INTERNET ADDICTION AND MENTAL HEALTH STATUS OF ADOLESCENTS IN CROATIA AND GERMANY*
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The modern way of life, computerization and the influence of Internet lead to the change of way of life
from the earliest age. The risk factors of man’s health are imposed upon from an early phase of adolescence. Adolescence is a period of adjustment, a time of physical and emotional changes and changes in behavior. It is a stressful life period where even the normal maturing gait includes a certain amount of emotional disturbance, as to oneself, so unto others. Adolescence is also a phase of developing an identity and building peer relationships so their online activities mainly focus on interacting with peers. For precisely this reason, the Internet, as a leading form of mass media, greatly affects the risk behavior of young people and consequently their health status. Recently, psychosomatic symptoms are becoming more frequent in adolescent populations (Santalahti et al. 2005). A study conducted in Finland showed an increase of symptoms over a 10-year period resulting from stressful life occurrences and changes in the way of life of young people. Playing video games has presented itself as a strong risk factor for the development of headaches and migraines (Xavier et al. 2015). Excessive Internet use leads to neglect of usual life habits; increasing amounts of time spent online have consequences for one’s health. The most common physical symptoms are the pain, stiffness in arms and joints, dry and strained eyes, back-pain, neck-pain leading to a headache, sleeping disorder, extreme hyperactivity, excessive talkativeness decreases in hygiene, and eating disorders (Saisan et al. 2012). As a form of eating disorder in adolescents, obesity demands attention all by itself, but also for its direct and indirect influence on morbidity and the of life expectancy (Saisan et al. 2012, Guo et al. 2002). Greater static burdening originating from long-term sitting at a computer can be dangerous for posture and young people’s health. The second most common causes of taking sick-leave are degenerative changes in the spine and spinal pain (Chuang 2006). Internet addiction is a type of psychological addiction and is defined as a form of behavior that is linked to persistence in an activity that causes decreases in health, social functioning, and quality of life. Research on Internet addiction and social deviance has occurred on a global scale in the last 20 years, especially in the frameworks of social psychology, medical sociology, and other public health disciplines. It shows that about 11% of all people using the Internet become addicted to it or show some compulsive behavior related to it. Findings from this research are very applicable in contemporary methodologies aiming at the betterment of physical or psychological well-being and improvements in social relations. The effectiveness of adolescent health services are evaluated by measures of health status, so we can clearly determine targets for action by assessing the broad spectrum of health including mobility, general functioning, mental health, and total well-being. The aim of the study was to identify the health problems and needs of vulnerable adolescent groups, particularly
Internet addicts who experience a certain degree of pleasure when using the Internet, and mostly psychological symptoms like discomfort, anxiety, and depression when they stop using it. The health status rating depends on individual assessment based on the complete psychological structure of an individual in interaction with their social environment. However, there are multiple effects on health; hence, a broad research health model is required. Besides biological factors, health or the outcome of the disease is also influenced by nonbiological factors – the individual’s personality, motivation, socio-economic status, availability of medical protection, network of social support, individual and cultural beliefs, and behavior. These non-biological factors are reflected in newer indicators of so called subjective health (Bowling 1991). In the majority of survey studies or broader clinical trials, one’s health condition is operationalized as self-assessment of own health or as functional capability. The answer to a seemingly simple question about one’s general health provides information about life expectancy of an individual – information that is difficult to acquire with detailed assessments of medical conditions and problems (Rakowski et al. 1994). General self-assessment of health is a subjective measure that cannot be confirmed objectively. Many researchers consider assessments to be “objective” if they can be medically checked if needed (Idler 1992). If the respondent provides information about his or her “objective” health, there is a danger that responses may be influenced by personality characteristics, such as self-respect, patient role, a perception of control over own health, and so on.
Therefore, “objective” health assessments must not be taken as completely objective measures, but still be
considered distinct from subjective health self-assessment. If there really is a mutual, overlooked factor underlying both objective and subjective health assessments, one can assume it will act the same way in
both assessments. A person’s health depends on several factors: heritage, the social context in which one lives, one’s medical behavior, and the medical system of one’s country (Lalonde 1974). Research shows that risky health behavior is mostly acquired during schooling (Harris et al. 2006). In most cases, changes of risky health behavior occur due to awareness of information and environmental pressure (Satia et al. 2001). The purpose of this research is to contribute to the understanding of individual health factors, primarily the behavior of excessive Internet use as a risky health habit, as well as the self-assessment of subjective feelings of adolescent’s health. Social health determinants are not only important for scientific research, they are also taken into the consideration when formulating developmental health strategies in particular countries (Wilkinson & Marmot 2003). Furthermore, behavior and lifestyle are important health factors and depend on the conditions in which one lives. Health analysis cannot be conducted without
examining health behavior and risky habits. Seeing that social environment and surroundings are important health factors, the researchers examined the influence of country of in adolescents in Croatia and Germany and their relationship to subjective feelings of health status. The aim of the paper was also to examine how a risky health habit, Internet addiction, affects adolescent health status. The SF-36 questionnaire proved very practical in measuring the subjective feeling of mental health due to a firm connection with the most common mental disorders (anxiety, depression) (Weinstein et al. 1989, Rumpf et al. 2001). Anxiety and depression are, among other things, disorders that occur as a consequence of Internet addiction.
