”. Pew Research Center, March 2018.
- 46- Hill AB. The environment and disease association or causation. Proc R Soc Med 1965; 58:295-300.
- 47- Leist AK. Social Media Use of Older Adults: A Mini-Review. Gerontology 2013; 59:378-84.
- 48- Koc M, Gulyagci S. Facebook addiction among Turkish college students: the role of psychological health, demographic, and usage characteristics. Cyberpsychol Behav Soc Netw 2013; 16(4):279-84.
- 49- Argyriou E, Davison CB, Lee TTC. Response Inhibition and Internet Gaming Disorder: A Meta-analysis. Addictive Behaviors 2017; 71:54-60.
- 50- Grimes DA, Schulz KF. Bias and causal associations in observational research. Lancet 2002; 359:248–52.
- 51- Aarts S, Peek STM, Wouters EJM. The relation between social network site usage and loneliness and mental health in community-dwelling older adults. Int J Geriatr Psychiatry 2015; 30:942–9.
- 52- Pittman M, Reich B. Social media and loneliness: Why an Instagram picture may be worth more than a thousand Twitter words. Computers in Human Behavior 2016; 62:155-67.
- 53- Song H, Zmyslinski-Seelig A, Kim J, Drent A, Victor A, Omori K, Allen M. Does Facebook make you lonely?: A meta analysis. Computers in Human Behavior 2014; 36:446-52.
- 54- Teppers E, Luyckx K, Klimstra TA, Goossens L. Loneliness and Facebook motives in adolescence: A longitudinal inquiry into directionality of effect. Journal of Adolescence 2014; 37:691-9.
Tıp Öğrencilerinde Sosyal Ağların Kullanımı ve Bunun Stresle İlişkisi
Yıl 2024,
Cilt: 10 Sayı: 3, 416 - 425, 19.09.2024
Uğur Bilge
,
Levent Donmez
Öz
Amaç: Sosyal ağ kullanımı tüm dünyada giderek artan bir fenomendir. Tıp öğrencilerinin çeşitli stres faktörlerine maruz kaldığı da bilinmektedir. Bu çalışmanın amacı tıp fakültesi öğrencilerinde sosyal ağ kullanımı alışkanlıklarını saptamak ve sosyal ağ kullanımı ile öğrencilerin kişisel özellikleri ve stres düzeyleri arasındaki ilişkiyi göstermektir.
Yöntemler: Xxxxxxx Üniversitesi Tıp Fakültesinde 2017-2018 eğitim öğretim döneminde eğitim gören 1311 öğrenciye algılanan stres ölçeğini ve katılımcıların diğer özelliklerini içeren bir anket formu uygulanmıştır. Kesitsel özellikte olan bu çalışmada elde edilen veriler lojistik regresyon ile analiz edilmiştir.
Bulgular: Üç temel sosyal ağ sitesinden en az birini kullanan öğrenci sayısı 1203'dü (%91.8). Öğrencilerin, 992'si (%75.7) Facebook, 928'si (%70.8) Instagram ve 512'si (%39.1) Twitter kullanıyordu. Toplam 766 (%58.4) öğrenci sosyal medyada günde bir saatten fazla vakit geçiriyordu. Lojistik regresyon analizi sonuçlarına göre; öğrencilerin kaçıncı sınıfta olduğu, cinsiyeti, tıp fakültesinden memnuniyet durumu, yalnızlık hissi duymaları, stresle başa çıkma becerisi ve anne babanın ayrı olup olmama durumu, bağımlı değişken olan yüksek stresle anlamlı olarak ilişkili faktörlerdi. Diğer değişkenler düzeltildiğinde sosyal medyayı daha sık kullananların stres sıklığı 1,3 kez (OR=1,35; %95GA=1.05-1.74; p<0,05) daha yüksekti.
Sonuç: Tıp Fakültesi öğrencilerinde sosyal medya kullanım sıklığı diğer ülkelerdeki aynı yaş grubundaki topluluklarla benzerdir ve yoğun sosyal medya kullanımı ile stres arasında bir ilişki mevcuttur. Tıp eğitiminin geliştirilmesi ve desteklenmesi için, sosyal medya kullanımının da önceden bilinen stres faktörlerinin yanında ilave bir risk olarak değerlendirilmesi gerekir. Sosyal medyayı daha yoğun kullanan tıp öğrencilerinin ruhsal, davranışsal ve fiziksel gelişimlerinin daha yakından izlenmesi bu grubun sağlığının geliştirilmesi yönünden uygun olacaktır.
Proje Numarası
TSA-2018-3537
Kaynakça
- 1- KussDJ, Griffiths MD. Social Networking Sites and Addiction: Ten Lessons Learned. Int. J. Environ. Res. Public Health 2017; 14:311.
- 2- Kuss DJ, Griffiths MD. Online Social Networking and Addiction-A Review of the Psychological Literature. Int. J. Environ. Res. Public Health 2011; 8:3528-52.
- 3- Statista (the statistical portal) Number of social media users worldwide from 2010 to 2021 (in billions). Available online: https://www.statista.com/statistics/278414/number-of-worldwide-social-network-users/(accessed on 25 Feb 2019).
- 4- Statista (the statistical portal) Social Media Statistics & Facts. Available online: https://www.statista.com/topics/1164/social-networks/ (accessed on 25 Feb 2019).
- 5- Oberst U, Wegmann E, Stodt B, Brand M, Chamarro A. Negative consequences from heavy social networking in adolescents: The mediating role of fear of missing out. Journal of Adolescence 2017; 55:51-60.
- 6- Lin LY, Sidani JE, Shensa A, Radovic A, Miller E, Colditz JB, Hoffman BL, Giles LM, Primack BA.Association between Social Media Use and Depression among U.S. Young Adults. Depress Anxiety 2016; 33(4):323–31.
- 7- Banjanin N, Banjanin N, Dimitrijevic I, Pantic I. Relationship between internet use and depression: Focus on physiological mood oscillations, social networking and online addictive behavior. Computers in Human Behavior 2015; 43:308–12.
- 8- Primack BA, Shensa A, Escobar-Viera CG, Barrett EL, Sidani JE, Colditz JB, James AE. Use of multiple social media platforms and symptoms of depression and anxiety: A nationally-representative study among U.S. young adults. Computers in Human Behavior 2017; 69:1-9.
- 9- Yoon S, Kleinman M, Mertz J, Brannick M. Is social network site usage related to depression? A meta-analysis of Facebook–depression relations. Journal of Affective Disorders 2019; 248:65–72.
- 10- Pantic I. Online Social Networking and Mental Health. Cyberpsychology, Behavior, and Social Networking 2014; 17(10):652-7.
- 11- Surís JC, Akre C, Piguet C, Ambresin AE, Zimmermann G, Berchtold A. Is internet use unhealthy? A cross-sectional study of adolescent internet overuse. Swiss Med Wkly 2014; 144: w14061.
- 12- Lee YS, Han DH, Yang KC, Daniels MA, Na C, Kee BS, Renshaw PF. Depression like characteristics of 5HTTLPR polymorphism and temperament in excessive internet users. Journal of Affective Disorders 2008; 109:165–9.
- 13- Muench F, Hayes M, Kuerbis A, Shao S. The independent relationship between trouble controlling Facebook use, time spent on the site and distress. Journal of Behavioral Addiction 2015; 4(3):163–9.
- 14- Turner RJ, Wheaton B, Lloyd DA. The Epidemiology of Social Stress, American Sociological Review 1995; 60(1):104-125.
- 15- Kessler RC, Greenberg PE. Chapter 67: The Economic Burden of Anxiety and Stress Disorders. In: Davis KL, Charney D, Coyle JT, Nemeroff C, editors. Neuropsychopharmacology. The Fifth Generation of Progress. Edited by American College of Neuropsychopharmacology; 2002. p.981-92.