Health status self-assessments between Croatian and German adolescents suggest differences in the following categories: general self-assessments of health, and health perception compared to peers. Ratings of German adolescents are somewhat better and more optimistic than those of Croatian adolescents only in 2 questions referring to general perception and change of health. Croatian and German adolescents most commonly rated their health as the medium, in the categories of health perception over a year, a perception of physical functioning, and perception of recent feelings of despondency and happiness.
In ontogenesis of motoric development in adolescence period, one reaches a phase of stabilization which
is linked to individual abilities and affinities, as well as a differentiation-related to gender. Adolescents from Croatia and Germany had relatively low rates of health problems, with an average rate of 9%. Differences were apparent between the 7% of Croatian and the 14% of German adolescents who perceived pain. Hence, German adolescents were twice as likely to be in pain compared to Croatian adolescents. In the period of adolescence begins the phase of independence. Adolescents who are directed towards peer groups want to grow up as soon as possible.
Unlike Croatian, German adolescents are leaving their parents extremely early, 10 and over ten years
earlier. The result of leaving this early is the appearance of anxiety, especially when they meet with problems with inadequate mental or physical growth. A situational variable like this can affect on a stronger feeling of pain. This relates to all types of pain, except neck-pain, which was experienced
by 5% of respondents, while 13% have experienced back-pain and 15% have had headaches.
The average daily amount of sitting has increased to 9.3 hours a day, and that is longer than people spend
asleep (7.7 hrs.). Therefore, it is not surprising that a large percentage (73%) of adolescents experience some consequences related to health and emotional problems.
The percentages by country are 76% of adolescents from Croatia and 67% from Germany respectively. In a
study performed by Andrijašević and Associates, the connection was found between the way free time was spent and subjective experiences of health indicated by a relatively large number of expressed difficulties that are more characteristic of old people than of students
(Andrijašević et al. 2005 ). A young person that spends 38 hours weekly at a computer weekly is already considered an Internet addict. Internet addiction demands involve long-term periods of
sitting, looking at the monitor, using the keyboard, using the mouse, repeating identical moves, the irregular position of the body. This may help explain why younger people display problems associated with old age. The inability to perform some work and other activities due to physical health or emotional difficulties were more common in Croatian than in German adolescents. The change of social system, wartime suffering, displacement, privatization, rising unemployment, the consequences of war trauma in children and adults, a growing number of suicides and violent behavior, migration, etc., are just some of the problems that the average Croatian family is faced with today and therefore adolescents, which then becomes an important indicator of their emotional health. For all other consequences of health problems, the reverse relationship was found. German adolescents more frequently reduced the time they spent working and in other activities, performed a smaller amount of work, and had difficulties in performing certain work and activities. Pain is a signaling mechanism that warns an individual about dysfunctions and danger in their bio-psychological and spiritual functioning. However, it may be noted that physical and emotional difficulties did not create problems in everyday life for most adolescents (61%), although they created very significant problems for 5% of participants. Regarding perceptions of mental health adolescents experienced a fullness of life, depression, tranquility, and peace, as well as nervousness equally often. Every feeling serves its function, and the results suggest that the presence of depression, a fullness of life, tranquility, and nervousness is a consequence of the nature of adolescence and is related to the complete and normal development of personality.
Croatian and German adolescents experienced similar frequencies of positive feelings. To be precise, about half of adolescents in both countries almost always have these kinds of feelings frequently. Croatian and German adolescents also experienced similar frequencies of negative feelings. Two-thirds of adolescents in these two countries rarely or almost never have negative feelings. Upon closer examination, adolescents from these two countries experience somewhat different individual positive and negative feelings. Among positive feelings, feelings of the fullness of energy and happiness are more frequent in Croatian adolescents, while the feeling of peace and tranquility are more common in Germans.
Negative feelings of nervousness, fatigue, and exhaustion are less represented in Croatia than in Germany.
Fatigue and exhaustion are mostly connected to a stressful way of life. Furthermore, chronic fatigue has negative consequences for health and 73% of people with chronic fatigue have an increased risk for different illnesses. A low level of bodily activities is a predictor of chronic fatigue. Bodily activity in free time reduces deterioration in physical health.