- 16- Kalia M. Assessing the Economic Impact of Stress-The Modern Day Hidden Epidemic. Metabolism 2002; 51(6):49-53.
- 17- Noorbala AA, Rafiey H, Alipour F, Moghanibashi-Mansourieh A. Psychosocial Stresses and Concerns of People Living in Tehran: A Survey on 6000 Adult Participants. Iran J Psychiatry 2018; 13(2):94-102.
- 18- Yang L, Zhao Y, Wang Y, Liu L, Zhang X, Li B, Cui R. The Effects of Psychological Stress on Depression. Current Neuropharmacology 2015; 13:494-504.
- 19- Buitron V, Hill RM, Pettit JW, Green KL, Hatkevich C, Sharp C. Interpersonal stress and suicidal ideation in adolescence: An indirect association through perceived burdensomeness toward others. Journal of Affective Disorders 2016; 190:143–9.
- 20- Buscemi V, Chang WJ, Liston MB, McAuley JH, Schabrun SM. The role of perceived stress and life stressors in the development of chronic musculoskeletal pain disorders: a systematic review. Journal of Pain. 2019; 20(10):1127-39.
- 21- Fanavoll R, Nilsen TI, Holtermann A, Mork PJ. Psychosocial work stress, leisure time physical exercise and the risk of chronic pain in the neck/shoulders: Longitudinal data from the Norwegian HUNT Study. Int J Occup Med Environ Health 2016;29(4):585-95.
- 22- Gasperin D, Netuveli G, Dias-da-Costa JS, Pattussi MP. Effect of psychological stress on blood pressure increase: a meta-analysis of cohort studies. Cad Saude Publica 2009; 25(4):715-26.
- 23- Li J, Zhang M, Loerbroks A, Angerer P, Siegrist J. Work stress and the risk of recurrent coronary heart disease events: A systematic review and meta-analysis. Int J Occup Med Environ Health 2015; 28:8-19.
- 24- Bot I, Kuiper J. Stressed brain, stressed heart? The Lancet. 2017; 389(10071):770-1.
- 25- Rahman AGA, Al Hashim BN, Al Hiji NK, Al-Abbad Z. Stress among medical Saudi students at College of Medicine, King Faisal University. J PrevMed Hyg 2013; 54:195-9.
- 26- Cihan FG, Kutlu R, Karademirci MM. Occupational Future Concerns and Stress Management Conditions of Intern Doctors. JAREM 2017; 7:122-7.
- 27- Chowdhury R, Mukherjee A, Mitra K,Naskar S, Karmakar PR, Lahiri SK. Perceived psychological stress among undergraduate medical students: Role of academic factors. Indian J Public Health 2017; 61:55-7.
- 28- Goodwin R, Palgi Y, Lavenda O, Hamama-Raz Y, Ben-Ezra M. Association between Media Use, Acute Stress Disorder and Psychological Distress. Psychother Psychosom 2015; 84:253–4.
- 29- SchouAndreassen C, Billieux J, Griffiths MD, Kuss DJ, Demetrovics Z, Mazzoni E, Pallesen S. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study. Psychology of Addictive Behaviors 2016; 30(2):252-62.
- 30- Bilgrami Z, McLaughlin L, Milanaik R, Adesman A. Health implications of new-age technologies: a systematic review. Minerva Pediatr 2017; 69(4):348-67.
- 31- Cheng YS, Tseng PT, Lin PY, Chen TY, Stubbs B, Carvalho AF, Wu CK, Chen YW, Wu MK. Internet Addiction and Its Relationship with Suicidal Behaviors: A Meta-Analysis of Multinational Observational Studies. J Clin Psychiatry 2018; 79(4):17r11761.
- 32- Pontes HM, Taylor M, Stavropoulos V. Beyond "Facebook Addiction": The Role of Cognitive-Related Factors and Psychiatric Distress in Social Networking Site Addiction. Cyberpsychol Behav Soc Netw 2018; 21(4):240-47.
- 33- Orsal O, Orsal O, Unsal A, Ozalp SS. Evaluation of Internet Addiction and Depression Among University Students. Procedia - Social and Behavioral Sciences 2013; 82:445-54.
- 34- Carter A, Forrest JI, Kaida A. Association Between Internet Use and Body Dissatisfaction Among Young Females: Cross-Sectional Analysis of the Canadian Community Health Survey. J Med Internet Res 2017; 19(2):e39.
- 35- Akin A, Akin U. The mediating role of social safeness on the relationship between Facebook (®) use and life satisfaction. Psychol Rep 2015; 117(2):341-53.
- 36- Lazarus RS, Folkman S. Stress, appraisal, and coping. 1984 by Springer Publishing Company, Inc. 11 West 42nd Street. New York, NY 10036-8002
- 37- Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health SocBehav 1983; 24(4):385-96.
- 38- Eun-Hyun Lee RN. Review of the Psychometric Evidence of the Perceived Stress Scale. Asian Nursing Research 2012; 6:121-7.
- 39- Bilge A, Ögce F, Ekti Genc R, Tuna Oran N. Psychometric Properties of a Turkish Version of the Perceived Stress Scale (PSS). Ege Üniversitesi Hemşirelik Yüksek Okulu Dergisi 2009; 25(2):61-72.
- 40- Orucu MC, Demir A. Psychometric evaluation of perceived stress scale for Turkish University students. Stress and Health 2009; 25:103–9.
- 41- Kaya C, Tansey TN, Melekoglu M, Cakiroglu O, Chan F. Psychometric evaluation of Turkish version of the Perceived Stress Scale with Turkish college students. J Ment Health 2017; 20:1-7.
- 42- Subrahmanyama K, Reich SM, Waechter N, Espinoza G. Online and offline social networks: Use of social networking sites by emerging adults. Journal of Applied Developmental Psychology 2008; 29:420–33.
- 43- Greenwood S, Perrin A, Duggan M. “Social Media Update 2016”. Pew Research Center, November 2016.
- 44- Anderson M, Jiang J. “Teens, Social Media & Technology 2018”. Pew Research Center, May 2018.
- 45- Smith A, Anderson M. “Social Media Use in 2018”. Pew Research Center, March 2018.
- 46- Hill AB. The environment and disease association or causation. Proc R Soc Med 1965; 58:295-300.
- 47- Leist AK. Social Media Use of Older Adults: A Mini-Review. Gerontology 2013; 59:378-84.
- 48- Koc M, Gulyagci S. Facebook addiction among Turkish college students: the role of psychological health, demographic, and usage characteristics. Cyberpsychol Behav Soc Netw 2013; 16(4):279-84.
- 49- Argyriou E, Davison CB, Lee TTC. Response Inhibition and Internet Gaming Disorder: A Meta-analysis. Addictive Behaviors 2017; 71:54-60.
- 50- Grimes DA, Schulz KF. Bias and causal associations in observational research. Lancet 2002; 359:248–52.
- 51- Aarts S, Peek STM, Wouters EJM. The relation between social network site usage and loneliness and mental health in community-dwelling older adults. Int J Geriatr Psychiatry 2015; 30:942–9.
- 52- Pittman M, Reich B. Social media and loneliness: Why an Instagram picture may be worth more than a thousand Twitter words. Computers in Human Behavior 2016; 62:155-67.
- 53- Song H, Zmyslinski-Seelig A, Kim J, Drent A, Victor A, Omori K, Allen M. Does Facebook make you lonely?: A meta analysis. Computers in Human Behavior 2014; 36:446-52.
- 54- Teppers E, Luyckx K, Klimstra TA, Goossens L. Loneliness and Facebook motives in adolescence: A longitudinal inquiry into directionality of effect. Journal of Adolescence 2014; 37:691-9.