The results showed that feelings of nervousness, fatigue, and exhaustion were less represented in Croatia,
while there were no differences in perceiving feelings of despondency, depression, and sorrow. There was no difference in perception of health status change among Croatian and German adolescents; that is, there were no differences in whether physical health and emotional problems disturbed or did not disturb their social activities. The majority of adolescents (70% of them) rarely and never experienced such disturbances.
Subjective ratings of general perceptions of health did not differ with respect to claims that “I get ill more
easily than other people,” “I am healthy as anyone else I know,” “I think my health will worsen,” and “My health is excellent. Croatian and German adolescents had a similar tendency to become ill (about 15%). Two-thirds of participants denied a tendency to become ill. There were no differences in perceptions of health and social functioning between Croatian and German adolescents regarding any variables.
Interventions based on social planning can be highly effective when they target individuals at the earliest
stages of development. However, social planners must be careful not to intervene in ways that disrupt living conditions or interfere with normal development, to avoid causing psychological or social problems for individuals. Most adolescents (70%) rarely or never experience disruptions in social functioning.
Adolescents were classified into three health status groups based on their composite health scores.
Approximately 25% of adolescents rated their health as bad, 51% of them rated it medium, and 24% rated their health as good. Retrospect on own health mostly superficial and uninterested. There were no statistically significant connections between respondents’ gender, age, and health quality. A research sample of 844 subjects in a high school in Košice, Slovakia showed significant worsening of mental health and vitality in both genders, with boys self-reporting a larger worsening of health, while the differences between the proportions of respondents who reported either betterment or worsening were negligible (Salonna et al. 2008). However, there was a statistically significant connection between the country of the respondent and health quality in this study. Notably, the percentage of respondents who reported bad health was 23% for Croatians and 31% for Germans. Furthermore, the percentage of respondents with medium health was 54% in Croatia is, and 42% in Germany. Therefore, one can conclude that compared to Croatian respondents, Germans evaluate their health as being worse. There was a highly significant statistical connection between adolescents’ health quality and the degree of their addiction. Among all adolescents in bad health, 39% of them were moderately or severely addicted to Internet use; 20% of those in medium health were moderately or severely addicted; while only 13% of adolescents in good health were moderately or severely addicted. Accordingly, better adolescent health is associated with lower rates of Internet addiction, while worse health is associated with higher rates. Kim and Chun showed in their study that severe Internet addicts had the lowest ratings of promotion and perception of health status suggesting that Internet addiction has a negative influence on the health status of adolescents (Kim & Chun 2005). Tendencies towards risky behavior increase a young person’s chance of developing inappropriately, depending on their environment. Socioeconomic status affects how factors such as social networks, family, and individual health behavior influence risky behavior and should be understood within the broader concepts of health guidelines. This key conclusion in the research is further analyzed according to adolescents’ gender, age, and origin. Namely, one wishes to know is this conclusion valid with men as well as with women, with younger as well as with older adolescents, with Croatian adolescents as well as with German ones.
CONCLUSION
The goal of this research was to determine the existence of differences concerning health status, among
adolescents in Croatia and Germany. Results of the analysis suggest the following conclusions. Results of subjective health assessment between Croatian and German adolescents show statistically significant differences in the category of general health perception, although there was no difference in change perception compared to peers, health perception over a year, a perception of physical functioning of health, and recent feelings of despondency and happiness. The inability to perform some work and other activities due to physical health or emotional disorders were more frequent in Croatian than German adolescents. German adolescents often reduced time spent working and other activities, did smaller amounts of work, and had difficulties performing some work and activity. However, it is noticeable that the physical and emotional health of most adolescents (61% of them) did not create problems in everyday life. On the other hand, 5% of them experienced substantial problems. Feelings of nervousness, fatigue, and exhaustion were less represented in Croatia, while there were no differences in perceiving feelings of despondency, depression, and sorrow. Furthermore, most adolescents (70%) were not impeded by physical health and emotional problems in social activities. It can be seen that 23% of Croatian respondents had bad health, while 31% of Germans did. Additionally, 54% in Croatia had medium health, compared to 42% in Germany. Hence, one can conclude that German respondents evaluated their health worse than Croatians did. There was a highly significant statistical connection between adolescents’ health quality and the degree of their addiction. Among all adolescents in bad health, 39% were moderately or severely addicted to the Internet use; 20% of those in medium health, were moderately or severely addicted, and only 13% of those in good health were moderately or severely addicted. Accordingly, adolescents in better health are proportionately less likely to be Internet addicts, while conversely, those in worse health are proportionately more likely to be Internet addicts.
*The integral version of this article Silvana Karačić, Stjepan Orešković “INTERNET ADDICTION AND MENTAL HEALTH STATUS OF ADOLESCENTS IN CROATIA AND GERMANY · August 2017 with tables, pictures, and references were concurrently published in Psychiatria Danubina, 2017; Vol. 29, No. 3, pp 401–125
